Of: Wang Bing lawyers Source: Powered original
Bing counsel
Peking University Third Hospital v. Medical Malpractice Compensation disputes
a statement, the main fault of the medical process and behavior of medical evidence
Patients Sun, male, 60 years old. because of dizziness, dizziness for 10 years, with blurred vision, memory loss, 1 week treatment in the defendant hospital, was diagnosed as: , bilateral vertebral artery stenosis; 2, hypertension; 3, cerebral infarction, into the ward. preoperative (April 18) carotid artery MRA examination revealed: Display: multiple lacunar infarction, cerebral infarction is not showing sheet, not shown with cerebral hemorrhage (evidence 2).
4 On 20 April, has signed a consent form according to Lu doctor should be in the afternoon, for the patients with central venous catheterization, but until 20:00, Lu doctors are able to ward something that has been in surgery today, no time to catheterization, catheterization before surgery tomorrow. surgical patient's family was very worried about whether the catheter feasible, Lu doctor replied sure the line, and 16 patients were adjacent, said: When did the first 4 almost did not want a life did not have problems, you have no problem, rest assured! good sleep see you tomorrow! the right carotid artery stenting. according to the relevant position and open support good blood flow. but at this time were yawning, physical examination showed left hemiplegia, strength 0. angiography showed once again review: umbrella spasm of distal vessels, the proximal suspected thrombosis. then by the long sheath slow injection of nitroglycerin 200ug, urokinase 250 000 IU (50 000 per minute, IU). again, angiography, carotid artery spasm better the original, the original suspect thrombosis disappeared. left limb muscle strength in patients recovered to grade 4 ---- - treatment of cerebral vasospasm ; Bolivia 75mg/qd; 10mg plus 0.9% nitroglycerin continuous pumping of saline 50ml 5ml / hour for 4 weeks (Evidence 5,6).
about 2 hours after surgery, patients were released from the operating room, the After the family members of patients found out the left upper and lower limbs were not voluntary movement, anxious for the doctor, then Dr. Lv has an urgent, said: cerebral hemorrhage.
second-line medical consultation by the Department of Neurology, said: At the same time, heparin treatment is still continuing.
Since then, the defendant hospital to give patients the diagnosis of unpredictable, and brain CT in the same day report the opposite. which: April 21, 2006, the government doctors were 2 times for the patients brain CT, which number is 06-08519 CT inspection report: multiple cerebral hemorrhage; the brain CT surgeon recommended a brain MRI to clarify or cerebral hemorrhage, but the treating physician not adopted this recommendation; is on the same day another one for another CT examination; April 21 another of the same day, No. 06-08559 CT brain CT examination report: right cerebral infarction, more than was normal ; 22, brain CT examination report: right cerebral infarction, I was no exception; 23 brain CT examination report: right cerebral infarction, more than was normal (not excluding the possibility of a hemorrhagic cerebral infarction); May 15 Day report: cerebral hemorrhage cerebral infarction; June 15 report the brain CT examination: a large area cerebral infarction, brain softening of the brain CT .9 21 page report shows the top of the right temporal infarction, the right basal ganglia Garden center and right half of the eggs malacia.
Following the above treatment, no improvement in patients with brain lesions, but the range increases gradually. be transferred to neurological treatment. Neurology Department into the diagnosis: Brain CT showed right temporal, occipital, fan-shaped low density roof junction, so consider cerebral infarction. intraoperative cerebral vasospasm may lead to cerebral hypoperfusion, watershed infarction due to During treatment, the treating physician arrangements were not given the rehabilitation therapy after intracerebral hemorrhage. in the patient's condition improved slightly after the Department of Neurology, the treating physician and director of several family members of patients found, the patient to another hospital or discharged by the government to urge doctors every day family members of patients discharged from hospital, family members of patients it is unpleasant to you is not presented to back it involved subjects. desperation, patients and their families forced to intervene again, back to Division!
2006 年 1 月 28 at seven o'clock on the evening of , a sudden onset patients, syncope in bed, unconscious, his eyes staring left. Jicha the doctor on duty brain CT, cerebral hemorrhage in addition, the consideration infarction, need for thrombolysis, the families agreed and signed by thrombolysis, thrombolytic therapy After the patient is not clear, review the left side of the brain CT showed cerebral hemorrhage, Neurology, after consultation please give appropriate treatment. At this point, the patient is still unconscious, no significant improvement in the disease, and left just before the onset of the hands and feet to lose control, and now deteriorated to all the limbs can not move, seeing patients in critical condition. At this critical moment as much as the doctor said: on December 8, 2006 death of the defendant hospital.
