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山西太原的张医生来信问：我院于2007年发生一起医疗纠纷，由医院和患者共同委托医学会进行医疗事故鉴定，鉴定结论是不构成医疗事故，我院没有对其赔偿。该患者后来向法院起诉，法院委托了司法鉴定，最后法院判决我们承担赔偿责任。但是根据《医疗事故处理条例》第四十九条的规定，不属于医疗事故的，医疗机构不承担赔偿责任。为什么法院还要判定我院承担赔偿责任？     

论我国医疗纠纷的法律适用

随着公民法制观念和自我保护的法律意识不断增强 ,医疗纠纷案件大量增加 ,但现行的《医疗事故处理办法》已不能适应形势的发展。目前对医疗事故的认定是由医疗事故鉴定委员会的鉴定结论为最终结论 ,这实际上是让当事人一方的上级主管部门作为鉴定人来作鉴定结论 ,有可能使人身伤害的侵权者得不到相应的民事责任追究 ,受害人得不到应有的民事赔偿 ,这有悖于民法通则中公平、平等的原则。本文对此提出相应的解决办法 ,同时对医疗纠纷的法律适用和赔偿原则作了有益的探讨。     

我国现阶段立法有待完善

2002年9月1日由国务院颁布实施的《医疗事故处理条例》（以下简称（（条例》）第49条第二款规定：不属于医疗事故的，医疗机构不承担赔偿责任。很显然，本案例经两级医学会鉴定均认定“不属医疗事故”。如果法官按此《条例》审决，医疗机构将不承担赔偿责任，更不会出现巨额赔款。在司法实践中，即使医学会鉴定不构成医疗事故，医疗机构不承担医疗事故赔偿责任，但仍然要按承担一般侵权的民事责任判令有过错的医疗机构承担赔偿责任。     

论我国医疗事故处理特点

解放以来 ,我国医疗事故处理经历了不同历史时期 ,变化很大 ,有目共睹 ,但有一点从未改变过 ,可谓我国处理医疗事故的传统和特点 ,这就是“医疗事故责任原则”。所谓医疗事故责任原则就是给医疗事故下一个定义 ,按定义对医疗纠纷进行鉴定 ,鉴定为事故 ,就要承担相应责任 ,不是事故 ,就不承担责任。解放初期医疗事故处理就是这样做的 ,由卫生行政机关处理的医疗纠纷如此办理 ,由司法机关管辖的涉讼医疗纠纷也是如此办理。当然 ,那个时期的责任主要是行政责任和刑事责任 ,谈不上民事赔偿责任。“文革”后期 ,是一个由混乱走向法制的过渡期 ,行…     

习惯法国家如何处理医疗事故和医疗纠纷

习惯法是英联邦、美国等国家沿袭使用的传统法律,而我国是属于成文法国家。习惯法国家和我们成文法国家最大的区别是他们的司法原则存在于案例之中,存在于法庭的审案过程中,并总是从过去的案例中寻找当前判案的依据,或通过对过去案例中司法原则的解释来帮助审理眼前的案子。习惯法国家对医疗事故或纠纷的处理以司法途径为主,医疗事故或医疗纠纷的处理最终都要涉及到赔偿问题,需要分清赔偿责任。以下就习惯法国家确定这些法律责任的一些原则思想做一简介,借此对他们的司法传统窥见一斑。1　关于民事责任1.1　诉讼时限　诉讼必须在一定的时期…     

