Medical Tangle and Malpractice Chen Ying (Lecturer) [email protected].

Medical Tangle and Malpractice

Chen Ying (Lecturer)

[email protected]

Contents

IntroductionIntroduction

Medical malpracticeMedical malpractice

Grading of medical malpracticeGrading of medical malpractice

Mediation and expertise of medical Mediation and expertise of medical

malpracticemalpractice

medical tanglemedical tangle

the definition of medical tanglethe definition of medical tangle

divergence and discrepancy in interpreting divergence and discrepancy in interpreting

causes about unfavorable consequence of causes about unfavorable consequence of

medical treatment between medical medical treatment between medical

institution and patientinstitution and patient

patients patients

medical institution: include…medical institution: include…

medical personnel: include…medical personnel: include…


Four components of medical tangleFour components of medical tangle

relationship (relationship ( hospital service contract hospital service contract ) )

unfavorable medical results (unfavorable medical results (damage damage

consequence consequence ))

medical process (medical process (causationcausation))

different cognition and opinion (different cognition and opinion (divergence divergence ))



medical malpracticemedical malpractice

(most important)(most important)

non-medical malpracticenon-medical malpractice


the definition of medical malpracticethe definition of medical malpractice

An accident that during An accident that during medical activitiesmedical activities patient's patient's

physical damagephysical damage was caused by medical was caused by medical

institution/healthcare professional, due to their institution/healthcare professional, due to their

violationviolation of governmental of governmental laws,laws, health administration health administration

regulations,regulations, as well as as well as conventional diagnostic and conventional diagnostic and

therapeutic specifications.therapeutic specifications.

--------- Regulations of Medical Malpractice --------- Regulations of Medical Malpractice

Treatment, China (2002) Treatment, China (2002)

★ ★ the four components of medical malpracticethe four components of medical malpractice

medical institution and staff (subject)medical institution and staff (subject)

delinquent behavior (negligence)delinquent behavior (negligence)

lawbreaking and personallawbreaking and personal injuryinjury

causal relationship between damage and causal relationship between damage and

delinquency delinquency


Case Doctor diagnosed the illness of patient X as Doctor diagnosed the illness of patient X as Acute Acute

Myocardial Infarction (AMI)Myocardial Infarction (AMI) and then did the and then did the operation of operation of coronary arteriography coronary arteriography and and stent stent implantationimplantation in which eight heart stents were in which eight heart stents were implanted into the X's heart. A few days later, the X implanted into the X's heart. A few days later, the X felt felt chest pain, sweating, but the doctor did not timely chest pain, sweating, but the doctor did not timely treatment. Shortly the X lost consciousnesstreatment. Shortly the X lost consciousness. . Electrocardiogram (ECG) showed cardiac arrest. Electrocardiogram (ECG) showed cardiac arrest. The doctor did the rescue measures but the XThe doctor did the rescue measures but the X was was dead at last.dead at last.

Question delinquent behavior from delinquent behavior from

the following:the following:

selection of operation

the conventional

specifications of stent

implantation

time of rescue

delinquent behaviordelinquent behavior

heart bypass surgery not coronary a

rteriography

the order of implantation is from far to

near not from near to far

not found the condition changes timel

y and did the rescue measures

ResultResult


a causal relationship between the a causal relationship between the

operation fault and damage operation fault and damage

compensation conducted by compensation conducted by

hospitalshospitals

iatrogenic medical tangleiatrogenic medical tangle


Medical MalpracticeMedical Malpractice


medical fault ≠ medical malpracticemedical fault ≠ medical malpractice

e.g. the violation of Medical Informed Consent e.g. the violation of Medical Informed Consent

fault in the medical service attitudefault in the medical service attitude

Non-iatrogenic medical tangleNon-iatrogenic medical tangle

1. 1. Sudden unexpected natural death Sudden unexpected natural death

The sudden and unexpected death caused by The sudden and unexpected death caused by

potential natural disease of the body or potential natural disease of the body or

dysfunction of important organs of patient dysfunction of important organs of patient

who looks healthy. who looks healthy.

The time duration is within 24 hrs from onset The time duration is within 24 hrs from onset

of symptom to death.of symptom to death.

—— ——WHO standardsWHO standards


Example:Example:

cardiovascular diseases and pneumoniacardiovascular diseases and pneumonia

See text P349See text P349


2.2.inevitable inevitable complications or secondary diseasescomplications or secondary diseases

Example:Example:

amniotic fluid embolism after parturition

cerebral hemorrhage caused by hypertensive

arteriosclerosis


3. medical unexpectedness3. medical unexpectednessexample: allergic shock example: allergic shock


3.rare diseases 3.rare diseases

① ① congenital malformation or genetic discongenital malformation or genetic dis

easeease

② ② rare infectious disease rare infectious disease bird flubird flu H7N9H7N9

③ ③ rare tumor rare tumor myoblastomamyoblastoma


4. Others 4. Others

Patient's faultsPatient's faults

Patient's autonomy, suicide, homicide Patient's autonomy, suicide, homicide

or accidental hurtor accidental hurt

Grading and responsibility of medGrading and responsibility of medical malpractice ical malpractice

