摘要
目的从法医学角度分析医疗纠纷的成因并提出预防措施,探讨医疗过错鉴定的发展趋势及先进理念。方法对2008—2012年湖南省湘雅司法鉴定中心办理的218例医疗纠纷案例进行统计分析。结果 （1）医疗纠纷案例逐年增加。男女比例接近1∶1,10岁以下儿童、41~50岁男性人群、21~30岁女性人群所占比例较其他年龄组高;（2）被鉴定人死亡的占25.69%;被鉴定人残疾的占34.40%;被鉴定人完全康复或未构成残疾的占39.91%。符合生存机会或治愈机会丧失概念的案例有37例,占16.97%;（3）医疗纠纷多见于县级医院,占33.03%。发生医疗纠纷最多的临床专业科室大类为外科,占50.46%;（4）认定医疗机构存在医疗过失行为的占78.44%,主要医疗过失种类有：误（漏）诊误（漏）治,治疗（操作）不规范,违反医疗相关法律法规及操作规范等;（5）认定医疗过失与被鉴定人的损害后果之间存在因果关系的占62.39%。鉴定医方有责任的占65.60%。结论医疗纠纷不仅数量逐年增多,鉴定的复杂性和难度也在不断增加。低级别医疗机构出现医疗纠纷的比例相对较高,骨科、妇产科发生医疗纠纷风险较高,医疗纠纷所涉及的临床专业科室也越来越多。生存机会丧失等理论在司法实践活动中的应用,有助于更加科学、公正地开展鉴定工作。
Objective To investigate the causes of medical disputes, offer precautions from forensic point of view, and discuss on the development and advanced concepts of forensic identification of medical malpractice as well. Method 218 forensic cases of medical malpractice, which were undertaken by Xiang Ya Judicial Expertise Center of HuMan Province from 2008 to 2012, were analyzed statistically. Results （1） The medical disputes increased year by year. Among the patients, the proportion of male and female was 1：1. The proportions of children under the age of 10, male of 41-50 years old and female of 21-30 years old were higher than other age groups. （2） 50% of the patients died, 34.40% of the patients were with disability, and 39.91% of the patients were healed or without disability. 37 cases （16.97%） were conformed to the concept of losing chance of survival/cure. （3） Most medical disputes happened in county-level health institutes, which accounted for 33.03%. 50.46% occurred in surgical department, which was the main area of medical disputes. （4） 78.44% of the health institutes were identified as having medical negligence. The frequent causes of medical disputes were misdiagnosis or missed diagnosis, the irregular treatment/operation and the medical practice that violated medical law and regulation. （5） 62.39% of the cases had causal relationship between the medical negligence and the injury of patients, and hospitals were responsible in 65.60% of the cases. Conclusion Besides the continuingly increase of medical disputes, the complexity and difficulty of forensic expertise is also increasing. Based on the present analysis, the proportion of medical disputes happening in low-level medical institutions is rather high. Additionally, more and more departments are involved in medical disputes, among which orthopedics department and obstetrics and gynecology department have a relatively high level of medical disputes. According to the analysis, the application of the Loss Survival Chance Theory and
出处
《中国司法鉴定》
2015年第4期62-66,70,共6页
Chinese Journal of Forensic Sciences
关键词
医疗纠纷
法医学鉴定
回顾分析
预防措施
medical dispute
forensic medical identification
retrospective analysis
precaution
