Summary of medical disputes

Summary of medical disputes

Chen was admitted to a hospital on May 18, 2019 due to repeated pain on the right side of the rib. Diagnosis: Herpes zoster. Admission examination: blood pressure 158/58mmHg, skin pigmentation on the right flank flank, skin irritation in the area. He has had a history of hypertension, diabetes, and knee osteoarthritis for more than ten years. Diagnosis: 1, post-herpetic pain, 2, knee osteoarthritis, 3, hypertension, type 4 and type 2 diabetes. After admission, the blood potassium level was low. After admission, the nerve block and Chinese medicine were treated. Because of the high blood pressure and low blood potassium, the hospital gave nifedipine sustained-release tablets oral hypotensive therapy and oral potassium supplementation. I don't know why, after 5 days of medication, the hospital stopped the nifedipine sustained-release tablets and potassium supplementation oral drugs. During the withdrawal, Chen had a high blood pressure, and the blood potassium level was still low. After 3 weeks of treatment, the neuralgia improved. The hospital was in Chen. When blood pressure is high, avoid nerve block treatment. Suddenly, one day, Chen’s blood pressure is as high as 175/79 mmHg, and 169/70mmHg in the afternoon. The hospital told him that he did not need nerve block treatment on the day, but he continued to do nerve block treatment in the afternoon. During the treatment of stagnation, Chen had a sudden cardiac arrest. After the rescue, the vital signs were stable. However, due to myocardial ischemia and hypoxia after cardiac arrest, Chen had mental symptoms and talked indiscriminately. After the family asked the hospital for compensation, the two sides failed to negotiate and entrusted me to sue.

The first time I opened the court, I pointed out the inadequacies of the hospital. The hospital denied it in court and negotiated with the court to select a medical damage appraisal agency for identification.

After the trial, I contacted the parties and family members to report the situation of the trial. I also learned that after the patient was discharged from the hospital, the mental condition was greatly improved. The life was basically self-reliant. The situation of the parties has improved, the damage is not particularly large, the medical damages are identified for a long time, and the expenses are high. Mediation can resolve the dispute as soon as possible. The parties agree with me, but the amount proposed is somewhat inconsistent with the actual situation. I inform the current situation in detail, do not constitute a disability level, and the disability compensation is not supported. The mental damages may not be supported. The parties will take the initiative after understanding the situation. Some compensation claims were withdrawn. The hospital also felt willing to mediate and accept the amount proposed by Chen. In the end, the two sides reached a mediation agreement satisfactorily.

Through the mediation of this dispute, I realized that in order to achieve mediation success, the following points are very important:

First, the patient's condition has improved, the damage is not great, and the cases of grievances in the hospital are relatively easy to mediate. It is easier to communicate and negotiate, and finally reach an agreement.

The author once mediates another successful case. The party told me that after the accident, the doctor was very guilty at the time. He often went to see him. Sometimes he watched him several times a night. He was very concerned about him and tried to alleviate his condition. Eventually the party spent some time. Money, but the condition is getting better, so after the incident, the hospital should do its utmost to let the patient recover, relieve the pain, and pay attention to human care, so that the dispute can be resolved as soon as possible.

Second, should have professional medical and legal knowledge and experience

Professional medical knowledge, in the analysis of medical behavior, easy to communicate with the hospital, reach a consensus, professional legal knowledge, in the analysis of the case to be justified, in the analysis of the degree of responsibility, calculate the amount of compensation is easy to get approval from both sides. The parties are very clear that if the mediation fails, the dispute can only be settled through litigation. Use professional medicine and legal knowledge to analyze the case, so that the parties fully understand the legal problems and legal basis of the case, and understand the results of the referee that will not be obtained. In this case, I informed Ms. Chen of the legal basis of the court's judgment and explained the compensation items and compensation standards to her one by one. Ms. Chen quickly recognized her after listening to the explanation.

Third, an in-depth analysis of the case is an effective way to promote the success of mediation

The original intention of mediation is to resolve the differences between the two sides. The reason for the differences is that the two sides are inconsistent with the incident. In order to resolve disputes and balance the differences between the two sides, we should analyze the case in depth, find the dispute points of inconsistency between the two sides, and then seek effective solutions based on the dispute points.

4. Legal and reasonable compensation items and amounts are easily agreed upon by both parties, and the final mediation is successful.

Summary of medical disputes

Medical disputes are caused by many patients and medical staff. As medical institutions and medical personnel, they should also have a normal mentality and make more criticism and self-criticism. In the medical activities, we must actively create a good cultural environment, provide patients with a beautiful medical environment, establish a "people-oriented" service concept, minimize the occurrence of disputes from social objective factors, and should learn from the medical disputes that have occurred in the past. Actively improve their service attitudes and improve service levels; and improve medical quality to avoid medical disputes, so it is very important to develop practical and preventive measures.

