试论医疗过失行为的特殊性

医疗过失是医师对具体医疗行为的操作规程和医疗惯例的违反，是判断是否构成医疗事故的要件之一。可表现为一般注意义务的过失和特殊注意义务的过失。医疗过失以医疗水准作为判断医疗过失的标准，但在笔者看来，还要考虑医疗行为的专门性、地域性、紧急性以及医疗技术发展水平、医疗环境、医学尝试等多种因素。     

教学医院防范医疗纠纷的方法研究

医疗纠纷是当前社会上的一个热门而又沉重的话题。发生医疗纠纷的原因非常复杂，有的是在诊疗护理工作中医务人员确有失职行为或技术过失，导致患者发生了不良后果甚至构成医疗事故；但多数是无诊疗护理过失，或虽有诊疗护理过失，但与不良后果无直接因果关系。发生医疗纠纷后，部分病人及家属由于法律知识淡薄，曾发生扰乱医院正常医疗秩序的过激行为，甚至发展成打砸医院，对医院的设施直接造成了破坏。     

非医疗过失纠纷中的法律问题

非医疗过失,是指在诊疗护理工作中,并非由于医生的技术和责任原因造成病员的不良后果,而是发生难以预料和防范的意外或并发症,导致病员出现不良后果是非医疗过失。非医疗过失纠纷,是     

侵权责任法之医师注意义务探讨

医师注意义务是指医师在实施医疗行为过程中,依据法律、行政法规、规章、诊疗护理规范以及医疗习惯和常理、医学伦理道德,保持足够的小心谨慎,以预见医疗行为结果和避免损害结果发生的义务.医师注意义务应考虑医疗行为当时的地域性、专门性、紧急性因素.患者应承担医师违反注意义务的举证责任,除非医师违反了法律、行政法规、规章以及其他有关诊疗规范的规定.     

医疗风险及风险管理战略

一、医疗风险的特点（一）风险风险指人类无法把握与不能确定的事故发生导致损失的不确定性,也有人解释为某种损失发生的不确定性,也可以理解为实际情况与预期结果的偏离。风险具有客观性、永恒性、不定性和危害性等特征。（二）医疗风险１－医疗风险分类医疗风险是指存在于医疗机构内部的、可能会导致损失和伤残事件的不确定性。医疗风险主要包括医疗事故,医疗差错,医疗意外、并发症和医疗纠纷。（１）医疗事故　医疗事故是指在诊疗护理过程中,因为医务人员的过失,直接造成病人死亡、残废、组织器官损伤所致的功能障碍。医疗事故属于…     

熟悉司法鉴定基本原则防范医疗纠纷发生

目前已有越来越多的医疗纠纷通过司法鉴定,由人民法院根据《民法通则》进行判决或调解来解决。医疗纠纷司法鉴定的基本原则是:明确有无医疗过失,有无不良后果,过失与不良后果之间有无因果关系,并对伤残程度进行鉴定。医疗机构及医务工作者只有熟悉司法鉴定的基本原则,切实履行注意义务,避免医疗过失行为;履行"告知义务",获得患者"知情同意";履行"预见、回避义务",避免不良后果的发生,才能有效防范医疗纠纷的发生。     

试论医务人员的注意义务

医疗过错包括医疗故意和医疗过失,医务人员的注意义务,是一项重要的诊疗义务,是评判医疗过错的一项重要标准。     

洪泽县15例医疗纠纷分析

医疗护理工作直接关系着人民的生命与健康,是一项严肃、认真、细致、复杂的科学技术工作.在诊疗护理工作中,因医务人员诊疗护理过失或任何处理不当,都会发生医疗差错事故,增加病人痛苦,甚至造成病人残废或死亡。本文就我县1989～1991年发生的15例医疗纠纷中,纠其原因的分析,探讨医疗差错事故发生的主要原因、特点及规律,从中吸取教训,提高防范措施。     

告知不当将承担赔偿责任——医疗诉讼中出现的新动向

当前，在医疗事故损害赔偿案件的审判实践中出现了一种新动向，它将医院的医疗行为分为两个相对独立的部分，即告知行为和诊疗行为。只要医务人员在这两种行为中有某一种过失，并造成患者损害结果的，医院将承担相应的赔偿责任，从而一改过去只有医院存在诊疗行为过失才承担赔偿责任的传统审判思路。新的审判思路表现出患者的知情同意权已受到法学界的高度重视，医院一旦侵犯了患者的知情同意权，就会构成民事侵权。１“告知”是医疗机构的基本义务新的审判思路认为，医院作为从事医疗服务这一特殊行业的机构，其执业活动不但应当以救死扶伤…     

