论医疗侵权案件中的精神损害赔偿

随着最高人民法院《关于确定民事侵权精神损害赔偿责任若干问题的解释》的通过，精神损害赔偿已经逐步在走向制度化，而作为医疗侵权诉讼中的精神损害赔偿问题，因为其牵涉到医疗专业领域知识，与一般的侵权案件中的精神损害赔偿案件相比又有其特殊性。文献就这类案件从理论和实务上应注意的问题，对我国医疗侵权责任中的精神损害赔偿制度的过去与现状做了对比分析，并针对司法实践中的三类主要案件做出详细阐述。     

护理安全隐患探讨与干预

护理安全是指在实施护理的全过程中患者不发生法律和法规允许范围以外的心理机体结构或功能上损害、障碍、缺陷或残废。从护理管理的发展角度来看,护理安全还应该包括护士的执业安全,即在执业过程中不发生允许范围与限度以外的不良因素影响与损害。随着医疗技术的迅速发展和患者法律意识的不断增强,患者安全日益受到关注。     

护理不安全因素探讨及对策

护理安全是指在实施护理的全过程中，患者不发生法律和法规允许范围以外的心理、机体结构或功能上的损害、障碍、缺陷或死亡。从广义的角度和现代护理管理的发展看，护理安全还应包括护士的执业安全，即在执业过程中不发生允许范围与限度以外的不良因素的影响和损害。护理不安全因素的管理是护理管理的重点，是护理质量的保证，     

护理不安全因素分析及对策

护理安全是指在实施护理的全过程中,患者不发生法律和法规允许范围以外的心理、机体结构或功能上的损害、障碍、缺陷或死亡[1]。从广义的角度和现代护理管理的发展看,护理安全还应包括护士的执业安全,即在执业过程中不发生允许范围与限度以外的不良因素的影响和损害。护理不安全因素的管理是护理管理的重点,是护理质量的保证,提高护理的安全性是一个不可忽视的课题,也是衡量医院护理管理水平高低的标准。随着科学技术的迅速发展,现代医疗护理活动日趋复杂化,各种影响因素越来越多,患者在医院接受诊断、治疗、护理的同时也面临着一定的不安全…     

论医疗过失的若干法律问题

医患之间的关系属于民事法律关系。医疗契约是一种广义的服务合同,它既具有一般契约的共性,也有其因有的特殊性。医疗过失不同于医疗事故,其行为兼具违约与侵权两种行为的特征。医疗过失的具体现任包括财产损失赔偿和精神损害赔偿,医疗过失赔偿应实行过错推定责任原则。     

精神损害如何赔偿

精神损害赔偿是指自然人因人格权、隐私权、监护权等受到非法侵害，人格利益受到损失而向侵权人要求赔偿的一种救济制度。根据有关规定，自然人因下列人格权利遭受非法侵害，可以向人民法院起诉要求精神损害赔偿：生命权、健康权、身体权；姓名权、肖像权、名誉权、荣誉权：人格尊严权、人身自由权：隐私权或其他人格利益；亲子或亲属的监护权。     

举证责任倒置与消毒供应中心的规范化管理

2002-09-01起开始实施的《医疗事故处理条例》加大了医疗机构及医务人员的责任，扩大了患者的权力，明确了赔偿费用等。同时．在《最高人民法院关于民事诉讼证据的若干规定》中指出：因医疗行为引起侵权诉讼，由医疗机构就医疗行为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。也就是说，只要患者提出诉讼，医方就应当列举事实及证据材料，证明自己医疗行为没有过错，否则，医方就要承担责任。医院的消毒供应中心是医院消毒灭菌和供应各种无菌医疗用品的重要场所，其工作质量的高低与医院感染的发生和控制有着密切的联系。因此，在新形势下医院消毒供应中心实行规范化管理就显得尤为重要。     

规范医疗行为减轻或避免医疗纠纷赔偿

近20年来，医疗纠纷在世界各国一直都是一个热门的议题。在我国，随着社会经济的不断发展、医疗体制及司法体系的不断完善，医院和患者的市场意识被唤醒，患者作为消费者维权意识在日渐增强，患者对医疗效果的期望值增加，因医疗意外、并发症或未达到预期治疗效果引发的医疗纠纷日益增多，医疗纠纷已成为一个备受关注的医疗和社会问题［1-2］。大多数医疗纠纷是以医院花数万、数十万乃至上百万的经济赔偿作为最终的解决方式，这不仅造成医院重大的经济损失，而且严重损害医院的社会声誉。引起医疗纠纷赔偿的原因很多，其中不规范的医疗行为是造成医疗纠纷赔偿的重要因素。为了减轻或避免医疗纠纷赔偿，作者就医疗行为存在的关键问题进行系统分析，综述如下。     