Second, the focus on the controversial
1, the treating doctor during the operation involved in violent action induced cerebral vasospasm;
2, after the occurrence of cerebral artery spasm The medical treatment is not timely detection and timely treatment, patients with massive cerebral infarction;
3, interventional procedures led to the formation of carotid artery wall plaque off cerebral embolism;
4, the process of fabrication of surgical intervention in patients with left transient paralysis of limbs improved the facts;
5, violation of the relevant technical specifications application of nitroglycerin, over thrombolytic, anticoagulant, leading to cerebral infarction in patients with multiple cerebral hemorrhage at the same time;
6, brain CT examination The results, suspected forgery.
three acts on medical mistakes
(a), the government doctors in the cerebral vascular intervention in violation of technical specifications related to operations, gross operating result due to surgery in patients with cerebral vasospasm, cerebral vasospasm after not timely screening, diagnosis, treatment, resulting in massive cerebral infarction patients, constitute evidence of medical fault
article has been proven by medical treatment for the patients in the interventional treatment of cerebral arteries occurs during cerebral vasospasm. while the treating physician cerebral vascular spasm not the first time, clearly identified and diagnosed with cerebral vasospasm occurred early in the event of failure to make the appropriate treatment of cerebral vasospasm not occur on the exact location of a clear description, not patients with a clear record of the degree of arterial spasm, vasospasm were found in angiography in the process, not the state of vasospasm contrast radiography, failed to find the exact location of vascular spasm.
People's Health Publishing House Therapy silk rough handling and easier to induce cerebral vasospasm The most effective means of mitigation after the timely termination of a variety of stimulating action cerebral vasospasm; that the above situation occurs completely avoidable;
as long as the timely detection of cerebral vasospasm in patients, according to the above practices, stop irritating timely intervention operations, timely application of anti-spasm drugs , then the patient will not be a large area cerebral infarction of the serious adverse consequences.
violation of the treating physician and cerebrovascular intervention practices of these technologies, leading to cerebral vasospasm in patients for too long, a large area cerebral infarction in medical practice constitutes a medical mistake.
(b) violation of operating practices, leading off the right carotid artery wall causes plaque in patients with massive cerebral infarction, constitute medical mistakes
record in the intervention operation we have seen, the Doctors found that patients with treatment of cerebral vasospasm, the patient has symptoms of paralysis of the left limbs occurred. The government also proved he does not know when the patient started to occur from the left limb paralysis, indicating that patients with cerebral artery vasospasm occurred at a time may have occurred at an earlier time.
People's Health Publishing House, As more plaque off the vessel wall surgery or lead to the emergence of the wall of cerebral thrombosis through the narrow part, the umbrella has not yet reached the narrow part of the remote, the umbrella for protection is not open before.
violation of the treating physician and cerebrovascular intervention operations specifications for interventional procedures, resulting in the vessel wall plaque in patients with stenosis loss, severe cerebral infarction, constitute medical mistakes.
(c), in violation of mandatory provisions of national law, process of fabrication of surgical intervention in patients with left limb paralysis transient improvement of facts that constitute medical mistakes
article have evidence to prove, the government doctor in April 21, IU). again, angiography, carotid artery spasm better the original, the original suspect thrombosis disappeared. left limb muscle strength in patients recovered to grade 4 ------cerebral vasospasm itself does not occur, but too long vasospasm, leading to hypoperfusion of regional cerebral blood vessels, leading to cerebral blood coagulation may occur only in case of cerebral infarction, the patient's limb paralysis can not be in the application of nitroglycerin or urokinase, the short period of time better.
there is only simple if the patient cerebral vasospasm is the treatment of the treating physician need only anti-vasospasm therapy without the need for thrombolytic therapy, but the treating doctor in patients paralysis of limbs immediately after the thrombolytic therapy, indicating that there was cerebral infarction patients. recorded in the records of patients: cerebral thrombosis suspected the existence of proximal umbrella, saying intravenous thrombolytic therapy is not established, because the brain umbrella, even if there is suspicious thrombosis, thrombolysis is not required. At this point the treating doctor for thrombolytic therapy is entirely due to cerebral infarction in patients already exists. the treating physician because of rough handling in order to conceal his, leading to vessel wall of patients artery spasm on the plaque off and cause infarction in patients with already existing, fabricated by nitroglycerin in patients undergoing treatment of paralysis after surgery improved clinical performance.
