In order to build a harmonious doctor-patient relationship and give full play to the guiding and normative role of the people's courts in preventing and resolving medical dispute cases, on October 21, 2021, the Beijing Third Intermediate People's Court held a press briefing on the three convenience mechanisms for medical disputes, launched the three convenience mechanisms for medical disputes, effectively implemented the "I do practical things for the masses" activity, and strived to enhance the people's sense of judicial gain and satisfaction. Xue Qiang, member of the party group and vice president of the Beijing Third Intermediate People's Court, Chen Xiaodong, president of the First Civil Court, Guo Lin, second-level researcher of the Policy and Regulation Department of the Beijing Municipal Health Commission, and Kang Haitao, deputy director of the Policy and Regulation Department, attended the briefing. The briefing meeting was presided over by Li Chunxiang, deputy director of the General Department of the Third Intermediate People's Court. Representatives of the Health Commission of the Three Intermediate People's Courts, some hospital staff and cadres and police officers attended the meeting. Many news media, such as China Central Radio and Television Corporation, Workers' Daily, Rule of Law Daily, China Court Network, Beijing Radio and Television Station, Beijing Daily, Beijing Political science and Law Network, and Chaoyang Rong Media, participated in the report.
At the briefing, Xue Qiang, member of the party group and vice president of the Third Intermediate People's Court, introduced the background, specific content and operational effectiveness of the three convenience mechanisms for medical disputes. Vice President Xue Qiang pointed out that the three convenience mechanisms for medical disputes include the notification mechanism of typical cases of medical disputes, the mechanism of judicial advice on medical disputes, and the mechanism for supervising the implementation of effective legal documents on medical disputes. The three mechanisms are based on the principle of "timeliness, legality and convenience" and "prevention and resolution of medical disputes" as the goal. Among them, the typical case notification mechanism of medical disputes takes the prevention of doctor-patient disputes as the foothold and focuses on avoiding the occurrence of doctor-patient disputes from the source; the judicial advice mechanism for medical disputes is committed to the efficient resolution of doctor-patient disputes and guiding medical institutions to improve medical service standards; the mechanism for supervising and urging the effective legal documents of medical disputes is based on protecting the legitimate rights and interests of patients and reducing the enforcement of litigation by parties. The organic combination of the three mechanisms provides a strong guarantee for the prevention of medical disputes, the resolution of doctor-patient conflicts, and the protection of patients' rights and interests.
Three convenience mechanisms for medical disputes
★ Notification mechanism for typical cases of medical disputes. In view of the experience and practices discovered in the trial of medical dispute cases, the experience and practices of medical institutions in the resolution of medical disputes, or the problems with warning significance, the cases that have been final judgments or mediations and related circumstances that have been final judgment or mediation will be reported to medical institutions and relevant departments from time to time, so as to promote information sharing between internal departments of medical institutions and between different medical institutions, so as to standardize medical activities, improve service levels, and promote benign communication between doctors and patients and the harmonious development of doctor-patient relationships.
★ Judicial advice mechanism for medical disputes. Focusing on the problems or management loopholes in medical administrative management or other relevant units found by the people's courts in the trial of medical dispute cases, the health administrative departments or other relevant units have problems or management loopholes in medical administration and other social governance, and through judicial suggestions, the medical and health administrative departments and other relevant units have been proposed to establish and improve rules and regulations, improve work, plug loopholes, pursue responsibility or give rewards, and then guide and supervise medical institutions to improve medical service standards, create a good medical environment, and effectively protect the legitimate rights and interests of patients.
★ Mechanisms for supervising the implementation of effective legal documents for medical disputes. Based on promoting the efficient resolution of doctor-patient disputes, it aims to help parties get the benefits of judgment performance in the shortest possible time. For effective medical dispute case judgment documents and mediation documents with monetary payment content, the judge shall urge the obligor to perform the payment obligation within the performance period provided for in the legal document, so that the validity of the legal document can be realized as soon as possible, effectively reducing the litigation burden of the parties' enforcement, and opening up the "last mile" from trial to enforcement. Since the trial operation of the mechanism in July 2020, the Third Intermediate People's Court has supervised the completion of 29 cases of automatic performance by medical institutions, with a total performance amount of up to 10 302 753 yuan.
Chen Xiaodong, president of the First Civil Division of the Third Intermediate People's Court in Beijing, reported two typical cases.