护理安全隐患探讨与干预

护理安全是指在实施护理的全过程中患者不发生法律和法规允许范围以外的心理机体结构或功能上损害、障碍、缺陷或残废.从护理管理的发展角度来看,护理安全还应该包括护士的执业安全,即在执业过程中不发生允许范围与限度以外的不良因素影响与损害.随着医疗技术的迅速发展和患者法律意识的不断增强,患者安全日益受到关注.隐患管理是护理管理工作的重中之重,医院应以患者的安全为前提,否则无论对患者、医院、科室、个人均可导致重大损失.护理部对我院2007年1月～2008年1月日常护理工作质量检查存在的安全隐患问题以及各科室上报的安全隐患问题进行了归类、分析,并不断改进,收到了一定成效.现报告如下.     

加强安全管理防范护理纠纷

安全管理直接影响到医疗质量、病人的安危、医院的声誉。护理安全是指在实施护理的全过程中,患者不发生法律和法规允许范围以外的心理、机体结构或功能上的损害、障碍、缺陷或死亡。所谓安全管理是指保证患者的身心健康,对各种不安全因素进行有效的控制。     

关于设立医疗损害赔付基金的建议和思考

依据医学界在治疗疾病过程中医源性疾病和医源性损害不可能完全避免性，为保证医疗消费公平、公正，防止医疗纠纷不断升级的势头，提出“设立医疗损害赔付基金”的建议。医疗损害赔付基金的来源应由医务人员、医疗机构及医药产品的生产、销售企业共同承担，基金的赔付应实行有限补偿、部分损害陪付、特殊病种拒付及损害和责任分享等原则。文章同时就赔付程序及有关细节问题提出相关建议。     

When Patients Are Harmed,But Are Not Wronged: Ethics,Law, and History

Iatrogenic injury—injury caused unintentionally by medical treatment—breaks the oldest and most famous rule of medical ethics: primum non nocere, or above all, do no harm. Medical malpractice law, however, focuses on whether an injury was caused by negligence, not on whether an injury was iatrogenic. Iatrogenic injury inflicted without negligence is a common pattern in medical malpractice lawsuits; it is likely the pattern of Jacobs v Cross (Minnesota, 1872), in which Dr W. W. Mayo testified as an expert witness. As a matter of law, the doctor defendants should win all those lawsuits, for iatrogenic injury inflicted without negligence is not a legal wrong in the United States and has not been considered a legal wrong for hundreds of years. However, the medical ethics applicable to doctors' duties to report incompetence in colleagues, including those who inflict excessive iatrogenic injury, have developed dramatically over time. In 1872, the ethical codes in the United States exhorted doctors not to criticize another doctor, even if incompetent. Today, doctors in the United States are ethically required to report an incompetent colleague.     

Health courts: an alternative to traditional tort law

The current adversarial tort-based system of adjudicating malpractice claims is flawed. Alternate methods of compensation for birth injuries related to oxygen deprivation or mechanical injury are being utilized in Virginia and Florida. Although utilization of both of these schemes is limited, and they are not without problems in application, both have been successful in reducing the number of malpractice claims in the tort system and in reducing malpractice premiums. While the Florida and Virginia programs are primarily focused on compensation, other models outside the US focus include compensation as well as enhanced dispute resolution and potential for clinical practice change through peer review. Experts in the fields of law and public policy in the United States have evaluated a variety of approaches and have proposed models for administrative health courts that would provide both compensation and dispute resolution for medical and nursing malpractice claims. These alternative models are based on transparency and disclosure, with just compensation for injuries, and opportunities for improvements in patient safety.     

Women’s intimate partner violence versus community violence: Comparing injuries as presented in Iceland’s largest emergency department

