First, the reporting and investigation system of medical accidents.
(A) the reporting system
Article 13 of the Regulations on the Handling of Medical Accidents stipulates: "If medical personnel have or find medical accidents, medical negligence or medical accident disputes that may lead to medical accidents in medical activities, they shall immediately report to the person in charge of their department, and the person in charge of the department shall promptly report to the department or full-time (part-time) staff responsible for monitoring the quality of medical services in this medical institution; After receiving the report, the department responsible for monitoring the quality of medical services or full-time (part-time) personnel shall immediately investigate and verify, truthfully report the relevant situation to the person in charge of the medical institution, and inform and explain the patient. " Article 14 stipulates: "In the event of a medical accident, a medical institution shall report to the local health administrative department in accordance with regulations. In case of the following major medical negligence, the medical institution shall report to the local health administrative department within 12 hours: (1) Causing the patient's death or possibly causing a medical accident above Grade II; (2) Causing personal injury to three or more persons; (3) Other circumstances stipulated by the health administrative department of the State Council and the health administrative departments of the people's governments of provinces, autonomous regions and municipalities directly under the Central Government. " It is clearly stipulated that medical accidents or incidents should be reported immediately because: 1. After a medical accident or incident, we should minimize the adverse effects of the accident or incident on patients. Report to the superior doctor or administrative leader immediately, so as to organize forces in time and take active and effective remedial measures to reduce the final consequences of accidents or incidents. 2. Mastering first-hand information and evidence is the premise of accurately identifying and judging the nature of medical accidents or events. This requires medical units to properly keep all kinds of original materials related to medical accidents or incidents and seal up the site to prevent responsible personnel from altering, forging, concealing or destroying the original materials or damaging the site and articles. Only by reporting immediately, it is possible for the medical unit to send personnel to keep all kinds of materials needed to find out the case in time and seal up and keep the scene, so as to avoid some situations that are not conducive to the identification and handling of medical accidents or incidents. 3. After a medical accident or incident, medical units and patients or their families often have disputes over the nature and causes of the accident or incident, and it is difficult to unify their understanding, so technical appraisal or autopsy is needed. Only by reporting immediately can the medical unit investigate and deal with it in time, especially for fatal accidents or events, which can be used for timely autopsy to ensure the accuracy of autopsy results.
(2) Investigation and handling
The Regulations on Handling Medical Accidents stipulates: "Article 36 After receiving a report from a medical institution about a major medical negligence, the health administrative department shall not only order the medical institution to take necessary medical treatment measures in time to prevent the damage from expanding, but also organize an investigation to determine whether it belongs to a medical accident; If it is impossible to determine whether it is a medical accident, it shall be submitted to the medical association responsible for the technical appraisal of medical accidents in accordance with the relevant provisions of these regulations. " After a medical accident or incident occurs, patients and their families may also ask the medical unit to investigate and handle it. This regulation takes into account that the medical staff involved may not report immediately or truthfully in order to conceal the facts and evade their responsibilities, which will lead to the result that it is not conducive to protecting the legitimate rights and interests of patients and their families.
Second, the custody and preservation of various materials and objects.
Article 8 of the Regulations on Handling Medical Accidents stipulates: "Medical institutions shall write and properly keep medical records according to the requirements stipulated by the health administrative department of the State Council. If the medical records cannot be written in time due to the rescue of critically ill patients, the relevant medical personnel shall make up the records according to the facts within 6 hours after the rescue and record them. " Article 9 stipulates: "It is strictly forbidden to alter, forge, conceal, destroy or rob medical records." Article 16 stipulates: "In the event of a medical accident dispute, the discussion records of death cases, difficult cases, superior doctors' rounds, consultation opinions and course records shall be sealed and unsealed in the presence of both doctors and patients. Sealed medical records can be copied and kept by medical institutions. "Article 17 stipulates:" If blood transfusion, blood transfusion, injection, drug abuse, etc. Suspected of causing adverse consequences, both doctors and patients shall jointly seal and unseal the on-site physical objects, and the sealed on-site physical objects shall be kept by medical institutions; If inspection is needed, both parties shall jointly entrust an inspection agency with inspection qualification according to law to conduct inspection; When both parties cannot make an appointment at the same time, it shall be designated by the health administrative department. "
Medical units that have medical accidents or incidents should do the following work:
Preservation of medical records
Medical record is a comprehensive and true record of the patient's health status, the occurrence, development, prognosis, diagnosis and treatment methods and treatment effects for the purpose of treating diseases. Medical records are very important raw materials. Under normal circumstances, it is of great significance to directly judge whether there is a diagnosis and treatment fault in the medical process, which is of great significance for correctly handling medical malpractice disputes. After the occurrence of a medical accident, the medical unit shall immediately designate a special person to keep the medical records, and it is strictly forbidden for anyone to alter, forge, conceal or destroy them. When medical staff think it is necessary to write down or supplement medical records, they can only write another course record. Sealed medical records are naturally secret, and no one can borrow them except the relevant leaders responsible for handling medical accidents, medical accident appraisers or judicial personnel who have access to them. If you need to discuss medical records, you should designate a special person to be responsible for recording and sorting, and you should not be scattered or lost.
