某院医疗诉讼案件院内甄别结论分析

A comparative analysis of the discrimination conclusions for medical litigation cases of a hospital

目的针对某院近年来发生的52例医疗纠纷诉讼案件,比较分析院内医疗专家判定的责任比例与司法鉴定责任比例的差异。方法选择北京某三级甲等医院2015年至2018年历次院内专家甄别会议评估的全部纠纷病例,共计52例,根据纠纷发生的原因,将52例诉讼案件分为七类,分别计算同一类纠纷中全部案例司法鉴定责任比例的均值和院内专家甄别责任比例的均值。采用配对t检验比较上述两种方式定责比例的一致性。结果司法鉴定责任程度的整体水平(35.00%)明显高于院内专家甄别定责(20.96%)。其中,对于因治疗方案选择不当、手术操作不当或手术难度风险评估不足、因并发症导致医疗纠纷的案例,司法鉴定院方承担的责任程度与院内甄别结果差异较大。结论由于司法鉴定机构对复杂医疗技术问题进行鉴定有一定的困难,建议尽快建立司法鉴定专家库,鼓励专家辅助人参与纠纷的审理。

Objective To compare the differences found between the proportion of responsibility between in-house experts of the hospital and that of judicial appraisals for 52 cases of medical disputes of a hospital in recent years.Methods A total of 52 cases of disputes were selected, which were evaluated by the in-house experts screening meeting at a tertiary hospital in Beijing from 2015 to 2018.According to the causes of these disputes, these cases were divided into seven categories, calculating respectively the mean value of the proportion o judicial appraisal responsibility and that of in-house experts for all cases of the same category.The paired t test was used to compare the consistency of the above two methods.Results The overall level of judicial appraisal responsibility ( 35.00%) was significantly higher than the in-house expert screening(20.96%).Among them, the cases of improper selection of treatment plan, improper operation of surgery or insufficient evaluation of surgical difficulty risk, and medical disputes caused by complications, the degree of responsibility of the judicial appraisal institutions was quite different from that of in-house experts of the hospital.Conclusions Because the judicial appraisal agencies have certain difficulties in the identification of complex medical technology problems, it is recommended to establish a library of judicial appraisal experts as soon as possible to encourage the experts to participate in the trial of disputes.