Article 1224
In any of the following circumstances, the medical institution shall not be liable for compensation if the patient suffers damage in the course of diagnosis and treatment:
(1) The patient or his close relatives do not cooperate with the medical establishments in carrying out diagnosis and treatment that meets the standards of diagnosis and treatment;
(2) Medical personnel have fulfilled their obligation to make reasonable diagnosis and treatment in emergency situations such as rescuing patients who are dying;
(3) It is difficult to diagnose and treat due to the level of medical care at the time.
In the circumstances provided for in item (1) of the preceding paragraph, where medical establishments or their medical personnel are also at fault, they shall bear the corresponding liability for compensation.
1. The main purpose of this article
This article is about the exemption of medical institutions.
II. Evolution of the Provisions
Article 60 of the original Tort Liability Law stipulates that: "If a patient suffers damages, the medical institution shall not be liable for compensation due to any of the following circumstances: (1) the patient or his close relatives do not cooperate with the medical institution in carrying out diagnosis and treatment in accordance with the diagnosis and treatment standards; (2) the medical personnel have fulfilled their obligation to provide reasonable diagnosis and treatment in emergency situations such as rescuing patients who are dying; (3) it is difficult to diagnose and treat patients due to the medical level at that time." In the circumstances of item (1) of the preceding paragraph, where medical establishments and their medical personnel are also at fault, they shall bear corresponding liability for compensation. This article basically retains this provision, but there are three changes: first, the original "patients have damages" is amended to "patients are harmed in the course of diagnosis and treatment", which is mainly in consideration of the fact that Article 54 of the original Tort Liability Law and Articles 1218 and 1222 of this Law all stipulate that "patients are damaged in the course of diagnosis and treatment activities" Thirdly, in paragraph 2, "medical institutions and their medical personnel" is amended to "medical institutions or their medical personnel".
3. Interpretation of Provisions
This article provides for the exemption from liability for medical damages.
This article provides for the following three exemptions for medical institutions:
(1) The patient or his/her close relatives do not cooperate with the medical institution to conduct a diagnosis that meets the standard of diagnosis and treatment
Therapy. This is often referred to as non-cooperation on the part of the patient. Where medical establishments and their medical personnel conduct diagnosis and treatment activities that comply with the standards of diagnosis and treatment of patients, but patients and their close relatives obstruct, interfere with, refuse, etc., by means of non-cooperation, so that medical personnel are unable to carry out normal diagnosis and treatment activities, the medical institutions shall not be liable for compensation for the damages caused thereby. However, if the medical institution or its medical personnel are also at fault in the course of not cooperating with the treatment, it constitutes negligence and shall be offset by negligence, and the medical institution shall bear the corresponding liability for compensation.
(2) Medical personnel have fulfilled their obligation to provide reasonable diagnosis and treatment in emergency situations such as rescuing patients who are dying. In this case, if the medical personnel take emergency rescue measures in order to save the patient and save the life, the medical personnel shall not be liable for compensation for the occurrence of the damage as long as they have fulfilled their reasonable obligation to provide diagnosis and treatment. For example, almost all of the medical measures taken to treat patients during the SARS code have left serious sequelae, but they do not constitute liability for medical damages, and disputes should be resolved through other methods.
(3) It is difficult to diagnose and treat due to the medical level at the time. This is also known as the limitation of the level of medical care. In the event of medical damage, if the consequences of the damage occur because the medical level at that time is difficult to diagnose or cure, it does not constitute liability for medical damage, and the medical institution shall not be liable for compensation.
4. Cases
Zeng Moujie v. Zhangzhou Hospital of Traditional Chinese Medicine, a dispute over compensation for medical malpractice damages
Facts: Zeng Moujie was admitted to Zhangzhou Hospital of Traditional Chinese Medicine for treatment and surgery. The following year, Zeng Moujie went to Zhangzhou Hospital of Traditional Chinese Medicine again, and the outpatient trauma department recommended that the patient undergo artificial joint replacement, but the patient refused and insisted on surgery to remove the fixation. After the operation, Zeng Moujie was admitted to the 175th Hospital of the Chinese People's Liberation Army and underwent "left artificial total hip arthroplasty". In 2016, Zeng Moujie sued the court, requesting that Zhangzhou Hospital of Traditional Chinese Medicine be ordered to bear the liability for compensation. The court of first instance held that Zeng Moujie's postoperative symptoms were common complications. There was no fault in the diagnosis and treatment behavior of Zhangzhou Hospital of Traditional Chinese Medicine in the process of diagnosis and treatment, and there was no causal relationship between its diagnosis and treatment behavior and Zeng Moujie's postoperative symptoms. Therefore, Zeng Moujie's litigation claim was not supported. Zeng Moujie was dissatisfied with the first-instance judgment and appealed. The court of second instance held that Zhangzhou Hospital of Traditional Chinese Medicine was not at fault for delaying treatment, so this case did not have the tortious elements of "delayed treatment". Although Zhangzhou Hospital of Traditional Chinese Medicine was at fault for the corresponding improper handling, it had no causal relationship with Zeng Moujie's damage and did not have the causal elements of infringement. Zhangzhou Hospital of Traditional Chinese Medicine does not constitute infringement and shall not be liable for compensation.
5. Analysis
This case involves the issue of the exemption of medical institutions. Consistent with other tort liability, liability for medical damage can also be exempted under certain conditions. In addition to the application of the exemption grounds in Chapter 1 "General Provisions" of Part VII of the Civil Code, Article 1224 of the Civil Code inherits the provisions of Article 60 of the Tort Liability Law and continues to stipulate three special exemptions for medical institutions, namely: the patient or his close relatives do not cooperate with the diagnosis and treatment, the medical personnel have fulfilled their reasonable obligation to provide diagnosis and treatment in an emergency, and it is difficult to diagnose and treat the patient due to the medical level at that time. In this case, patient Zeng Moujie suffered from an unhealed fracture of the left femoral neck and avascular necrosis of the femoral head, which were common complications after surgery, rather than a disease caused by non-standard diagnosis and treatment during the operation. Based on our current level of medical care, Zhangzhou Hospital of Traditional Chinese Medicine and its medical staff can foresee complications, but there is no way to avoid them. Therefore, for the damage suffered by the patient Zeng Moujie after surgery, Zhangzhou Hospital of Traditional Chinese Medicine enjoys exemption from liability and does not need to bear the liability for compensation.