医疗纠纷的防范与处理(4)

3.1.4关于举证责任讲两个问题,一是举证责任倒置,二是病历涂改的民事法律责任。3.1.4.1关于举证责任倒置《最高人民法院关于民事诉讼证据的若干规定》中规定:因医疗行为引起的侵权诉讼,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。北京市高级人民法院就举证责任的分配作出了具体规定:患者一方应当首先证明其与医疗机构之间存在医疗关系并发生医疗损害,医疗机构应就医疗行为与损害后果之间不存在因果关系及不存在医疗过错承担举证责任。举一个案例说明举证责任倒置的法律适用。这是一个2007年6月1日来我…     

律师信箱

辽宁省鞍山市鲍医生来信问：现在在医疗事故诉讼中实行举证责任倒置，是否意味着所有的举证责任都由医院来承担，患者是否仍需举证？北京市岳成律师事务所宋丽红律师回答：在医疗侵权案件中，要涉及四大要件：侵权行为、被告方过错、医疗行为与损害结果之间的因果关系及损害后果。根据《最高人民法院关于民事诉讼证据的若干规定》第四条：（八）因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。因此，在医疗事故诉讼中，医院要就医疗行为与损害结果之间不存在因果关系及不存在医疗过错方面提出证据，患者要就侵权行为和损害后果提出证据。也就是说，举证责任倒置后，医院要向法院提供2个要件的证据，而患者也要向法院提供一定的证据，证明自己确实与那家医院存在医疗关系，而医院对自己权益造成了损害。     

再论举证责任倒置强化病案证据意识

本文着重对病案在有关司法解释规定有关医疗侵权实行举证责任倒置的情况下作为医疗事故处理过程中作为证据的重要性及如何提供病案证据材料对医院病案管理进行了论述，并指明了强化病案证据意识的意义。     

打医疗官司 谁出示证据

部分举证责任倒置更有利于保护患者的合法权益医疗机构只在两个要件上承担举证责任患者不能全部免除举证责任医疗机构表示将积极应对从2001年4月1日起,在我国医疗侵权的诉讼中,开始实行举证方式上的改革,做为原告方的患者,将不再承担对医疗行为与损害结果之间不存在因果关系及不存在医疗过错这两个方面的举证责任,而改由医疗机构承担。在医疗侵权诉讼中,这种由一方当事人提出,而由另一方当事人举证的方式,与《民事诉讼法》中“谁主张、谁举证”的方式相反,因而被称为“举证责任倒置”。这一转变源于2000年12月21日公布的《最高人民法院关于民事诉讼证据的若干规定》,     

对医疗诉讼案中举证责任倒置的哲学思考

2002年4月1日开始实施的《最高人民法院关于民事诉讼证据的若干规定》第四条规定“因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。”这一规定将医疗侵权诉讼区别于一般的民事诉讼“谁主张，谁举证”的举证责任分配原则，实行举证责任倒置。近几年媒体关于医疗侵权方面的报道连篇累牍，接连不断的护患纠纷案件和不绝于耳的各种争论，引发了大家对我国司法实践中医疗侵权诉讼举证责任倒置的规定对护理工作影响的讨论。辩证地看，既有积极的影响，也有不利的影响；从实践的检验来看，有利也有弊。     

举证责任倒置与护理工作相关问题的探讨

随着医疗体制改革及《医疗事故处理条例》，最高人民法院《关于民事诉讼证据的若干规定》的颁布实施，规定了“医院在医疗纠纷中的举证责任因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损害结果之间存在的因果关系及不存在医疗过错承担举证责任”，这一规定不仅引起医学界的震动也引起社会各界的广泛关注，下面笔者就举证责任倒置的内容及护理工作与之相适应的问题进行探讨。     

医嘱签名中潜在的法律问题分析及对策

2002年4月1日实施的《最高人民法院关于民事诉讼证据的若干规定》明确指出,在医疗侵权诉讼中,实行举证责任倒置[1]。作为医疗文件     

面对举证责任倒置 规范执行签名制度

最高人民法院 2 0 0 1年 12月公布的司法解释明确规定 ,因医疗行为引起的侵权诉讼 ,医院承担举证责任。据此 ,从 2 0 0 2年 4月 1日起 ,一旦发生医疗纠纷 ,医院须自证无错 ,否则医院就应该承担相应的法律责任 ,这在诉讼证据上称为举证责任倒置[1] 。在临床的医疗护理过程中 ,医     