Class ⅠClass Ⅰ Class ⅡClass Ⅱ Class ⅢClass Ⅲ Class ⅣClass Ⅳ

Grade AGrade A Grade AGrade A Grade AGrade A

Grade BGrade B Grade BGrade B Grade BGrade B

Grade CGrade C Grade CGrade C

Grade DGrade D Grade DGrade D

Grade EGrade E

Medical Malpractice Grading Standard,China,2002


Class ⅠClass Ⅰ

Grade AGrade A Death of patientDeath of patient

Grade BGrade B complete loss or dysfunction of an importancomplete loss or dysfunction of an importan

t organ, which is irreplaceable. t organ, which is irreplaceable.

depend on special medical care.depend on special medical care.

e.g. vegetative being, very severe dysgnosia,e.g. vegetative being, very severe dysgnosia,

quadriplegia etc. quadriplegia etc.


Class ⅡClass Ⅱ

Grade AGrade A Complete loss or dysfunction of an organ, Complete loss or dysfunction of an organ,

which is irreplaceable; which is irreplaceable;

e.g. double eyes removed e.g. double eyes removed

Grade BGrade B Severe loss or malformation of an organ Severe loss or malformation of an organ

e.g. one eye removed e.g. one eye removed


Class ⅡClass ⅡGrade CGrade C Severe loss or malformation of an organ Severe loss or malformation of an organ

e.g. lack of a hand, loss of 50% functions e.g. lack of a hand, loss of 50% functions

another, no recovery by operation or by using another, no recovery by operation or by using

an artificial limban artificial limb

Grade DGrade D Severe loss malformation of an organ Severe loss malformation of an organ

can take care of himself.can take care of himself.

e.g. lack of a hand, normal function another, e.g. lack of a hand, normal function another,

no recovery by operation or artificial no recovery by operation or artificial


Class ⅢClass ⅢGrade AGrade A Major loss or malformation of an organ Major loss or malformation of an organ

e.g. lack of a thumb, loss of 50% function e.g. lack of a thumb, loss of 50% function

another, no recovery by operation another, no recovery by operation Grade BGrade B Major imperfection or malformation of an Major imperfection or malformation of an

organ;organ;

e.g. lack of a thumb, normal function another, e.g. lack of a thumb, normal function another,

no recovery by operation no recovery by operation


Class ⅢClass Ⅲ

Grade CGrade C Partial imperfection or malformation of an Partial imperfection or malformation of an

organ organ

e.g. lack of three fingers except the thumbe.g. lack of three fingers except the thumb

Grade DGrade D Partial imperfection or malformation of an Partial imperfection or malformation of an

organ organ

e.g. lack of a hand, loss of 50% functions e.g. lack of a hand, loss of 50% functions

another, recovery by operation or by using another, recovery by operation or by using

an artificial limban artificial limb


Class ⅢClass Ⅲ

Grade EGrade E Partial imperfection or malformation of an Partial imperfection or malformation of an

organ organ

e.g. joint function is not complete e.g. joint function is not complete


Class ⅣClass Ⅳ

some lesions to patient.

e.g. organ or tissue minor damage, after repair,

no dysfunction

Ten Disability GradesTen Disability GradesClass Grade BⅠ first-grade disability 100%

Class ⅡGrade A second-grade disability 90%

Class ⅡGrade B third-grade disability 80%

Class ⅡGrade C forth-grade disability 70%

Class ⅡGrade D fifth-grade disability 60%

Class ⅢGrade A sixth-grade disability 50%

Class ⅢGrade B seventh-grade disability 40%

Class ⅢGrade C eighth-grade disability 30%

Class ⅢGrade D ninth-grade disability 20%

Class ⅢGrade E tenth-grade disability 10%

subsidies for the disabled life = subsidies for the disabled life =

average living expenses ×average living expenses ×

the period for paying the subsidies ×the period for paying the subsidies ×

coefficient of disability coefficient of disability

standards of disability compensationstandards of disability compensation

Occurrence of medical malpracticeOccurrence of medical malpractice

nonstandard inquiry —— case historynonstandard inquiry —— case history

negligent examinationnegligent examination

false diagnosis —— inadequate knowledge and false diagnosis —— inadequate knowledge and

experience, prejudice, irresponsibilityexperience, prejudice, irresponsibility

wrong treatmentwrong treatment

other processesother processes

★ forensic autopsy in medical tangle

SignificanceSignificance

— — determine the cause of death and determine the cause of death and

responsibilityresponsibility

— — provide definitive diagnosis by obtaining provide definitive diagnosis by obtaining

direct and objective pathological findingsdirect and objective pathological findings

forensic autopsy in medical tangle

Three Medical Technical Analysis WaysThree Medical Technical Analysis Ways

— — clinical treatment clinical treatment (medical record, symptom and (medical record, symptom and

signs)signs)

— — imaging examination imaging examination (CT,MRI,X ray, ultrasound)(CT,MRI,X ray, ultrasound)

— — pathological examinationpathological examination ((direct and objective )direct and objective )


Article 18 Article 18

Where any patient dies, and both the medical institutiWhere any patient dies, and both the medical instituti

on and the relatives of the patient cannot determine thon and the relatives of the patient cannot determine th

e cause or they e cause or they have different ideas about the causehave different ideas about the cause ，，an autopsy shall be made within an autopsy shall be made within 48 hours48 hours after the pat after the pat

ient dies. ient dies.

