Chapter 25 Chapter 7 Who will "appraise" the medical appraisal?

This is a question from China Youth Daily reporter Huang Ping—— At noon on December 31, 1998, Chen Jie, an employee of the Hangzhou Materials Recycling Company, returned home from the court listlessly. The first sentence he said when he entered the door was: "If I knew this, why should I file a lawsuit? There is no need to even protest! "His 8-year-old daughter, Chen Jiani, underwent eye surgery at Hangzhou Zheyi Eye Clinic a year ago. As a result, her right eye was sick and her left eye was stabbed.In desperation, he had no choice but to accompany his daughter to court. On the morning of December 31, the People's Court of Shangcheng District, Hangzhou made a verdict on the case: the claim was dismissed, and the litigation costs were borne by oneself.

Chen Jie couldn't believe his ears: on what basis did the court make the judgment? The court makes a judgment based on the medical appraisal. As for whether the medical appraisal is fair and correct, the court does not need and "has no right" to intervene (such as judging the case according to the "Medical Accident Handling Measures").It is reported that an important basis for the judgment of the Shangcheng District Court is the "Appraisal Opinion on Chen Jiani's Medical Events" provided by the Medical Malpractice Appraisal Committee of the First Affiliated Hospital of Zhejiang Medical University.The opinion concluded that the incident "is not a medical malpractice."

Chen Jiani is a second-grade student in a primary school in Hangzhou. In January 1994, due to right eye esotropia, she went to Hangzhou Zheyi Ophthalmology Clinic (then called the Ophthalmology Department of Zhejiang Medical First Hospital) and was treated by Dr. Chen Kaisui.After four years of treatment, there are certain results.In order to get a fundamental improvement in the right eye, she finally took off her glasses. On January 14, 1998, the parents adopted Dr. Chen's suggestion and performed corrective surgery on Chen Jiani's right eye. As usual, the hospital had a preoperative conversation with the family members, and signed a "preoperative conversation record", which clearly stated that Chen Jiani's right eye was operated on.

At noon on January 19, the day after the operation, Chen Jiani complained of pain in her left eye.Because both eyes were tied with bandages, and Dr. Chen who performed the surgery could not be found, the parents could not figure out the reason.The next day, during Dr. Chen's routine rounds, the parents raised a question: Could it be that the operation was done in the wrong place?Dr. Chen replied: "I can't remember clearly either. I'll talk about it after the gauze is removed." Unexpectedly, when the gauze was removed, it was discovered that Chen Jiani was stabbed in the left eye.According to the parents' recollection, Dr. Chen was stunned on the spot, explaining that he changed his mind temporarily on the operating table, and then left in a hurry with an excuse.

After the operation, Chen Jiani's right eye was still oblique, while her left eye was exotropic by 5 to 10 degrees.On the one hand, Dr. Chen, the chief surgeon of Zheyi Ophthalmology Center, admitted that it was wrong not to explain clearly to the parents that "changing the operation plan" before, during, and after the operation; It has been recorded and reported on the Internet", refused to admit that this was a medical accident, and refused to bear the corresponding responsibility. The hospital believed that what Chen Jiani was suffering from was "common esotropia and amblyopia". Therefore, the attending doctor proposed surgery to correct the eye position.Diagnosed again before the operation, Chen Jiani has a common esotropia of 15 degrees, the right eye is mainly squinted, and the left eye is fixated.At that time, it was planned to operate on the main squint eye (ie, the right eye).The operation was carried out as scheduled. Under general anesthesia, the chief surgeon found that Chen Jiani's eye was still 10 degrees esotropic, so he decided to operate on the left eye.The hospital also believes that with the eye diseases Chen Jiani suffers from, there is no question of which is a sick eye and which is a good eye.In the process of surgical correction, according to the different conditions of the patient and the experience of the surgeon, it can be done on the main squint eye, or on the fixation eye, or both eyes can be operated on.