举证责任倒置与护理文件书写

当前，在医疗纠纷的民事诉讼中，医疗机构承担举证例置的责任。最高人民法院《关于民事诉讼证据的若干规定》第四条第八款明确规定：因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。这一法规出台明确了医疗机构的举证责任。随着举证责任倒置的实施，在医疗事故争议中，病历是医患双方关注的焦点，是明确责任的重要依据之一，一旦发生医疗纠纷，病历是不可缺少的重要证据。     

从举证倒置谈护士的自我保护

2002-04最高人民法院颁布的《关于民事诉讼证据的若干规定》，明确规定了医疗纠纷的处理实行“举证责任倒置”，即因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损坏结果之间不存在因果关系及不存在医疗过错承担举证责任。     

Defenses to malpractice: what every emergency physician should know

Background

Emergency medicine is a high-risk specialty that carries a constant risk of malpractice litigation. Fear of malpractice litigation can lead to less-than-optimal patient care as well as impairments in physician quality of life. Although malpractice fear can be ubiquitous among emergency physicians, most receive little to no education on malpractice.

Discussion

Medical malpractice requires that 1) The physician had a duty, 2) The physician breached the duty, 3) There was harm to the patient, and 4) The harm was caused by the physician’s breach of duty. Even if all four medical malpractice conditions are met, there are still special legal defenses that have been and can be used in court to exonerate the physician. These defenses include assumption of the risk, Good Samaritan, contributory negligence, comparative fault, sudden emergency, respectable minority, two schools of thought, and clinical innovation.

Conclusions

These legal defenses are illustrated and explained using defining precedent cases as well as hypothetical examples that are directly applicable to emergency medical practice. Knowledge of these special legal defenses can help emergency physicians minimize their risk of litigation when caring for patients.     

超大型医院医疗不良事件之管理

医院有效事前监测、管控医疗不良事件,是保障患者安全、提高医疗质量的管理措施之一。超大型医院对医疗不良事件管理的实战中,建立、实施医疗安全隐患事件关键监测指标、医疗安全隐患事件筛查程序指标,积极开展医疗不良事件后台监管工作,切断医疗安全隐患事件向医疗风险事件演变、医疗风险事件向医疗纠纷事件演变的环节,保障患者安全。     

Tort reform: an issue for nurse practitioners

PURPOSE: To inform nurse practitioners (NPs) about the issues related to tort reform and its relationship to malpractice insurance costs. DATA SOURCES: Current journals, newspapers, professional newsletters, and Internet sites. CONCLUSIONS: NPs are paying more for their malpractice premiums, and many are losing their places of employment as clinics close due to the increased cost of premiums. One method proposed for curbing the flow of monies spent on premiums and litigation is tort law reform. California serves as an example; its Medical Injury Compensation Reform Act (MICRA) tort reform law was passed 25 years ago, and it has maintained stable malpractice premiums. Other states have proposed similar laws, but some have not had similar success. To curb litigation costs, not only should tort laws be reformed, but NPs and physicians should keep abreast of current practice standards in order to provide quality medical care. IMPLICATIONS FOR PRACTICE: Like physicians, NPs are affected directly by tort laws. These laws hold NPs accountable at the same level as physicians. In addition, many states limit NPs' practice to delegation of authority by a physician. Liability is therefore transferred from the NP to the physician and vice versa in cases of injury or wrongful act. In addition, many NPs are finding it increasingly difficult to locate insurers who will write policies for medical liability.     

Clinical negligence and the need to keep professionally updated

Nurses and doctors are under a legal duty to keep reasonably up to date; this is a fundamental aspect of their legal duty of care to their patients. A nurse or doctor could be negligent if a patient is harmed because of ignorance of well accepted and known published nursing and medical research findings. It is all a question of fact and degree and cases will turn on their own circumstances. There are a number of reported court cases which explore this issue and which contain useful guidance. These cases are discussed within the context of the new NHS and the Government's emphasis on health quality, and increasing healthcare litigation.     

