Medical disputes caused by complications of cerebrovascular interventional surgery may be the most common type in neurology and neurosurgery, and Mr. Lin's team has represented the most new cases this year in this category.
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1. The reasons for the many complications of cerebrovascular interventional surgery.
Compared with interventional surgery for heart diseases (Dr. Lin is a doctor in this specialty), cerebrovascular interventional surgery has many complications and is difficult to deal with, because brain tissue is less compensatory and tolerable than heart tissue, and the technology of cardiac interventional treatment is much more mature. Although the brain tissue is very safely protected by the skull, it is this protection that makes the brain tissue very fragile, once ischemia or hemorrhage complications occur, there is no ability to compensate, there is no space to release bleeding pressure, such as no reflow caused by cerebral vascular stenosis surgery, thrombus escaping to distal blood vessels, stent leading to perforator occlusion, basically there is no effective way to prevent and deal with it; Aneurysm embolization during rupture, because the cerebral blood vessels are usually small in size, there is no suitable stent graft, and can only be treated intraoperatively by embolization, which will lead to a larger area of cerebral infarction, if it is postoperative bleeding, then there is no good way except for craniotomy (there will be a time delay). Therefore, as an aside, it is recommended that patients and friends try to find a hospital with mature technical conditions to do cerebrovascular interventional surgery, and it is advisable to be cautious.
2. Common diagnosis and treatment mistakes in hospitals.
1. Violation of surgical indications.
The cost of cerebrovascular interventional surgery is very high, and it is common to charge more than 100,000 yuan, so the treatment enthusiasm of surgeons is very high, and it is common to have more than surgical indications. For example, many hospitals actively mobilize patients to do intracranial unruptured aneurysms, but according to the guidelines, certain requirements must be met before surgery is recommended (according to the "Chinese Guidelines for the Diagnosis and Treatment of Intracranial Unruptured Aneurysms 2021", UIA patients with hypertension that is not well controlled, smoking cannot be withdrawn, previous intracranial aneurysm rupture and bleeding, multiple aneurysms, and aneurysms with a diameter greater than 5 mm (or significantly larger than the aneurysm artery in measurement) , symptomatic aneurysm, aneurysm located in the posterior circulation or bifurcation site, irregular aneurysm such as ascomycetes or multiple lobulations, etc., if one or more of the above conditions appear, the aneurysm patient has an indication for active treatment), and some hospitals even fabricate that the patient has uncontrollable risk factors or a history of aneurysm compression symptoms without meeting the indication for surgery. For internal carotid artery stenosis, acute cerebral vascular stenosis cerebral infarction, and vascular malformation, there are also relatively strict surgical indications.
2. Alternative treatment options are not well informed.
In order to actively carry out surgical treatment, many hospitals deliberately do not inform conservative treatment, drug treatment, surgical treatment, etc., such as intravenous thrombolysis is preferred within the time window of acute cerebral infarction, endometrial dissection is preferred for internal carotid artery stenosis, unruptured aneurysms less than 5mm can be temporarily observed without special circumstances, and cerebral artery stenosis with good collateral circulation and no obvious ischemic symptoms can be strengthened for drug treatment, etc. According to the medical records of the surgical consent, doctor-patient notice and other informed documents, it is clear whether the hospital is at fault for the failure to inform the alternative treatment plan.
3. Improper surgical operation.
Improper operation is a common fault of this type of dispute hospital, because the cerebrovascular interventional treatment technology is difficult, the technical level of the surgeon is very high, most of the complications of vascular rupture and bleeding and stent thrombosis are caused by improper operation and inadequate technology, because the intraoperative guidewire, stent and catheter are not easy to be accurately in place, the surgeon has to prolong the operation time, repeatedly carry out endovascular operations, the probability of error increases, and the complications increase. Patients can ask a competent medical lawyer or doctor to help watch the video of the operation to determine whether there is any fault for improper operation.