In this regard, Chen Jiani's parents categorically denied the hospital's opinion.They told the reporter that Chen Jiani has been receiving diagnosis and treatment in Zheyi Eye Center for four years. The diagnosis has always been "right eye esotropia", and there has never been a diagnosis or record of "common esotropia" in the medical history.In addition, in the content of the preoperative conversation and the operation records, there is no statement that the surgical site is uncertain, nor is there any record of temporarily changing the surgical site.Even if it is indeed difficult to clarify the surgical site before surgery, the patient and family members should be informed of the change in the surgical site immediately after surgery.The parents also pointed out that the hospital had altered the preoperative conversation and operation records, changed the word "right" to "left" at the surgical site without permission, and changed "right eye strabismus" to "binocular strabismus" and even signed a letter five days before the operation. The word "left" also appeared on the anesthesia record.The behavior of the hospital has violated the medical service contract agreed by the two parties and violated the patient's right to life and health.

Due to repeated negotiations with the hospital to no avail, Chen Jie had no choice but to go to court with the hospital as Chen Jiani's legal representative, hoping that the law could seek justice for the 8-year-old girl.But I didn't expect such a result: not only did the hospital not make any compensation, it didn't even need to say an apology. The news that Xiao Jiani lost the lawsuit became a topic of discussion among Hangzhou citizens at the beginning of the new year. People expressed sympathy for Xiao Jiani's misfortune. Some people in the legal profession have analyzed the deep-seated reasons that led to the "Chen Jiani Incident" and that lies in the medical malpractice identification system that needs to be reformed urgently.

In response to the "appraisal opinion" made by the Medical Malpractice Appraisal Committee of Zhejiang No. Therefore, it is illegal and has no legal effect on the whole. Relevant people pointed out that the most urgent task is to reform the medical malpractice appraisal system as soon as possible, so that the medical malpractice appraisal committee can be separated from the medical and health departments. The Appraisal Committee appraises medical disputes. Unsupervised medical appraisal, no matter whether it is fair or not, always makes people angry and dissatisfied.This is the shortcoming of the medical appraisal black box operation, covering up and hiding, which is not only not good for patients, but also not very beneficial to the medical and health department itself.

"China Youth Daily" published a report by reporter Tang Yu on April 10, 1999: 22-year-old Chen Fang had a caesarean section in Xining First People's Hospital in 1993 due to dystocia.After she was discharged from the hospital, she developed symptoms such as waist and abdomen pain, swelling of her face and lower limbs, nausea, difficulty urinating, and painful urination.For the next four years, Chen Fang sought medical advice everywhere and was heavily in debt. Although she was diagnosed and treated in various ways, the cause was not found out. On April 8, 1998, Chen Fang was critically ill and was admitted to Qinghai Provincial People's Hospital. On the 28th, when the doctor of the provincial hospital performed the right ureter operation on Chen Fang, he found that: "There is a No. 4 suture in the outer rear of Chen Fang's right ureter, and the ureter was pulled and rotated in the horizontal direction, so that the local ureter was S-shaped. The ureter is obviously shifted to the midline due to the adhesion, the ureter is heavily watered, the wall of the ureter is cyanotic, and it is obviously thinned, showing fibrosis... The adhesion is as hard as a stone."

"The ureter was sewn" surprised Chen Fang's family.Because Chen Fang had never had an operation except for a caesarean section at Xining First People's Hospital four years ago. The operation records of the Provincial Hospital showed that due to the complete occlusion of the lower and intersegmental segments of Chen Fang's right ureter, the right ureter and right kidney had severe hydrops, resulting in left kidney disease, impaired renal function, and uremia. On June 6, 1998, Chen Fang was critically ill again, but the provincial hospital failed to rescue her, and died in the early morning of the next day.After Chen Fang died, she left her family a debt of 110,000 yuan, a 4-year-old daughter, and endless grief.

