河南省妇产科医疗损害二审案件鉴定与赔偿分析

An analysis on the current situation and compensation in the obstetrics and gynecology-related medical malpractice second-instance cases in Henan Province

目的分析河南省妇产科二审医疗损害责任纠纷案件的特点、原因、鉴定与赔偿情况,为预防妇产科医疗损害和减少社会负担提供依据。方法选用2017年1月~2021年12月中级人民法院妇产科医疗损害二审案件进行实证性研究。共检索文书1897例,医疗损害1024例,妇产科医疗损害二审案件164例。结果医疗损害二审案件2019年后呈下降趋势,医方上诉的占46.34%(76/164例),二审判决“驳回上诉,维持原判”占75.00%(123/164例)。争议焦点主要为违反诊疗规范/操作不当,告知义务不足,病历不规范等。妇产科医疗损害司法鉴定量远远大于医学会医疗事故技术鉴定,但二者采信率无统计学差异(P≥0.05)。不同医院等级中,二级医院总赔偿额占院方赔付总额的54.40%(2241.69/4120.78万元),差异有统计学意义(H=6.146,P≤0.05),司法鉴定费由双方按原因力大小共同承担的占80.17%(97/121例)。精神损害赔付率高达72.56%(119/164例),精神损害赔偿占索赔额的60.00%(3.00/5.00万元)。结论完善医疗损害预防处理条例,加强二级医院妇产科病历、诊疗规范管理,充分履行告知义务,有利于降低医疗损害的发生。院方应重视一审中的举证和抗辩,尤其是过错因果关系和原因力大小,避免上诉二审,减少社会司法资源的浪费,维护社会稳定和减轻社会负担。医疗损害鉴定双轨制仍有一定合理性。

Objective To analyze the characteristics,causes,judicial expertise,and compensation of the medical malpractice second-instance cases related to obstetrics and gynecology in Henan Province to prevent medical malpractice and reduce social burden.Methods This empirical research was conducted by collecting second-instance medical malpractice cases related to obstetrics and gynecology,which were trialed in intermediate people's courts from January 2017 to December 2021.A total of 1,897 documents were examined,including 1,024 medical malpractice cases and 164 second-instance medical malpractice cases of obstetrics and gynecology.Results The results showed a downward trend in the second-instance medical malpractice cases since 2019.In 46.34%of the secondinstance cases(76/164 cases),it was unilaterally appealed by the medical institutions.Among the second-instance verdicts,75.00%(123/164 cases)upheld the original judgment by rejecting the appeal.The main points of the contention were violations of diagnosis and treatment standards,improper operations,insufficient disclosure obligations,and non-standard medical records.The quantity of forensic appraisal for obstetric and gynecological medical malpractice was significantly greater than the quantity of technical appraisal performed by medical associations.However,there was no statistically significant difference in the acceptance rates by the second-instance court between the two groups(P≥0.05).Among various hospital grades,second-grade hospitals accounted for 54.40%(22.42/41.21 million RMB)of the total compensation paid by hospitals(H=6.146,P≤0.05).Forensic appraisal fees were shared by both parties according to the degree of responsibility in 80.17%cases(97/121 cases).The compensation rate for mental impairment reached 72.60%(119/164 cases),and the mental impairment compensation accounted for 60.00%(3.00/5.00 million RMB)of the total claims.Conclusion Improving the regulations for preventing and handling medical damages,strengthening the management of medical records and treatment protocols in the obstetrics and gynecology departments of second-grade hospitals,and fulfilling the duty to provide comprehensive information can contribute to reducing the occurrence of medical malpractice.The medical institutions should attach importance to the presentation of evidence and defense during the first instance,particularly focusing on the causality and the degree of responsibility.Both doctor and patient sides should avoid the need of retrial,reduce the wastage of judicial resources,maintain the social stability,and alleviate the burden on society.The dual-track system for medical malpractice appraisal still has certain rationality.