Recently, the Suining County People's Hospital in Xuzhou, Jiangsu Province, was "reported to the higher authorities to demote the Suining County People's Hospital in accordance with the relevant regulations on the management of medical institutions" because of the incident involving the death of a baby.
The author | Xu Yucai
Source| Medical Community (ID: vistamed)
Recently, the Suining County People's Hospital in Xuzhou, Jiangsu Province, was "reported to the higher authorities to demote the Suining County People's Hospital in accordance with the relevant regulations on the management of medical institutions" because of the incident involving the death of a baby.
Source: Suining County People's Hospital official website
According to the hospital's official website, Suining County People's Hospital was established in 1949, was rated as a second-class first-class comprehensive hospital in 1995, identified by the Jiangsu Provincial People's Government as a pilot unit for the reform of county-level public hospitals in Jiangsu Province in 2011, identified by the National Health and Family Planning Commission as the first phase of comprehensively improving the comprehensive capacity of county-level hospitals in 2014, and was recognized by the National Health Commission as meeting the recommended standards for comprehensive service capabilities of county-level hospitals in 2019, and successfully converted into a tertiary general hospital in 2020. The hospital has 730 beds, and the actual number of open beds is 850.
If the higher authorities agree to "demote", it also means that they have just been successfully converted to a tertiary general hospital and will be downgraded to a secondary hospital.
So, what is the Suining incident? Who has the authority to downgrade a healthcare facility? What conditions can cause hospitals to be lowered? Will I recover after downgrading?
What is the incident involving the death of the infant in Suining County People's Hospital?
According to the report, on the night of April 29, Shi Mouyuan, a child in Suining County, was sent by his family to Suining County People's Hospital for treatment due to a foreign body in the trachea, and then transferred to Xuzhou New Health Hospital for treatment through suining county emergency medical station, and died on the morning of April 30 after ineffective rescue. Subsequently, Xuzhou City set up a joint investigation team composed of relevant departments such as the Municipal and County Discipline Inspection Commission, Health and Health, Public Security and other relevant departments and medical experts to conduct an in-depth investigation of the diagnosis and treatment of children.
After investigation, Suining County People's Hospital received the child Shi Mouyuan (male, 1 year old and 5 months, his aunt Shi Mouye) at 20:10 on April 29, and his aunt and grandmother reported that the child had swallowed a foreign body by mistake, and the family cut out half a shelled pumpkin seed from his mouth. After asking about the medical history, auscultation of the lungs, the receiving doctor preliminarily judged that it was a foreign body in the trachea, and gave the child first aid measures such as oxygen inhalation and continuous monitoring of pulse oxygen.
Suining County People's Hospital considered that its own treatment capacity was insufficient, and issued a referral form at 21:00 that night, informing the relatives of the children to be referred as soon as possible. Because the child's parents were not present, his aunt and grandmother failed to agree to the referral. At 21:45, the parents of the children arrived at the hospital. At about 22:00, the receiving doctor handled other cases after explaining the condition with the father of the child, during which time, he repeatedly called the father of the child to inquire about the condition and urged the transfer to the hospital at 23:55, 0:00 on the 30th, 1:04, 1:07, 1:19 and 1:23. The Medical Department of Suining County People's Hospital contacted the general duty office of Xuzhou New Health Hospital at 22:00 on the 29th. At 1:08 on the 30th, the child's mother dialed 120. At 1:22, the 120 ambulance of Suining County Emergency Medical Station rushed to the county people's hospital and arrived at the rescue room of Xuzhou New Health Hospital at 2:30. The doctor on duty perfects the examination, opens the venous channel, gives oxygen, ECG monitoring and treatment, and assists such as CT and blood routine. At 3:47, the child suddenly appeared apnea, the hospital immediately implemented cardiopulmonary resuscitation and other rescue measures, and organized expert consultation, at 4:56, the child died due to ineffective rescue.
The investigation showed that after the Suining County People's Hospital received the diagnosis, the child was treated with emergency treatment without a report of nucleic acid test results, and a referral form was issued in a timely manner; during this period, at 20:22 on April 29, the children and their aunts were sampled for nucleic acid, and in the process of treatment, reception and referral, Suining County People's Hospital and Xuzhou New Health Hospital did not require them to provide nucleic acid test results.
The investigation found that suining county people's hospital in the process of diagnosis and treatment of the child Shi Mouyuan in the first diagnosis responsibility system is not strict, did not take relevant examinations in time to further clarify the diagnosis, did not communicate with relatives enough, and did not inform the child's condition and the serious consequences that may occur; in the process of referral, there was a lack of connection, and the detailed condition of the child was not fully informed to the receiving hospital in time.
According to the results of the investigation, in accordance with party discipline and relevant laws and regulations, the units involved and the relevant responsible persons will be seriously dealt with:
1. The Xuzhou Municipal Health Commission gave a warning to suining county people's hospital, and zheng mouxiang, a doctor who was diagnosed with the clinic, suspended his practice activities and conducted further investigation. Suining County People's Hospital was instructed to carry out comprehensive internal rectification.