1
The case involving the conduit is not preserved The appraisal cannot lead to disputes
Basic facts of the case
In February 2017, Jia mou in a hospital for the right upper lobe resection + middle lobe partial resection + elurrhey 1 day before the operation, a hospital for Jia's right upper limb involved in the case of 1 set of catheters. The next day, a hospital performed surgery on Jia. In March 2017, Jia went through the discharge procedures, but the catheter involved in the case could not be removed, and a hospital repeatedly tried to remove the catheter without success, so he contacted Wang Mou, a technician of the catheter seller A company involved in the case, to carry out the case-related catheter removal for Jia, but the catheter was ruptured during the extraction process, and the stump of the catheter was left in the vein of Jia's right upper limb. Later, Jia mou tried to remove the residual catheter in the body at other hospitals, but it was unsuccessful, and the catheter involved in the case still remains in Jia's body. Jia sued a hospital and the catheter seller A and a medical device company limited to the court for compensation.
Court judgment
After trial, the Beijing Third Intermediate People's Court held that because a hospital did not retain the part of the pipe that was pulled out, it was impossible to carry out relevant appraisals, and it was impossible to complete the evidence that the medical products were not defective, so a hospital should bear the corresponding adverse consequences. Regarding the issue of a hospital allowing Wang to perform extubation operations for patient Jia, because of the violation of the relevant provisions of the Nurses Regulations, the health administrative department has given an administrative penalty of warning, so it can be inferred that there is a fault in the diagnosis and treatment behavior of a hospital, and there is a causal relationship between the fault and the damage consequences of jia's part of the catheter left in the body. Because Wang Mou, a technician of Company A, directly carried out extubation beyond the scope of technical support when performing work tasks, a hospital and the catheter seller A involved in the case had common negligence subjectively, and the two constituted joint infringement, and should bear joint and several liability for compensation for the damage consequences of Jia.
2
Although the medical record defect does not affect the identification, it does lead to the disease
Party trust is missing
On April 27, 2018, the child Wang Moumou was admitted to a hospital for hospitalization because of "2 weeks of nausea, fever for more than 1 day, anemia found for 1 day, and a poor response for half a day". After the rescue was ineffective, he died at 22:37 on the same day.
During the trial of the case, the child's parents, Shang X, and two others submitted the April 28, 2018 auxiliary examination report issued by a hospital, and the sampling time recorded in the report sheet was "18.4.28", which was later than the time of Wang X's death on April 27, 2018. Shang X and the other two believed that the report sheet was obviously suspected of falsification, and that a hospital concealed the true cause of the child's death and should bear full responsibility for Wang X's death, so they sued the court for compensation.
In this regard, a hospital advocated that the April 28 report single system supplement, the sampling time is actually April 27, when the laboratory test for the child was a bedside test, the testing instrument was placed in the ward, and the test results were printed on thermal paper immediately. Because the detection instrument is printed with thermal paper, the test results cannot be stored for a long time, and the formal report form needs to be manually printed, and the report form is supplemented on the next day, so the time displayed on the report sheet is April 28, 2018, and the relevant data on the report sheet has been actually used in the course record at 21:20 pm on April 27, 2018.
In the first instance, due to the great controversy between the two parties over the report in the medical records, it was not submitted for appraisal as an appraisal material. The court of first instance decided that a hospital should bear 20% of the compensation liability in light of the slight liability determined by the appraisal body's appraisal opinion and the irregular behavior of a hospital. In the second-instance trial, Shang X and other two people applied for the expert evaluator to appear in court for questioning, and the expert evaluator stated that whether the report was used as an appraisal material did not affect the appraisal conclusion of the case. The Beijing Third Intermediate People's Court held that the explanation made by a certain hospital was reasonable for the date recorded on the dispute report, and the expert evaluator also stated that the appraisal conclusion was not affected by the report sheet, so the court did not accept the claim that Shang X and other two people believed that a certain hospital had falsified medical records, and the proportion of liability determined by the first instance was upheld.
The circular points directly to typical problems
The Court made three recommendations
Chen Xiaodong, president of the First Civil Division of the Third Intermediate People's Court of Beijing, pointed out that the above cases reflect the problems of some medical personnel's lack of sense of responsibility, weak sense of service, weak legal concepts, irregular medical record production, and imperfect dispute resolution mechanisms, and these problems have directly caused medical disputes, aggravated doctor-patient conflicts, or caused trial obstacles, or consumed social resources, which are not conducive to the harmonious and stable doctor-patient relationship and the timely and effective resolution of doctor-patient disputes.
