Upload
philip-stephens
View
259
Download
0
Embed Size (px)
Citation preview
Contents
IntroductionIntroduction
Medical malpracticeMedical malpractice
Grading of medical malpracticeGrading of medical malpractice
Mediation and expertise of medical Mediation and expertise of medical
malpracticemalpractice
medical tanglemedical tangle
the definition of medical tanglethe definition of medical tangle
divergence and discrepancy in interpreting divergence and discrepancy in interpreting
causes about unfavorable consequence of causes about unfavorable consequence of
medical treatment between medical medical treatment between medical
institution and patientinstitution and patient
patients patients
medical institution: include…medical institution: include…
medical personnel: include…medical personnel: include…
medical tanglemedical tangle
Four components of medical tangleFour components of medical tangle
relationship (relationship ( hospital service contract hospital service contract ) )
unfavorable medical results (unfavorable medical results (damage damage
consequence consequence ))
medical process (medical process (causationcausation))
different cognition and opinion (different cognition and opinion (divergence divergence ))
medical tanglemedical tangle
medical tanglemedical tangle
medical malpracticemedical malpractice
(most important)(most important)
non-medical malpracticenon-medical malpractice
medical malpracticemedical malpractice
the definition of medical malpracticethe definition of medical malpractice
An accident that during An accident that during medical activitiesmedical activities patient's patient's
physical damagephysical damage was caused by medical was caused by medical
institution/healthcare professional, due to their institution/healthcare professional, due to their
violationviolation of governmental of governmental laws,laws, health administration health administration
regulations,regulations, as well as as well as conventional diagnostic and conventional diagnostic and
therapeutic specifications.therapeutic specifications.
--------- Regulations of Medical Malpractice --------- Regulations of Medical Malpractice
Treatment, China (2002) Treatment, China (2002)
★ ★ the four components of medical malpracticethe four components of medical malpractice
medical institution and staff (subject)medical institution and staff (subject)
delinquent behavior (negligence)delinquent behavior (negligence)
lawbreaking and personallawbreaking and personal injuryinjury
causal relationship between damage and causal relationship between damage and
delinquency delinquency
medical malpracticemedical malpractice
Case Doctor diagnosed the illness of patient X as Doctor diagnosed the illness of patient X as Acute Acute
Myocardial Infarction (AMI)Myocardial Infarction (AMI) and then did the and then did the operation of operation of coronary arteriography coronary arteriography and and stent stent implantationimplantation in which eight heart stents were in which eight heart stents were implanted into the X's heart. A few days later, the X implanted into the X's heart. A few days later, the X felt felt chest pain, sweating, but the doctor did not timely chest pain, sweating, but the doctor did not timely treatment. Shortly the X lost consciousnesstreatment. Shortly the X lost consciousness. . Electrocardiogram (ECG) showed cardiac arrest. Electrocardiogram (ECG) showed cardiac arrest. The doctor did the rescue measures but the XThe doctor did the rescue measures but the X was was dead at last.dead at last.
Question delinquent behavior from delinquent behavior from
the following:the following:
selection of operation
the conventional
specifications of stent
implantation
time of rescue
delinquent behaviordelinquent behavior
heart bypass surgery not coronary a
rteriography
the order of implantation is from far to
near not from near to far
not found the condition changes timel
y and did the rescue measures
ResultResult
medical malpracticemedical malpractice
a causal relationship between the a causal relationship between the
operation fault and damage operation fault and damage
compensation conducted by compensation conducted by
hospitalshospitals
iatrogenic medical tangleiatrogenic medical tangle
iatrogenic medical tangleiatrogenic medical tangle
Medical MalpracticeMedical Malpractice
iatrogenic medical tangleiatrogenic medical tangle
medical fault ≠ medical malpracticemedical fault ≠ medical malpractice
e.g. the violation of Medical Informed Consent e.g. the violation of Medical Informed Consent
fault in the medical service attitudefault in the medical service attitude
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
1. 1. Sudden unexpected natural death Sudden unexpected natural death
The sudden and unexpected death caused by The sudden and unexpected death caused by
potential natural disease of the body or potential natural disease of the body or
dysfunction of important organs of patient dysfunction of important organs of patient
who looks healthy. who looks healthy.
The time duration is within 24 hrs from onset The time duration is within 24 hrs from onset
of symptom to death.of symptom to death.