4. Surgical qualifications are uneven.
According to the "2019 Management Standards for the Clinical Application of Comprehensive Interventional Diagnosis and Treatment Techniques", the General Office of the National Health Commission organized the revision of the management specifications for the clinical application of four interventional diagnosis and treatment technologies, namely cardiovascular disease intervention, comprehensive intervention, peripheral vascular intervention and neurovascular intervention, and released them on November 15, 2019, mainly including interventional technologies for the diagnosis and treatment of non-vascular diseases and tumors. Physicians who intend to independently carry out neurovascular interventional diagnosis and treatment techniques according to the four-level surgical management should meet the following conditions on the basis of meeting the above conditions: have been engaged in relevant clinical professional diagnosis and treatment for no less than 10 years. A total of no less than 400 cases of neurovascular interventional diagnosis and treatment operations have been completed independently, of which no less than 100 cases have been completed according to the three-level surgical management. After systematic training in the neurovascular intervention technology training base that meets the requirements, it has the ability to carry out related technologies (neurovascular intervention training and assessment certificate). There are not many doctors in primary medical institutions who really have the above-mentioned surgical qualifications, and there are many cases where doctors who do not meet the above-mentioned qualifications in tertiary hospitals complete the operation independently.
5. Lack of timely observation and treatment of complications.
Cerebrovascular intervention treatment complications must be closely observed, actively start the emergency plan, especially hemorrhagic complications, once suspicious symptoms appear, imaging examination should be improved as soon as possible, in line with the indication of surgery immediately surgery, otherwise it will lead to catastrophic consequences, either death or disability. The fault of inadequate observation and management in the hospital usually occurs at night, when the doctor on duty has an inert mind and does not want to alarm the senior physician, or the senior physician is unwilling to get up in the middle of the night for emergency surgery.
3. Precautions for protecting the rights of the patient.
1. Be sure to copy it to the video of the operation.
As long as it is an interventional operation, it is necessary to record a video, and the operation cannot be carried out without recording the video, so if the hospital says that there is no surgical video, it must be a lie.
2. Be sure to submit the surgical video as a sample material during the appraisal.
Some cases have entered the legal process, and the patient's friends do not know the importance of the surgical video, and some appraisal institutions have the same inert thinking, if you don't submit the surgical video, I won't bother to ask for a consultation, so whether the appraisal has not been carried out yet, or has been carried out, it is necessary to submit the surgical video to the appraisal agency through the court, and the appraisal report has been issued for supplementary appraisal, after all, there is a considerable proportion of damage caused by improper surgical operation, how can it be determined without watching the surgical video?
3. Hire a lawyer with a high level of professionalism.
According to Mr. Lin's experience, if you don't understand medical disputes caused by technical reasons, the appraiser may bully you for your lack of knowledge and maintain the hospital. If you can't hire a professional lawyer, you should at least ask a professional to analyze the medical records, videos, and scrivener materials, otherwise the result of the case may not be satisfactory.
4. Paralysis patients should go through legal procedures as much as possible.
If the patient insists on negotiating a solution, it will be difficult to reach an agreement with the hospital and waste time because of the high expected compensation; if the patient is unwilling to pay a higher appraisal fee and go through the medical malpractice appraisal, it is easy to characterize it as an inevitable complication and identify that it does not constitute a medical malpractice; at the same time, because the negotiation is a one-time compensation, it is impossible to claim the high follow-up treatment fee. According to Mr. Lin's experience, such cases basically need to go through legal procedures to obtain reasonable compensation, and the court judgment can preserve the opportunity for subsequent claims.
5. Those who stay in the hospital for a long time may consider a settlement through negotiation.
Some patients have been stranded in the disputed hospital for rehabilitation treatment because of serious complications after surgery, and have owed huge medical expenses, resulting in the loss of cost-effectiveness through legal procedures, that is, the final compensation may not be worth the arrears, this situation is recommended to be resolved through negotiation, because the inherent risks of cerebrovascular intervention surgery will make it difficult for the appraiser to conclude that the hospital bears the main or full responsibility, and there is no cost-effective lawsuit, but the hospital can digest the medical arrears by itself through negotiation, and generally can obtain partial compensation and discharge.
To sum up, medical disputes with complications of cerebrovascular interventional surgery require professional knowledge and experience in handling cases, and at the same time, such cases have serious damage consequences and high expected compensation, so it is recommended that patients with conditions should entrust professional medical lawyers as much as possible.