The practice of resolving medical disputes by the mediation studio specially invited by the people′s court / 中华医院管理杂志

Based on the main problems existing in the current way of handling medical disputes, the authors explored a new method for handling medical disputes, and summarized the advantages of the mode of mediation studio specially invited by the people′s court. This mode effectively connected the traditional medical dispute resolution approaches, complemented each other′s advantages, and provided a faster, more efficient and national compulsory solution for medical disputes.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery / 法医学杂志

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Analysis of the Forensic Identification of Medical Disputes Related to 22 Cases of Death from Otolaryngology Diseases / 法医学杂志

Objective To discuss the causes and precautionary measures of the risks of relevant medical disputes by analyzing 22 cases of death from otolaryngology diseases. Methods A retrospective analysis of 22 judicial expertise cases of medical disputes related to death from otolaryngology diseases accepted by Chongqing Zhengding Judicial Appraisal Institute and Academy of Forensic Science during 2008-2018 were made. Results Of the 22 cases, the male to female ratio was 3.4∶1. The age of death was from 1.3 to 76 years old, with an average age of 45.3 years. There were 28 medical institutions involved, of which 71.4% were tertiary medical institutions. Statistics for death causes showed that respiratory asphyxia accounted for 50%. Conclusion Forensic identification provides an important scientific basis for medical disputes cases related to otolaryngology diseases. It also has an important reference value for medical institutions to optimize the work procedure of diagnosis and treatment of otolaryngology diseases and improve the quality of diagnosis and treatment.

A comparative analysis of the discrimination conclusions for medical litigation cases of a hospital / 中华医院管理杂志

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 of 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.

Medical Litigations Associated with Cataract Surgery in Korea

BACKGROUND: To analyze the results of court rulings about medical litigations related to cataract surgery in Korea. METHODS: We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded. RESULTS: Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010). CONCLUSION: Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.

Analysis on Forensic Expertise of 49 Medical Disputes in Prenatal Examination / 法医学杂志

OBJECTIVES@#To analyze the cases of medical disputes involving prenatal examination from a point of view of forensic expertise, and to discuss the risk of medical disputes and the preventive measures.@*METHODS@#A retrospective analysis was conducted on 49 forensic expertise cases of medical disputes in prenatal examination which were identified in Academy of Forensic Science and Shanghai Di'an Forensic Science Limited Company from 2010 to 2017.@*RESULTS@#In recent years, the number of medical disputes involving prenatal examination showed an increasing trend year by year. The common causes of medical disputes were: uninformed or insufficiently informed disclosure （20 cases）; the propaganda and application of three-dimensional, four-dimensional ultrasound were not standardized （14 cases）; ultrasound examination and serological screening process were not standardized （12 cases）; no antenatal counseling （2 cases）, etc.@*CONCLUSIONS@#In order to minimize the occurrence of such medical disputes, hospitals or related associations should avoid the risk of prenatal examination through the standardization of management and operation.

Medical Disputes and Classification Solution Mechanism from the Perspective of Petition / 中国医学伦理学

The explosion of medical disputes is the product of modern science and technology,legalism and unreasonable health management systems.In China,petitioning to health administration is an important channel to resolve medical disputes.It is a beneficial attempt to deal with medical disputes by classifying medical disputes from the perspective of petition and formulating the corresponding resolution principles.The classification solution of medical disputes also needs to perfect the relevant supporting system.

The Development of Extraterritorial Apologies Laws and Its Enlightenment to Medical Dispute Settlement in Our Country / 中国医学伦理学

At present, 35 states and the District of Columbia have established apologies laws in America; in Australia, six states and two territories have enacted apologies law. Although various countries in the word still face many problems in the process of formulating apologies laws, its promotion in the settlement of medical disputes is very rapid. The paper point out three unique roles of apologies laws in medical dispute settlement, enlightening our country to take apology law of absolute immunity, sincerely face medical negligence and dig out the institutional roots by the disclosure of the truth of the accident, in order to avoid the recurrence of similar incidents, and finally achieve the purpose of improving the quality of hospital medical safety.