(2) Physical storage and retention on site
Physical object refers to all suspicious physical evidence that has been used before causing adverse consequences to patients. Such as medicines, blood transfusion and transfusion residues, containers and other appliances. If it is a medical accident or incident caused by drugs, be sure to take good care of the empty ampoules or objects; In case of death accident or incident due to blood transfusion or infusion, it is necessary to immediately find out the evidence of the collection process, send the residual liquid for inspection in time, and properly seal the original packaged liquid medicine until the medical accident is solved; Medical accidents or incidents caused by various instruments and equipment (such as the death of patients due to electric knife leakage, or the burn of patients due to electric plate leakage of ECG machine, etc.). ) must be inspected by specialized personnel at the scene and recorded before leaving the scene. Judging whether it is a medical accident is mainly based on autopsy results and medical history data. Therefore, the significance of scene preservation is not as great as that of criminal cases or traffic accidents. Generally speaking, after the patient dies, the relevant personnel will sort out and record the body at the scene, and then move it to the morgue for safekeeping for autopsy. For those cases that obviously do not belong to medical accidents, such as suicide or suspicious homicide during hospitalization, in order to exclude the medical responsibility of medical units, they must also be handled carefully; If the patient has died and does not need to be rescued, the medical unit shall try to keep the scene and shall not move the body before the public security organ conducts on-site investigation; If the patient still has the hope and possible conditions for rescue, the medical unit should immediately organize personnel to rescue the patient.
Third, the way to deal with medical accidents
According to the spirit of the new Regulations on Handling Medical Accidents, there are three ways to deal with medical accidents:
First, both doctors and patients should negotiate and solve it by themselves; Second, the health administrative department to solve; The third is to solve it through litigation. The order of these three methods can neither be reversed nor parallel, but there is a sequence, that is, first, it is solved by both doctors and patients through consultation; Secondly, it is handled by the health administrative department; Once again, it will be accepted and resolved by the people's court.
(1) Both doctors and patients should negotiate to solve the problem.
It is an effective way to resolve medical malpractice disputes through self-negotiation between doctors and patients. In some medical malpractice disputes, although there may be some serious adverse consequences (such as patient death, disability, etc. ), except for a few cases, most of the adverse consequences of medical accidents or incidents belong to the category of tort civil liability, and legally belong to the dispute of civil rights and obligations. In medical accidents or disputes, some are medical accidents that require medical units to bear civil liability, while others are not. Of course, there is no question of letting medical units bear civil liability. Therefore, as long as medical units and patients and their families adhere to the principle of seeking truth from facts, on the basis of clarifying facts and distinguishing right from wrong, it will not only help both sides understand each other, but also reduce mental losses; It can also reduce unnecessary administrative processing and litigation procedures and save manpower, material resources and financial resources. This will ultimately help to solve medical malpractice disputes in time and safeguard the legitimate rights and interests of both doctors and patients. In practice, doctors and patients resolve medical malpractice disputes through self-consultation, which generally takes two forms: one is that the legal representative of the medical unit (usually the person in charge of the unit) comes forward to negotiate with patients and their families, or the legal representative of the medical unit authorizes the members of the unit to negotiate as agents; The other is to resolve medical malpractice disputes through non-litigation mediation and negotiation. The so-called non-litigation mediation refers to the legal adviser of the medical unit involved in handling medical malpractice disputes, based on facts and laws, persuading and mediating both parties realistically, promoting voluntary consultation between doctors and patients, and solving medical malpractice disputes fairly and reasonably. In mediation, legal counsel should not be partial to any party, especially to avoid blindly standing on the side of medical units to harm the legitimate rights and interests of patients. Non-litigation mediation involves lawyers as legal advisers, which is more conducive to solving medical disputes fairly, legally and promptly. Because lawyers are familiar with relevant laws and understand the business and technical equipment conditions of medical units, it is easiest to grasp the crux of the contradiction between doctors and patients and their psychological activities. Therefore, in a certain sense, this form is more likely to mediate directly than the legal representative of the medical unit, and the solution effect is more ideal. In particular, the principle of giving consideration to the interests of the state, the collective and the individual must be adhered to in resolving medical disputes through self-consultation. If this principle is violated, the result will be harmful to the legitimate rights and interests of the state, the collective or the individual, and this self-negotiation solution will be invalid, so the state will intervene to safeguard the legitimate rights and interests of the injured party.
(two) the administrative department of health.
Medical malpractice disputes shall be negotiated by medical units and patients and their families themselves. If no consensus can be reached on the confirmation (i.e. qualitative) and handling of medical malpractice, it shall be identified by the local medical malpractice technical appraisal committee, and then handled by the health administrative department. The administrative department of health is the functional organization of the state, and its task is to implement the principles and policies of the party and the government in health work and ensure people's health. To this end, health departments at all levels are responsible for leading national and local health work, formulating development plans, formulating relevant laws and regulations, and supervising and inspecting the implementation of health work principles and policies. According to the Constitution of our country and the organic laws of governments at all levels, the national health administrative institutions are set up according to administrative divisions. The central government has the Ministry of Health, provinces, autonomous regions and municipalities directly under the Central Government have health departments (bureaus), regions (cities) and autonomous prefectures have health bureaus, and counties (cities and municipal districts) have health bureaus (offices). These all belong to the health administrative institutions under the people's governments at all levels. The health administrative department's handling of medical malpractice disputes has the dual nature of administrative mediation and legal arbitration. On the basis of insisting on taking facts as the basis and taking law as the criterion, the health administrative department persuades and educates both parties to reach an agreement to solve medical disputes, which has the nature of administrative mediation; At the same time, the decision made by the health administrative department also has legal effect. If both parties fail to raise objections to the decision within the statutory time limit, apply for reconsideration to the health administrative department at a higher level, or bring a lawsuit to the local people's court, then the decision will become legally effective and all parties (including any party) shall implement it. If one party fails to perform the relevant obligations in the decision, the other party may apply to the people's court for compulsory execution.
(3) Litigation settlement
The so-called litigation settlement refers to the settlement of medical malpractice disputes through the trial of the people's court. Litigation reconciliation can be divided into three ways: civil litigation reconciliation, criminal litigation reconciliation and administrative litigation reconciliation.