Chapter 26 2. Appraisal through confusion

Lei Zucheng did not expect that his wife would die in the hospital because of giving birth to a child, nor did he expect that he would go to court to sue the doctor for this. On the evening of September 21, 1997, he sent his wife to the health center of Shixing County Suburban Management District to wait for the delivery. His wife died in the early morning of the next day. At that time, the rural doctor Rao examined the mother and found that the heart, lungs and fetal heart sounds were normal, and the cervix had been dilated by 6 cm, so he went upstairs because "the fetus was not delivered so quickly." Around 1:20 a.m. on the 22nd, the pregnant woman experienced frequent abdominal pains, and Lei Zucheng immediately asked for forgiveness to come downstairs.After Rao's examination, 10 units of oxytocin were injected to the parturient. At 1:33, the mother gave birth to a baby boy.The procedure went smoothly and there was not much bloodshed.After a while, Rao pressed the parturient's abdomen with one hand, and pulled out the broken end of the umbilical cord wrapped around the placenta with the other hand.The mother screamed in pain.Not only did Rao not stop, but he also asked the assistant who dressed the newborn to press the mother's abdomen, and asked the mother to put her hand into the throat to cause nausea, so as to increase abdominal pressure and promote the expulsion of the placenta.The mother still complained of pain, and Rao said consolingly, "The placenta will come out soon." At 2 o'clock, the assistant saw that there was too much bleeding (about three bundles of toilet paper were used), and proposed to send her to the hospital.But Rao didn't express his opinion, and continued to pull.The mother was already pale and asked to rest.Rao said: "It has been going on for more than an hour, don't stop." At about 2:40, Rao pulled out an oval lump from the parturient's vagina.Rao picked up the lump and looked at it repeatedly, and then yelled: "I don't know what it is, send it to the hospital." So, he took a pair of maternal trousers, wrapped the lump, and took it to Shixing County People's Hospital by tricycle obstetrics.During the delivery, the mother remained unconscious and her vagina was still bleeding.

Sent to the hospital, after inspection, it was acute uterine prolapse, postpartum hemorrhage, hemorrhagic shock, and placental adhesion.Although the whole hospital mobilized its strength and tried its best to rescue her, the mother died at 6:30 because of disseminated intravascular coagulation and heart, brain, kidney, and respiratory failure caused by severe hemorrhagic shock. Lei Zucheng was very sad, and believed that Rao was responsible for his wife's death, and asked Rao to bear the economic losses caused by his wife from the time she was about to give birth to her death, and compensate the living expenses of raising her parents and children.

The Medical Accident Technical Appraisal Committee of Shixing County accepted the dispute, and believed that the accident was a first-class medical accident, mainly a liability accident, and also a technical accident.Because Rao made several mistakes: 1. It is inappropriate to use oxytocin when the cervix of the parturient has been dilated by 6 cm; Leaving the parturient, and the whole process did not measure blood pressure, and did not record the labor process; 3. Improper handling of the third stage of labor, excessive stretching of the umbilical cord and squeezing the parturient's abdomen, resulting in acute uterine prolapse and postpartum hemorrhage, making the parturient's rescue ineffective Died; 4. When the assistant suggested sending her to the hospital and the mother asked to take a break, she did not stop pulling the umbilical cord and squeezing the abdomen, and did not send her to the hospital in time, which resulted in two lost and delayed rescue opportunities; 5. Insufficient understanding of the concept of shock , When the puerpera was in shock, no treatment measures were taken, nor was it transferred to the hospital in time, which delayed the timing of rescue.Therefore, it was ruled that Rao should bear all the medical expenses and medical malpractice appraisal fees used by the puerpera, and compensate Lei Zucheng 20,000 yuan in one lump sum, totaling 23,746 yuan.

