论医疗过失的判断标准

本文首先分析了侵权法的过失的主观标准和客观标准及民法上过失判断标准客观化的立法趋势；接着分析了医疗行为的法律性质和法律特征，并探讨了医疗责任的法律基础和法律本质，医疗责任的法律基础是过失，法律本质是侵权责任；然后进一步探讨了医疗过失的判断标准问题。医疗过失的判断标准是客观标准，同一专业通常合理医护人员的注意义务是医疗过失的判断标准；最后具体探讨了医疗法规、医疗指导准则、医疗实践惯例、医疗水准等因素与医疗过失判断的关系。     

对医疗责任保险模式的分析

医疗责任风险管理方法，包括风险的避免、减少、自留和转移。由于我国目前人身损害赔偿数额并未对综合医院的收入造成重大影响，并且综合医院每年发生的医疗过失案件数量基本稳定，所以风险自留和风险转移都是适应医疗过失损害赔偿的风险管理方式。根据风险管理原理和国际医疗责任保险发展历程，商业医疗责任保险不宜作为我国医疗责任风险管理的首选；适合医院财务安全需要的风险自留、自保信托等方式，均可采用。为了配合医疗责任保险开展，应建立独立的医疗纠纷调解与鉴定机构。     

论医疗过失诉讼的基本特征与缺陷——兼评我国医疗损害责任制度的改革

医疗过失诉讼具有过失认定的专业性和不确定性、医疗损害的基础性和自然进展性、因果关系判断的复杂性与多元性等基本特征,并存在诉讼结果的非预测性、证明责任的医患两难性以及诉讼导致医患对立的缺陷。这些基本特征与缺陷是基于医疗服务和法律的专业性以及医学与法学的局限性而产生的,与一个国家的法律制度与医疗服务模式没有关系。我国当前的医疗损害责任制度改革并没有充分认识到这些因素．以至采取了开放性的医疗过失诉讼制度,并在某些方面基本上视医疗损害责任为一般人身损害责任。这种改革趋势加剧了医疗服务的非医学化,有违医学规律,在某种程度也违背了法律的公平原则。     

医疗纠纷民事诉讼案件审理适用法律现状与思考

为维护医患双方的合法权益,结合医疗纠纷民事诉讼案件审理实际,分析了当前不同法院在审理案件事实基本相同的医疗纠纷民事诉讼案件时,因在医疗损害赔偿标准、医疗事故鉴定方式以及医疗机构赔偿责任判定等方面适用法律不一,导致判决结果出现差异的若干问题,提出应尽快确定医疗纠纷民事诉讼案件审理的法律适用、将医疗事故技术鉴定纳入司法鉴定管理系统和引进医疗过失责任强制保险制度等建议.     

谈我国医疗责任保险问题及对策

发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,保障患者和医疗机构及其医务人员的合法权益,优化医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择合适医疗责任保险模式,如医疗责任保险信托等,能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

对我国医疗损害鉴定制度的思考

医疗鉴定是医疗损害赔偿案件中法官确认医方是否承担医疗损害责任的关键环节,其鉴定结论直接关系到法官能否公正裁判案件、合理化解医疗纠纷。从医疗事故技术鉴定与医疗过错司法鉴定两个方面分析,提出对我国医疗鉴定制度的相关建议和设想。     

医疗损害鉴定的责任因素分析及其对策研究——基于徐州市医学会鉴定434份案例定性比较

目的：研究患者因素、知情同意权损害、过错医疗损害和医院监督过失四个责任因素对医方责任的组合作用。方法：文章用定性比较分析方法研究徐州市医学会2016年至2020年鉴定的案例共计434例。运用fsQCA3.0软件检测单因素必要性和多因素组态路径。结果：条件必要性检测结果中仅过错医疗行为对判定为医方责任具有必要性，但是组态分析结果中有三条组合路径对判定为医方责任的总体覆盖度高达0.914179,且具有较高的必要性解释力度。结论：我国仍需进一步提升医疗服务质量、加强医院监督职能、保障患者知情同意权、完善医学会鉴定标准和鉴定模式，以助于医患关系和谐发展。     

医疗损害赔偿适用法律“二元化”问题对策

在医疗损害赔偿纠纷案件的司法的实践中，有的案件适用《民法通则》，有的案件适用《医疗事故处理条例》，这种适用法律“二元化”现象导致了鉴定“二元化”和赔偿标准的“二元化”。本文通过医疗损害赔偿适用法律“二元化”问题的分析思考和正确理解《医疗事故处理条例》的内容和法律位阶，提出结合《民法通则》和《医疗事故处理条例》制定更高法律位阶的《医疗损害处理法》改进对策。     

医疗损害赔偿立法存在的问题与完善建议

《中华人民共和国侵权责任法》虽然用专章规定了医疗损害责任,但对医疗损害赔偿没有作出专门性规定,不能完全解决在司法实践中涌现的诸多医疗损害赔偿问题。拟从医学与法学理论及实践相结合角度,同时借鉴有关国家和地区医疗损害赔偿相关经验,对医疗损害赔偿立法存在的问题及完善进行分析、探讨。     

《侵权责任法》医疗损害责任若干问题的探讨

医疗损害责任的归责原则、医疗损害的鉴定及医疗损害的赔偿一直是医疗损害赔偿诉讼中最具争议性3个核心问题。文章从卫生法理论与医疗诉讼实践相结合的角度对上述3个问题的相关法律规定及其医疗诉讼领域的适用进行了分析与探讨。     

Liability and liability insurance for medical malpractice

Physicians typically carry virtually complete malpractice insurance coverage. This contradicts standard theoretical predictions that under a negligence rule of liability there should be no demand for insurance, and insurance policies under moral hazard will contain co-payment provisions. It is argued that judicial 'errors' in defining negligence generate a demand for liability and legal defense insurance. Physician co-payment undermines the insurer's incentives for legal defense and thus induces a trade-off between loss reduction by injury prevention and by legal defense. Fee-for-service reimbursement further distorts the physician's choice between injury prevention and insurance. Implications for the deterrent function of the tort system are discussed.     

