Author: Medical Law Exchange
Reprint please indicate the source: Medical Law Hui WeChat public account
Fact sheet
Patient Ms. Qin (69 years old) was injured in a traffic accident. After receiving a call from 120 at 10:56, the county hospital arrived at the scene at 11:17. Dr. Liu carried out a medical examination on the patient. Examination, the patient’s carotid artery pulse disappeared, no spontaneous breathing, mydriasis, light reflex disappeared, 11:22 ECG showed a straight line. Bone fricatives can be palpated in many parts of the chest and abdomen collapse. According to the clinical manifestations and signs, the patient’s death time is too long and there is no rescue value, and clinical death is declared.
The patient’s family requested the medical staff to transfer the patient to the city hospital for rescue. The medical staff believed that the patient was dead and had no rescue value, and the ambulance had no obligation to operate the corpse. Leaving the scene at 11:31 after the single cap was placed on the patient’s body.
Afterwards, the patient’s family drove the patient to the city hospital to continue the rescue. After 50 minutes of rescue, the patient still had no breathing, no heartbeat, no spontaneous breathing recovery, bilateral mydriasis was fixed, and electrocardiogram The guardianship showed a straight line and was pronounced dead at 13:00. The autopsy showed that the patient died of multiple injuries caused by a road traffic accident, traumatic, hemorrhagic shock, and respiratory and circulatory failure.
The family members of the patients believe that Dr. Liu, the outpatient staff of the county hospital, is an acupuncture and massage staff member who has no clinical experience and skills in the emergency department, and did not have any written notice. As a result of the death of the patient, the lawsuit requires the county hospital to compensate for various losses totaling more than 160,000 yuan.
Court hearing
The Medical Malpractice Technical Appraisal of the Municipal Medical Association believes that the hospital has the fault of insufficient communication with the patient’s family in determining that the patient’s death has no rescue value. The patient’s death has no causal relationship with the hospital’s medical behavior, and does not constitute a medical malpractice. The patient refused to accept the appraisal conclusion and applied for re-appraisal. Afterwards, the Municipal Medical Association suggested that the court should not use the appraisal written by the patient as the basis for the judgment on the grounds that the patient did not recognize the medical records and believed that the electrocardiogram was forged and the re-appraisal could not be carried out.
In addition, it was found that Dr. Liu of the County Hospital’s practice category is traditional Chinese medicine, and the scope of practice is acupuncture and massage. He has participated in the provincial emergency medicine department job training.
The court of first instance held that the county hospital, as the first medical institution to visit the patient, only checked the patient’s injury after arriving at the scene, and did not take further corresponding emergency measures in accordance with the diagnosis and treatment specifications. When the patient’s family requested an ambulance to assist in the transfer, the medical staff refused to assist in the transfer, and left the scene after declaring clinical death. Compared with the 50-minute first aid measures taken by the city hospital, the county hospital obviously failed to provide adequate and reasonable treatment, and failed to fulfill its obligation of timely rescue and transfer. In addition, Dr. Liu’s practice category is traditional Chinese medicine, and the scope of practice is acupuncture, moxibustion and massage, which exceeds the scope of practice and is also at fault. To sum up, the court decided that the county hospital should bear 30% of the compensation liability and compensate the patients for various losses totaling more than 120,000 yuan.
Both the doctor and the patient were dissatisfied and filed an appeal. The court of second instance held that the traffic accident was the main cause of the patient’s death. Dr. Liu participated in the 3-day provincial emergency medicine professional job training. The training certificate cannot be used as a basis for changing the scope of practice of physicians. The original judgment determined that the hospital should bear 30% of the compensation liability is not inappropriate. The judgment rejected the appeal and upheld the original judgment.
Legal Brief
Pre-hospital medical first aid is an important part of emergency medicine, which means that the first aid center (station) and the network hospital undertaking pre-hospital medical emergency tasks are dispatched according to the unified command and dispatched to the hospital after the patient arrives at the medical treatment center. Before the treatment in the institution, the medical activities carried out outside the medical institution mainly include on-site rescue, emergency treatment in transit, and monitoring. Professionals who perform pre-hospital medical emergencies include physicians, nurses, and paramedics. Among them, doctors and nurses shall obtain corresponding practicing qualification certificates in accordance with relevant laws and regulations.
Dr. Liu from the county hospital in this case is a practitioner of traditional Chinese medicine. Regarding the issue of whether physicians in the category of traditional Chinese medicine can engage in emergency work, the “Physician Law of the People’s Republic of China” clearly stipulates that after a physician is registered, he can Medical and health institutions shall practice according to the registered practice location, practice category and practice scope, and engage in corresponding medical and health services. Physicians of traditional Chinese medicine and integrative medicine may practice in the departments of traditional Chinese medicine, integrative medicine or other clinical departments in medical institutions according to the registered practice category and scope of practice. This article clarifies that the type of physician’s practice registration must be based on the type of physician’s qualification. The original Ministry of Health’s “Approval for TCM Physicians Can Engage in First Aid Work” also clarifies that TCM physicians can practice according to the registered scope of practice in emergency departments (rooms) and emergency centers (stations) of medical institutions. In this case, Dr. Liu’s practice category is traditional Chinese medicine, but his scope of practice is acupuncture, moxibustion and massage, and the court finds that he is at fault for practicing beyond the scope.
Pre-hospital medical emergency requires medical staff to use the simple pre-hospital conditions and equipment to rescue acutely and critically ill patients. At the same time, a high degree of attention should be exercised, the best prudence and concern for patients should be exercised, and their due responsibilities should be actively performed, so as to protect the life and health of patients from harm other than medically permissible dangers. Whether the first aid is accurate and timely is directly related to the life safety and prognosis of the patient. According to the regulations, emergency centers (stations) and emergency network hospitals should transfer patients to medical institutions for treatment in accordance with the principles of proximity, emergency, meeting professional needs, and taking into account the wishes of patients. In this case, the county hospital, as the first-visit hospital, refused to assist in the transfer, and left the scene after declaring clinical death. The court determined that it failed to provide adequate and reasonable treatment, failed to perform timely rescue and transfer, based on the emergency rescue measures of the city hospital. obligations.
In practice, after the death of a patient is confirmed at the scene of 120, there is a lot of controversy over whether it is necessary to send the patient to the hospital. Netizen @tq01agv’s point of view is worth thinking about: It is necessary to give up the rescue on the spot. There is a risk of disputes. For those who have reached the clinical indication of death for a short period of time and are in good health, do not give up easily. We have personal experience that the heart stopped beating for more than 30 minutes after electric shock, persistent CPR and timely transport, and the heartbeat resumed after 3 hours. There are still many unknown problems in medicine, not to mention giving up other people’s lives on the spot; perhaps, most of our efforts are meaningless, but it is important that our decisions have scientific basis and objective convincing.
(This article was originally written by the Medical Law Institute, adapted from a real case, using a pseudonym to protect the privacy of the parties)