常见医疗风险的现状分析与规避

医疗风险对患者是指存在于整个医疗服务过程中,可能会导致损害或伤残事件的不确定性,以及可能发生的一切不安全事情 对医院是指在医疗服务过程中,发生医疗失误或过失导致的不安全事件的风险.医院的各个工作部门、各个工作环节都存在潜在的医疗风险.本文笔者就常见医疗风险的现状进行了分析,并提出了相应的规避措施.     

Is treatment adherence associated with better quality of life in children with sickle cell disease?

The association of treatment adherence with quality of life (QOL) and the role of sickle cell disease complications were explored in children with sickle cell disease. Primary caregivers of 43 children, ages 5 years and older, and 21 children, ages 8 years and older, completed a standardized measure of QOL during an admission for pain or fever to the hematology acute care unit. Adherence was measured through medical staff ratings, caregiver-report of sickle cell disease-related care activities, and matching of medical staff standard recommendations for treatment of pain and fever with sickle cell disease-related care activities. Sickle cell disease complications were assessed via medical file review. Pearson correlation coefficients indicated that better adherence was associated with poorer overall QOL. In follow-up analyses, although sickle cell disease complications were associated with adherence, it did not explain the negative correlation of adherence with QOL. Higher treatment adherence may interfere with activities that contribute to QOL for some children. Further research to investigate the role of sickle cell disease complications, as well as psychosocial factors, in determining both treatment adherence and QOL is suggested.     

规范医疗行为是预防医疗事故的关键

规范医疗行为是预防医疗事故的基础和关键，医疗机构和医务人员在医疗活动中需要重视医疗行为规范及相关注意义务。     

Office staff responsibilities in preventing surgery malpractice suits

Improved communications, procedures, administration, and system routines in a medical office are everyone's responsibility. It is an area in the overall treatment of the medical malpractice disease in which the entire office staff plays a critical part. The reward is that everyone--the patient, the physician, and the staff--benefits. Office staff can make a vital contribution to achieving a pleasant, efficient office where very few mistakes occur and preventable errors are eliminated.     

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.     

Instruction on health care malpractice issues in entry-level physical therapy curricula

In the face of an ongoing health care malpractice crisis, instruction on malpractice issues in entry-level health care professional education programs is vital for the legal well-being of prospective clinicians. A 1978 survey of US medical schools revealed that less than 40% required instruction in medical law. By 1989, 76% of US medical schools required medicolegal instruction. This article summarizes the results of a survey of entry-level physical therapy educational programs to determine whether a majority currently offer required malpractice instruction. The study found that the majority do offer such instruction. Half of the physical therapy programs with instruction in malpractice employ attorney instructors, essential for improving relations between health care and legal professionals. Graduate entry-level programs offer 11 or more hours of medicolegal instruction with greater frequency than undergraduate programs. Additional surveys of other allied health disciplines are recommended to ascertain other standards for entry-level malpractice-related instruction.     

Impact of sociocultural factors on hospital length of stay in children with nephrotic syndrome in Japan

Hospital length of stay (LOS) of Japanese inpatients is extraordinarily long, partly because of the nature of the health insurance system in Japan. We investigated factors that affect the LOS in Japan, taking pediatric nephrosis as an example. The characteristics of 78 hospitalized children with steroid-sensitive nephrotic syndrome were studied. The median LOS of the patients was 47 days. Most of the patients' mothers (92.3%) stayed in hospital during admission to care for their children. Using multivariate Cox's regression analysis with time-dependent covariates, non-working mother and smaller number of siblings were found to be factors significantly associated with prolonged LOS. These factors are presumed to allow the mothers to care for their hospitalized children for a long period. No medical or clinical factors played a significant role in the prolonged LOS. These results suggest that sociocultural factors have a greater influence on the LOS in Japan than do medical factors such as disease course, coexisting illness, complications, and treatment response.     

