论医疗损害责任制度

<正>1医疗损害责任制度的立法成就1.1使用统一的医疗损害责任概念医疗损害责任概念的使用割断了《侵权责任法》与先前《医疗事故处理条例》所规定的医疗事故责任之间的联系,并从真正意义上拒绝将《医疗事故处理条例》作为《侵权责任法》的特别法对待,从而实行统一的、一     

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。     

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,     

医疗损害鉴定的实践体会与思考

《中华人民共和国侵权责任法》于2010年7月1日正式实施,结合最高人民法院《关于适用<中华人民共和国侵权责任法>若干问题的通知》有关精神,江苏省高级人民法院、江苏省卫生厅联合出台了《关于医疗损害鉴定工作的若干意见(试行)》。     

对《中华人民共和国侵权责任法（草案）》医疗损害责任的立法建议

第十一届全国人大常委会第六次会议第二次审议了《中华人民共和国侵权责任法（草案）》，但医疗损害责任的内容却引起社会各界的广泛关注。从条款内容上看，笔者认为草案显得不够全面、具体，不足以解决目前司法实践中普遍存在的医疗纠纷问题。所以，非常有必要完善相应立法建议。其期待完善《中华人民共和国侵权责任法（草案）》医疗损害责任部分的立法，促进和谐医患关系的构建。     

医学会组织医疗损害鉴定的优势--来自南京医学会的经验

《侵权责任法》实施至今，国家层面关于医疗损害鉴定尚无明确规定，医疗损害鉴定仍存在“多元化”的状况。医学会在组织医疗损害鉴定的实践中，除具备广泛的专家资源等传统优势外，在制定设计上加以革新，亦取得了明显成效，鉴于医疗损害鉴定的特殊性和复杂性，为保证鉴定意见的科学性、公正性，医学会组织医疗损害鉴定具有较大优势，是符合我国当前体制的较优选择，但尚需在国家层面予以立法上的支持。     

《侵权责任法》背景下医学会医疗损害鉴定职能的思考

《侵权责任法》实施后,医学会医疗鉴定职能面临重大转变。现阶段医学会行使医疗损害鉴定职能具有合法性。未来应当建立起统一的医疗损害鉴定体制,医学会将不再承担组织医疗损害鉴定的职能。但医疗专家不应被轻易否定,仍应当在医疗损害鉴定工作中承担主要角色。     

江苏省开展医疗损害鉴定的实践与思考

2010年7月1日《侵权责任法》正式施行,为规范全省的医疗侵权损害鉴定工作,同年10月11日,江苏省高级人民法院、江苏省卫生厅联合发出《关于医疗损害鉴定工作的若干意见（试行）》的通知（以下简称＂若干意见＂）,要求医疗损害鉴定一般应委托本行政区域内市医学会组织进行,当事人均同意委托其他司法鉴定机构进行鉴定的,应予准许。     

医疗损害鉴定机制探究

在《侵权责任法》实施的背景下,一元化的医疗损害鉴定机制的确立,成为法律适用的必然.将医疗损害鉴定融入司法鉴定模式,具有化解社会信任危机、实现鉴定公正化的天然优势.因此有必要从静态和动态两个层面考察这种鉴定模式的融合和完善.相应的,对完善鉴定主体、鉴定内容、鉴定证据的应用以及鉴定的外部监督的制度设计,就成为医疗损害鉴定机制确立的前提.     

《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.     

我国医疗损害举证责任分配制度的完善——以《侵权责任法》相关规定为视角

《侵权责任法》对医疗损害案件的举证责任分配制度作了较大调整,克服了《最高人民法院关于民事诉讼证据的若干规定》一刀切的弊端,但仍有未臻完善之处。文章分析和讨论了我国医疗损害证明责任的分配问题,试图找到较为合理的举证责任分配方式,以期对我国司法实践做出一点有益的探索。     

完善医疗事故立法方略初探

从法理与实践结合上，就１９８７年国务院发布的＜＜医疗事故处理办法＞＞中的某些问题进行了探讨，并就完善医疗事故立法方略提出了四点建议：（１）建立医疗事故行政仲裁制度；（２）改进医疗事故技术鉴定制度。（３）建立医疗事故保险制度和完善社会医疗保险制度；（４）加强行医资格的管理。     

Development of a Composite Measure of State‐Level Malpractice Environment

Objective

To develop a composite measure of state-level malpractice environment.

