Chapter 27 3. Who has the final say on medical appraisal?

According to the Ministry of Health's "Explanation on Several Issues", the Medical Appraisal Committee "is the only legal organization for technical appraisal of medical malpractice in this region, and only its appraisal conclusions can be used as the basis for identifying and handling medical malpractice."This gives full authority to the identification conclusions. The appraisal conclusion is of great importance.It not only determines whether the patient can get compensation, but also sometimes determines whether the relevant person will be imprisoned or even executed.Patients expect the appraisal to be objective and fair, and they cannot bear all opaque confusion.

What confuses them more than this is that when they have objections to the conclusion and sue directly in the local court, due to the relevant judicial interpretation of the Supreme People's Court, the court only accepts the administrative litigation where the parties disagree with the medical malpractice decision made by the health administrative agency. , the prosecution court with objections to the appraisal conclusion will not accept it, and the patient can only turn to the higher-level medical malpractice appraisal committee for re-appraisal.For the same reason, this re-appraisal often makes the patient's family members have the understanding of "Lao Tzu's identification of sons", which is still unconvincing.People call for medical malpractice identification to increase transparency and move towards openness, fairness and justice.The uniqueness and finality of medical appraisal makes many people skeptical about this kind of fairness and impartiality - because after all, the health department has the final say.

23-year-old Yang Qiaoling died because she wanted to cure her mild underarm odor, which was not a serious problem.Her husband was in no way convinced that this was not a malpractice. On September 25, 1998, "Southern Weekly" published a report on the case by reporter Du Weidong: On the morning of June 6, 1998, Yang, accompanied by his sister, went to Shenzhen Bo'ai Hospital to treat underarm odor.The doctor Zhang who received the consultation said that this is a minor operation, and surgical excision or laser treatment can be used.Yang Qiaoling chose the latter. He entered the treatment room at 11:45, and about half an hour later, Yang's breathing and heartbeat stopped.The next day, the hospital transferred her to Shenzhen People's Hospital. On July 9, Yang Qiaoling, who had been in a coma for 32 days, died.

Yang's husband, Wu, volunteered to work in the Chengdu office of a company in Shenzhen. Both are from rural Meizhou, Guangdong.A few days before Yang's surgery, the couple were still talking on the phone about buying a house. Shenzhen Bo'ai Hospital did not admit that Yang's death was a medical accident, and believed that Yang's allergy to the anesthetic lidocaine was a medical accident.At the same time, the hospital also stated that it can pay more than 70,000 yuan to settle the matter at one time.Wu didn't want to be selfish without knowing it. On August 19, he received an appraisal conclusion from the Shenzhen Municipal Medical Malpractice Technical Appraisal Committee, which determined that it was not a medical malpractice.The Pok Oi Hospital no longer talks about "privacy".

Wu did not understand medicine, but he found that the medical records with the official seal of the hospital stated that the concentration of lidocaine used at that time was 5%, while the conclusion book of the Municipal Appraisal Committee stated that it was 2%. Is the 5% explained "purely a clerical error"? According to experts, two drugs are generally used for local anesthesia: pudocaine or lidocaine. The former requires a skin test, and the latter is used if there is a problem with the skin test.No skin test is required for lidocaine, but the blood needs to be withdrawn after the injection to prevent the drug from being injected into the blood vessels, which is required.Even if lidocaine is accidentally injected into a blood vessel and enters the heart, it will not be fatal under normal doses.The expert estimated that the cause of Yang's death was probably an overdose of drugs injected into a blood vessel.

Wu's attorney said that the hospital should bear two main responsibilities: first, the most important physical evidence, the lidocaine remaining that day, was thrown away by the hospital; second, the client, Dr. Zhang, did not have the qualifications to practice medicine in Shenzhen Qualifications, the hospital must be responsible for this. Whether it is the "Criminal Procedure Law", "Civil Procedure Law" or "Administrative Procedure Law", it is stipulated that the acceptance of identification shall be determined by the judicial department. To identify the authenticity, and finally decide whether to accept or not.However, the medical appraisal is still the final decision of the medical department, and whether it is right or wrong, it is a final decision, and even the judiciary has no room to speak.This neither conforms to the essence of the rule of law, nor can it convince patients.