1. Strictly abide by medical and health management laws, regulations, rules and medical care standards and routines, abide by the professional ethics of medical services, improve service attitudes, establish a good doctor-patient relationship, and prevent medical disputes.

(1) Hospital administrators and medical personnel should be familiar with common health management laws and regulations.

(2) Strengthen the professional ethics education of medical services and enhance service awareness.

Medical staff has a high professional ethics, is the primary prerequisite for serving patients wholeheartedly, and is the minimum standard for measuring a medical worker. Therefore, hospitals should educate medical staff to establish a spirit of dedication and a "people-oriented" service concept, and carry out in-depth " Patient-centered quality service activities, civilized medical practice, develop a good service attitude, establish a family-friendly relationship between patients and patients, get rid of the traditional concept of "medical family first, patient seeking treatment", respect the patient's will in the diagnosis and treatment activities To fulfill the obligation of notification to the patient, so that the patient can timely understand the information about diagnosis, treatment, prognosis, etc., in order to exercise the patient's own right to the diagnosis and treatment of the disease, and reduce the dispute caused by the patient's incomprehension of medical behavior.

(3) Medical staff should abide by various rules and regulations and medical care norms and routines.

Rules and regulations and medical care practices and routines are scientific summaries of long-term experience in medical practice; an important guarantee for the quality of medical services; and a criterion for judging whether there is fault in medical care. Therefore, the hospital should establish and improve the hospital rules and regulations, personnel responsibility system at all levels, and strengthen the training of medical staff on the technical practice of medical treatment, as the focus of the hospital and department management, so that there are rules to follow, violations must be corrected To make the hospital work on the track of institutionalization, standardization and standardization, and reduce the occurrence of medical disputes.

2 Medical institutions should strengthen quality management and plug loopholes, which is an effective measure to prevent medical disputes.

Medical quality concerns the health and safety of patients. The occurrence of medical disputes is positively related to the quality of medical care. To improve the quality of medical care, ensure medical safety, and reduce the occurrence of medical disputes, it is necessary to effectively guarantee the quality of medical care and effectively monitor all aspects that affect the quality of medical care. The hospital should improve the quality management system of medical services, adhere to the principle of “prevention first”, formulate practical and feasible plans for preventing and handling medical disputes, and pay close attention to the three-level management of basic quality, link quality and final quality, and plugging loopholes. Preventing problems before they happen, we must grasp the training of “three basics and three strictes” to ensure that medical disputes do not occur or occur less.

3 Improve the quality of medical records and the management of various medical documents and strengthen management. The medical record is the original record of the diagnosis and treatment of the disease and the efficacy. It is the original information for medical research and the legal evidence for judging whether the medical staff's medical behavior is appropriate. It involves not only medical and technical issues, but also the issue of medical disputes that may occur in the future. After a dispute occurs, the medical record will become an important basis for determining the civil liability of medical institutions and their medical personnel. In view of the important role of medical records in medical and legal aspects, first of all, the hospital should set up a medical record quality management committee to improve the medical staff's understanding of the legal status of medical records in the handling of medical disputes, strengthen the training of medical staff to write basic medical records, and improve medical records. The quality of writing ensures the objective, authentic and complete medical records. Secondly, it is necessary to carry out layer-by-layer responsibility for the quality of medical records, strictly implement the three-level ward rounding system, and the attending physicians will revise the regulations. The director, medical department and medical record management committee will regularly check and prevent the defective medical records from being filed. These measures will undoubtedly play a preliminary role in preventing the occurrence of medical disputes, and also provide evidence for the defense of medical disputes that can occur in the future. It should be highly noticed that it is forbidden to be smart and to smear or falsify medical records in violation of objective facts in order to cover up faulty or defective medical behavior. Otherwise, it is likely to bear more serious legal responsibilities. Only by this point can the court determine that the doctor has lost the case.

4 Pay attention to other safety issues other than medical care and reduce medical disputes caused by non-medical factors.

