计算医疗损害赔偿方法例析

医患纠纷中因医疗事故产生赔偿时 ,关于赔偿数额应当如何计算的问题 ,在现行《医疗事故处理条例》实施之前 ,实践中通常参照《医疗事故处理办法》和《民法通则》的相关规定。《医疗事故处理办法》第11条规定 :“病员及其家属和医疗单位对医疗事故或事件的确认和处理有争议时 ,可提请当地医疗事故技术鉴定委员会进行鉴定 ,由卫生行政部门处理……也可以直接向当地人民法院起诉。”本《办法》第 18条还规定 :“确定为医疗事故的 ,可根据事故等级、情节和病员的情况给予一次性经济补偿。补偿标准 ,由省、自治区、直辖市人民政府规定。”由于各…     

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.     

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。     

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…     

检验科对医患纠纷的有效防范

通常所说的医患纠纷就是医疗事故争议,指医患双方就医疗过程中对患者造成的不良后果产生的原因及如何处理等问题发生分歧,从而引发的纠纷.近年医疗纠纷数量逐年增多,并具有如下几个特点:医疗投诉多,要求医疗技术鉴定的多,要求伤残鉴定的多,同时新闻媒体参与的也增多;院方败诉的增多,新的<医疗纠纷侵权责任损害鉴定与赔偿>所采用的"举证责任倒置"[1],使医院出现举证不能的情况增多;赔偿数额增大,医疗纠纷的最终结果往往是向医院提出经济赔偿的要求,只要有对医院不利的情况,尤其是出现举证不能的情况时患者和家属就大肆喧闹,要求赔偿,数额越多越好;处理困难增大,多数医疗事故与医疗纠纷发生原因复杂,相关法律法规尚不健全,而且社会各界一般认为患者是弱势群体应当加以特殊保护,因此,处理起来非常困难;社会影响增大,特别是有些医疗事故与医疗纠纷因患者要求高额赔偿不能满足,而反复向卫生行政部门、司法部门及相关媒体投诉,加之有些媒体缺乏医学知识,不明事实真相,盲目炒作,给医院的声誉造成极大损坏.     

医疗纠纷鉴定的司法程序（上）

在处理医疗纠纷的方式中，法院的判决是最强有力的一种，在国家法制的保护下，生效判决具有绝对的权威性和强制力，迫使任何人都必须遵照执行。 通过司法程序解决医疗纠纷，首先必须熟知诉讼程序。在实践中，因医疗纠纷提起的诉讼常见下列几种：一是对医疗事故或严重医疗差错的赔偿数额有争议，属民事案件，由民事审判庭依《民事诉讼法》审理；二是对卫生行政机关的医疗事故鉴定处理决定不服，属行政案件，由行政审判庭依《行政诉讼法》审理；三是对医疗事故鉴定结论有异议，不属于人民法院主管的案件，不能通过司法程序解决；四是个别极其严重的一级医疗责任事故，应按照刑事诉讼法的程序追究直接责任人员的刑事责任。     

关于建立医疗风险机制的思考

随着"医疗责任举证倒置"条例出台及人们自我保护意识的增强,当前医疗纠纷和医患关系的紧张度存在加剧趋势.在市场经济条件下,如何充分运用法律和市场的手段来规范医患双方的行为,更好地解决医疗事故界定的赔偿问题,也越来越显得必要.作者就医疗风险机制不完善的负面效应和对策,阐述以下思考.     

提高护士的自律行为正确认识举证责任倒置

近几年，随着我国卫生法制建设的不断完善，人们法律知识的普及，以及《医疗事故处理条例》等一系列法律法规的颁布，无疑对医务工作者特别是护理人员提出了更高的要求，新《医疗事故处理条例》就医疗纠纷诉讼的举证责任问题明确做出了规定：因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与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，这就是举证责任倒置。其基本的出发点足保护弱势群体，法律向弱势的患者倾斜。这无疑从法律角度对医疗医疗活动提出了更高的要求为适应这一卫生环境的重大变革，本文从法律角废分析患者和护理人员在法律意识上的差别，对怎样更好的依法执业进行探讨。     