Standard of care and liability in medical malpractice litigation in Japan

Although the incidence of medical malpractice litigation is increasing in Japan, it remains unclear whether medical malpractice litigation gives doctors and hospitals, an economic incentive to provide high-quality medical care by requiring that they compensate patients for harm caused by negligence. Therefore, to evaluate whether the medical malpractice litigation system contributes to the delivery of high-quality medical care, we first analyzed the decisions made in medical malpractice cases between 1986 and 1998 in ten district courts (n=421). We found the following results: (1) the probability that patients received compensation and the amount of compensation received, increased with the level of negligence, for all injury severity levels; (2) the significant predictors that a case would be decided in favor of the patient were the patient's legal basis (P=0.00) and the severity of injury (P=0.02). Although, it seems that Japanese medical malpractice litigation gives doctors an economic incentive to avoid delivering substandard medical care, since both the severity of injury and negligence were significant predictors, medical litigation in Japan might in fact corrupt the compensation process by creating an adversarial atmosphere.     

对医疗事故技术鉴定中自由心证的探讨

医疗事故技术鉴定结论是卫生行政部门、司法机关处理医疗事故争议的重要依据和证据.由于医疗事故技术鉴定存在设计上的缺陷,技术鉴定中专家对证据采信存在困难.在医疗事故技术鉴定中应当引入自由心证原则.在心证中,专家必需遵循如下原则：依照法定程序,全面、客观审核医患双方提供的证据;遵循鉴定工作道德,确保鉴定的中立性;运用专业知识、临床实践经验和逻辑推理;依法对证据进行独立判断,明确鉴定结论.运用自由心证必需接受法律法规制约,并承担相应的法律责任.     

刍议医疗技术鉴定中的因果关系及认定标准

在医疗纠纷案件的审理过程中,原被告争议的焦点往往是医疗技术鉴定问题。由医学会组织的医疗事故技术鉴定与司法鉴定机构组织的司法鉴定也称为此类案件,原被告据以支持自己诉讼主张的重要证据。对目前我国医疗技术鉴定中的几个问题,做出了分析与探讨。     

《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。     

Legal requirement of private practice medical records

The hospital medical record is a critical communication vehicle for the numerous health professionals who provide care to each patient. It is also an essential evidentiary tool in malpractice suits. Even though the medical record is not the sole information upon which the courts will rely in determining negligence liability, it can serve as an important chronology of care. Dietitians entering private practice, whether with a physician or not, should establish a system of record keeping. Although specific standards have not been set for private patient records, it is argued that records kept must meet many of the requisite guidelines for medical records in institutional settings. Additionally, the records must provide documentation that may be absent and difficult to obtain in the private setting. Discussed are legal issues surrounding patient records of the dietitian in private practice.     

The forgotten third: liability insurance and the medical malpractice crisis

Although the most visible manifestations of medical malpractice involve patient safety and the legal process, the availability and affordability of liability insurance largely determine the direction of medical malpractice policy. Scientific and industrial developments since the first modern malpractice crisis in the 1970s reveal major problems with the structure and regulation of liability insurance. Comprehensive reforms that approach medical malpractice insurance as a health policy problem are needed, and the Medicare program may have a major role to play.     

处理医患纠纷中存在的鉴定“二元化”问题初探

《医疗事故处理条例》是解决医患纠纷的专门性规范,医学鉴定是我国目前认定医疗行为是否有过失以及过失与损害结果是否存在因果关系的权威鉴定。司法鉴定中的法医类鉴定有其专门的适用领域,将法医类鉴定用于处理医患纠纷,出现"二元化"甚至"多元化"鉴定,很难客观、公正地解决医患纠纷。因此,树立医学技术鉴定的权威性,维护医患双方的合法权益,更有利于促进医学科学的发展。     

重大医疗过失行为和医疗事故报告系统应用评述

介绍了卫生部规定全国统一使用的重大医疗过失行为和医疗事故报告系统的有关概况,讨论了在具体实践应用中存在的不足与问题,提出了相应的改进对策和建议。     

A needs assessment investigation of continuing medical education in risk management

Training of physicians in risk management has become an important task for continuing medical education (CME) directors, particularly in states where risk management education is required for licensure. Physicians in Florida who completed an introductory program in risk management were surveyed to determine future topics for risk management education. Physicians identified desired topics using a five-point Likert-type scaling (5 = high priority; 1 = low priority) and rated 55 topics within 10 major subject areas. The means, standard deviations, and rank order of topics within the subject areas are reported. Multivariate analysis of variance (MANOVA) revealed no significant differences between surgeons and non-surgeons with respect to the subject areas. A significant difference, however, was shown, between academic physicians and non-academic (private practice) physicians; non-academic physicians gave significantly higher scores to six subject areas: malpractice, medical records, acts or omissions constituting negligence, negligence/malpractice actions, defenses, and risk management programs. The results suggest that it is not necessary to plan separate risk management education programs for physicians according to their specialty; one should note, however, the higher priorities given by non-academic physicians and consider these differences when planning advanced risk management programs.