Safety issues outside of medical care account for a certain proportion of complaints about medical disputes in recent years. For example, patients who are on leave or go out on their own are accidents outside the hospital; patients fall, burn, and commit suicide in the hospital; mental patients are injured in the hospital, or they are fleeing, etc. According to national laws, the hospital has no guardianship responsibility for patients. However, there should be regulatory responsibility. Once a problem arises, it is difficult to prove that the hospital is completely at fault. Therefore, paying attention to and preventing the occurrence of unexpected situations caused by other factors other than medical care is a new requirement for hospital administrators in the new era. All departments of the hospital should coordinate and cooperate with each other to formulate and establish safety precautions outside the medical treatment, strictly manage the patients in the hospital, adhere to various "information, agreement" systems, do a good job in admission education, and obtain patients. With the support of family members, we adhere to the principle of “all patient-centered” and establish the idea of ​​serving the patients wholeheartedly, not only to meet the medical services necessary for patients, but also to meet the other reasonable requirements of patients and to make non-medical factors.

Summary of medical disputes

The city's social contradictions and disputes large mediation work mechanism started in the month of the year. According to the requirements of the municipal party committee and the municipal government on strengthening the mediation of medical disputes, the bureau earnestly fulfilled the statutory duties of guiding the people's mediation work, and strengthened cooperation with the municipal health department. In recent years, the number and types of doctor-patient disputes in the city, the causes and social impacts of medical disputes have been seriously investigated, and the experience of mediation of local doctor-patient disputes has been studied in Liuhe District. In the middle of this year, the establishment of the Municipal Medical Disputes Dispute Coordination Committee was set up. At the same time, the Bureau and the Health Bureau jointly drafted the “Implementation Opinions on the Mediation of Medical Disputes in the City” and the “Interim Measures for the Mediation and Disposal of Medical Disputes in the City”, and organized relevant departments and medical institutions. The professionals discussed and solicited opinions. After several revisions, they were submitted to the municipal government executive meeting for research and approval on the 14th of the month, and the city was issued with the No. 44 file of Tianzheng. Since the establishment of the Municipal Medical Disputes Dispatch Committee, it has successfully transferred 3 doctor-patient disputes in a short period of time, safeguarding the legitimate rights and interests of both doctors and patients, and exploring new ways to solve the disputes between doctors and patients in the city.

I. Basic situation of the establishment and operation of the third-party mediation organization for medical disputes in the city

Strengthen departmental collaboration and build a work platform.

1. Set up a platform for mediation of doctor-patient disputes. In the middle of this year, the Center for Dispute and Dispute Resolution of the City appointed three full-time mediators and one mediator assistant. In the same month, the Bureau and the Municipal Health Bureau agreed to form a member of the Municipal Medical Disputes Dispatch Committee and reported it to the Municipal People's Mediation Committee for approval. The city's contradictory dispute mediation center three full-time mediators participated in the Municipal Medical Disputes Dispatch Committee, responsible for the acceptance and mediation of the city's doctor-patient dispute cases. At the same time, with the support of the Municipal Health Bureau, the establishment of the city doctors and patients dispute mediation work liaison team, in the city health bureau and 38 medical institutions to determine 42 doctors and patients dispute mediation work liaison, to emphasize the committee and medical Inter-institutional interactions. At the first time of the doctor-patient dispute, the liaison officer contacted the doctor-patient dispute adjustment committee, and the mediator rushed to the scene in time to take the initiative to intervene. During the mediation phase, the liaison officer actively cooperated with the dispatch committee to carry out work to promote the doctor and the patient. And mediation between the three parties.

2. Set up a professional support platform for the analysis of the responsibility of doctors and patients. In order to meet the professional requirements of doctor-patient dispute mediation work, 82 medical professionals with rich clinical experience, such as medicine, pathology and nursing, were selected to form a medical expert library for the identification of medical disputes in the city. In the event of major and complicated medical disputes, doctors and patients The Dispute Mediation Committee employs 3-5 medical experts to form a medical responsibility analysis and demonstration team, and puts forward the responsibility to make opinions for the mediators to enhance the professional conviction of the people's mediation to resolve the disputes between doctors and patients.

3. Set up a positional platform for mediation of disputes between doctors and patients. Relying on the Municipal Social Contradiction Dispute Resolution Center to set up the office of the Medical Disputes Dispute Commission, invested 30,000 yuan to rent office space in the court of the Judicial Bureau, carry out renovation, purchase office furniture, filing cabinets, installed telephones, computers, air conditioners For office facilities, the software and hardware facilities shall be configured in accordance with the standard of “five and six reunifications” of the standardization committee, and all work systems and work processes shall be open to the public to meet the needs of daily work. It is stipulated that all disputes between doctors and patients will leave the medical institution and be unified to the mediation committee for mediation.

Establish a chapter and establish a strong team.