To this end, the Third Intermediate Court made three recommendations to medical institutions:
The first is to pay attention to the education and training of medical regulations, and improve the legal awareness and risk prevention awareness of medical personnel. In addition to professional training, medical personnel should strengthen the study of medical treatment norms such as the Regulations on the Handling of Medical Accidents, the Regulations on the Prevention and Handling of Medical Disputes, and the Basic Norms for The Writing of Medical Records, and effectively strengthen the standardization of diagnosis and treatment and the risk prevention awareness of medical personnel. At the same time, all medical institutions should strengthen the professional ethics education of medical personnel, effectively enhance the sense of responsibility of medical personnel, and regularly carry out supervision and inspection, and correct and deal with the problems found in a timely manner.
The second is to attach importance to doctor-patient communication and disease risk notification, and fully protect the patient's right to know. Hospitals should truthfully inform patients of their condition, medical measures and corresponding medical risks in their diagnosis and treatment activities. The consultations, opinions, and suggestions submitted by patients in the course of diagnosis and treatment shall be patiently explained, explained, and handled in accordance with regulations; questions raised by patients on diagnosis and treatment behavior shall be promptly verified and self-examined, and relevant personnel shall be designated to communicate with patients or their close relatives to truthfully explain the situation.
The third is to strengthen the emergency handling capacity of medical disputes, and report and deal with work in accordance with laws and regulations. Where medical personnel occur or discover medical disputes, medical negligence that may give rise to medical liability, or disputes over medical liability occur during medical activities, they shall immediately report to the person in charge of the department where they work, and take disposition measures in accordance with laws and regulations in accordance with the relevant plans. In particular, attention should be paid to the sealing and storage of important materials such as medical records and on-site physical objects, and attention should be paid to the timeliness and accuracy of medical records.
In response to the conflict of interest of lawyers in a medical dispute case, the Beijing Third Intermediate People's Court sent judicial advice to the All China Lawyers Association
In the case of the dispute between the appellant Hospital A and the appellee Zhou X and the defendant Hospital B in the original trial, hospital A and hospital B were different parties with conflicts of interest, and both hospitals entrusted different lawyers of a law firm to participate in the litigation during the first instance and pre-trial trial stages of the case. Upon inquiry, both Hospital A and Hospital B agreed that there was a conflict of interest between them and the other party, while a lawyer of a law firm said that when accepting the entrustment in this case, the client did not explicitly raise the issue of conflict of interest, so the law firm did not take the initiative to conduct a conflict of interest review.
The staff will seal and hand over the judicial recommendation on the spot
With regard to the issue of different lawyers of the same law firm representing parties with conflicts of interest in litigation at the same time, the Measures for the Administration of Law Firms and the Code of Conduct for Lawyers' Practice have all made explicit provisions and prohibited them in principle, and lawyers associations in some provinces and cities have also issued rules for the review and handling of conflicts of interest. However, during the trial of the case, the Third Intermediate People's Court found that there were some problems in judicial practice in the provisions of the Code of Conduct for Lawyers' Practice on conflicts of interest, so it sent judicial suggestions to the All-China Lawyers Association, suggesting that it revise the Code of Conduct for Lawyers' Practice, consider establishing a party consent (exemption) mechanism for civil cases with conflicts of interest under certain conditions in litigation activities, and refine the construction of firewall mechanisms, the scope of application of the firewall, the trigger conditions, Specific provisions are made on specific operation and supervision mechanisms.
Guo Lin, a second-level researcher at the Policy and Regulation Department of the Beijing Municipal Health Commission, said that the Beijing Third Intermediate Court attaches great importance to the prevention and resolution of medical disputes, and the establishment of the three convenience mechanisms fully reflects the sense of social responsibility of the Beijing Third Intermediate Court to continuously expand judicial functions and actively participate in the resolution of social contradictions. Since the trial operation of the three convenience mechanisms for a period of time, good results have been initially shown. As a health administrative department, it will actively cooperate with the typical case notification mechanism of the Third Intermediate Court, give full play to the responsibility of medical administrative management, do a good job in the supervision and management and service work of medical institutions, strive to prevent the occurrence of medical disputes, actively resolve doctor-patient conflicts, and promote the benign interaction of doctor-patient relations and the harmonious development of economy and society.
In the media interaction session, reporters from the Rule of Law Daily and the Beijing Political and Legal Network asked questions, and Xue Qiang, vice president of the Beijing Third Intermediate People's Court, and Guan Haitao, deputy director of the Policy and Regulation Department of the Beijing Municipal Health Commission, gave detailed answers to the questions that media reporters were concerned about.
Finally, media reporters went to the litigation service hall of the Third Intermediate People's Court in Beijing to follow up and interview the process of supervising the parties to the performance mechanism to receive compensation.
Text: Beijing Third Intermediate Court
Photo: Wang Liran Ma Guoqiang
Editor: Zhao Meilan Yao Rihui