But Rao refused to accept it, and on November 10, 1997, he submitted an application for re-appraisal to the Shaoguan Medical Malpractice Appraisal Committee.According to the medical history, physical examination and supporting information, the identification committee believed that the main cause of the patient's death was hemorrhagic shock.Mr. Rao mishandled the third stage of labor. Under the condition of increasing abdominal pressure, he forcibly pulled the umbilical cord, which caused the uterus to protrude, aggravated postpartum hemorrhage, and caused death from hemorrhagic shock.It is concluded that this incident is a "level one technical accident".This basically negated the conclusion of the Shixing County Appraisal Committee. Lei Zucheng was very dissatisfied and applied for re-appraisal to the Provincial Medical Accident Technical Appraisal Committee. On August 26, 1998, the conclusion of the Provincial Medical Malpractice Appraisal Committee overturned the conclusion of the Shaoguan Municipal Medical Malpractice Appraisal Committee, and believed that this was a first-level liability accident, and the responsible person was Rao.

This repeated again and again, not to mention making Lei Zucheng puzzled, and even us confused. According to Gao Xiaoyan, a Beijing-based reporter from Southern Weekend, reported on September 18, 1998: At the end of August 1998, the Letters and Calls Bureau of Yutian County, Hebei Province formally notified Liu Weixing and Liang Shulan that they could not meet their requirements for the identification of their grandson Liu Xiaoxiao's medical accident and suggested that they go to justice path solves this problem.So far, their journey of petitioning has come to an end. They said in the materials distributed: grandson Liu Xiaoxiao, born in 1993, only meowed like a kitten when he was born, and he didn't like to cry very much after that.They thought the child was very well-behaved and didn't take it seriously. Later, they found that the child was later than other children in everything and could not walk after one year old. They became anxious and took the child to Beijing University Hospital for treatment.The doctor asked them to go back and ask the midwife doctor about the situation of the child during delivery.The midwife doctor Li Chunyan "opened the medical records and blurted out: 'Oh, it's really suffocation in the uterus, and the fetal heart sounds are 100 beats per minute.'" Liu Weixing and his wife also saw the fetal heart sounds 100 beats per minute on the medical records.At their request, Li wrote a note introducing the birth of the child.

When Liu Xiaoxiao was two years old, he could walk, but he couldn't speak.They went to Beijing to see a doctor again. "Experts still agree that the child is a 'sequel of hypoxic-ischemic encephalopathy'." The expert also asked about the length of hypoxic time, and said: If the time is short, the child is more likely to recover, otherwise it will be difficult to recover. They went to the county hospital to inquire about the time of hypoxia, "but the county hospital used the excuse of not being able to find the medical records, and did everything possible not to tell us." In this way, they embarked on the road of suing.

The County Health Bureau quickly issued a report, which stated: Regarding their grandson’s mental retardation, the county hospital’s reply believed that “the diagnosis was correct, there was nothing wrong with the treatment and operation, and there was no intrauterine asphyxia in the fetus. The county hospital has nothing to do." The appraisal conclusion of the Tangshan Medical Malpractice Technical Appraisal Committee is "does not constitute a medical malpractice".They refused to accept it.Half a year later, the Hebei Provincial Appraisal came down, and the conclusion was still "does not constitute medical malpractice."

Liu Weixing asked the county party committee and the county government to answer 16 questions on the grounds that the hospital "modified the medical records."The County Bureau of Letters and Calls took the lead in organizing a task force to conduct an investigation, and replied on June 8, 1998: "During the process of adjusting and checking the original medical records, no traces of revisions and additions were found, reflecting that the medical records proposed by the person were not true and could not be identified." Reply According to the regulations of the Ministry of Health, the investigation team cannot provide the respondent with original medical records.

They were stunned when they got this answer: everything they saw was not recognized, and they couldn't accept the fact that it was recognized. Who is playing tricks on people?They repeatedly compared Li Chunyan's note, the county hospital's report to the China Consumers Association, the conclusions of the county task force, and the provincial and municipal appraisals, and found many "doubtful points" from them. : 1. The hospital violated the routine of obstetrics and gynecology, and performed artificial rupture of the membranes for trial labor; 2. The hospital violated the routine of diagnosis and treatment of "disproportionate head and basin" and banned oxytocin, and abused oxytocin to cause fetal distress, reducing fetal heart sounds to 100 times / min; 3. The hospital violated the obstetrics and gynecology department’s diagnosis and treatment routines for immediate termination of fetal distress delivery, resulting in severe fetal hypoxia for a long time; 4. The doctor not only did not carry out key observations and remedies for high-risk infants with severe hypoxia before delivery , Instead, ask the family members to take the high-risk baby home.