African American race was associated with an increased risk of complications following venous thromboembolism

OBJECTIVE: Limited data exist on the quality of care for patients with venous thromboembolism (VTE), and it is unknown whether the processes and outcomes of care for this illness differ between African Americans and whites. STUDY DESIGN AND SETTING: We retrospectively studied 168 patients hospitalized for VTE in two Veterans Affairs hospitals during fiscal years 2000-2002. Patient characteristics, information about processes of care, and medical outcomes at 90 days after the index VTE event were abstracted from medical records. We used logistic regression to explore associations between race, processes of care, and the overall 90-day complication rate (i.e., death, bleeding, or recurrent VTE), adjusting for patient baseline characteristics. RESULTS: Multivariable analysis demonstrated that administration of warfarin within 1 day of starting heparin (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.05-0.42) and overlap of heparin and warfarin treatment >or=4 days (OR 0.09, 95% CI: 0.02-0.50) were associated with a lower complication rate, and African American race was associated with a higher complication rate (OR 5.2, 95% CI: 1.3-21.6). Race was not significantly associated with the performance of processes of care in multivariable analysis. CONCLUSION: Although African Americans had an increased risk of complications following VTE, race was not independently associated with the use of processes of care for VTE.     

'Lumping it': the hidden denominator of the medical malpractice crisis.

In a recent article, Miller has reminded us that medical malpractice litigation is not simply an economic problem which inhibits medical practice and increases health care costs. She argues that it has three broader "societal objectives": reparation, emotional vindication, and deterrence. Viewed in the broader perspective of social values, the Maine data suggest that our current approach to medical malpractice does not perform well. Significant numbers of respondents believe that they have been neither vindicated nor compensated for their own or their relatives' illness, injury, or death; and that they have not had the opportunity to protect others from harm. As Miller suggests in her review of British alternatives to medical malpractice litigation, there may be more efficient and effective means of reparation. There may also be more direct and less costly means to deter incompetent practitioners and vindicate those who are harmed. We shall never discover these alternatives if we view the medical malpractice "crisis" as a simple or straightforward problem of costs of premiums, costs of settlements, and costs of judgments; numerators. Medical malpractice litigation is the expression of deep and highly complicated problems, which cannot be solved or even significantly alleviated by false solutions motivated only by concerns of costs and cost containment. They can be addressed only by careful, thoughtful, and comprehensive analysis.     

Adverse consequences of hospitalization in the elderly

This study prospectively examines 502 general medical patients for evidence of side-effects of hospitalization unrelated to diagnosis or therapy of acute illness. Symptoms of depressed psychophysiologic functioning (confusion, falling, not eating, and incontinence) unrelated to acute medical diahnoses were found in 8.8% of the patients under 70 and in 40.5% of the elderly population (P < 0.0001). The rate of medical intervention secondary to these symptoms (psychotropic medications, restraints, nasogastric tubes, and forely catheters) was 37.9% among the young patients and 47.1% in the elderly group (P=0.4). The sample was too small to permit adequate empirical determination of the complication rate from medical intervention (thrombophlebitis, pulmonary embolus, aspiration pneumonia, urinary tract infection, septic shock) but estimates from the literature indicate that each of the interventions studied entails a complication rate of 25–30%. Combining the observed rate of functional symptoms development and intervention, and the literature rates of complications, yields a risk of complications of 1.0% for the young and 5.7% for the elderly (P < 0.0001). These data indicate that hospitalized elderly patients are at high risk of developing symptoms of depressed psychophysiologic functioning and of sustaining medical intervention as a result of these symptoms, with attendant medical complications. We suggest that the incidence of depressed psychophysiologic function needs to be assessed in patients treated outside the hospital, along with efficacy of treatment outside the hospital, to determine whether there are patients for whom hospitalization is not optimal therapy.     

试论医疗事故处理中医务人员合法权益的保护

医疗事故处理条例确立了对患者的法律保护，但同时却忽视了对医务人员合法权益的保护。覆行告知义务时应当避免对患者产生不利后果的规定，容易造成认识上的分歧和实践操作上的困难，使医务人员处于极为不利的境地；而主观性病历资料封存的规定侵犯了医务人员的保密权，不利于医疗事故的处理；医疗事故鉴定制度中没有确定医务人员的主体地位，使医务人员权利受到损害时没有救济的途径。建立并完善医务人员权利保护机制十分必要。