—— ——WHO standardsWHO standards
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
Example:Example:
cardiovascular diseases and pneumoniacardiovascular diseases and pneumonia
See text P349See text P349
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
2.2.inevitable inevitable complications or secondary diseasescomplications or secondary diseases
Example:Example:
amniotic fluid embolism after parturition
cerebral hemorrhage caused by hypertensive
arteriosclerosis
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
3. medical unexpectedness3. medical unexpectednessexample: allergic shock example: allergic shock
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
3.rare diseases 3.rare diseases
① ① congenital malformation or genetic discongenital malformation or genetic dis
easeease
② ② rare infectious disease rare infectious disease bird flubird flu H7N9H7N9
③ ③ rare tumor rare tumor myoblastomamyoblastoma
Non-iatrogenic medical tangleNon-iatrogenic medical tangle
4. Others 4. Others
Patient's faultsPatient's faults
Patient's autonomy, suicide, homicide Patient's autonomy, suicide, homicide
or accidental hurtor accidental hurt
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅠClass Ⅰ Class ⅡClass Ⅱ Class ⅢClass Ⅲ Class ⅣClass Ⅳ
Grade AGrade A Grade AGrade A Grade AGrade A
Grade BGrade B Grade BGrade B Grade BGrade B
Grade CGrade C Grade CGrade C
Grade DGrade D Grade DGrade D
Grade EGrade E
Medical Malpractice Grading Standard,China,2002
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅠClass Ⅰ
Grade AGrade A Death of patientDeath of patient
Grade BGrade B complete loss or dysfunction of an importancomplete loss or dysfunction of an importan
t organ, which is irreplaceable. t organ, which is irreplaceable.
depend on special medical care.depend on special medical care.
e.g. vegetative being, very severe dysgnosia,e.g. vegetative being, very severe dysgnosia,
quadriplegia etc. quadriplegia etc.
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅡClass Ⅱ
Grade AGrade A Complete loss or dysfunction of an organ, Complete loss or dysfunction of an organ,
which is irreplaceable; which is irreplaceable;
e.g. double eyes removed e.g. double eyes removed
Grade BGrade B Severe loss or malformation of an organ Severe loss or malformation of an organ
e.g. one eye removed e.g. one eye removed
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅡClass ⅡGrade CGrade C Severe loss or malformation of an organ Severe loss or malformation of an organ
e.g. lack of a hand, loss of 50% functions e.g. lack of a hand, loss of 50% functions
another, no recovery by operation or by using another, no recovery by operation or by using
an artificial limban artificial limb
Grade DGrade D Severe loss malformation of an organ Severe loss malformation of an organ
can take care of himself.can take care of himself.
e.g. lack of a hand, normal function another, e.g. lack of a hand, normal function another,
no recovery by operation or artificial no recovery by operation or artificial
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅢClass ⅢGrade AGrade A Major loss or malformation of an organ Major loss or malformation of an organ
e.g. lack of a thumb, loss of 50% function e.g. lack of a thumb, loss of 50% function
another, no recovery by operation another, no recovery by operation Grade BGrade B Major imperfection or malformation of an Major imperfection or malformation of an
organ;organ;
e.g. lack of a thumb, normal function another, e.g. lack of a thumb, normal function another,
no recovery by operation no recovery by operation
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅢClass Ⅲ
Grade CGrade C Partial imperfection or malformation of an Partial imperfection or malformation of an
organ organ
e.g. lack of three fingers except the thumbe.g. lack of three fingers except the thumb
Grade DGrade D Partial imperfection or malformation of an Partial imperfection or malformation of an
organ organ
e.g. lack of a hand, loss of 50% functions e.g. lack of a hand, loss of 50% functions
another, recovery by operation or by using another, recovery by operation or by using
an artificial limban artificial limb
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅢClass Ⅲ
Grade EGrade E Partial imperfection or malformation of an Partial imperfection or malformation of an
organ organ
e.g. joint function is not complete e.g. joint function is not complete
Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice
Class ⅣClass Ⅳ
some lesions to patient.
e.g. organ or tissue minor damage, after repair,
no dysfunction
Ten Disability GradesTen Disability GradesClass Grade BⅠ first-grade disability 100%
Class ⅡGrade A second-grade disability 90%
Class ⅡGrade B third-grade disability 80%
Class ⅡGrade C forth-grade disability 70%
Class ⅡGrade D fifth-grade disability 60%
Class ⅢGrade A sixth-grade disability 50%
Class ⅢGrade B seventh-grade disability 40%
Class ⅢGrade C eighth-grade disability 30%
Class ⅢGrade D ninth-grade disability 20%
Class ⅢGrade E tenth-grade disability 10%
subsidies for the disabled life = subsidies for the disabled life =
average living expenses ×average living expenses ×
the period for paying the subsidies ×the period for paying the subsidies ×
coefficient of disability coefficient of disability
standards of disability compensationstandards of disability compensation
Occurrence of medical malpracticeOccurrence of medical malpractice
nonstandard inquiry —— case historynonstandard inquiry —— case history
negligent examinationnegligent examination
false diagnosis —— inadequate knowledge and false diagnosis —— inadequate knowledge and
experience, prejudice, irresponsibilityexperience, prejudice, irresponsibility
wrong treatmentwrong treatment
other processesother processes
★ forensic autopsy in medical tangle
SignificanceSignificance
— — determine the cause of death and determine the cause of death and
responsibilityresponsibility
— — provide definitive diagnosis by obtaining provide definitive diagnosis by obtaining
direct and objective pathological findingsdirect and objective pathological findings
forensic autopsy in medical tangle
Three Medical Technical Analysis WaysThree Medical Technical Analysis Ways
— — clinical treatment clinical treatment (medical record, symptom and (medical record, symptom and
signs)signs)
— — imaging examination imaging examination (CT,MRI,X ray, ultrasound)(CT,MRI,X ray, ultrasound)
— — pathological examinationpathological examination ((direct and objective )direct and objective )
forensic autopsy in medical tangle
Article 18 Article 18
Where any patient dies, and both the medical institutiWhere any patient dies, and both the medical instituti
on and the relatives of the patient cannot determine thon and the relatives of the patient cannot determine th
e cause or they e cause or they have different ideas about the causehave different ideas about the cause ,,an autopsy shall be made within an autopsy shall be made within 48 hours48 hours after the pat after the pat
ient dies. ient dies.