Second, the Suining County Party Committee gave Wang Yanlong, secretary of the party committee of the county health and health commission, a warning within the party, and removed Zhang Tao, secretary of the party committee and president of the Suining County People's Hospital, from his posts inside and outside the party.
3. In accordance with the relevant regulations on the management of medical institutions, report to the higher-level departments to demote the Suining County People's Hospital.
Who has the authority to downgrade a healthcare facility?
In order to strengthen the management of medical institutions, on February 26, 1994, the State Council formulated and promulgated the Regulations on the Administration of Medical Institutions, which was revised once in February 2016. In 2022, it was revised again and decided to take effect from May 1, 2022.
In the three revisions, although some of the provisions were revised according to the changes in the situation, the system of rating medical institutions has been adhered to. It is clear that "responsible for organizing the evaluation of medical institutions" is one of the ways in which the health administrative departments of people's governments at or above the county level exercise their supervision and management powers (Article 39), affirming that "the state implements a medical institution review system, and the evaluation committee composed of experts conducts a comprehensive evaluation of the practice activities and quality of medical services of medical institutions in accordance with the evaluation methods and evaluation standards of medical institutions." The evaluation measures and evaluation standards for medical institutions shall be formulated by the administrative department of health under the State Council. (Article 40) It also requires that "the health administrative departments of local people's governments at or above the county level shall be responsible for organizing the evaluation committees of medical institutions in their respective administrative regions." The Medical Institution Review Committee is composed of experts in hospital management, medical education, medical treatment, medical technology, nursing and finance. The members of the evaluation committee shall be appointed by the health administrative department of the local people's government at or above the county level. (Article 41) "The health administrative departments of local people's governments at or above the county level shall, on the basis of the appraisal opinions of the appraisal committee, issue appraisal certificates to medical institutions that meet the appraisal standards; (Article 42)
What rules are violated that may result in a downgrade in a healthcare facility?
Although the Regulations on the Administration of Medical Institutions have many provisions on revoking the Medical Institution Practice License or ordering them to stop practicing activities, there are no provisions on the reduction of the level of medical institutions.
Maybe it's because the medical institution level comes from the medical institution review.
On September 21, 2011, the former Ministry of Health issued the Interim Measures for Hospital Evaluation (Wei Yi Guan Fa [2011] No. 75).
The Interim Measures for Hospital Review stipulates that the periodic review of hospitals includes a comprehensive review of written evaluation of hospitals, statistical evaluation of medical information, on-site evaluation and social evaluation. The evaluation conclusions of hospitals at all levels are divided into grade A, grade B and unqualified. Grade A and Grade B hospitals shall be issued by the provincial health administrative departments with grade certificates and logos in a unified format of the Ministry of Health. The hospital health administrative department that concludes that the review is "unqualified" shall issue a rectification notice and give a rectification period of 3-6 months. The hospital shall apply to the health administrative department for re-evaluation within 5 working days after the expiration of the rectification period, and the re-evaluation conclusion is divided into B or unqualified. For hospitals that fail to pass the re-evaluation, the health administrative department shall appropriately lower or revoke the level of the hospital according to the specific circumstances of the review; where there are violations of laws and regulations, it shall be dealt with accordingly in accordance with law.
The "Interim Measures for Hospital Review" also stipulates that if there are major defects in medical ethics, medical quality and medical safety in the validity period of the grade certificate, the health administrative department shall revoke the original review conclusion, cancel the review grade, and withdraw the certificate and logo.
Of course, there are "major defects in medical ethics, medical quality and medical safety" here, which is relatively broad.
Judging from the evaluation standards for tertiary hospitals (2020 edition) issued by the National Health Commission in December 2020, it may be more specific about the provisions on the downgrading of medical institutions.
The 2020 edition of the tertiary hospital evaluation standards consists of 3 parts and 101 sections, and sets 448 standards and monitoring indicators. The first part is the pre-requirements part, with a total of 3 sections and 25 pre-clauses for review. The standard stipulates that if one or more situations occur in the hospital during the review cycle, the review shall be postponed for one year. The original grade cancellation during the extension period shall be managed in accordance with the "undetermined wait". Obviously, this pre-requirement is actually the threshold for hospital grade review, the premise of whether it is eligible to participate in the review and whether it can be "admitted", and it is also a single "veto" indicator, so it can also be understood as canceling or lowering the "gold standard" of hospital grade.
The three sections of the preceding requirements are set up and practiced according to law, public welfare responsibility and conduct integrity, safety management and major events.
