论医疗侵权诉讼举证责任倒置后医方的抗辩事由

随着《医疗事故处理条例》和最高人民法院《关于民事诉讼证据的若干规定》的实施，医疗侵权诉讼逐年增多。本文就如何正确认识医疗诉讼中医疗行为、损害结果、因果关系和医疗过错的法律含义和实行举证责任倒置后如何运用法律法规在医疗侵权诉讼中进行抗辩的策略进行了系统的阐述。     

对医疗侵权诉讼案件举证相关问题的探讨

对侵权诉讼案件的证明内容和举证责任:医疗事故侵权诉讼中的证明内容及举证责任分配和非医疗事故侵权时的证明内容及举证责任分配进行了探讨,提出在涉及医疗机构侵权纠纷的案件中,根据侵权诉讼案件的类型不同,应区分医疗行为侵权和非医疗行为侵权,在现行法律体制下,还应区分属于医疗事故的医疗行为侵权和不属于医疗事故的医疗行为侵权这两对概念,从而准确把握举证责任的分配和赔偿额的计算.     

对医疗侵权诉讼案件举证相关问题的探讨

对侵权诉讼案件的证明内容和举证责任:医疗事故侵权诉讼中的证明内容及举证责任分配和非医疗事故侵权时的证明内容及举证责任分配进行了探讨,提出在涉及医疗机构侵权纠纷的案件中,根据侵权诉讼案件的类型不同,应区分医疗行为侵权和非医疗行为侵权,在现行法律体制下,还应区分属于医疗事故的医疗行为侵权和不属于医疗事故的医疗行为侵权这两对概念,从而准确把握举证责任的分配和赔偿额的计算.     

严格责任倾向--对当前医疗纠纷诉讼审判的思考

我国现有法律表明医疗侵权诉讼适用过错责任原则,但是目前审判界有对医方采取严格责任的倾向。严格责任主要通过举证责任倒置实现,强调对受害人的保护。作者列举典型案例,分析医疗事故争议案件采用严格责任的表现:①患方对医方造成的损害是否具有过错无须举证;②医方免责事由是受到限制的,医方不得以尽到合理注意为抗辩条件;③医疗行为与患方损伤结果之间的因果关系也是推定的。作者认为严格责任虽可以提高医务人员的注意义务,但是在缺乏成熟的医疗责任保险情况下审判适用严格责任原则加重了医疗机构及其工作人员的责任,并不能真正解决医患争议。审判机构应该严格按照法律规定的情形来适用严格责任,救济患方损害不能牺牲司法公正。     

处理医疗侵权纠纷需要解决的几个认识问题

新《医疗事故处理条例》扩大了医疗事故的范围 ,采用了广义医疗事故之概念。对此 ,一部分人认为医疗侵权就是指医疗事故。其实 ,医疗事故是不等同于医疗侵权的 ,二者是两个不同的法律事实。在认定医疗侵权时应特别注意医疗侵权与医疗事故的区别 ,切忌受医疗事故概念的影响 ,用医疗事故的构成要件来分析判断医疗侵权 ,同时还要注意医疗侵权与“与医疗行为有关的侵权行为”的区别 ,以求达到正确认定医疗侵权 ,正确适用举证责任倒置的法律规定     

试析《侵权责任法》对医疗损害诉讼的影响

《中华人民共和国侵权责任法》对医疗损害责任做出了专门规定。对于该规定对医疗损害诉讼的影响,众多专家学者表达了自己的观点。本文认为《侵权责任法》的实施,并不会影响《医疗事故处理条例》的有效性,但《医疗事故处理条例》应当作必要的修订,以免误读;医疗赔偿双轨制的产生从根本上就是错误的,并在实践中造成了严重的后果,但《侵权责任法》的实施并不必然终结双轨制;至于医疗损害诉讼举证责任问题,《侵权责任法》作为民事实体法对其并无直接的影响。立法、行政与司法部门应抓住《侵权责任法》实施的契机,及时修订有关法律法规,以建立良性的医疗损害赔偿制度。     

《医疗事故处理条例》保留与修改方向探讨

探讨了在《侵权责任法》正式实施后《医疗事故处理条例》(以下简称《条例》)的保留与修改问题,包括医疗事故概念的调整以及《条例》所构建的医疗事故技术鉴定制度在《侵权责任法》实施后的改革方向等内容.在适用《侵权责任法》审理医疗损害责任案件的同时,《条例》作为国务院法规,应当在修改后继续在预防医疗纠纷发生、医疗纠纷案件处理以及违规医疗机构及其医务人员的行政处罚方面发挥其作用.     

谁来证明“医疗过错”？

《中华人民共和国侵权责任法》（简称《侵权责任法》）将于今年7月1日起施行。这部新法律对医疗损害责任进行了规定,对医务界议论颇多的医疗纠纷案件的表述、举证责任、医疗事故鉴定等做出了相应调整。如何理解《侵权责任法》的精神？《侵权责任法》与《医疗事故处理条例》应该如何衔接与过渡？近日,     

试析"举证责任倒置"

随着社会经济的发展和全民法律意识的不断增强,人们对医疗服务质量的要求越来越高,医疗行为引起的侵权诉讼逐年上升。为完善医疗纠纷处理机制,加大对患者的保护力度,2002年国务院颁布了新的《医疗事故处理条例》(以下简称《条例》),详细规定了医疗事故的概念、鉴定程序以及患者的权利保护、损害赔偿标准等。同年4月1日起实行的最高人民法院《关于民事诉讼证据的若干规定》(以下简称《规定》)规定了法院在审理医患纠纷案件时要严格适用“举证责任倒置”原则。在医疗行为引起的侵权诉讼中,实行“举证责任倒置”的法理依据,主要是医患双方地位…     

论医疗侵权诉讼举证责任倒置后医方的抗辩事由

随着《医疗事故处理条例》和最高人民法院《关于民事诉话证据的若干规定》的实施．医疗侵权诉讼逐年增多。文章就如何正确认识医疗诉讼中医疗行为、损害结果、因果关系和医疗过错的法律含义和实行举证责任倒置后如何运用法律法规在医疗侵权诉语中进行抗辩的策略进行了系统的阐述。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.