病理诊断医疗损害鉴定89例分析

Retrospective analysis of 89 cases of medical damage liability disputes caused by pathological diagnosis

目的为了明确该类涉病理医疗损害鉴定的鉴定路径以及遵循原则,探寻医疗卫生部门涉病理医疗纠纷预防和解决思路,构建人民法院审理涉病理医疗损害责任纠纷案件路径。方法以2019—2023年审结生效并公布于裁判文书网的医疗损害责任纠纷案件判决为样本,从病变部位、医疗过错、损害后果、因果关系及原因力大小(参与程度)、事故分级和责任程度、鉴定方式的选择、鉴定意见的采信等方面进行回顾性分析。结果从病变部位分析,乳腺、肺、甲状腺、皮肤和子宫存在较高的病理诊断误诊比例;从医疗过错分析,由于治疗方案选择不当造成延误治疗占58.4%、过度治疗占41.6%;从损害后果分析,死亡后果仅占约20%,绝大部分为活体鉴定范畴;从责任划分分析,医疗机构承担次要原因居多,占30.3%;从鉴定与采信情况分析,鉴定方式多采用医疗损害鉴定,法院对鉴定意见的采信度达到92.1%。结论(1)涉及女性身体的病理纠纷较多,在过错类型上误诊最多;(2)法医临床专业鉴定人也可以参与涉及病理诊断的医疗损害鉴定;(3)对涉及病理诊断和死亡后果的医疗损害责任纠纷案件,应当进行死亡原因鉴定;(4)医疗损害鉴定应当遵循同行评议原则。

Objective In order to clarify the identification path and the followed principles in this kind of pathological-related medical damage identification,explore the prevention and resolution ideas of pathological medical disputes in the medical and health departments,and build a path for the people's court to hear the cases of pathological medical injury liability disputes.Methods Taking the judgement of medical damage liability disputes that took effect in 2019-2023 and published on the judgement document network as a sample,conduct a retrospective analysis in terms of the site of lesion,medical fault,the consequences of the damage,the causal relationship and the degree of cause(degree of participation),the degree of accident classification and responsibility,the selection of appraisal method,and the acceptancde of appraisal opinions.Results From the analysis of the lesion site,there is a high proportion of misdiagnosis in breast,lung,thyroid,skin and uterus;from the analysis of medical fault,58.4%of delayed treatment and 41.6%of overtreatment due to improper selection of treatment plan;from the analysis of the consequences of damage,the consequences of death only account for about 20%.Most of them are in the category of living appraisal;from the analysis of responsibility division,medical institutions bear secondary reasons,accounting for 30.3%;from the analysis of appraisal and acceptance,medical damage identification methods are mostly used,and the court's acceptance of appraisal opinions reaches 92.1%.Conclusion(1)There are more pathological disputes involving women's bodies,and misdiagnosis is the most in the type of fault;(2)Forensic clinical professional appraisers can also participate in the identification of medical damage involving pathological diagnosis;(3)For cases of medical damage liability disputes involving pathological diagnosis and the consequences of death,the cause of death should be identified;(4)Medical damage identification should be in accordance with the principle of peer review.