Introduction to the facts of the case
On October 3, 2020, the plaintiff was admitted to the defendant's place for childbirth due to full term pregnancy. After being admitted to the hospital, the defendant conducted various relevant examinations on the plaintiff and found that it was suitable for vaginal delivery (the plaintiff requested a caesarean section, and the hospital did not accept the plaintiff's opinion), and the plaintiff gave birth to a baby boy at 16:45 on October 4. After giving birth, the plaintiff's vagina continued to bleed. Later, the defendant diagnosed postpartum hemorrhage, contraction weakness, hemorrhagic shock, diffuse intravascular coagulation, acidosis and other symptoms, in order to save the plaintiff's life, and finally the defendant performed a total hysterectomy for the plaintiff. On October 6, 2020, for further treatment, the plaintiff was transferred to the First Affiliated Hospital of China Medical University for hospitalization. After his condition stabilized, the plaintiff was transferred back to Liaoyang Central Hospital on October 11 for continued treatment, but a blood clot had formed during the treatment. On November 9, 2020, the plaintiff was discharged from the hospital and went home to recuperate.
The plaintiff (Wang X) believed that the defendant hospital was at fault and needed to bear the liability for compensation, and after the two parties had no results in consultation, they told the local people's court and saw the details of the trial.
The patient's point of view
The plaintiff argued that on October 3, 2020, the plaintiff was admitted to the defendant's place for childbirth due to pregnancy and full term. After being admitted to the hospital, the defendant conducted various relevant examinations on the plaintiff, and the plaintiff gave birth to a baby boy normally at 16:45 on October 4. After giving birth, the plaintiff's vagina continued to bleed. Later, the defendant diagnosed postpartum hemorrhage, contraction weakness, hemorrhagic shock, disseminated intravascular coagulation and other symptoms, in order to save the plaintiff's life, the defendant finally performed a total hysterectomy for the plaintiff. On October 6, 2020, for further treatment, the plaintiff was transferred to the First Affiliated Hospital of China Medical University for hospitalization. After his condition stabilized, the plaintiff was transferred back to Liaoyang Central Hospital on October 11 for continued treatment, but a blood clot had formed during the treatment. On November 9, 2020, the plaintiff was discharged from the hospital and went home to recuperate. In the treatment of pregnancy and postpartum haemorrhage, the defendant did not inform the plaintiff whether it was suitable for natural childbirth, did not accept the plaintiff's request for a caesarean section, found that the plaintiff's vagina continued to bleed after childbirth, did not carry out timely and effective treatment, and lost the best treatment time, resulting in the plaintiff's life being in extreme danger, and only at the cost of losing his uterus was to save his life, which brought great harm and hidden dangers to the plaintiff's health. Therefore, the plaintiff argued that the defendant had a medical fault in the treatment of the plaintiff's pregnancy and postpartum haemorrhage, and that there was a causal relationship between the faulty act and the physical damage suffered by the plaintiff. Therefore, the plaintiff shall bear the corresponding compensation liability for various economic losses such as medical expenses caused by this bodily injury. In summary, the plaintiff submits the above request based on the above facts and reasons, and implores your court to make a fair ruling in accordance with the law in order to safeguard the legitimate rights and interests of the plaintiff.
Medical opinion
The defendant believes that in this case, our hospital agrees to compensate in accordance with the appraisal conclusion and relevant standards, because according to the appraisal conclusion, the causal relationship is between 31% and 50%, and our hospital agrees to compensate according to the compromise standard, that is, 40% of the liability ratio. The plaintiff's claim for the moral consolation payment is too high, the living expenses of the dependents are miscalculated, and the nursing expenses after discharge should be calculated according to the standards of the resident service industry multiplied by the nursing period of 60 days concluded by the appraisal conclusion.
Forensics
The court entrusts a judicial laboratory to issue a judicial appraisal opinion, Opinions: 1. In the treatment process of the appraisee Wang X, the Third People's Hospital of a certain city has faults such as uterine cavity tamponade, arterial ligation is not in place, surgical treatment is delayed, and the operation time is too long, and the postpartum bleeding control is not timely, there is a causal relationship between the occurrence of DIC and the inevitable hysterectomy, there is a causal relationship between the medical damage factors and the patient's own factors (uterine contraction weakness) in the occurrence of damage consequences, and the participation in medical damage is between secondary liability and equal responsibility (31%-50%). 2. After the total hysterectomy of the appraised person Wang X, it constitutes the seventh level of disability. 3. The post-hysterectomy nursing period of the identified person Wang X is 60 days, and the nutrition period is 60 days. 4. The cost of follow-up treatment of the thrombosis of the appraisee Wang X is subject to the actual occurrence.
Court view
The hospital believes that if the patient is damaged in the diagnosis and treatment activities, and the medical institution and its medical staff are at fault, the medical institution shall bear the liability for compensation. In this case, it was determined that there was a causal relationship between the medical damage factors and the patient's own factors in the occurrence of the damage consequences, and the participation in the medical damage was between secondary liability and equal liability (31%-50%), so it was appropriate for the defendant to bear 40% of the liability of the Third People's Hospital of a city.
Verdict
On December 29, 2021, the court ruled that the defendant, the Third People's Hospital of a city, compensated the plaintiff Wang X for RMB209,333.61.
The author reminds
1. Why are hospitals reluctant to give pregnant women a caesarean section?
(1) The state has established assessment standards.