After Chen Fang's illness was found out, relatives approached the First People's Hospital of Xining City to negotiate.The person in charge of the hospital visited Chen Fang at the provincial hospital and made private comments. The opinions of the Technical Committee of Xining First People's Hospital on this matter are roughly as follows: 1. In order to rescue pregnant women and fetuses, the hospital performed caesarean section on pregnant women after conducting routine examinations, and did not conduct urine laboratory examinations, which is really a lack of work.However, the patient was in critical condition when he was transferred, and it is doubtful whether the patient had a history of chronic nephritis in the past. 2. The Urology Department of the Provincial People's Hospital removed the so-called "occluded and adhered ureter" during the operation and discarded it without pathological examination, which brought disadvantages to the identification work and caused some objections, making it difficult to conclude. 3. In view of the fact that the patient has a long course of disease and the fact that the provincial hospital has died for a long time, resulting in a poor economic situation, the hospital can give a one-time hardship subsidy of 5,000 yuan. On August 18, 1998, the Xining Municipal Health Bureau and the Municipal Medical Accident Appraisal Committee organized relevant experts to conduct an appraisal on "Chen Fang's medical dispute".The Municipal Medical Malpractice Appraisal Committee analyzed the appraisal opinion and concluded that: the Appraisal Committee and experts carefully analyzed and discussed the whole process of the patient Chen Fang’s multiple hospitalizations leading to her final death, and agreed that it was timely for the Department of Obstetrics and Gynecology of a city hospital to end childbirth by cesarean section. Correct, the mother was hospitalized for seven days, and the mother and daughter were safe and recovered.Since then, Chen Fang has been hospitalized for diagnosis and treatment in the Affiliated Hospital of Qinghai Medical College and the Provincial Hospital due to many diseases, and died.Appraisal Committee Appraisal Conclusion: It is not a medical malpractice. Chen Fang's family refused to accept the appraisal, and took Chen Fang's medical records to consult some domestic medical experts.Some experts believe that this conclusion is prevarication and prevarication, which obviously conceals the serious consequences caused by suturing the ureter, and is suspected of favoring the hospital.The Chen family has been complaining about this.Since then, the Provincial Medical Malpractice Appraisal Committee conducted an expert demonstration meeting, but did not form an appraisal conclusion. Chen Guolin told the reporter that if the provincial appraisal still cannot make a fair appraisal conclusion, they will use legal weapons to seek an explanation for Chen Fang's death. If only he could! On July 24, 1998, "Southern Weekend" published a report by reporter Du Weidong, introducing the unfortunate experiences of several women. Ding Guifang from Fuzhou City died on the operating table with her soon-to-be-born child. The family members were full of suspicion, but the hospital said it was not a medical malpractice. On March 13, 1998, Ding Guifang, who was five days past her due date, was admitted to the Fujian Provincial Maternal and Child Health Hospital to await delivery.Three days later, when the doctor performed a B-ultrasound examination on her, she found that the umbilical cord was stuck in the neck of the fetus.Under the advice of the doctor, Ding took two eggs fried in 30ml of castor oil by the hospital to induce labor.At 3:30 a.m. the next day, Ding's amniotic fluid ruptured naturally. An hour later, Ding Guifang suffered from abdominal pain, vomited blood, and profusely bled from her lower body. It took another hour before she was sent to the operating room. At 6:30, both mother and daughter died. After the tragedy, on April 17, the hospital issued a medical malpractice appraisal report, arguing that the direct cause of the death of the pregnant woman was acute respiratory and circulatory failure caused by acute amniotic fluid embolism, which was not a medical malpractice.The Fujian Provincial Department of Health agrees with this conclusion. Ding Guifang's relatives couldn't accept this result, and they raised many questions: Why did a tertiary hospital still adopt the outdated way of inducing labor by oral administration of castor oil fried eggs?After pregnant women took castor oil fried eggs, did the medical staff take necessary monitoring measures?After the maternal condition deteriorated, why didn't the medical staff send them to the operating room for rescue in time?Xie Hongming, the husband of the deceased, said: "The doctor decided to operate after the fetal sound disappeared. I don't believe that the hospital has no responsibility!" Xiong Zhaoxia, a laid-off female worker in Jingdezhen City, Jiangxi Province, has gone to court for cutting her ureter by mistake. On May 7, 1997, Xiong