—— ——Regulations of Medical Malpractice Treatment,Regulations of Medical Malpractice Treatment,

China (2002) China (2002)


What is autopsy applied What is autopsy applied

in China?in China?


• past: small numberpast: small number

• now: more and more now: more and more

people acceptedpeople accepted


Characteristics (civil case )Characteristics (civil case )

— — observed by both medical institute and the observed by both medical institute and the

patient sides, voluntarypatient sides, voluntary

— — predetermine the key points of examination predetermine the key points of examination

and select a suitable procedure and method of and select a suitable procedure and method of

autopsyautopsy


autopsy: comprehensive and systemic

— histopathological examination （ main method ）

— laboratory tests (blood, urine etc.)

— toxicology

— immunological and microbiological examination

case

Patient X felt chest tightness, difficult breathing,

then the emergency center gave him first aid, bu

t he was dead during rescue. The cause of death

is unknown. the emergency center considered h

e was died of acute pneumothorax, but the relati

ves claimed the center injected too much amino

phylline.

Thus, what will the pathologist do?

What is the knowledge structure of coroners?What is the knowledge structure of coroners?

What is the knowledge structure of coroners?What is the knowledge structure of coroners?

• basic clinical basic clinical medicinemedicine

• natural sciencesnatural sciences

• lawlaw

• ethicsethics

•criminal psychologycriminal psychology

•……

Mediation and Expertise of Medical TangleMalpractice

Three ways to solve Medical Tangle

negotiation

administrative mediation

lawsuit

negotiationnegotiation

Aim: arrive at an agreement on the

dispute and economic compensation

Ways:

—— the patient and the hospital

—— mutual negotiation: lawyer / the

Neutral Institution for Mediating (third party)

administrative mediationadministrative mediation

Aim: mutual mediation by local health Aim: mutual mediation by local health

administrationadministration

Characteristics :Characteristics :

— — non- compulsorynon- compulsory

— — medical expertise beforemedical expertise before

— — no legal binding forceno legal binding force

LawsuitLawsuit

— — medical technical expertise employedmedical technical expertise employed

— — civil procedure civil procedure

expertise of medical tangle and malpracticeexpertise of medical tangle and malpractice

expertiseexpertise

medical technical expertise medical technical expertise

by medical associationby medical association

judicial expertisejudicial expertise by judicial by judicial

expertiseexpertise institutioninstitution

medical technical expertise of medical associationmedical technical expertise of medical association

peer review

the medical association organized a

group or committee of experts including

legal medical expert


identification meetingidentification meeting

(1) statement of both parties(1) statement of both parties

(2) question by experts(2) question by experts

(3) discussion and analysis(3) discussion and analysis

(4) opinion of the majority of the experts (4) opinion of the majority of the experts


expertise report (main terms)expertise report (main terms)

(1) whether the medical treatment act has (1) whether the medical treatment act has violatedviolated any any

of the laws, and the standards of treatment and nursof the laws, and the standards of treatment and nurs

inging ；；(2) whether there is a (2) whether there is a causal relationshipcausal relationship between the between the

negligent medical act and damagenegligent medical act and damage ；；(3) the (3) the seriousness of the negligent medical actseriousness of the negligent medical act in the i in the i

njury of medical malpracticenjury of medical malpractice ；；(4) the (4) the grade grade of the medical malpractice of the medical malpractice

judicial expertisejudicial expertise

In the litigation, court consigns a mediIn the litigation, court consigns a medi

colegal expertise institution to carry oucolegal expertise institution to carry ou

t expertiset expertise

non-medical malpracticesnon-medical malpractices

Regulations of Medical Malpractice Treatment, Regulations of Medical Malpractice Treatment,

China (2002) China (2002)

（ 1 ） unfavorable consequences resulting from

emergent medical measures taken under dang

erous circumstances for rescuing the life of th

e patient ；


（ 2 ） the special physique of the patient or unf

avorable consequences caused by the delay of

the patient ；


（ 3 ） unfavorable consequences that cannot unfavorable consequences that cannot

be predicted or prevented under the existing be predicted or prevented under the existing

technical and medical conditionstechnical and medical conditions

the

the

endend

Medical Tangle and Malpractice Chen Ying (Lecturer) [email protected].

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Transcript of Medical Tangle and Malpractice Chen Ying (Lecturer) [email protected].