But another logical system is very simple and clear: "The child's mental retardation has nothing to do with intrauterine asphyxia! The provincial and municipal two-level appraisal should be the final conclusion, and it is a definitive result." Are there two "facts"?Both sides have found a set of logic and facts to justify themselves, and it seems reasonable to stand on either side.But the problem now is that the child Liu Xiaoxiao is indeed mentally retarded, and the possibility of intrauterine asphyxia cannot be ruled out, and the hospital's various rhetoric provided Liu Weixing with something to draw the conclusion of "intrauterine asphyxia".On the other hand, because there was no detailed record of the production process, Liu Weixing could not produce enough evidence to convince the court.When the child was born, no one thought about the future entanglements. The twenty-ninth day of the twelfth lunar month was forgotten and dusted in a corner of history. Only God knows what happened.

At 9 a.m. on May 6, 1998, the People's Court of Yunyan District, Guiyang City, Guizhou Province opened a court session to hear a case of compensation for human organ damage, which is rare in the country. According to the report of "Guizhou Metropolis Daily" reporter Yang Tonghe and others, the plaintiff's claim for re-appraisal of the plaintiff's organs for civil compensation caused by the autopsy involved Zhou Yuexiang, a worker at the Guizhou Rubber Shoes Factory, and the autopsy party was Guiyang Medical College. In the affiliated hospital, the husband of the deceased, Yang Xiulong, and his mother, Yang Wenlian, demanded the return of the heart, lung, liver, spleen, stomach, uterus, kidney, brain tissue and other internal organs "lost" after the autopsy, and demanded compensation of 30,000 yuan. On November 16, 1997, Zhou Yuexiang, who was 10 months pregnant, felt abdominal pain and was sent to Guizhou Provincial People's Hospital for treatment. The diagnosis result: the pregnant woman had premature rupture of membranes and needed emergency admission.The next day, a completely healthy baby was born, but 15 minutes after delivery, Zhou Yuexiang had a postpartum hemorrhage at 17:15. At 18:35, the family members received Zhou Yuexiang's death notice, which stated: The cause of death was placental adhesion, implantation, postpartum hemorrhage, and cardiopulmonary failure... According to Zhou Yuexiang's various signs after giving birth, the family members believe that Zhou Yuexiang's death is related to the fact that some doctors on duty in Guizhou Provincial People's Hospital left their posts and failed to carry out emergency rescue in time.According to the consultation: postpartum hemorrhage, as long as the rescue is timely, the consequences of maternal death can be avoided, and the worst result is hysterectomy, so they think this is a medical liability accident, and they decided to seek an explanation for Zhou Yuexiang's death. At 4:00 p.m. on November 19, 1997, the family members asked the hospital for an autopsy, and the hospital agreed.The autopsy was carried out by the Affiliated Hospital of Guiyang Hospital at 7:00 pm on November 19, but no forensic doctor was invited to the scene.To be on the safe side, Yang Xiulong invited the vice president Chu Xianyuan, chief physician Tao Fusheng, and Dai Yang of his unit Guizhou Fertilizer Factory Workers' Hospital to attend the autopsy at the Affiliated Hospital of Guiyang Medical College.Before the autopsy, three physician representatives from the Guizhou Chemical Fertilizer Factory were told: "You can only watch the autopsy site, you cannot sign the autopsy records, you cannot express your opinions, and you cannot take pictures." The autopsy ended at 9:00 that night. After the autopsy, three doctors from Guizhou Chemical Fertilizer Factory accepted the investigation by Zhang Qichun, Yang Xiulong’s special entrusted agent, and proved that all internal organs in the corpse were normal except for the yellow liver and gray intestinal wall, and there was 13×11CM placental tissue left in the deceased’s uterus. ...all symptoms seemed to support the diagnosis of postpartum haemorrhage.However, the autopsy report issued by the Affiliated Hospital of Guizhou Medical College on December 12, 1997 determined that Zhou Yuexiang's cause of death was pulmonary amniotic fluid embolism. Pulmonary amniotic fluid embolism is a disease that rarely occurs in puerpera. In