解决医疗纠纷 切莫贻误时机

张师傅在1990年发现自己尿中带血,不知得了什么病。张师傅治病心切,先后到市里多家医院进行检查,但是都没有查出明确的尿血原因。后来,张师傅便到一家比较著名的大医院去看,这家医院的医生根据病情,给张师傅做了肾脏造影和尿镜检查,结果还是没有找到病因。医生建议,用一些止血的药来控制尿血。这次检查没过多久,张师傅又出现了尿频、腰痛等症状。到医院检查后,确诊为肾积水。是什么原因造成了肾积水,医院没有查出原因。张师傅怀疑自己目前的病症可能是那家大医院做尿道内窥镜检查所造成。但自己又不敢确定,心想,反正我就在这家医院治疗,过一段时间看看再说。此后十几年,张师傅一直在这家医院治疗,为治疗肾积水花费医疗费几万元,但至今没有痊愈。去年,我国《医疗事故处理条例》颁布实施后,张师傅知道了由医院原因造成医疗事故或差错,可以给予赔偿。张师傅便找到律师询问,医院给自己做检查后出现了肾积水的情况是否构成医疗事故,能否通过法院请求那家医院赔偿自己的医疗费等费用。律师听了张师傅的情况介绍后,告诉张师傅,除非医院自愿赔偿,否则,不能通过诉讼得到赔偿。原因是:第一,张师傅的病症是否是医院检查行为所造成,是否构成医疗事故,要经过医疗事故鉴定部门进行鉴...     

医疗事故鉴定书中"但书"存在的问题

由于大众法律意识的增强,人们为维护自己的权益,对医院进行诉讼的案例也逐渐增多.我院参加医疗事故鉴定的专家也有三、四十名之多,但如何进行鉴定,鉴定书如何书写却大有学问.我院在多起医疗事故鉴定中被鉴定为不属医疗事故,但最终却被判赔偿患者损失,究其原因是因为鉴定书中的尾巴--"但书".     

医疗事故技术鉴定的性质及其在医疗人身损害赔偿纠纷和医疗服务合同纠纷案件中的作用

医疗事故技术鉴定结论是当前医患双方当事人与法院鉴别和判断医疗事故有无的唯一依据,具有特殊的法律属性.医疗事故技术鉴定启动方式可由当事人共同委托、卫生行政部门移送或人民法院指定.医疗事故技术鉴定结论直接影响医疗纠纷案件的审理结果,必须经医学会的行业审查、卫生行政部门的行政审核和人民法院的司法审查.医疗事故技术鉴定结论在医疗人身损害赔偿纠纷案件和医疗服务合同纠纷案件中的作用是不完全相同的.对医疗事故技术鉴定书的审查存在实体与形式上的隐忧.科学理解与正确运用医疗事故技术鉴定及其结论,必须认清医疗事故技术鉴定性质,妥善处理与医疗事故技术鉴定相关事项等的平衡与协调.     

《侵权责任法》系列讲座之六:医事侵权赔偿散论

《医疗事故处理办法》时代,医疗事故除补偿之外,还建立了配套的保障制度,从补偿标准规定来看,当时医疗机构直接的补偿数额确实不大,但是,当时患方最终得到的补偿却并不少。《医疗事故处理条例》关于医疗事故民事赔偿的7条规定,具有可操作性,在《侵权责任法》生效后继续合法有效。死亡赔偿金现行规定存在的问题是体系混乱、内部互相矛盾、赔偿项目名称和计算标准不一致、赔偿范围不一致等。被侵权人由于其人身权益受到侵害造成死亡的能否请求精神损害赔偿,国内外立法及司法在实践和理论上都存在争议。     

妥善解决医与法的矛盾

处理医疗事故与医疗纠纷的问题使医与法的矛盾突现。具体表现在逮捕当医务人员,判刑不公,巨额赔偿医院不堪重负,少数新闻媒 炒作导知患关系紧张,等等。为此,尽快建立《医疗事故法》,限制新闻媒体的片面炒作,各级医院加强医德医风及法制教育,是解决医与法矛盾的当务之急。     

Medical records--legal perspectives.

Good documentation of medical diagnosis and treatment is not only a medical necessity, it is a legal one. Whether the physician is innocent or guilty of malpractice quickly becomes a side issue when it is discovered that he has tampered with the evidence, thereby attempting to perpetrate a fraud upon the court. And discovered it will be--the techniques are sophisticated and the motivation is high. Medical records are also important in workman's compensation cases, insurance claims, personal injury cases, and even in physician disciplinary hearings as well as their collection of bills. In creating and maintaining patient records, physicians and hospitals have several legal duties, including the duty to do so adequately, to safeguard the records' physical existence, and to prevent such use of the records as would violate the patient's right to confidentiality. Courts and legislatures are looking with increasing favor on the patient's interest in the content of his record, a phenomenon which is closely linked to the nationwide trend in favor of the patient's right to know and his right to determine his own physical destiny. For all these reasons, medical records no longer serve exclusively as the physician's private aid; medical records are increasingly becoming legal documents as well.     