An ordinary cryptorchidism operation turned a child into a vegetative state and brought endless disasters to him and his family. However, the medical appraisal concluded that this was a medical accident, not a medical accident. According to a report by Ran Duowen, a reporter from Legal Daily, on February 24, 1999: At 3:00 pm on August 26, 1997, Fu Qiang, a sick child who had just turned 8 years old, came to Shandong Yidu Central Hospital for a second-stage cryptorchidism operation.Normally, this kind of operation only takes about an hour to complete. However, two hours later, the surgeon Wang walked out of the operating room and told the anxiously waiting family members that the operation was successful and the testis was reset. It's time to ask the family members to wait patiently outside.Until 9:30 in the evening, the child's father, Fu Jinshan, was allowed to enter the operating room.Fu Qiang was lying flat on the operating table, his hands were twitching, his eyes were open, and his eyeballs were rolled upwards, motionless.The director of the anesthesiology department introduced to the family members: During Fu Qiang's operation, when the testicles were pulled down, the nerves were injured, which led to a sudden stop of breathing.After the consultation with the relevant director, a rescue plan was formulated. Don't wake him up tonight, claiming that this will protect the brain.

Unexpectedly, more than a month passed, and the child still hadn't woken up. Only then did the hospital feel that the child was in a coma, unable to speak, and a vegetable with paralyzed limbs. On March 25, 1998, the hospital issued a certificate to the family members stating that during the operation anesthesia, an anesthesia accident occurred, leading to respiratory and cardiac arrest, and causing cerebral vascular hypoxic damage.The family members of the sick child questioned: Fu Qiang’s operation performed in the hospital more than two years ago was successful, and there was no anesthesia accident. Two years later, the same doctor performed the same operation and used the same anesthetic. Why did an anesthesia accident occur? ?Why not routinely do allergy tests before surgery?The medical records and doctor's interview confirmed that Fu Qiang's earliest symptoms were respiratory arrest and a heartbeat of 40 beats per minute.The family members of the sick child went to Beijing, Shanghai, Jinan, Qingdao and other medical units to consult with experts, and the explanation they got was that it was caused by excessive anesthesia during the operation.Anesthesia overdose manifests as respiratory arrest first, followed by cardiac arrest; anesthesia accident manifests as both sudden arrests at the same time.Fu Qiang's symptoms were in line with the changes in vital signs caused by "overdose of anesthesia", which should be a medical liability accident.

The family members of the sick child reported the case to the Qingzhou Public Security Bureau on March 29, 1998. When the Public Security Bureau formed a special case team to investigate, they were accused by the hospital, saying, "This is an anesthesia accident. The anesthetist did not leave his post. The Public Security Bureau has no right to investigation". On November 24, 1998, the Qingzhou Municipal Medical Accident Technical Appraisal Committee (14 members of the appraisal committee, including 5 from Yidu Central Hospital and 5 from the Municipal Health Bureau) conducted an analysis and concluded that medical accidents are not Medical Liability Incidents.The family members of the sick child were dissatisfied with the appraisal conclusion, and then applied to the Shandong Weifang Medical Accident Technical Appraisal Committee for re-appraisal.

Wang Hualan, the sick child's litigation representative and a lawyer of Shandong Mingyun Law Firm, who has been in medical work for many years and represented more than ten medical dispute cases, said: "Through investigating the relevant evidence, I believe that Fu Qiang's disability It was caused by an overdose of anesthesia, and it was caused by the anesthesiologist leaving the post without authorization and failing to implement rescue measures in time." After the incident, what information is used as the basis for identification is the focus of controversy in this case.According to the relevant provisions of the criminal law, relevant departments should be entrusted with technical issues. In this case, the public security department entrusted the health department to appraise, but the health department refused to accept the commission, and the public security department has no appraisal power, which made the investigation of this case difficult.The identification is based on the information provided by both the doctor and the patient, and the patient has no medical records and other materials. All the information is provided by the hospital. The evidence is kept by the medical department and kept absolutely confidential. It is very difficult for the family members and parties involved to obtain evidence that is beneficial to them.In judicial practice, it often happens that hospitals alter, forge, and destroy original evidence, which makes it difficult for the court to justly identify evidence and make a fair judgment.