clinical practice, even if medical personnel carry out timely rescue of this disease, the result of maternal death is difficult to avoid.This diagnosis completely overturned the clear cause of death diagnosis in the death notice issued by Guizhou Provincial People's Hospital: placental adhesion, implantation, postpartum hemorrhage, and cardiopulmonary failure. The family members of the deceased raised questions immediately, and believed that your hospital deliberately concealed the fact that there was a placenta in the uterus, and pointed out that your hospital fabricated the deceased’s progressive dyspnea three hours after delivery to be in line with the diagnosis of amniotic fluid embolism. Shirk responsibility for medical malpractice.The family requested another autopsy. On December 12, 1997, the day when the Affiliated Hospital of Guizhou Medical College issued the autopsy report, Zhang Qichun, Yang Xiulong's authorized agent, immediately sent a lawyer's letter to the Guizhou Provincial Department of Health, raising objections to the autopsy report, and clearly proposed to redo the autopsy and take new specimens. Send out-of-province application for verification of cause of death. On January 6, 1998, when the forensic doctor went to the Affiliated Hospital of Guizhou Hospital to prepare for the autopsy, he was rejected. Later, under the coordination of the Provincial Health Department, Zhou Yuexiang's body was returned to the family of the deceased on January 7, and the family of the deceased immediately moved the body to Guiyang. City funeral home.On January 8, forensic doctor Liu Kailai and technician Yu Wenjiu from the Guiyang Municipal Public Security Bureau went to the funeral parlor to take samples for autopsy and found that all internal organs, uterus, and brain tissue were not in the body, making autopsy impossible.Why did the internal organs of the deceased disappear?The family members found your affiliated hospital, but the other side did not give any answer. Thus, a rare case of returning viscera took place.The indictment of the party concerned, Yang Xiulong, stated that: the Affiliated Hospital of your hospital illegally occupied the internal organs of the deceased, artificially created obstacles to the autopsy, prevented the extraction of specimens for re-verification, and was suspected of concealing the truth, which was another heavy burden to the family of the deceased besides the pain of losing their loved ones. hit.He demanded that the Affiliated Hospital of your hospital return Zhou Yuexiang's human organs in full, and bear the corresponding transportation expenses, lost wages, mental damage and legal costs of about 30,000 yuan. Yunyan District People's Court formally accepted the case. So far, the Affiliated Hospital of your hospital has admitted that the deceased's organs have been made into "pathological specimens" for preservation.However, the Affiliated Hospital of Guizhou Medical College believes that during the autopsy process, in accordance with the relevant regulations promulgated by the national health administration, it has the right to retain the organs of the corpse to make pathological specimens for diagnosis and research purposes.Since autopsy needs to select a certain amount of tissue from certain organs to make pathological specimens, it is difficult to maintain the integrity of the organs, and it is impossible to return the organs of the deceased. On May 6, the Yunyan District Intermediate People's Court held a hearing on the "Return of Corpse Organs Case" as soon as the news was reported by the local media, it immediately attracted the attention of the legal, medical and press circles.The defendant believed that according to the autopsy rules and the Ministry of Health's approval to the Jilin Provincial Health Department regarding the handling of autopsy organ specimens, your hospital has the right to handle it on its own.What's more, if the family of the deceased had a medical dispute with the provincial doctor, the specimen can only be properly preserved by a special person designated by the autopsy unit according to the medical malpractice treatment method, and it is impossible to return it to the family of the deceased. The family members of the deceased did not understand that the organs of their loved ones were gone if they said they were gone. Is there any reason for this?If the organs are lost, re-autopsy will be even more difficult.