培养护理人员法律意识预防护患纠纷

随着我国社会经济的发展，人民群众物质生活、文化水平的提高，以及我国法制建设的深入，人们的法律意识不断增强。近年来，我国的卫生保健领域的法制建设取得了较大进展。自2002年国务院颁布实施的行政法规《医疗事故处理条例》等系列卫生法律性文件，已成为社会各界关注的焦点。患者的就医权利增强，对就医环境、医疗服务质量、医疗安全等方面有了更高的要求，[第一段]     

对完善我国医疗纠纷调解制度的思考

调解是指纠纷双方当事人，在第三方的协调、帮助和促进下，进行谈判、商量取得一致意见，消除争议，建立新的权利义务关系。在医疗纠纷现有的协商、调解、诉讼三种解决途径中，调解具有明显的优势。 1 医疗纠纷调解制度的优势1．1调解是医患纠纷双方的合法救济手段，调解协议具有法律效力《医疗事故处理条例》（以下简称《条例》）第46条规定，发生医疗事故的赔偿等民事责任争议，医患双方可以向卫生行政部门提出调解申请。由此，卫生行政部门作为调解主持人，就医疗纠纷中所涉及的民事权利义务（主要是民事责任和民事赔偿问题）进行调解，达成的调解协议具有民事合同性质，具有一定的法律效力。     

试论医疗事故的赔偿责任

医疗事故除包括责任事故和技术事故外，还应包括医疗差错。医疗事故的法律性质为侵权责任，医疗事故的损害赔偿应适用过错推定原则，实行举证责任例置。损害赔偿额的确定标准应根据《民法通则》第１１９条，实行全额补偿。现存的医疗事故鉴定体制违反了公平、公正原则、必须进行三方面的改革。     

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。     

A review of health professional attitudes and patient perceptions on 'inappropriate' accident and emergency attendances. The implications for current minor injury service provision in England and Wales

Increasing attendances in accident and emergency (A and E) departments in the United Kingdom have been attributed to a greater number of patients presenting with minor injuries. A and E staff believe this type of patient is suitable for primary care, and is 'inappropriate' for A and E management. Thus, A and E staff find 'inappropriate' attenders time-consuming and unrewarding, and are less motivated to help them, whilst 'inappropriate' patients believe they have attended the appropriate service for their medical needs and expectations. This review examines research into health professional and patient attitudes towards 'inappropriate' attendances in accident and emergency. It identifies a discrepancy between health professional and patient perspectives regarding 'inappropriate' attendances. However, the change in accident and emergency services with the development of minor injury units and nurse practitioners within A and E to treat minor injury patients away from the mainstream A and E service, appears to be based on the professional attitude of what constitutes an appropriate A and E attendance, and not on the patients' perspective. As negative attitude formation towards 'inappropriate' A and E attendances has occurred, there is concern that such attitudes could remain or develop again in the new units. Patients are generally not medically trained and may experience difficulty in ascertaining the severity of their own condition and attending the 'appropriate' service, as defined by trained professionals. This is exacerbated by the unclear boundaries and roles of minor injury units, nurse practitioners and general practitioners in minor injury care. Therefore research is required into current attendances in minor injury units, A and E departments and general practice, in order to develop clear roles and boundaries for these services. More importantly, research is warranted into the attitudes of all minor injury care providers towards attending patients, and into patient perceptions of the services offered.     

Current system of undergraduate and postgraduate education in clinical chemistry in Croatia.

We present here a specific model of education and practice in clinical chemistry that is almost exclusively based on the medical biochemists academically educated at the Faculty of Pharmacy and Biochemistry. This model has been successfully used for 35 years in Croatian Health Care System. Undergraduate education in clinical chemistry consists of four years of specific university education which provides for all requirements to maintain the high quality of our profession. Postgraduate education leading to more specific scientific and professional expertise is further regulated by the laws issued by The Ministry of Health and The Ministry of Science and Technology. At present there is a compulsory programme of lifelong continuing education recognised by Croatian Chamber of Medical Biochemists.     

Expanding horizons: innovations in community health nursing education

Application of this learning process (problem assessment, program planning, intervention, and evaluation) at the aggregate level, was a creative, enjoyable, growth producing experience for the senior nursing students. It is a process that is not only useful in the local community, but also prepares nurses for working at county, state, and national levels. They learn to make valid observations and firm decisions, to carry out actions, to overcome obstacles, to alter behavior, and to evaluate results. It does not replace other practices and former services of community health nursing, but complements them. There exists a tremendous potential for nurses in planning health care, already being realized in many settings. Certainly grass roots communities, rural populations and urban neighborhoods are in the highest need of creative, effective health programs that take into account the total population. Given such creativity, it is possible by the year 2000, that the Community Health Nurse may become a combination medical advisor, health instructor, community leader, playwright, photographer, author and television director; certainly a captivating career for people of the New World.     