Zhaoxia was found to have a "chocolate cyst on the right ovary with severe adhesions", so she underwent surgery at Jingdezhen Second Hospital.During the operation, the doctor mistakenly cut off her ureter as a fallopian tube, which caused her to urinate frequently after the operation, her waist could not be straightened due to the ureter, her limbs were weak, her memory declined, and she suffered a heavy mental blow. The hospital admitted in the appraisal report that during the operation, "the left ureter was damaged after the cyst was taken out, and the loss was about 5 cm", "but remedial measures were taken in time after the discovery, and the operation was successful." After the operation, Xiong's "liver and kidney functions were normal." "Not a medical malpractice". Later, Xiong Zhaoxia went to the Zhongshan Hospital Affiliated to Shanghai Medical University for a reexamination at her own expense and learned: "The left kidney function is not good and hydronephrosis, and the left ureter is dilated." Xiong Zhaoxia is a laid-off worker. For several years, she has relied on working for a private boss to make ends meet.Due to the unsuccessful operation, she has been unable to take this job. On March 15, 1998, Xiong Zhaoxia filed a lawsuit with the Jingdezhen City Intermediate People's Court, demanding that the Municipal Second Hospital compensate a total of 300,000 yuan for various economic and mental losses. However, the medical appraisal "does not belong to medical malpractice", which doomed Xiong Zhaoxia's road to appeal. The hospital's perjury was exposed, but the appraisal results after two months turned around 180 degrees. Who is responsible?This is a complaint from a Beijing reader named Guo Ping to the press: What happened was like this: On June 2, 1995, my father was admitted to a hospital in Beijing because of stomach discomfort.Because the medical records he brought with him showed kidney disease, the doctor didn't do a comprehensive examination, thinking that it was just kidney disease and heart failure, so he was given the vasodilator drug niprena.Although my father passed black stool on the night of admission to the hospital, we told the doctor, but she ignored it, let alone did a test, and there was still no test the next day.On the morning of the third day, the doctor showed us the three sheets that had just been tested (no stool test) and explained to us: everything is getting better, it is not the late stage of uremia, and the next treatment is to add nutritional medicine.But at noon, my father passed out suddenly. The doctor didn't know why, so he called another doctor for consultation.At this moment, my father put the black stool on the bed again.Only then did the doctor test the black stool, and the test result was massive gastric bleeding.The doctor hastily stopped the infusion of the vasodilator nitroprusside and switched to blood transfusion.Because the blood transfusion was too fast, there were no medical staff present to observe the blood transfusion reaction, and the patient died of severe panting. The Ministry of Health stipulates that when transfusion blood must be observed to ensure safety.At that time, it was our family members, not the medical staff, who discovered that the patient was dying.We went to find the doctor, but the attending doctor had already gone home, and a young doctor was replaced. He was in a hurry, and the defibrillator was pushed and couldn't be activated.When rescuing, only do external compression, do not do artificial respiration.It is common sense that without artificial respiration, there is no hope of recovery at all (the medical record report provided by the hospital afterwards fabricated that artificial respiration was performed during the rescue, but it was finally clarified that it was not done). Afterwards, the hospital replied to our inquiry that we are first-class doctors and nurses, and we have not made any mistakes.In order to get justice, we had no choice but to sue in court. The court held its first court session. The focus of the problem was that we believed that the patient had black stools on the night of admission (same as the black stools on the day of death) and gastrointestinal bleeding, and the doctor did not test it. sky.In court, the hospital got many medical staff who were present and those who were not present to give false testimony, saying that the patient did not have a bowel movement at all on the night of admission.In this regard, the court had no choice but to invite the Medical Malpractice Appraisal Committee of the Beijing Municipal Health Bureau to make an appraisal. At the beginning of the appraisal meeting, the medical staff of the hospital still said that the patient did not have a bowel movement at all on the night of admission.But an old expert said after reviewing the medical records provided by the hospital, you said that the patient did not have a stool, so why did it record 300 mg of stool in the medical records?At this point they had nothing more to say. The facts have been clarified, proving that the family members did not tell lies.The