ObjectiveTo understand patients’ cognition of third-party mediation model for medical disputes, analyze the factors influencing the trust of patients on third-party mediation, and propose recommendations for building third-party mediation mechanisms. MethodsFrom November 2013 to April 2014, we referred past literature to design a relevant questionnaire on the cognition of third-party mediation for medical disputes. Patients who had reached the end of the treatment were surveyed by random cluster sampling. The raw data were put into the computer for statistical analysis by SPSS 18.0. ResultsAfter giving out 500 questionnaires, we acquired 486 effective questionnaires. The result showed that 61.52% of the patients knew of third-party mediation; 55.35% of the patients considered that thirdparty mediation should be set in and supervised by the court or judicial administrative department; if the mediation failed, 57.41% of the patients chose to resolve the dispute through legal channels, and 67.90% of the patients tended to confirm the force of mediation conclusion by arbitration; 70.58% of the patients considered that mediators should have professional background of medicine and law; 73.05% of the patients tended to take conclusions of forensic identification as the basis for mediation; 64.81% of the patients were biased to take Tort Liability Act as the basis for determining the compensation; 53.70% of the patients believed that financial allocations could solve the fund problems of third-party mediation, while 38.48% of the patients thought the funds should be provided by insurance companies; 91.15% of the patients thought the medical institutions should purchase medical liability insurance, and 54.32% of the patients thought insurance companies should not intervene the process of meditation. Conclusions Government should provide financial allocations to ensure the funds of third-party mediation. Besides, medical insurance should be brought in as a supplement. Medical institutions should purchase medical liability insurance to solve problems caused by medical disputes. Third-party mediation should be set in and supervised by the court or the judicial administrative department. Mediators should have professional background of medicine and law. Conclusions of forensic identification should be the basis for third-party mediation.
Objective To identify and analyze all medical injury liability disputes lawsuits pertaining to inferior vena cava filters (IVCF) in “Lexis®China” database, the causes and outcomes of litigation of the cases were clarified with a view, and to provide suggestions for preventing potential medical patient dispute lawsuits and improving the clinical diagnosis and treatment level of doctors. Method The term “inferior vena cava filter” was searched in Lexis®China, and spanning from 2011-01-01 to 2022-12-31. Results A total of 221 cases of medical injury liability disputes were found, after screening and exclusion, a total of 179 relevant cases were included in this study for analysis. All first instance lawsuits were brought by patients against hospitals and had a high rate of compensation awarded (91.6%). Forty four cases were entered second instance litigation, and the proportion of maintaining the original judgment was high (68.2%). The main content involving the modification of the judgment was to increase the compensation amount (85.7%). In the 14 lawsuits related to the failure to place IVCF by the medical authority, the litigation points were all disputes arising from the hospital’s improper diagnosis and treatment of VTE patients, which led to the failure to place IVCF, with the highest proportion (92.3%) of improper diagnosis and treatment of pulmonary embolism (PE). For PE and deep vein thrombosis patients with clear indications for IVCF implantation but not placed, leading to litigation, the hospital bore different liability for compensation (18%–100%) depending on the fault factors of the hospital’s negligence in diagnosis and treatment. The hospital could also be held responsible for inadequate informed disclosure to affect patient judgment (23.1%). In 165 lawsuits related to the placement of IVCF, the vast majority of IVCF implants were for the diagnosis and treatment of VTE in patients (73.9%). However, such unplanned operations caused additional injuries and expenses to patients, and VTE occurred most frequently during hospitalization (76.2%). This type of embolism was most commonly secondary to fracture incision and fixation surgery (31.2%), and the average liability of hospitals for compensation varied due to different secondary factors. The occurrence of intraoperative and postoperative complications related to IVCF implantation could also lead to litigation (18.8%), and the proportion of dead patients in litigation was relatively high (32.3%). The most common complication leading to litigation was PE recurrence or exacerbation (22.5%), while intraoperative complications were vascular injury during interventional procedures (2/3). The overall trend of IVCF-related lawsuits reserves between 2011 and 2020 showed an overall upward trend, reaching a peak of 37 cases in 2020; the average amount of damages exceeded 100 000 yuan per case in 10 of the 12 years included in the statistics. Conclusions In China’s IVCF-related medical liability lawsuits, patients most often sue their doctors, who are often sued for failure to insert a filter due to untimely diagnosis and treatment of VTE, inadequate notification of informed consent for IVCF insertion, unplanned IVCF insertion due to the presence of VTE and IVCF-related complications, and the outcome is often unfavourable to the doctors. In addition, the number of IVCF related lawsuits and hospital compensation amounts have remained high in recent years.
Family members are crucial for medical disputes. From the psychology and social perspective, the paper analyzes a specific medical dispute case, and discusses the psychological care for (potential) " shidu” (loss of the only child) family. Based on the current social context, an early intervention suggestion is proposed, that is to provide the whole-process psychological intervention to the special patients’ families. The intervention includes: regular psychological evaluation and psychological support if necessary; providing disease knowledge and death education; providing continuous psychological care by the hospital and community; offerring more psychological care for " shidu” family by society.
目的 从法医学角度探讨儿科医疗纠纷案件特点及成因。 方法 对四川华西法医学鉴定中心2002 年1月－2011年12月受理的184例儿童死亡并进行尸检的儿科医疗纠纷案件的法医学鉴定资料进行回顾性研究。 结果 儿科医疗纠纷呈逐年升高趋势，年龄以新生儿为主，死因以呼吸系统疾病为主；临床-尸检符合率低（55.23%），医疗过错率高（60.47%），且两者呈负相关。 结论 儿科医疗纠纷临床-尸检符合率比所有年龄段人群低，医疗过错率比所有年龄段人群高，且呈现出临床-尸检诊断符合率越低，医疗过错率越高的特征。
目的 分析骨科医疗纠纷的原因及特点，为医疗纠纷的防范提供参考。 方法 收集2010年1月－2011年12月四川华西法医学鉴定中心涉及四川省各级医疗机构的骨科医疗纠纷鉴定案例55例，进行回顾性分析。 结果 55例骨科医疗纠纷中2010年25例，2011年30例；医源性医疗纠纷41例（74.5%），非医源性医疗纠纷14例（25.5%）。医源性医疗纠纷中医疗机构存在的问题主要以手术操作不当及失误为主（15例，占27.3%），其次为医患沟通不到位（8例，占14.5%）。 结论 骨科医疗纠纷防范的关键在于医务人员认真履行其诊疗义务。