After the young couple fought, the wife was hospitalized and died on the operating table, and the husband was arrested.The eighty-year-old mother and 8-year-old Liu Shuai were left behind in the family, crying all day long, making a living difficult.This is a heart-wrenching incident that happened in Chunshui Township, Biyang County. Liu Aiting, Liu Shuai's aunt, recalled: On the morning of April 14, 1998, Liu Shuai's father, Liu Jinyou, and his wife, Sun Fengmei, got angry and got into a fight over trivial family matters.The next morning, Sun Fengmei told her husband that she had a dull pain in her abdomen.Liu Jinyou rode a motorcycle and took his wife to the Chunshui Township Health Center for medical treatment. The B-ultrasound examination revealed that there was blood stasis in the abdomen and needed surgery. Liu asked if surgery could be done here?The doctor Tian Shu said: If you can do it, you can do it for three to five hundred yuan.So, Liu Jinyou went through the admission procedures for his wife.The hospital designated Tian Shu as the chief surgeon. At 9:30 a.m. that day, Sun Fengmei walked into the operating room. The operation began at 9:50.It was only after Tian Shu opened Sun Fengmei's abdominal cavity that he realized that the major caesarean surgery required blood transfusion, but there was no blood at all in Chunshui Health Center.Under such circumstances, Chunshui Health Center asked Liu Jinyou to ride a motorcycle and take a health center worker to Banqiao Health Center, 22.5 kilometers away, to get blood at 10:30 am. After Sun Fengmei's abdominal cavity was cut open, she lay quietly on the operating table. Blood flowed out from the incision. Tian Shu had to ask someone to cover the incision with their hands. Because there was no blood supply, the operation was interrupted.In view of this situation, the patient's relatives and neighbors waiting outside the operating room were extremely anxious and offered to donate blood to the patient, but the hospital doctors ignored it.Sun Fengmei's own blood has basically drained on the operating table.It was not until 2:10 in the afternoon that three bags of blood were transfused from Banqiao Hospital, and the operation was able to continue.At 4:20 p.m., the operation ended, and Sun Fengmei was sent back to the ward.Due to the unsuccessful operation, the patient continued to bleed from the surgical incision, and his life was dying. Liu Jinyou urgently asked to continue the blood transfusion, but the doctor on duty at the hospital said that there was no blood, and did not take any remedial measures for the patient.Under the strong condemnation of the Liu family, Chunshui Health Center contacted Biyang County.At 9 o'clock in the evening, several blood sellers came from Biyang. The hospital didn't talk about blood type and disinfection at all, so they hastily drew half a glass bottle of blood and gave it to Sun Fengmei. After a few minutes, Sun Fengmei stopped breathing. At this time, Liu Jinyou who was present was immediately taken away by the criminal police who had been waiting here, and soon he was arrested on suspicion of intentional injury.The Liu family believed that it was just a traumatic oozing of the spleen, which was just a common operation, and this was a serious medical accident. On April 22, the autopsy report issued by the forensic doctor of the Biyang County Public Security Bureau showed that Sun Fengmei died of hemorrhagic shock due to spleen rupture and hemorrhagic shock caused by violent blows to the left abdomen. On May 26, the Biyang County Medical Accident Appraisal Committee issued an appraisal conclusion on the cause of Sun Fengmei's death: Sun Fengmei's death did not constitute a medical accident. The family members of the patient believed that this identification was "partial listening", "fabricated facts", "wrong conclusion", and that it was "the identification of my son by my father", and asked the Medical Accident Identification Committee of Zhumadian District to re-identify. On July 20, the Zhumadian District Medical Malpractice Appraisal Committee made a conclusion on this medical dispute: "Sun Fengmei's case does not constitute a medical malpractice." This means that it is not the hospital that is responsible for Sun Fengmei's death, but her husband - who will be sentenced for intentional injury.There are big differences and opinions among the family members. This is an identification of human life and nature, but it can only be determined by the health department. According to "Life Daily" reporter Yang Yi's report: On the day of 3.15 International Consumer Rights Protection Day, there were crowds of people in front of the Modern Mall Plaza. At about 9 o'clock, a young woman wearing a white vest with two large characters of "injustice" written on it cried and complained that her father died tragically on the operating table during the operation to remove a foreign body in the esophagus due to a denture stuck in his throat. Attract the attention of various media reporters. It is understood that the woman is from Handan City, Hebei Province. Her 59-year-old father, Zhou Xirong, accidentally dropped a denture into her throat while having breakfast on December 19, 1998, and rushed to a hospital in Handan City with her family. ENT visit. At 11:40, I went to the operating table without any preoperative examination. The operation was carried out until 1:00 pm without success.Zhou was speaking normally at this time.At 4:30 p.m., another operation was performed, and he died at 5:30 p.m.The death certificate presented by the hospital around 12 o'clock in the middle of the night stated that Zhou died of a "cardio-cerebrovascular accident." On January 18, 1999, the "Autopsy Report" issued by the Pathology Teaching and Research Office of the Municipal Medical College entrusted by the Handan Municipal Health Bureau showed that "no hemorrhage or space-occupying lesions" were found in the heart and brain of the deceased.At the request of the