瑕疵病历在医疗纠纷案中的证据认定研究

Research on evidence determination of defective medical records in medical dispute case

瑕疵病历根据法律效力的完全性和是否排除适用的绝对性,将其分为完全瑕疵病历、主观部分瑕疵病历及客观部分瑕疵病历三种类型,不同类型的瑕疵病历有着不同的证据认定规则。完全瑕疵病历在证据效力上被视为无效,完全被排除适用,其可直接推定医方具有过错;主观部分瑕疵病历则具有一定的适用空间,对于其未被违法改造的部分,可以认定其法律效力和适用其中合法真实部分的病历资料;客观部分瑕疵病历的适用空间更为广阔,其原则上属于合法有效,可依法适用并进行医疗鉴定,只有在瑕疵部分对案件产生实质影响并且医方无法补正说明的情况下才可予以排除。这种分类型认定瑕疵病历法律效果的方法有助于司法人员更好地解决医疗纠纷案中瑕疵病历的证据疑难问题。

Defective medical records can be divided into three types based on the completeness of their legal effect and the absoluteness of whether they are excluded from application.These types of defective medical records include complete defective medical records,subjective partially defective medical records,and objective partially defective medical records.Different types of defective medical records have different rules for evidence recognition.Completely flawed medical records are considered invalid in terms of evidence validity and are completely excluded from application,which can directly infer that the medical party is at fault;Subjective defective medical records have a certain scope for application,and for the parts that have not been illegally modified,their legal validity can be determined and the medical record data of the legitimate and true parts can be applied;The application space of objective defective medical records is broader,and in principle,they are legal and valid.They can be applied and subjected to medical appraisal by the law.They can only be excluded if the defective part has a substantial impact on the case and the medical party is unable to provide corrective explanations.This method of categorizing the legal effects of defective medical records can help legal professionals better participate in and resolve doctor-patient disputes.