基于裁判文书的基层医疗机构严重医疗损害责任纠纷研究

目的:发现基层医疗机构严重医疗损害责任纠纷的基本规律与特征,为防范与治理基层医疗机构医患纠纷提供针对性指引。方法:搜集案例大数据平台中所有案由为医疗损害责任纠纷、造成患者死亡、当事人为基层医疗机构且承担全部或主要责任的民事判决书,进行严重医疗损害责任纠纷发生趋势、地域分布、发生纠纷的各基层医疗机构类型分布、诊疗项目、手术类型、赔偿情况的定量统计分析。结果:2013~2018年基层医疗机构严重医疗损害责任纠纷案件数量及判决赔偿金额呈上升趋势,经济最发达及最不发达地区较少发生,主体以卫生院及社区卫生服务中心为多,高发诊疗活动在呼吸内科(尤其用药相关)及产科(尤其剖宫产术)。建议:基层医疗机构严重医疗损害责任纠纷的防范重点在乡镇卫生院,要加强诊疗项目及人员的资质管理、诊疗规范管理、病例书写规范管理,提升医疗纠纷应对意识,加大对基层医疗机构的人才输入,加强医务人员的业务能力培训,特别是呼吸内科、消化内科用药相关培训,剖宫产术的手术/操作培训,提升对诊疗常规及操作规范的认知实践能力,防范诊疗义务履行不能。

Studying on The Serious Medical Damage Liability Disputes in Primary Medical Institutions Based on Judgment Documents

Objective To explore the basic law and characteristics of serious medical damage liability disputes in primary medical institutions, and provide guidance for preventing and managing doctor-patient disputes in primary medical institutions. Methods The civil judgment documents of related cases were collected from big data platform based on related conditions, and quantitatively analyzed. Results From 2013 to 2018, the number of serious medical damages liability disputes and amount of judgment compensation of the primary medical institutions showed an upward trend, while it less occurred in the most developed and underdeveloped areas. The main body was township hospitals and community health service centers. High-risk medical activities were in respiratory medicine department, especially medication-related, and obstetrics department, especially cesarean section. Conclusion The focus of preventing serious medical damage liability disputes in primary medical institutions is township hospitals. It is necessary to strengthen the qualification management of medical treatment projects and personnel, management of medical treatment norms, management of medical record on writing standards, and the awareness of medical disputes, increase the talents input to primary medical institutions, improve the training on medical personnel, especially the medication related training of respiratory medicine and gastroenterology, surgery operation training for cesarean section.