1. Form a professional mediation team. In view of the special nature of the doctor-patient disputes, the personnel composition has fully taken into account both the knowledge of the law and the understanding of medicine. At present, the Municipal Medical Disputes Dispute Commission has one director, two deputy directors, and nine members. The municipal judicial administration, health, and public security departments are in charge of leaders and representatives of the Municipal People's Congress, members of the CPPCC, and professionals in medicine and law. A full-time mediator consists of eleven people. The Municipal Commission has appointed 3 comrades who have long been engaged in legal work and have rich experience in grassroots and people's work, and have been appointed as non-leaders, but they are full-time mediators. They are responsible for the mediation of doctor-patient disputes and hire another law major. A mediator assistant who is proficient in computer operation assists in the work and forms a mediation team with “professional complementarity and mutual skills assistance”.

2. Establish a work system. In order to improve the normative and credibility of mediation of disputes between doctors and patients, the bureau's grassroots work management unit has guided the formulation of mediation scope, mediation principles, mediation discipline, and work responsibilities and work processes of the doctors' and patients' dispute resolution committee. Established regular meetings, reception registration, dispute acceptance registration, mediation designation, investigation and evidence collection, mediation work procedures, mediation agreement production, agreement implementation and return visits. According to the format of the mediation document, the "People's and Children's Mediation Reception Registration Form", "Conciliation Application", "Dispute Acceptance and Mediation Registration Form", "Dispute Acceptance and Mediation Notice", "Provision of Material Provided", and "Delivery" were printed. The documents such as the “Certificate of Reimbursement” have established various types of reception, acceptance, and registration accounts, so that the mediation of disputes between doctors and patients can be followed by rules and regulations.

3. Improve the working mechanism. Establish regular consultation training for third-party mediation work for doctor-patient disputes, collective consultation for major doctor-patient disputes, expert analysis and evaluation for difficult disputes, report coordination for excessive disputes, and work with the Municipal Health Bureau to continuously improve the team. Business ability and professional quality. At the same time, the work expenses of the Medical Disputes Dispatch Committee were all included in the municipal budget, ensuring the independent and fair mediation of the Medical Disputes Dispatch Committee.

Work quickly and efficiently.

After the establishment of the Municipal Medicinal Disputes Mediation Committee, three applications for disputes between doctors and patients were accepted. The medical dispute resolution committee successfully passed all the mediation work. Both the doctors and the patients expressed satisfaction with the results of the mediation. In the specific work of mediation of doctor-patient disputes:

First, warm reception and patient guidance. The four full-time mediation staffs are responsible for the dual responsibility of the hospital and the patients. They are warmly welcoming the patients and their families who have come to consult and apply for mediation. They listen carefully to the statements of the parties, make a good conversation record and patiently guide the patients and their families. Ideologically burdened and worried, and voluntarily accepted the mediation of the Commission.

The second is to analyze carefully and communicate with many parties. Listen carefully and review the statements and information provided by the patient who came to apply for mediation. At the same time, visit the hospital, collect the cases, listen to the instructions of the representatives of the hospital, organize the work of dispute acceptance, evidence preservation, investigation and evidence collection, etc. The causal relationship between the doctor-patient dispute process and the details and contradictory focus is carefully analyzed. Based on the evidence materials and laws and regulations, the patient and the hospital are communicated in an objective and fair position, and the doctors and patients are effectively organized. Preparation for mediation.

The third is the mediation of the truth and the signing of the agreement. During the mediation process, the mediator of the Medical Disputes Dispatch Committee acts as a third party and upholds the principle of objectivity and justice. From the perspective of jurisprudence and reason, it conducts patient and meticulous analysis to both the affected party and the hospital to enhance mutual understanding, mutual understanding and mutual promotion. The two sides reached a consensus, signed a mediation agreement and performed it in a timely manner.

Second, the problems and suggestions in the third-party mediation work of medical disputes in our city

The third-party mediation work for doctor-patient disputes is a brand-new work. There is no ready-made experience to copy and use. As the guiding department of the people's mediation, combined with the preliminary preparation, construction and recent operation, we believe that the third-party mediation work for doctor-patient disputes. It is also necessary to improve and strengthen in the following aspects.

It is necessary to further strengthen the construction of a collaboration mechanism for doctor-patient disputes and achieve departmental linkage. After the dispute between doctors and patients, the parties are emotionally excited and easily intensify into group incidents and “people-transfer” cases. A multi-sectoral collaboration system should be established and fully implemented to ensure the effectiveness of mediation of doctor-patient disputes.

1. Establish a system of collaboration between the people's mediation and health administrative departments and medical institutions for doctor-patient disputes, regularly report mediation information, and strengthen prevention of doctor-patient disputes. In the event of major medical disputes, the two departments should promptly send personnel to guide and coordinate and resolve the situation in a timely manner.