Republic of China, : concealment, forgery, unauthorized destruction of medical documents and relevant information, warning, suspension of implementation of treatment or treatment shall be investigated for criminal liability.
the law of the relevant content of medical personnel may not be forged medical records, the treating physician a breach of the law provides the performance of fabricated disease patients, forged medical content, constitutes a medical mistake.
(d), violation of the relevant technical specifications clinics to give patients with cerebral hemorrhage prohibit the use of nitroglycerin, thrombolysis, anticoagulation, patients with multiple hemorrhage, constitute evidence of medical fault
this article has proven cerebral vascular intervention in patients receiving 3 hours after treatment, the patients with brain CT examination revealed multiple brain hemorrhage in patients with multiple brain hemorrhage after the discovery by the government doctors continue to Nitroglycerin for patients 4 and low molecular weight dextran therapy, continuous infusion of heparin 12500u 20ml / h; low right-500ml 20ml Salvia miltiorrhiza intravenously day 1; Bolivia 75mg/qd;
nitroglycerin, low- molecular dextran, heparin and other drugs are banned from cerebral hemorrhage patients! the defendant hospital violated the treating physician regulate the drug treatment, its dose, long used has been clearly confirmed in patients with multiple cerebral hemorrhage, constitute medical fault.
(e), in violation of mandatory provisions of national law, forged the brain CT findings constitute evidence of medical fault
this has proved April 21, 2006, the government doctors for patients CT examination carried out 2 times , No. 06-08519 in which CT examination report: multiple cerebral hemorrhage; the brain CT surgeon recommended a brain MRI to clarify or cerebral hemorrhage, but the treating physician does not follow this recommendation, but at the same days, another one for another CT examination; April 21 the same day another No. 06-08559 CT examination of brain CT reports: right cerebral infarction, I was no exception;
for patients with brain possible large-scale multiple cerebral hemorrhage and infarction, the patient will not appear on the same day the lesions of multiple cerebral hemorrhage was absorbed, while the emergence of new diseases infarct lesions, however, the same day of the inspection report, for the same individuals, for two different lesions, the defendant has appeared in the hospital two different reports, of which only one is false test results.
accused the hospital of brain CT findings in connection forged medical practice constitutes a medical mistake.
four, on the consequences of the damage
1, operation of the treating physician in violation of relevant technical specifications result in patients with severe infarction;
2, the treating physician violated cerebral hemorrhage prohibit the application thrombolysis, anticoagulation and increased drug-induced intracerebral hemorrhage;
3, patients eventually died of severe cerebral hemorrhage, cerebral infarction and its complications;
4, because the fault of the treating doctor's medical cause patients to assume more health care costs; suffered suffering serious illness; patients and their families suffer mental damage;
V. fault and the damage on the health consequences of the relationship between the cerebral vascular intervention
during surgery in patients with only mild cerebral infarction before, not associated with body paralysis. surgery because the treating physician violated the operational specifications, leading to surgery in patients with severe cerebral vasospasm and plaque off the right carotid artery wall lead to cerebral infarction, followed, as the treating doctors use thrombolytic agents cause cerebral hemorrhage, bleeding and then continue to a large number, combination of the application for intracerebral hemorrhage of thrombolysis and anticoagulation prohibited drugs, leading to increase in patients with cerebral hemorrhage, leading patients died of cerebral infarction and cerebral hemorrhage and its complications. Therefore, the government doctors The medical consequences of the fault between the patient's injury, there is a direct causal relationship.
six, on the legal responsibility
, regulations and medical technical specifications. a clear causal link between the consequences of the damage. the defendant's actions are consistent with the Hospital of the constituent elements of tort, to the patients and their relatives caused moral damage and economic loss. under nineteen of the provisions of this defendant should be liable for the hospital.
attorney: Bing Bar
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