Analysis of Medical Dispute Relating to Ophthalmology in Korea Medical Dispute Mediation and Arbitration Agency

PURPOSE: To analyze the characteristics of medical disputes relating to ophthalmology for prevention in advance. METHODS: Retrospective analyses of ophthalmic cases applied for Korea Medical Dispute Mediation and Arbitration Agency between June 2013 and September 2016. RESULTS: A total of 41 cases were analyzed. The number of cases relating to cataract were 19 (46.3%), refractive surgery 4 (9.8%), anterior segment 4 (9.8%), retina 7 (17.1%), oculoplasty 3 (7.3%), glaucoma 2 (4.9%), and miscellaneous 2 (4.9%). The specialty with the lowest mean payment of mediation per case was cataract (￦3,591,700), which has the largest number of cases, and oculoplasty was the highest mean payment per case (￦21,933,000). There were 16 cases confirmed as negligence by authenticators. Among these 16 cases, 7 (44%) were related to accident during surgery or procedure, 5 cases (31%) were insufficient explanation, and 4 cases (25%) were lack of tests which should have be performed before or after surgery. The results of mediation were agreement in 25 cases (61%), decision made by mediation department in 6 cases (15%), 7 cases were not adequate to mediate (17%), and 3 cases were canceled (7%). CONCLUSIONS: The number of cases associated with cataract was the largest. Among negligence of doctors, cases during surgery were most common, suggesting the need to explain surgical factors such as complications or side effects and the need for complete surgical records. If a medical dispute occurs, the Korea Medical Dispute Mediation and Arbitration Agency can be used to achieve an agreement.

Is the “ghost surgery” the subject of legal punishment in Korea?

PURPOSE: Recently a controversy has arisen about so-called “ghost surgery” practices, and people have voiced their opinions for legal sanction against such practices, which clearly undermine the foundation of medical ethics. However, there has been a lack of legal basis for punishing those actions. The present study aims to examine which pre-existing legal provisions could be applied to regulate ghost surgery. METHODS: The Korean Medical Service Act has a provision relating to informed consent to inhibit ghost surgery but does not include penalty provisions prohibiting ghost surgery itself. Also, the Korean Supreme Court precedents on this issue have not been settled as of yet. Therefore, this study referred to U.S precedents, law books, and related papers. RESULTS: With respect to ghost surgery, we expect the charges of bodily harm, assault and battery, and fraud could be applied under Korean law, in addition to charges regarding the violation of medical law, such as the omission of entries or false entries in medical records. A patient provides consent to bodily harm prior to surgery, and only the person who is entrusted with such permission can become the operating surgeon in the operating room. CONCLUSION: In other words, even if other medical professionals are present in the operating room, the operating surgeon who received consent must take overall responsibility for the whole process of the surgery. A surgeon should bear in mind that a violation of such duty can constitute a criminal offense.

Present Situation and Countermeasures of Conflict between Off-label Drug Use and Judicial Evaluation / 中国药房

OBJECTIVE:To provide suggestions for standardizing and protecting the off-label drug use. METHODS:Accord-ing to the field interviews with pharmacists and lawyers,the present situation of off-label drug use in judicial practice at home and abroad,and relevant countermeasures were put forward. RESULTS & CONCLUSIONS:At present,there was no mechanism for off-label drug use in the laws and regulations in China;there was only"special circumstances"statement in sporadic terms,while lacking explanation. In judicial practice of medical disputes,judges had different identifications in various references,such as the le-gality of routine and guidelines,teaching medical materials,clinical pathways,and internal regulations of medical institutions pre-pared by authoritative departments. Meanwhile,the judicial environment of hearing cases by identification made the off-label drug use had impartial adjudication. Legislation in 6 countries,including America,allows reasonable off-label drug use;FDA required off-label drug use must be for the benefit of patients rather than clinical trials,and it also should protect the patient's right to know. China should establish the authority specification of off-label drug use,providing scientific identification procedures,protect the patient 's informed consent by law. Medical institutions should develop relevant management system and processes to regulate medical prac-tices and ensure off-label drug use in line with the interests of doctors and patients.