医院如何适应医疗侵权诉讼中举证责任倒置的新规定

新近施行的医疗侵权诉讼由医疗机构举证的新规则将对医患双方产生广泛而深远的影响。为适应这一新规则，各级医疗机构应增强举证意识，注意收集并保存各种医疗活动证据，恪守诊疗常规，尊重病人的知情同意权和选择权；加强医疗质量和医疗安全管理，增强医务人员法制观念，同时当务之急是完善和建立医疗责任保险制。     

“It's All About How You Carry Yourself About”: How Medical Students Conceptualize Professionalism in Trinidad & Tobago

Phenomenon: This paper concerns itself with the value system that informs and motivates medical students of the twenty-first century as distinct from earlier cohorts. It notes a shift from an era of altruism within which the medical professional was a ‘pillar of society’ always ‘on duty’ and always concerned foremost for the patient to an era in which he/she is just another member of the work force, subject to public scrutiny and criticism, to patient autonomy and to a self-serving ethos which characterizes the present age. Whilst concerns have been raised for a continuing and separate morality of medicine, young professionals in other studies have cited a range of characteristics including honesty, trustworthiness and respect alongside competence and medical skill. However, the notion of ‘performance’ has made a strong thrust into the literature, with students citing the putting on and taking off of dual personae as part of their complex identity in this present time. They are entitled to their own lives, to drop the act and just be themselves when off duty, picking it back up again with the duty call. Approach: The present study then investigated the views on this subject of two groups of medical students in Trinidad & Tobago in the Caribbean, one made up entirely of nationals and one including students from other parts of the Caribbean and the USA. They discussed the topic in focus groups of eight; their responses were then analysed thematically and subject to discourse analysis. Findings: The study revealed diverse attitudes with some embracing the ethical standards of a high calling that whilst others were concerned that too much was expected, that they had a right to break free and be themselves as long as they did not transgress too far from their expected roles. There were two distinct groups both concerned with ‘how’ they ’carried themselves about’ but this meant different things to each dependent on which of the two perspectives they embraced. As a whole, the study revealed an ongoing conflict of value systems with concern for patient welfare just remaining uppermost. Insights: As The University of the West Indies has now stepped into the field of medical professionalism actively it would hope to support students in resolving their conflicts more consciously in response to the range of philosophical stances which currently present themselves.     

试论临床误诊误治的"不可预见性"

侵权行为法的研究表明,对于一般的侵权损害适用过错责任原则。“应当预见”是判定过失的一个基本前提,是否承担法律后果的大前提在于是否应当预见。但是临床误诊误治的严峻性、已然性以及其预见标准的模糊性,预见部分的难以避免性,决定了临床误诊误治不具备法律认定的“过错”事件。因此,它应当承担什么样的法律责任,在法律适用时,应进行慎重的选择。     

智能化门诊治疗管理信息系统的研制和应用

目的:基于医院信息系统研制一套适用于门诊治疗室为患者进行药物治疗的工作和管理的软件。方法:利用智能化技术和自主研制的门诊临时输液单,针对性地解决门诊治疗流程中手工操作容易产生的错误,开发出门诊治疗管理信息系统。结果:系统改变以往的门诊治疗流程,使用简便、可靠,有效缓解了医护人员的工作压力,医患纠纷明显减少。结论:该系统的应用可以提高门诊护理工作效率和工作质量,提高患者及家属满意度。     

实习护生对护理相关法规知识掌握情况的调查分析

目的了解实习护生对护理相关法规知识的掌握情况.方法选择2003年在本院实习的大专、本科护生100名,自行设计问卷进行调查.内容包括一般资料,护理相关法规理论知识、临床典型医患纠纷案例处理、护生对护理相关法规教育的需求.结果实习护生对护理相关法规知识掌握不够,存在着许多盲区和误区,对临床上常见的可能导致的医患纠纷事件缺乏处理能力,存在许多模糊甚至错误的认识.护生对护理相关法规知识非常需要.结论对护理专业学生应开设护理法规课程,实习期间进行护理相关法规知识培训.     

Establishing breach of the duty of care in the tort of negligence

This article, the third in a series on clinical negligence, looks at the law surrounding breach of the duty of care in negligence. It shows some of the principles that judges and lawyers use in order to decide whether a person has broken his/her duty of care in the tort of negligence. It will be seen that the principles are contained in decided court cases, some of which are quite old but are still relevant today. The focus of this article is on the rule that courts, in deciding the issue of a breach of duty of care, would judge the defendant's conduct by the standard of what the hypothetical, 'reasonable person' would have done in the circumstances of the case.