BackgroundIntimate partner violence (IPV) is a widespread, often unidentified and hidden public health problem, which has serious consequences. The purpose of this study was to describe and compare the clinical characteristics of women’s violence inflicted physical injuries, as presented at Iceland’s largest Emergency Department (ED). Three groups were created based on registered reason of injury: (1) IPV, (2) community violence (CV) with a history of IPV (HIPV), and (3) CV with no history of IPV.MethodsData was collected retrospectively by using the Nomesco classification system of external causes of injuries. Participants were adult women, residing in the capital area, visiting the ED during 2005–2019.ResultsIPV inflicted ED visits declined by 45% during the research period and CV visits declined by 61%. Women in the IPV group had the highest prevalence of repeated new ED visits per 1000 women in the capital area. The majority of IPV occurred in residential areas (86.4%), inflicted by a current partner (54.7%), and included only one perpetrator (95.3%). Women involved in CV were most likely to visit the ED on weekends (p = 0.003) and IPV women were most likely to visit between 08:00 and 16:00 (p < 0.001). Superficial injuries were the most common type of injury among all groups and IPV women were twice as likely (7.1%) to have injuries on their neck than CV women (3.5%). IPV women were most likely to be admitted (3.0%).ConclusionTime of ED visit, number of perpetrators and location of assault can be indicators of IPV inflicted injuries, as opposed to otherwise inflicted injuries. Repeated visits, superficial injuries and neck injuries might also be an indicator of IPV, however wounds and sprains and injuries on head and upper limbs are more likely to be non-IPV inflicted.     

Technical AIDS to compensate for disability: legal framework and need for reform

The supply with rehabilitative technical aids in Germany is regulated in a complex way. Technical aids can be granted by different social security agencies for purposes of medical treatment, for long term care, for compensation of disabilities in the context of medical rehabilitation, for workplace participation and for participation in society. At present, the most relevant carriers of technical aids for compensation of disabilities are the statutory health insurance funds. In practice and jurisprudence there are several problems. A distinction is made between direct and indirect compensation of disability, and the obligation to provide cover is restricted to the compensation of basic needs. Both are questionable in the light of the German disability law and the ICF. The needs assessment cannot be carried out by physicians alone but has to be multifactorial. Fixed prices for technical aids are not always sufficient. In that case they are unlawful according to the latest jurisprudence of the Federal Social Court. The technical aids register of the statutory health insurance funds cannot restrict the rights of the insured. Further problems of legislation and practice are the responsibility for the supply with technical aids in homes for elderly or disabled persons and the tendering procedures of the statutory health insurance funds. A new codification is needed to simplify and clarify the law.     

Diagnosis and treatment of thermochemical injuries of the airways in patients with severe burns]

Chromobronchoscopy allows objective assessment of the size and depth of injury to tracheobronchial mucosa. The type of inhalation injury to the tracheobronchial tree is an important parameter determining the preventive use of high-frequency assisted and artificial ventilation of the lungs (HFAVL and AVL, respectively). In patients with slight injuries to the airways, inflicted by burning products, the criteria of transfer to HFAVL or AVL should be traditional. In medium severe involvement HFAVL should be started immediately through a microtracheostoma. Severe and extremely severe inhalation injuries require urgent transfer to AVL even if there are no signs of acute respiratory failure.     

《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。     

医院在医疗损害赔偿案件应诉中要注意的法律实体问题

随着涉及医疗卫生工作的法律法规不断健全和完善,患者以医疗事故为由将医院诉至法院要求赔偿的案件越来越多,因此提高医院应诉能力十分重要。从法律实体方面看,医院只能按照过错责任原则承担民事责任,坚持不属医疗事故不赔偿的原则。法官对不同时期发生的医疗事故争议应适用不同的法律进行判决,客观公正地维护医患双方的合法利益。     

Ergonomics in the clinical laboratory.

Ergonomics can improve work quality, increase productivity, raise morale, reduce absenteeism, and reduce workers compensation. Laboratory managers are responsible for recognizing employees at risk of developing CTSs which represent 65 percent of all injuries reported. It is a wise investment to prevent injuries. It needs to be stressed to laboratorians that just because one is not suffering now, does not mean suffering will not occur in the future. All of these micro- (mini-) traumas add up over the years. Once there is pain, there are things that can be done to alleviate the discomfort or disability, but that part of the body is never the same again. CTDs are not inexpensive; the National Council on Compensation Insurance reports the average CTD victim compensation is $29,000. Policies and procedures are needed in every facility to address ergonomic safety issues. All employees should be educated about tasks or situations putting an individual at risk for CTDs. Employees should communicate with management and management should be open to information about potential or real risk situations. Safety is everyone's job.     

Self-inflicted injuries in adolescents presenting to a suburban emergency department

Emergency department medical records of adolescents presenting with a traumatic injury were screened daily by a designated follow up nurse for the presence of a precipitating historical event (such as an argument or a fight) in which anger or an uncontrolled temper resulted in self inflicted injury during 1998. The authors of this study conclude that anger or uncontrolled temper are responsible for a significant number of injuries in adolescents presenting to the ED. Measures to help adolescents control such reactions are warranted.