Investigation and analysis on patients of extended stay at 11 hospitals in Beijing / 中华医院管理杂志

Objective To investigate and analyze the status quo of the patients of extended stay at 11 clinical hospitals of a general university in Beijing, and explore the countermeasures and solutions.Methods Contact with the medical affairs departments of these hospitals to collect information about such patients of extended stay.Results A total of 43 cases of patients were identified as extended stay at these hospitals, accounting for 0.00% to 0.93% of total beds.Their stay ranged from 1 month to 15 years, including 17 cases with medical disputes (39.5%), and 26 cases without (60.5%).Conclusions The phenomenon of extended stay at hospitals deserve enough attention and appropriate actions accordingly.

Investigation on the Cognition of Medical Staff on the Third-Party Mediation in a Tertiary General Hospital of Nanjing / 中国医学伦理学

Objective:To investigate and analyze the cognition onthe third-party mediation among medical staff in a tertiary general hospital of Nanjing,and thus to put forward rational suggestions.Method:A questionnaire survey was conducted among 200 doctors from a tertiary general hospital.Chi-square test and non-parametric test were used to analyze the data.Results:Totally 57.5％ of doctors thought the doctor-patient relationship was tense,78.5％ of doctors to some extent had understood the third-party mediation,91.5％ of doctors thoughtthe third-party mediation played a different role in dealing the medical disputes,71.0％ of doctors had heard of medical liability insurance,and 89.5％ of doctors thought it necessary to purchase the medical liability insurance.Conclusions:Doctors gradually accept the third-party mediation,but as a new thing,the main bodies at all levels should publicize the third-party mediation so as to give full play to the role of it.

Research on the Cognitive of Doctor-Patient Relationship among Junior Medical Students in Guangzhou / 中国医学伦理学

Objective:To investigate the current situation of junior medical students'cognition on the relationship between doctors and patients,and to provide reference for medical students'medical education and medical education reform,Methods:Self-made questionnaire was adopted to investigate the cognitive status of doctor-patient relationship among junior medical students from three medical universities in Guangzhou.Results:Totally 41.04％ of junior medical students had a basic understanding of doctor-patient relationship,and the degree of understanding of doctor-patient relationship is not different between junior and senior medical students (P ＞ 0.05);76.62％ of medical students got acquainted with the status of doctor-patient relationship mainly through the media;86.57％ of junior medical students thought that the doctor-patient relationship was tense.The cognition of doctor-patient relationship between male and female students was similar (P ＞ 0.05),and so wasit between freshmen and sophomores (P ＞ 0.05).Male and female students had the same opinion on the future trend of doctor-patient relationship (P ＞ 0.05).Many junior medical students were optimistic about the future doctor-patient relationship.Compared with freshmen,sophomore medical students were less optimistic about the future doctor-patient relationship (P ＜ 0.05).Medical students mostly agreed on the causes of medical disputes (P ＞ 0.05),believing that the main reason was the medical system.Conclusions:The cognition of the doctor-patient relationship profoundly affects the junior medical students as well as their choices of future employment and communication styles between patients and them,which may have important significance for avoiding medical disputes.Society,schools and the media should actively create a good atmosphere for the doctor-patient relationship.

Study on the Public Cognition, Attitude and Coping Style of Medical Disputes——Empirical Analysis Based on a Sample of 2910 Citizens in Zhejiang Province / 中国医学伦理学

Objective:To investigate the public cognition,attitude and coping style of medical disputes among 2910 citizens from Hangzhou,Ningbo and Wenzhou and other cities in Zhejiang Province.Methods:Totally 11 cit-ies in Zhejiang Province were selected using the method of random sampling and a questionnaire survey was conduc-ted based on the principle of voluntary.Results:The public legal awareness was not strong,of which the primary influencing factors were the excessive prescription and medical professionals'unsatisfying attitude.Conclusion:In view of the existing problems,this paper put forward the optimization countermeasures including popularizing legal knowledge,enhancing citizens' sense of security,strengthening media management,correctly guiding public opin-ion,strengthening psychological intervention,and avoiding emotional stress.