family of the deceased, on January 25, the hospital conducted a technical appraisal on the matter and concluded that "it does not constitute a medical accident."The family of the deceased refused to accept this, and applied to the Municipal Health Bureau for a second-level identification, which identified the accident as a "first-level medical technology accident." Both doctors and patients were dissatisfied with the results. Lu Yunduan, director of the Complaints Department of China Consumers Association, said that at present, according to the materials he has, it is irresponsible to issue a death certificate of "cardiocerebrovascular accident" issued by the hospital after the patient's death.Families have the right to know the real reason. Even if the court cannot overturn the identification of the Medical Appraisal Committee, can the Consumer Association seek justice for consumers?We place a big question mark here. "Southern Weekend" reporter Du Weidong reported on the medical disputes encountered by several "special people". . "I have been working on letters and visits for more than ten years, and finally it is my turn to write letters and petitions." As a cadre of the Letters and Calls Bureau of Mian County, Shaanxi, Liu Xinmin couldn't help laughing at himself: he encountered a medical dispute, but he had no choice but to use the "appeal" experience". On July 24, 1998, Liu Xinmin's 25-year-old daughter, Liu Xiaoju, suffered a "sudden convulsion" (the hospital said it was "cardiac arrest") during an infusion in the People's Hospital of Hanzhong City, Shaanxi Province. She died after 33 days in a coma. The hospital believes that this is a medical accident, not a medical accident.Liu Xinmin refused to accept it, and he sent complaint materials to various relevant central and local departments.After the instructions of relevant provincial and municipal leaders, the Hanzhong City Health Bureau sent an investigation team to investigate the matter. On January 7, 1999, a report was confirmed: none of the seven major doubts raised by the family members was established, and there were only "some unsatisfactory problems" in the diagnosis and treatment process. place". Gao Yulin of the Complaints Department of China Consumer Daily is also complaining frequently about her own misfortune. On March 9, 1998, her 77-year-old father Gao Yunlong "died suddenly" in the Jiangxi Provincial Hospital for the Elderly.The family believed that the cause of death was improper infusion and blood transfusion in the hospital.The hospital believes that Gao's father's death is "irreversible". On October 7, 1998, Gao's "China Consumer News" reported the case in detail. Gao Yulin believes that the Provincial Appraisal Commission "finalized the case at first instance" without the appraisal by the Municipal Appraisal Commission, which does not conform to the appraisal procedures stipulated in the State Council's "Measures for Handling Medical Accidents".For this reason, she first sued the Jiangxi Provincial Health Department, and then she plans to sue the hospital. It is so difficult for those who deal with complaints to cry out for injustice. You can imagine what happened to ordinary people. There is something more embarrassing than this - doctors are also on the road to medical malpractice complaints.A year ago, Dr. Shi Xiaomin from Beijing Haidian District Hospital had his thyroid "mistakenly removed".She and her husband, Professor Qian, a doctoral supervisor at Peking University, have not written an article since then, and have been complaining. As the highest level of the three-level appraisal of medical malpractice, on June 8, 1998, the Beijing Municipal Medical Malpractice Appraisal Committee issued an appraisal report, admitting that Shi's "thyroid gland was removed by mistake", but also said that her thyroid gland was located in the midline of her neck "It is really rare" and "does not belong to medical malpractice". Dr. Shi retorted: "Ectopic thyroid is a common phenomenon in medicine, and it is not rare at all. Is there any statistical basis for what the 'Appraisal Committee' said?" According to Du Weidong, a reporter from Southern Weekend, on June 13, 1997, Shi received an expert examination at the Stomatological Hospital of Beijing Medical University. The expert said, "There is a tumor under the right jaw." They asked her to be hospitalized for surgery.The operation was performed six days later, and she didn't know until a few days after the operation that the doctor removed the "ectopic thyroid gland". "I will have to rely on drugs to maintain my life." As a doctor, she immediately understood the serious consequences of the incident. On July 28 of the same year, the Stomatological Hospital of Beijing Medical University made a medical appraisal opinion, admitting that "surgical extirpation objectively affects the patient's physiological function to a certain extent, but it can be treated effectively", and concluded that it was a "medical accident".Shi refused to accept this. On March 25 this year, the Beijing Haidian District Medical Malpractice Appraisal Committee identified that "after the operation, the patient developed hypothyroidism", but it was not a medical malpractice. Combined with the opinions of the Municipal Appraisal Committee, Shi asked: "Why did the three reports never mention whether the doctor misdiagnosed, nor did they make a judgment on the nature of this key issue?" Now Shi Xiaomin's monthly medical expenses and examination fees are about 500 yuan, all of which are at his own expense. "The scariest thing is the trauma of the soul. When I see a patient, I am terrified, and I am afraid that I will be a quack doctor and mislead others." Shi Xiaomin said. The couple wanted to file a lawsuit, but they were faced with a dilemma: to file a civil lawsuit, the conclusion of "medical accident" must be recognized, and how likely is it to file an administrative lawsuit to overturn the conclusion of the Appraisal Committee?