关于《医疗损害赔付细则和实施方法》的讨论

就医疗损害赔偿问题制定专门法律法规，新法规应将医疗损害赔偿的范围扩大到包括医疗事故在内所有原因引起的医疗损害；在确立发生医源性疾病，发生类型，损害部位，损害程度和赔付标准方面应有详细的规则和说明；同时还应保证我国患者在使用国外医药产品发生医疗损害后能得到法律支持和帮助。文章还提出损害赔偿范围扩大是为更好的维护患者的就医安全权益。但是赔偿仅靠医院和医务人员，则难以承受也不尽合理，需要建立医疗风险赔偿基金做新法规的基本保障。     

Physicians should be expert witnesses

Physicians have a responsibility to society, their peers, and patients to participate in malpractice litigation in a manner that ensures that medical malpractice cases are properly evaluated. Physicians are reluctant to involve themselves as expert witnesses in medical malpractice litigation because of not wanting to further any malpractice suits, mistrust of attorneys and misconceptions about expert witnesses and the legal system in general. The expert witness should be an impartial practicing physician who can select those suits that should or should not be filed and identify which parties were negligent in each case. If impartial physicians do not evaluate cases for attorneys, other more partisan and less objective physicians will.     

《侵权责任法》系列讲座之二:法律适用相关问题

《侵权责任法》试图建立一元化结构的医疗损害责任制度,引致《医疗事故处理条例》(《条例》)的存废之争。作者认为,围绕医患纠纷的民事赔偿法律规制,今后绝不会归于"一元化",而是继续保持甚至愈加"多元化"的态势。《侵权责任法》与《条例》肯定将并行不悖、各有侧重与分工。除《条例》将继续发挥规制作用外,对于《侵权责任法》生效之前诊疗行为结束并已出现损害后果的案例,事发当时有效的其他含有侵权责任规定的法律可能被优先适用,国际公约《经济、社会和文化权利国际公约》第12条及其拓展性文件规定了庞杂的"健康权"相关内容,亦不排除被优先于《侵权责任法》适用的可能性。     

Iatrogenic death: A review of cases from 1990�C2000 investigated at the Department of Forensic Medicine, Vienna

Medical malpractice is a global problem which can have considerable financial and legal consequences for the community as well as personal consequences for those involved. Austria does not record any statistical and epidemiological data concerning medical malpractice cases. Data from 7,211 autopsy cases from the Department of Forensic Medicine in Vienna covering the period from 1990 to 2000 were analyzed. Fifty-five autopsy reports that were filed as suspected medical malpractice were recorded and analyzed. Thirty cases were classified as surgical incidents, 19 cases as negligence, and 6 cases as medication incidents. Out of a total of 40 cases from available court files, 36 cases were dropped, there were 2 acquittals and only two resulted in convictions. The number of instances of medical malpractice leading to iatrogenic deaths in Austria seems to be very low in comparison to other countries. The possibility that many cases go unnoticed needs to be taken into consideration.     

Analysis of medical malpractice claims to improve quality of care: Cautionary remarks

Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malpractice claims with caution. Taking one recent study as a an example, this article insists on three areas of concern: (a) the quantity of legal materials available for analysis; (b) the content of the legal materials available for analysis; and (c) the ways in which the content of the legal materials should be analysed and the types of inferences that it can support. The article concludes with general recommendations for future medical research that would incorporate medical malpractice claims. These recommendations centre around recognizing the qualitative dimension of legal reasoning.     

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.     

Review of medical negligence cases: an essential part of residency programs.

Residency programs routinely review cases involving "morbidity and mortality." It would be a valuable experience to similarly review medical malpractice cases and the associated testimony by medical experts. When available, the cases reviewed in residency programs would be those in which faculty members at the same institution had testified. The faculty member in such cases would be intimately familiar with the case and able to share the knowledge necessary to take part in the legal process. This case review process would expose residents to the legal realities of medical practice, provide a forum for peer review of legal testimony by experts, and show residents how to participate in the legal system should the need arise.