—— ——Regulations of Medical Malpractice Treatment,Regulations of Medical Malpractice Treatment,
China (2002) China (2002)
forensic autopsy in medical tangle
What is autopsy applied What is autopsy applied
in China?in China?
forensic autopsy in medical tangle
• past: small numberpast: small number
• now: more and more now: more and more
people acceptedpeople accepted
forensic autopsy in medical tangle
Characteristics (civil case )Characteristics (civil case )
— — observed by both medical institute and the observed by both medical institute and the
patient sides, voluntarypatient sides, voluntary
— — predetermine the key points of examination predetermine the key points of examination
and select a suitable procedure and method of and select a suitable procedure and method of
autopsyautopsy
forensic autopsy in medical tangle
autopsy: comprehensive and systemic
— histopathological examination ( main method )
— laboratory tests (blood, urine etc.)
— toxicology
— immunological and microbiological examination
case
Patient X felt chest tightness, difficult breathing,
then the emergency center gave him first aid, bu
t he was dead during rescue. The cause of death
is unknown. the emergency center considered h
e was died of acute pneumothorax, but the relati
ves claimed the center injected too much amino
phylline.
Thus, what will the pathologist do?
What is the knowledge structure of coroners?What is the knowledge structure of coroners?
• basic clinical basic clinical medicinemedicine
• natural sciencesnatural sciences
• lawlaw
• ethicsethics
•criminal psychologycriminal psychology
•……
Mediation and Expertise of Medical TangleMalpractice
Three ways to solve Medical Tangle
negotiation
administrative mediation
lawsuit
negotiationnegotiation
Aim: arrive at an agreement on the
dispute and economic compensation
Ways:
—— the patient and the hospital
—— mutual negotiation: lawyer / the
Neutral Institution for Mediating (third party)
administrative mediationadministrative mediation
Aim: mutual mediation by local health Aim: mutual mediation by local health
administrationadministration
Characteristics :Characteristics :
— — non- compulsorynon- compulsory
— — medical expertise beforemedical expertise before
— — no legal binding forceno legal binding force
LawsuitLawsuit
— — medical technical expertise employedmedical technical expertise employed
— — civil procedure civil procedure
expertise of medical tangle and malpracticeexpertise of medical tangle and malpractice
expertiseexpertise
medical technical expertise medical technical expertise
by medical associationby medical association
judicial expertisejudicial expertise by judicial by judicial
expertiseexpertise institutioninstitution
medical technical expertise of medical associationmedical technical expertise of medical association
peer review
the medical association organized a
group or committee of experts including
legal medical expert
medical technical expertise of medical associationmedical technical expertise of medical association
identification meetingidentification meeting
(1) statement of both parties(1) statement of both parties
(2) question by experts(2) question by experts
(3) discussion and analysis(3) discussion and analysis
(4) opinion of the majority of the experts (4) opinion of the majority of the experts
medical technical expertise of medical associationmedical technical expertise of medical association
expertise report (main terms)expertise report (main terms)
(1) whether the medical treatment act has (1) whether the medical treatment act has violatedviolated any any
of the laws, and the standards of treatment and nursof the laws, and the standards of treatment and nurs
inging ;;(2) whether there is a (2) whether there is a causal relationshipcausal relationship between the between the
negligent medical act and damagenegligent medical act and damage ;;(3) the (3) the seriousness of the negligent medical actseriousness of the negligent medical act in the i in the i
njury of medical malpracticenjury of medical malpractice ;;(4) the (4) the grade grade of the medical malpractice of the medical malpractice
judicial expertisejudicial expertise
In the litigation, court consigns a mediIn the litigation, court consigns a medi
colegal expertise institution to carry oucolegal expertise institution to carry ou
t expertiset expertise
non-medical malpracticesnon-medical malpractices
Regulations of Medical Malpractice Treatment, Regulations of Medical Malpractice Treatment,
China (2002) China (2002)
( 1 ) unfavorable consequences resulting from
emergent medical measures taken under dang
erous circumstances for rescuing the life of th
e patient ;
non-medical malpracticesnon-medical malpractices
( 2 ) the special physique of the patient or unf
avorable consequences caused by the delay of
the patient ;
non-medical malpracticesnon-medical malpractices
( 3 ) unfavorable consequences that cannot unfavorable consequences that cannot
be predicted or prevented under the existing be predicted or prevented under the existing
technical and medical conditionstechnical and medical conditions