1. Basic facts of the case
On September 23, 2018, Qiao X went to the defendant's internal medicine department for treatment, and the attending physician of the department, Sun X, diagnosed him with hypokalemia based on Qiao X's self-report, and issued a written prescription and an electronic outpatient prescription, of which the written prescription recorded that 0.9% sodium chloride 10 ml 2 sticks, 5% glucose 20 ml 1 stick, potassium chloride 10 ml 2 sticks / oral qd; in addition to the above drugs recorded in the electronic prescription, there is 1 0.6 infusion device, 20 ml empty needle, The defendant collected medical expenses from Qiao Moumou according to the electronic office. Qiao Moumou took the above drugs home and injected potassium chloride injection into the vein of his right arm at home on September 25, 2018, and then died on the same day due to discomfort and ineffective rescue.
Qiao Moumou graduated from X Health School in July 1983, has been engaged in nursing work in the hospital since May 1988, transferred to the defendant's office to engage in nursing work, and has been serving as a nurse in charge since September 2003. The two plaintiffs denied that Qiao had a history of hypokalemia.
Second, the patient's point of view
The defendant's above-mentioned diagnosis and treatment behavior violated the medical operation procedures and caused serious consequences of Qiao X's death, and should bear 50% of the compensation liability according to law. Litigation claim: The defendant was ordered to compensate the plaintiff for death compensation, funeral expenses, etc. a total of 200,000 yuan, and during the litigation, the two plaintiffs changed the amount of the above litigation claims to 440,000 yuan.
Third, the medical point of view
Qiao xxx went to the defendant's outpatient clinic on September 23, 2018, claiming to be fast heartbeat, vomiting, etc., and claimed to have a history of hypokalemia, and the defendant's outpatient physician also examined it, in this case the doctor asked Qiao XX to treat in the outpatient clinic, Qiao XX refused, based on the colleague relationship, the attending physician did not force it, and prescribed the corresponding drugs according to his examination and Qiao XX's self-reported situation.
Qiao Moumou graduated from the health school in July 1983, was transferred to the defendant's office in May 1988, and was rated as the intermediate title of competent nurse in September 2003, and has his own professional safety and standardized medication ability and experience. The dosage specified in the defendant's prescription was a safe dosage, and it was stated that it was taken orally, and Qiao moumou did not take oral methods, but directly injected it into the vein of his right arm, and his behavior was the only and fundamental cause of the death accident involved in the case, which the defendant could not control.
4. Autopsy results
According to the autopsy, it can be excluded that it died of mechanical injury, mechanical asphyxia, organophosphorus drug poisoning, and disease. During the autopsy, the blood content of potassium chloride was 4935mg/kg, indicating that its content was significantly increased. According to the literature, the lethal amount of potassium chloride is 0.5-5g/kg, and the blood concentration of potassium poisoning is 6mmol/L.
Deaths from potassium chloride poisoning generally present with acute death changes, corpse spots, both eye bulbs, and eyelid conjunctiva visible bleeding spots. The congestion and edema of various organs are obvious. In subcutaneous and intramuscular injections, local tissues can degenerate, necrosis, etc. Due to the rapid transfer of intracellular potassium ions to the extracellular after human death, the potassium content can reach 25mmol/L 24 hours after death. Excess potassium chloride enters the bloodstream, increases the concentration of potassium ions in the blood, exceeds it, inhibits the autonomy, conductivity and excitability of the myocardium, and can lead to cardiac arrest and death.
Although the blood potassium content may increase with the development of postmortem changes, the potassium concentration in Joe's blood increases significantly. Combined with Qiao Moumou's prescription at the outpatient clinic on September 23, 2019, and the hospital's 120 emergency patient visit certificate on September 25, 2019, which proved that the main complaint at 120 o'clock in the call for help was "potassium chloride poisoning", a comprehensive analysis of Qiao Moumou may have died of cardiac arrest caused by potassium poisoning caused by elevated blood potassium.
5. Appraisal opinions
Upon the plaintiff's application, this court entrusted the x judicial appraisal center to conduct the appraisal, and on August 12, 2019, the center issued a notice of termination of the appraisal no. x, so that the entrustment exceeded the technical conditions or appraisal capacity of the institution, so the appraisal was terminated.
VI. Trial Opinions
As to whether Qiao Moumou's death was damaged in the defendant's medical and therapeutic activities. According to the plaintiff's statement, the defendant's diagnosis and treatment behavior and the appraisal opinion of the appraisal agency, qiao xxx died due to injection of potassium chloride injection, and it can be determined that there is a certain causal relationship between the defendant's fault diagnosis and treatment behavior and the death of Qiao xx, and qiao xx's death is damaged in the defendant's diagnosis and treatment activities.
Question as to whether the defendant was at fault for his or her medical conduct. According to the relevant medical literature, for the diagnosis of hypokalemia, it is necessary to confirm the diagnosis through medical examinations such as blood routine and biochemical examination, and the defendant failed to provide evidence to confirm that the relevant examination was carried out, and the basis for qiao xxx's diagnosis was made, but in this case, the corresponding prescription drugs were prescribed for Qiao xxx. In addition, the written prescription issued by the defendant was inconsistent with the specific content of the electronic prescription, and there was also an irregularity in the written prescription adding content after the blank slash.
As to whether the prescription drugs prescribed by the defendant to Qiao X were taken orally or injected, the defendant argued that it was taken orally and claimed that it was clearly recorded in the written prescription, but the record was recorded under the slash in the blank space of the prescription, and in the corresponding electronic prescription issued by the defendant, there were also infusion sets and empty needles, and the defendant failed to provide corresponding evidence or reasonable explanations for this, and this court did not accept the way in which the prescription drugs were used in its argument.
Therefore, the defendant should be liable for compensation for the losses caused by the death of Qiao X. As a nurse practitioner with more than 30 years of experience, Qiao Moumou has certain medical expertise and experience, and should have a full understanding of whether he suffers from hypokalemia, how to standardize the diagnosis and treatment of the disease, the dosage of prescription drugs, etc., but he has failed to effectively use his medical expertise and experience, failed to fulfill the corresponding duty of care for his own health and life safety, and has the main fault for the occurrence of damage consequences, and should bear the main responsibility.
Based on the doctor-patient ability of the doctor and the patient in this case to control the risk of the occurrence of damage, the faulty behavior of both parties and the causal force of the damage consequences, it is appropriate for the defendant to bear 20% of the compensation liability for the two plaintiffs. The damage accident involved in the case was mainly caused by the negligent acts of the relatives of the two plaintiffs, and this court does not support the moral consolation money claimed by them.
7. Judgment of the Court
The defendant x city x district x town center health center shall compensate the plaintiff within ten days from the effective date of this judgment for death compensation, funeral expenses, and lost work expenses totaling 165,134.01 yuan (825,670.12 yuan×20%).
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