2. The third-party mediation of doctor-patient disputes is unlikely to cover the handling of all doctor-patient disputes. It is necessary to strengthen the coordination between people's mediation and administrative mediation and court litigation, and form a diversified medical dispute resolution mechanism. For some disputes between doctors and patients with complicated disputes and large compensation, after the parties reach a mediation agreement, they should apply to the people's court for judicial confirmation in time, and strengthen the legal effect of the people's mediation agreement. The people's court should give support.

3. Establish a system of cooperation between people's mediation and legal services for doctor-patient disputes, give full play to the advantages of judicial administrative functions, and closely integrate mediation with popularization of law, legal counseling services, legal aid and notarization, and strengthen publicity and counseling to make simple medical disputes. "Unadjusted first solution", for the case of major difficult doctor-patient disputes, the resources of various judicial offices, legal service offices, and law firms are utilized, and full-time mediators are engaged to carry out the mediation.

It is necessary to further increase the publicity of doctor-patient dispute mediation work to raise public awareness. It is recommended to carry out propaganda work on the disputes between doctors and patients for patients and their relatives in medical institutions, so that the affected parties can understand the people's mediation and maximize the introduction of doctor-patient disputes into the channels of people's mediation. Through newspapers, magazines, and the Internet to promote the advantages and conveniences of third-party mediation of doctor-patient disputes, we will resolutely crack down on unreasonable claims of “medical troubles”, increase public awareness of third-party mediation disputes, and enhance social impact. Force, so that people rational choice of solutions in the case of medical disputes.

It is necessary to speed up the implementation of medical institution medical liability insurance and share the responsibility for medical risks. According to the archives requirements of the provincial health department, the judicial department, and the China Insurance Regulatory Commission, medical institutions should actively explore the establishment of medical liability insurance or jointly establish a medical accident compensation fund according to their own circumstances, and the insurance company or foundation directly bears the responsibility for compensation for medical disputes. This can not only improve the patient's trust in the doctor-patient dispute adjustment committee, but also enhance the doctor's ability to resist risks. Experience in the field shows that this is an effective measure to deal with doctor-patient disputes. At the same time, the relevant government departments have no faults and responsibilities for doctor-patient disputes, and the patients have significant losses and the economy is very difficult to maintain normal life. It is advisable to arrange funds appropriately and to help the patients feel the party. And the warmth of the government, reducing the opposition.

It is necessary to improve the emergency response mechanism for major doctor-patient disputes and severely crack down on the troubles caused by doctor-patient disputes. The public security organs shall formulate scientific and effective emergency response plans for emergencies in response to the frequency, manifestation, scale and intensity of mass and sudden incidents caused by disputes between doctors and patients. In the event of an emergency, the public security organ shall take corresponding measures according to law, promptly and decisively dispose of it, maintain order at the scene, and put an end to the phenomenon of “small troubles, big troubles, big losses”.

It is recommended that medical institutions improve the prevention mechanism for doctor-patient disputes and prevent them from happening.

1. Improve the system, strengthen management, standardize the behavior of medical personnel, strengthen the education of “medical ethics”, frequently check the weak links in the rectification work, plug the loopholes in personnel, facilities, equipment, medicines, etc., improve the quality of medical care, and maximize the Reduce medical accidents and work mistakes, and avoid disputes between doctors and patients.

2. Medical institutions shall grasp the situation, analyze the reasons and responsibilities in case of accidents or abnormal deaths in the medical process, take countermeasures according to laws and regulations, and grasp the initiative to handle disputes.

3. Strengthen the publicity of medical science knowledge, widely publicize the particularity, high-tech and high-risk nature of life sciences and clinical medicine, guide the people to rationally treat possible medical risks and medical damage disputes, and create a favorable relationship for building a harmonious relationship between doctors and patients. The atmosphere of public opinion.

It is necessary to further strengthen the credibility of the Medical and Patient Disputes Commission and improve the effectiveness of the work. The mediation of doctor-patient disputes must be based on the voluntary application of mediation by both doctors and patients. The mediator is neither the agent of the patient nor the defender of the doctor, but stands in the position of the third party and upholds the principle of objectivity and justice. However, in the practice of mediation disputes between doctors and patients, the mediator will have the concern of “unsatisfactory contribution”: that the doctor thinks that the committee “takes the bottom of others’ feet” and the patient cares about the committee to speak for the hospital. Further emphasize the construction of credibility of work, so that the disputes between doctors and patients are in compliance with laws and regulations in terms of both entity and procedure. We will handle each dispute well at the beginning and end, obtain the trust of both doctors and patients, and improve the effectiveness of disputes.