Data Sources

Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association.

Study Design

Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs.

Principal Findings

A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity.

Conclusion

An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments.     

The "new" medical malpractice crisis--part 1

It is important to put the current medical malpractice crisis into the historical context of the past several decades. Doing so provides an important perspective from which to understand the current iteration. One may reasonably conclude that the present medical malpractice situation is only the latest outbreak of a continuing, chronic condition, rather than a distinct, unusual event. In this regard, it is analogous to a chronic disease that occasionally flares up. Chronicity suggests the presence of major underlying problems, which may be linked to insurance carriers' business cycles as much as reflecting increases in either medical malpractice or the numbers and value of claims. It is useful to bear in mind that the fact of a claim may or may not indicate actual medical malpractice, and increased claims could well correlate more closely with patients' disgruntlement with the medical delivery system, access to it, and the way they were treated by staff than with significant injuries for which compensation should be paid. Regulatory and public policy efforts to date have only affected the problem of medical malpractice at the margin. Apparently, the core of the problem has not been addressed; in fact, it seems as yet to be unidentified. Solutions that focus on the economic dimensions only address the symptoms-claims for medical malpractice-and apparently have done nothing to correct the root cause(s). Part 2 of this two-part series considers and analyzes the current medical malpractice insurance crisis. Its evolution and analysis of specific aspects may provide guidance in understanding how to predict its future course. More important, the analysis will suggest guidance as to how organizations may reduce the potential for the problem and protect themselves from the negative aspects, should it occur.     

卫生与法医疗过失的司法认定探析——基于243例医疗损害赔偿诉讼民事判决的数据

医疗过失是构成医疗损害赔偿责任的要件和前提,通过对243份医疗损害赔偿纠纷案件民事判决书中医疗过失的统计分析表明,我国医疗过失的判定没有统一标准,未能体现医学判断和法律判断的双重属性;医疗过失的鉴定机制二元化,医疗过失责任程度阐释不明,导致医患难以信服,破坏了我国司法统一的法治原则。《侵权责任法》实施后,应确立当时医疗水平为判定医疗过失的法律标准,建立一套可操作性的医疗过失认定规则和统一的医疗损害鉴定机制,以发挥司法处理医疗纠纷的法律功能和社会作用。     

医疗事故的定义、性质与类型新探

文章在广泛比较借鉴国内外医疗事故方面的立法实例和学说理论的基础上，准确把握医疗事故的本质属性，揭示新旧立法中的医疗事故概念的缺陷和弊端，从学理上对它进行重新界定，并进而就医疗事故的性质、类型做出了精细的分析，应有助于相关法律立法质量的提高和司法中正确适用有关法律。     

"Health courts" and accountability for patient safety

Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations.     

Genetic ‘Risk Carriers’ and Lifestyle ‘Risk Takers’. Which Risks Deserve our Legal Protection in Insurance?

Over the past years, one of the most contentious topics in policy debates on genetics has been the use of genetic testing in insurance. In the rush to confront concerns about potential abuses of genetic information, most countries throughout Europe and the US have enacted genetics-specific legislation for insurance. Drawing on current debates on the pros and cons of a genetics-specific legislative approach, this article offers empirical insight into how such legislation works out in insurance practice. To this end, ethnographic fieldwork was done in the underwriting departments of Belgian insurance companies. Belgium was one of the first European countries introducing genetics-specific legislation in insurance. Although this approach does not allow us to speak in terms of ‘ the causal effects of the law’, it enables us to point to some developments in insurance practice that are quite different than the law’s original intentions. It will not only become clear that the Belgian genetics-specific legislation does not offer adequate solutions to the underlying issues it was intended for. We will also show that, while the legislation’s focus has been on the inadmissibility of genetic discrimination, at the same time differences are made in the insurance appraisal within the group of the asymptomatic ill. In other words, by giving exclusive legal protection to the group of genetic risks, other non-genetic risk groups are unintendedly being under-protected. From a policy point of view, studying genetics-specific legislation is especially valuable because it forces us to return to first principles: Which risks deserve our legal protection in insurance? Who do we declare our solidarity with?