In accordance with the requirements of the establishment and practice, including 15 articles:
(1) The scale and basic settings of the hospital do not meet the standards;
(2) Forging, altering, buying, selling, leasing, or lending the "Medical Institution Practice License"; the naming of hospitals is not compliant, the calibration is not verified on time, refuses to verify, or there are records of suspension of verification, the diagnosis and treatment subjects are changed without authorization, or there are diagnostic and treatment activities beyond the scope of registration of the diagnosis and treatment subjects; the medical and health institutions organized by the government and other organizations invest in the establishment of medical and health institutions with non-independent legal personality; medical and health institutions lease or contract medical departments; and non-profit medical and health institutions distribute or covertly distribute the proceeds to investors or organizers;
(3) Using non-health technicians to engage in medical and health technology work;
(4) Illegally purchasing or using drugs, equipment, instruments, and consumables to carry out diagnostic and therapeutic activities, causing serious consequences; configuring and using large-scale medical equipment that requires access approval without permission;
(5) Carrying out relevant maternal and infant health care technology without obtaining a license to practice maternal and child health care technical services;
(6) Buying and selling human organs or engaging in activities related to the sale and purchase of human organs, and carrying out human organ acquisition and transplantation techniques without permission;
(7) Illegally collecting blood, illegally organizing others to sell blood, or selling blood donated without compensation;
(8) Illegally causing the spread, epidemic or other serious consequences of infectious diseases; other major medical violations, causing serious consequences or serious circumstances; and the administrative departments of health and health or supervision and law enforcement agencies have focused on the comprehensive evaluation of the classification supervision and supervision of the prevention and treatment of infectious diseases in the past two years (subject to the results of the most recent evaluation in the past two years);
(9) Tampering, falsifying, concealing, or destroying medical record materials, causing serious consequences;
(10) Applying new medical technologies and prohibited medical technologies that have not passed technical assessments and ethical reviews to clinical practice, causing serious consequences;
(11) Illegally purchasing, storing, transferring, prescribing, registering, or destroying narcotic drugs and first-class psychotropic substances, or using persons who have not obtained prescription rights or physicians whose prescription rights have been revoked to prescribe prescriptions, causing serious consequences;
(12) Engaging in radiological diagnosis and treatment without obtaining a radiological diagnosis and treatment permit, causing serious consequences;
(13) Failing to carry out occupational health examinations or diagnosis of occupational diseases in accordance with law, failing to perform statutory duties such as reporting occupational diseases and suspected occupational diseases in accordance with law, causing serious consequences;
(14) Publishing medical advertisements in violation of regulations, where the circumstances are serious;
(15) Other major violations of laws or regulations, causing serious consequences or serious circumstances.
In terms of public welfare responsibility and integrity of conduct, there are 5 articles, (1) government directive work such as counterpart support, Chinese foreign aid medical teams, medical rescue for public emergencies, and public health tasks that should be completed but not completed. (2) The national essential drug system and graded diagnosis and treatment policies should be implemented but not implemented. (3) There were more than 3 serious job-related crimes or serious violations of discipline in the hospital leadership team, or more than 3 mass incidents (≥ 3 people per case) of medical personnel violating the "Nine Prohibitions on the Construction of Medical and Health Practices", causing major social impacts. (4) Occurrence of major illegal price or fee violations, as well as malicious deception of medical insurance funds. (5) Providing and reporting medical service information, statistical data, declaration materials, and scientific research results such as the home page of false inpatient cases, where the circumstances are serious.
In terms of safety management and major incidents, it includes 5 articles, (1) the occurrence of a first-level medical accident characterized as full responsibility or a major medical accident directly judged by the health administrative department. (2) Occurrence of major nosocomial infections, causing serious consequences. (3) Occurrence of major safety accidents that have been notified or punished due to major fires, radioactive source leaks, harmful gas leaks, etc. (4) Conduct that conceals or omits major medical negligence. (5) Large-scale medical data breaches or other major network security incidents occur, causing serious consequences.
The Suining incident should be classified as "other major medical violations, causing serious consequences or serious circumstances".
Will I recover after downgrading?
It can be seen that there are many rules and regulations that hospital violations will be downgraded, so after the hospital is downgraded, will it revert to the original level?
Of course.
On October 26, 2020, the official website of the Guangdong Provincial Health Commission released a "Announcement on Determining shunde Hospital of Southern Medical University as a tertiary general hospital". It is reported that in April 2019, the hospital was revoked from the third class due to a number of cases of unexplained fever in children and the death of 5 newborns.
According to the "Announcement", according to the Regulations on the Administration of Medical Institutions, the Implementation Rules of the Guangdong Provincial Health Department on the Evaluation of Medical Institutions (Trial Implementation), and the Notice of the Guangdong Provincial Health Commission on Further Improving the Grade Review of Tertiary Hospitals (General Hospitals and Specialized Hospitals), the Guangdong Provincial Health Commission organized experts to conduct qualification review, on-site review and comprehensive scoring of Guangdong Shunde Hospital, and the results met the standards. It is proposed to determine Guangdong Shunde Hospital as a tertiary first-class general hospital. (This article is published by "Seeing the Medical Community", reprinted with permission, and the author and source are indicated at the beginning of the article.) ）
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