Commercial aviation in-flight emergencies and the physician

Commercial aviation in-flight emergencies are relatively common, so it is likely that a doctor travelling frequently by air will receive a call for help at some stage in their career. These events are stressful, even for experienced physicians. The present paper reviews what is known about the incidence and types of in-flight emergencies that are likely to be encountered, the international regulations governing medical kits and drugs, and the liability, fitness and indemnity issues facing 'Good Samaritan' medical volunteers. The medical and aviation literature was searched, and information was collated from airlines and other sources regarding medical equipment available on board commercial aircraft. Figures for the incidence of significant in-flight emergencies are approximately 1 per 10-40 000 passengers, with one death occurring per 3-5 million passengers. Medically related diversion of an aircraft following an in-flight emergency may occur in up to 7-13% of cases, but passenger prescreening, online medical advice and on-board medical assistance from volunteers reduce this rate. Medical volunteers may find assisting with an in-flight emergency stressful, but should acknowledge that they play a vital role in successful outcomes. The medico-legal liability risk is extremely small, and various laws and industry indemnity practices offer additional protection to the volunteer. In addition, cabin crew receive training in a number of emergency skills, including automated defibrillation, and are one of several sources of help available to the medical volunteer, who is not expected to work alone.     

全瓷冠及其相关陶瓷粘接剂的研究与应用

背景：全瓷修复是当今口腔固定修复的发展趋势之一,全瓷修复体依赖良好的树脂粘接剂以保证其临床成功。目前,全瓷修复树脂粘接剂与牙本质的粘接技术及瓷表面处理技术仍在不断探索改进之中,以期进一步提高临床粘接效果。目的：总结全瓷冠及其相关陶瓷粘接剂的研究进展。方法：由第一作者检索2000/2010PubMed数据及万方数据库有关全瓷牙及陶瓷粘接剂的文献,英文检索词为＂ceramiccrown,bond,interface＂,中文检索词为＂全瓷修复,粘接,界面＂。共检得到41篇文献,最终纳入符合标准的文献24篇。结果与结论：理想的用于全瓷修复体的树脂粘接剂应具有粘度低、流动性好、被膜厚度不影响修复体就位、强度高、耐磨损等性质。全瓷修复体是一种新型口腔修复材料,在临床应用已日趋广泛,近些年也出现了许多新型的粘接材料,这些粘接材料之间的性能差异及其与全瓷冠粘结效果的评价不尽一致。文章综述了目前国内外各类全瓷冠及其相关粘接剂的研究进展,较系统地介绍其材料性能、表面处理及粘接技术等方面的情况,为陶瓷粘接剂更广泛的应用于临床提供理论依据。     

Occupational therapy in the Department of Veterans Affairs: focus on health care of the elderly veteran

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the world (VA, 1989), with designated departments and programs designed to meet the long-term care needs of the aging veteran. Occupational therapy is an important intervention to maximize the quality of life of older persons. Because of the increasing number of aging veterans and the national shortage of occupational therapists, the VA has been devising programs to recruit and retain occupational therapists in VA medical centers. The combination of long-term care programs and the VA's commitment to ongoing research, education, and occupational therapy services points to a promising outlook for care of our aging veterans.     

4-component chemotherapy and radiation therapy of breast cancer

The treatment schedule for disseminated breast carcinoma has been developed. It includes the use of adriamycin (30 mg/m2, days 1, 8, 15), methotrexate (30 mg/m2, day 1), 5-FU (600 mg/m2, day 8), and cyclophosphamide (400 mg/m2, day 15 i. v. by jet injection). A complete response was obtained in 50 to 56% of the patients, with remissions lasting for an appreciable period of time. The use of chemotherapy according to the described schedule combined with radiation of the bones of the pelvis and lumbar part of the spine brought about complete or partial reparation of the osteolytic, osteoblastic and mixed metastatic foci in 76.2% of the patients.