According to statistics, the caesarean section rate in mainland China was 5% in the 1980s, no more than 10% in the 1990s, and as high as 36% to 58% in 2010. While the World Health Organization sets a safe limit of 15 percent for caesarean section, China has surpassed it a lot. Therefore, the National Health Commission in the "2011-2020 China Women and Children Development Outline Implementation Plan" will "increase the rate of natural delivery, reduce the rate of caesarean section" into the scope of assessment of modern hospitals. If the doctors of the hospital casually allow pregnant women to undergo a caesarean section, it will be difficult to complete the goal, affecting the assessment standards of the hospital, and this risk is actually a risk that many doctors dare not easily disclose.
(2) Medical treatment does not support caesarean section without indications.
According to the Expert Consensus on Caesarean Section Surgery (2014), indications for caesarean section are pathological or physiological conditions that cannot be delivered vaginally or are not suitable for vaginal delivery. Caesarean section indications are only available in the following conditions: fetal distress, cepelvis asymmetry, scarred uterus, fetal abnormalities, placenta previa and previa, twin or multiple pregnancies, umbilical cord prolapse, placental abruption, and serious complications and complications in pregnant women: such as complicated heart disease, those who cannot withstand vaginal delivery, pregnant macrosomics, birth canal malformations, vulvar diseases, severe infectious diseases of the reproductive tract, pregnancy complicated by tumors, etc. For caesarean sections required by pregnant women, certain conditions must also be met: the American Association of Obstetricians and Gynecologists defines caesarean section required by pregnant women as a full-term singleton, caesarean section without medical indications due to maternal requirements. a. Only the pregnant woman's personal request is not indicated as an indication for caesarean section, if there are other special reasons to be discussed and recorded in detail. b. When a pregnant woman requests a caesarean section without understanding the condition, the overall pros and cons and risks of caesarean section surgery compared to vaginal delivery should be informed in detail and recorded. c. When a pregnant woman requests caesarean section because of fear of the pain of vaginal delivery, psychological counseling should be provided to help alleviate her fear; analgesia in childbirth should be used during labor to alleviate the pain of delivery and shorten the course of labor. d. Clinicians have the right to refuse a request for caesarean section delivery without clear indications, provided that the pregnant woman's request is respected and a recommendation of secondary selection is provided.
Therefore, in this case, although the patient pointed out that the hospital was at fault for not having a caesarean section, the appraisal agency did not adopt this opinion.
2. The hospital should make a full explanation of whether a caesarean section can be made to obtain an understanding.
Most of the medical disputes related to childbirth that Mr. Lin is exposed to have objections to the hospital's insistence on choosing a vaginal delivery method, and this is the reason for the dispute, they believe that if caesarean section is adopted or caesarean section is used in time, obstetric injuries such as brachial plexus nerve injury, neonatal cerebral hemorrhage, neonatal asphyxia and other situations will not occur. Therefore, fully explaining and understanding the choice of normal delivery method is conducive to alleviating the contradiction between doctors and patients and reducing the occurrence of medical disputes.
3. What are the dangers of caesarean section?
Due to the way of delivery of caesarean section, it is easy to cause harm to the mother, as follows: (1) The injury of anesthesia. Caesarean section surgery will mostly use semi-anesthesia (spinal anesthesia and epidural anesthesia), unless in the case of emergency will be used in general anesthesia, and anesthesia may cause some side effects, such as dizziness, headache, nausea and vomiting, etc., may also affect blood circulation, resulting in insufficient blood oxygen. (2) Injuries during surgery. Because the caesarean section is directly cut open the mother's belly into the uterus to take out the fetus, which is very challenging the doctor's medical skills and surgical environment, if in the whole process, there are some small mistakes, there may be infection, endangering the safety of maternal and fetal life, blood loss and unexpected situations in surgery are much higher than the vaginal birth. (3) Postoperative injuries. Since caesarean section is not a natural way of childbirth, the recovery rate will be much slower than that of a normal birth, such as a normal birth can freely get out of bed on the first day and feed the child, while a caesarean section needs to be supported by a family member on the second day before it can get out of bed and move around. In addition, caesarean section will leave wounds and scars on the abdomen and uterus, if the incision is not completely healed, it is easy to form a scarred uterus, and when pregnant again, there is a risk of uterine rupture, premature birth, the probability of miscarriage will increase accordingly. (4) For the baby, because the fetus is not squeezed out of the mother's birth canal with the help of the force of contractions during caesarean section, it is directly from the womb and is held out by the doctor, so it will have a certain impact on the baby, as follows. a. Damage body sensitivity. Since no parts of your baby's body are squeezed by a curved and narrow birth canal, the touch and sensitivity of his body may be lower than that of a vaginal birth. b. Respiratory system is affected. Because the baby's head, lungs, etc. are not squeezed by the mother's birth canal, and do not breathe under the action of atmospheric pressure, it is easy to lead to amniotic fluid inhalation and respiratory problems in the lungs. According to statistics, the probability of inhalation pneumonia in babies born by caesarean section is much greater than that of babies born vaginally. c. Immune system. Because the baby does not ripen and is squeezed by the birth canal, the body's tissues and organs have not been fully exercised, resulting in immunity is not as strong as the baby who gave birth to the baby, and studies have shown that there are 27 kinds of microorganisms in the birth canal of Chinese women of the right age, which will promote the phylogenetic development of the baby.
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