experts also pointed out some other mistakes in the hospital, some of which our family members did not realize (the medical records provided by the hospital for the appraisal meeting were not allowed to be seen by the family members). At that time, we felt that the appraisal meeting was fair. Unexpectedly, nearly two months later, the appraisal results turned around 180 degrees. Not only was it not a medical accident, but the hospital had no fault at all.The conclusion of the identification avoids many substantive issues. For example, based on the record that there was no black stool on the afternoon of June 4 provided by the hospital, the identification concluded that there was black stool on the afternoon of June 4. There was no mention of the fact that there was a stool that night but no laboratory tests.The appraisal claims to be based on the principle of science and fairness, but where is science and fairness reflected? Based on this paper identification, the court ruled in the first instance: the hospital has no responsibility.We were not satisfied with this, but after the appeal, the court of second instance "upheld the original judgment".In the past two years, we have endured the pain of losing our loved ones, and we have traveled here and there in order to seek justice. We have lost a lot, but we are still going to appeal... Why do the family members of the patient have so many questions about the identification of medical malpractice? Judging from the current medical appraisal process, the family members of the patient cannot obtain the important evidence that can prove the hospital is at fault—the medical records, and the second is unable to know how the entire appraisal process is carried out.Since the appraisal committee is set up in the local health administrative agency, and its members are composed of experts from major local hospitals, the members of the appraisal committee will inevitably have inextricable relationships with the appraised hospital. Moreover, the hospital where the members of the appraisal committee are located may also be the next one. It became the hospital to be appraised, and the staff of the hospital to be appraised this time may also become members of the appraisal committee next time.Can this inevitable "mutual identification" give people a convincing conclusion?In the third case, who can appraise these "appraisal conclusions" and explain their authenticity? On March 8, 1999, when hundreds of millions of women were immersed in the joy of the festival, Wang Xiquan, the deputy general manager of Zhengzhou Baiwen Co., Ltd., who was once hailed by Zhengzhou as the "Xingzheng Female Model", was crying quietly.She told the reporter that the Zhengzhou Orthopedic Hospital performed discectomy on the third and fourth lumbar vertebrae without the consent of her and her family, leaving behind bone fragments, which made her permanently disabled. According to reports: On May 11, 1998, Wang Xiquan came to the Zhengzhou Orthopedic Hospital on Longhai West Road, Zhengzhou City for medical treatment. The doctor in charge, Duan Wanzhu, diagnosed Wang Xiquan as: herniated disc at waist 415, spinal canal stenosis and slippage, requiring surgery. On the morning of May 28, Zhengzhou Orthopedic Hospital performed surgery on Wang Xiquan.Before the operation, the first anesthesia was unsuccessful, and then the second anesthesia was performed, but the effect was still not good.During the operation, Wang Xiquan's thighs felt like they were electrified many times, causing cramping and unbearable pain.Amidst Wang Xiquan's screams, the operation took more than five hours. Twenty-four hours after the operation, the doctor asked the nurse to remove the catheter for Wang Xiquan and let her defecate and defecate on her own. However, her perineum, anus, and buttock muscles were tight, cold, and stiff, and her legs were sore and weak.During the recovery period after the operation, only a little bit of urine came out, and the stool had to be squeezed on the stomach by an escort, and one person used his hands to pull out from the anus.She suffered inhuman torture.The whole family reported Wang Xiquan's current situation to the doctor many times. The doctor said that it was due to anesthesia and he would recover soon. Wang Xiquan was asked to persist for a few days and pay attention to nutrition. Urinating and urinating again and again, pain again and again, torture again and again, suffering again and again.Wang Xiquan told the doctor again with tears in his eyes, but the doctor replied confidently: "The nerve may be stretched during the operation (referring to the operation), and it should be recovered slowly." He also boasted: "It can be recovered in three months." However, , Day by day, Wang Xiquan's health not only did not improve, but worsened. On August 10, 1998, Wang Xiquan left Zhengzhou Orthopedic Hospital with extreme pain and regret, and successively went to the First Affiliated Hospital and the Second Affiliated Hospital of Henan Medical University, Henan Provincial People's Hospital, the First Affiliated Hospital and