Exploration of the Effectiveness of the Third Party Mediation in Medical disputes / 中国医学伦理学

Through the comparative analysis of traditional medical dispute handling methods and the concept of the third party mediation in medical dispute,this paper discussed that the third party mediation method in medical dispute obtain the recognition of both doctor and patient with its advantages such as neutrality,impartiality,convenience,and it had good running effect in the practice from place to place.But there still remain Some Problems,in cluding the intervention lacks initiative;the amount of indemnity lacks scientificity;the conciliation agreementlacks coercive enforcement;the privacy lacks protection;the institution development is limited.So we must improve the third party mediation work mechanism,identification process,operation mechanism and the relevant insurance system.

Application of Narrative Medicine in the Mediation of Medical Disputes / 中国医学伦理学

This paper analyzed a medical dispute mediation case through three main elements of narrative medicine including attention,representation,and affiliation.It discussed the significant impact of narrative medical skills on medical dispute resolution.The three elements reflected in the mediation of medical disputes are to adopt patients' all requests without preset positions,guide both sides to narrative the treatment process,and remedy the impaired doctor-patient relationship.In the process of current medical dispute mediation,the resolution of medical disputes keeps at a superficial level,causes the incomplete restoration of impaired doctor-patient relationship,and therefore influences the neutrality of mediation,just because of the lack of those three elements.

Present Situation and Countermeasures of Conflict between Off-label Drug Use and Judicial Evaluation / 中国药房

OBJECTIVE:To provide suggestions for standardizing and protecting the off-label drug use. METHODS:Accord-ing to the field interviews with pharmacists and lawyers,the present situation of off-label drug use in judicial practice at home and abroad,and relevant countermeasures were put forward. RESULTS & CONCLUSIONS:At present,there was no mechanism for off-label drug use in the laws and regulations in China;there was only"special circumstances"statement in sporadic terms,while lacking explanation. In judicial practice of medical disputes,judges had different identifications in various references,such as the le-gality of routine and guidelines,teaching medical materials,clinical pathways,and internal regulations of medical institutions pre-pared by authoritative departments. Meanwhile,the judicial environment of hearing cases by identification made the off-label drug use had impartial adjudication. Legislation in 6 countries,including America,allows reasonable off-label drug use;FDA required off-label drug use must be for the benefit of patients rather than clinical trials,and it also should protect the patient's right to know. China should establish the authority specification of off-label drug use,providing scientific identification procedures,protect the patient 's informed consent by law. Medical institutions should develop relevant management system and processes to regulate medical prac-tices and ensure off-label drug use in line with the interests of doctors and patients.

"Cause Analysis and Countermeasure Research on Public Remedy ""Silence"" in Medical Disputes" / 中国医学伦理学

Firstly, this article introduced the definition of medical dispute and public remedy. Thereafter, it analyzed the causes of public remedysilence in medical disputes from four perspectives including the self-defect of public remedy, inadequacy of legal construction, lack of trust in public remedy, and the popularity of private remedy. Finally, it pointed out the countermeasures of enhanced legal construction, unimpeded public remedy and striking private remedy to solve the problem of public remedy silence in medical disputes.

The state of medical malpractice caused by private practice physicians (2010-2012): analysis through incident reports at Korean Medical Association Medical Indemnities Mutuals

This study was conducted to understand the current state of medical malpractice through analyzing recorded incidents by characteristics of medical intervention, and treatment results classified by treatment type and so on. The data for this study were extracted from the recorded incidents of medical malpractices committed by private practice physicians, which were provided by the Korean Medical Association Medical Indemnity Mutuals (KMAMA). The analysis was based on the treatment codes registered as primary medical practice of the respective private practice physicians at the time of joining KMAMA Medical malpractice occurrence rate by region was highest in Daegu with 7.1%. Analysis of causes of malpractice by codes showed dermatology/urology/plastic surgery department's C5 (standard medical care [outpatient] including standard injection, drug administration, simple topical anesthesia, simple treatment+regional anesthesia [spinal/epidural anesthesia]+general anesthesia [intravenous/inhaled anesthesia]) had the highest number of incidents with 223 cases. For the cases of death as prognosis, code B2, consisting of "basic treatment+regional anesthesia, intra-articular injection, epidural nerve block," had the highest incidents. This study concluded with the suggestion for the need to establish a system that will allow reporting and sharing incidents of private practice medical malpractice, and the necessity of acknowledging the importance of sharing such knowledge among medical practitioners.