防医改领域漏洞之微,杜商业贿赂犯罪之渐——从刑事立法角度透析医疗领域的商业贿赂犯罪

医疗领域商业贿赂犯罪已危害到医药卫生体制本身的健康而为民众所诟病。因此,通过完善刑事立法来遏制医疗领域的商业贿赂犯罪,从而确保现有的医药卫生体制向新医改所确立的目标成功过渡,就显得紧迫而必要。     

论医疗事故的精神损害赔偿责任

2002年4月公布的《医疗事故处理条例》明确规定,对因医疗事故造成医疗损害的受害人及其亲属赔偿各种医疗费用的同时,给予其一定数额的“精神损害抚慰金”。这在某种程度上解决了一直困挠着在司法实践中是否给予精神损害赔偿的这一棘手问题。以《民法通则》以及最高司法机关发布的相关司法解释的规定为依据,对医疗事故精神损害赔偿的必要性、应遵循的原则、赔偿的范围以及行使请求权的主体等问题进行论述,使《条例》关于保护医疗损害受害人及其亲属的合法权益的规定在社会生活中得以贯彻和实施。     

中草药复合添加剂对虹鳟鱼增重及肝功能和结构的影响

为观察中草药复合添加剂富康163对虹鳟鱼生长性能、肝功能和结构的影响,选择18月龄的虹鳟鱼400尾,随机将其分为4组,Ⅰ组为对照组,Ⅱ、Ⅲ、Ⅳ分别在基础日粮中添加30、50和70g/kg富康163,试验期60d。结果显示:饲料中添加不同水平的富康163能提高增重率,并可不同程度地降低饲料系数;与对照组相比,试验组血清腺苷脱氨酶(ADA)活性、γ-谷氨酰转肽酶(γ-GT)活性、胆碱酯酶(CHE)活性、总胆红素(TBiL)浓度和肝指数无明显变化(P>0.05);Ⅰ、Ⅱ、Ⅲ组肝细胞界限清楚,核圆而大,核膜清晰,胞质丰富,而Ⅳ组有的肝细胞间分界不明显、胞内空泡化。结果表明,虹鳟鱼饲料中添加富康163能促进鱼体生长,提高营养物质利用率,对鱼肝的功能和结构无显著影响,建议虹鳟鱼饲料中富康163的添加剂量以50g/kg为宜。     

外伤后诊疗失误医疗纠纷分析

通过对5例外伤后医疗纠纷案件的回顾性分析,探讨了此类医疗纠纷的特点和医疗失误的成因。通过外伤和医疗失误在患者死亡后果中责任程度分析,提出了“死因竞合”和“参与度”的判定原则。并且认为,在涉讼的此类医疗纠纷案件的技术鉴定中,如将对死者进行全面尸体解剖和病理学检验以明确患者死亡的原因作为必要的前置程序．则对于此类案件的科学鉴定具有非常重要的意义。     

羊水栓塞死亡医疗纠纷案件的法医学分析

目的分析引发医疗纠纷的羊水栓塞死亡病例的相关因素,以帮助提高对羊水栓塞诊治能力,减少医疗纠纷。方法对我中心2006～2009年间鉴定的8例医疗纠纷相关羊水栓塞死亡病例的临床资料及过失认定进行回顾性分析。结果（1）医疗因素分析：7例具有使用催产素史;3例发生于产前破膜后,5例发生于产后;具有典型临床症状5例,不典型临床症状3例;早期诊断7例;3例实施子宫次全切除术;发生在二级医院以下6例。（2）法医学鉴定分析：催产素使用不当及观察记录缺陷占87.5%（7/8）;7例早期诊断羊水栓塞,但在供氧、解痉和子宫切除方面存在治疗缺陷。结论提高对产前、产后羊水栓塞症状特点的认识和处置能力,强化病历记录规范、完整及充分告知说明,是减少医疗纠纷案件的关键,也是法医学鉴定判断的重要依据。     

Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

论医疗产品损害责任

医疗机构在医疗过程中使用有缺陷的药品、消毒药剂、医疗器械以及血液及血液制品等医疗产品,因此造成患者人身损害,医疗机构或者医疗产品生产者、销售者应当承担的医疗损害赔偿责任属医疗产品损害责任。这种医疗产品损害责任适用无过失责任原则,适用《产品质量法》规定的产品侵权责任的一般规则,其基本责任形态是不真正连带责任,在特殊情形下构成连带责任。     

90例医疗纠纷尸检分析

目的分析、讨论医疗纠纷中法医病理学尸体解剖的重要性。方法收集温州医学院法医学系2001—2008年涉及医疗纠纷尸体解剖案例90例,按照死者年龄、性别、死亡原因及临床诊断和法医病理诊断等要素进行分类整理和分析。结果死者年龄从新生儿至72岁,男女比例为1∶1,医院级别以县级医院较多（30例,33.33%）,临床诊断与法医病理死因诊断符合率为33.33%。结论尸体解剖对涉及死亡的医疗纠纷的正确处理和防范有重要作用。     

Death Caused by Toxic Epidermal Necrolysis (Lyell Syndrome)

Abstract: Toxic epidermal necrolysis (TEN) is characterized by fever, scalded appearance of the skin, and epidermolysis associated to blister formation and exfoliation, and it is caused by hypersensitivity reaction to a drug. The authors report two cases of death as a result of TEN; both referred to old aged women treated with a polytherapy including allopurinol. Both patients displayed erythematous skin lesions similar to scald burns and epidermolysis at the face, chest, and abdomen and died shortly after hospitalization. Autopsy findings and histological examinations revealed epidermal necrolysis and confirmed the clinical diagnosis. A strict time‐correlation between allopurinol administration and symptoms was evidenced. Because of its iatrogenic origin, TEN often arises suspicions of medical liability; however, because of its unpredictable nature, the occurrence of this syndrome cannot be ascribed to the medical staff whose main task is the rapid diagnosis and the correct management.     

Burden of Neurodegenerative Diseases in a Cohort of Medical Examiner Subjects*

Abstract: Here we report studies of the burden of neurodegenerative neuropathologies in a cohort of Medical Examiner (ME) subjects from the County of Santa Clara (California) to determine if this unique population of decedents manifested evidence of neurodegeneration that might underlie causes of death seen in an ME practice. We found that 13% of the brains from ME cases showed significant tau pathology, including 55% of those 65 years old and older and 63% of those 70 years old and older. The histochemical and immunohistochemical findings were consistent with Alzheimer’s disease (AD) in 7 subjects and frontotemporal lobar degeneration (FTLD) tauopathy type in six cases. There were no cases of Parkinson’s disease, dementia with Lewy Bodies or other neurodegenerative conditions. Our study suggests that decedents >65 years of age in an ME practice are afflicted by common causes of dementia such as AD and FTLD which could contribute wholly or in part to their causes of death.