the Second Affiliated Hospital of Henan Provincial Traditional Chinese Medicine Hospital , let the experts consult.Some experts also found that Zhengzhou Orthopedic Hospital had problems with the operation, but they didn't know the reason. They didn't dare to speak out in the medical certificate, but revealed some ambiguous things for the patient and his family to think about.The patient's relatives repeatedly asked to see Wang Xiquan at the Zhengzhou Orthopedic Hospital, but they were all turned away by the hospital. Wang Xiquan and his family returned with tears in their eyes.Three months later, the muscles of Wang Xiquan's buttocks and thighs were severely atrophied, and the muscles of his buttocks and thighs were stiff, causing pain like electric shock from needles. On September 7, 1998, Wang Xiquan was admitted to the Changzheng Hospital Affiliated to Shanghai Second Military Medical University.In Changzheng Hospital, after a series of examinations, Wang Xiquan was listed as a major operation, and underwent lumbar spinal canal exploration and decompression, osteograft fusion, and pedicle screw internal fixation. On September 21, 1998, Director Jia Lianshun, one of the most authoritative experts in the country and a specialist in cervical and lumbar spine at Changzheng Hospital, was operating on Wang Xiquan. 2 cm bone.It was this "excess bone" that made Wang Xiquan unable to live or die, ruined her health, and made her permanently disabled. What is even more puzzling is that Zhengzhou Orthopedic Hospital diagnosed Wang Xiquan with spondylolisthesis of the fourth and fifth lumbar vertebrae, but removed the three spinous processes and rear tissues of the third, fourth and fifth lumbar spine. stability. Wang Xiquan's husband, Wang Tiesuo, said: "Zhengzhou Orthopedic Hospital took people's lives for fun. I paid 13,466.36 yuan for their medical expenses (total medical expenses now amount to more than 150,000 yuan), and they spent 5 hours creating a medical accident. It was a tragedy." Faced with Wang Xiquan’s misfortune, on December 21, 1998, Zhengzhou Orthopedic Hospital issued an appraisal opinion: the patient’s current series of symptoms are considered to be cauda equina syndrome, which is common after lumbar 4 and 5 intervertebral disc removal. One of the complications...doesn't constitute medical malpractice. Wang Xiquan, who was lying on the bed, cried bitterly while holding this "appraisal opinion". She pointed to the last sentence of the first paragraph of the "appraisal opinion" with her trembling fingers and said: "The hospital is also talking nonsense. It said that I was 'cured and discharged on August 9th. ', really wicked!" Wang Xiquan's husband, Wang Tiesuo, said: "Why doesn't the 'appraisal opinion' mention the bone that was abandoned on my wife's body?" Why?Why?Only Zhengzhou Orthopedic Hospital knows the answer. The State Council's "Medical Malpractice Handling Measures" stipulates: "Medical malpractice refers to the negligence of medical personnel in diagnosis, treatment and nursing work, which directly causes death, disability, tissue and organ damage and dysfunction of patients." Wang Xiquan and his family members believe that Wang Xiquan became disabled after being diagnosed and treated at Zhengzhou Orthopedic Hospital, and the postoperative directly led to urinary and bowel dysfunction. Wang Xiquan's family, relatives, friends and more than 1,000 colleagues in the work unit were very dissatisfied with the "appraisal opinion" of Zhengzhou Orthopedic Hospital, and believed that the appraisal was an "incorrect conclusion." On February 12, 1999, Wang Xiquan's husband, Wang Tiesuo, sent the letter of appeal and relevant materials to the Zhengzhou Municipal Health Bureau, requesting a new medical malpractice appraisal.He said that he believed that the superior leaders would uphold justice for the people and deal with the medical accident fairly. 41-year-old Wang Xiquan is a strong woman. In the past 10 years, the hardware company she is in charge of has handed over more than 1 million yuan in profits to the country every year. She herself has been praised by provincial and municipal leaders many times. Zhengzhou City named her "Xingzheng Female Model" ", such a capable business leader, she was not exhausted by work, but she was permanently disabled by this incident that I don't know whether it is a medical accident... The disputes of medical malpractice identification caused by medical disputes have brought us deeper and unavoidable problems.Medical malpractice may happen no matter in a large hospital or a small clinic. If an accident occurs, the identification made by the Medical Malpractice Appraisal Committee recognized by relevant laws and regulations still cannot solve the problem. Why?Even if the appraisal made is fair and objective, patients or their family members often think that "your doctors and doctors take care of each other". Why do you have such a view? The black-box operation of the health administrative department "Yiyantang" has led to a crisis of trust in the identification of medical malpractice.