Medical dispute case analysis and Prevention (six points)

Author: Chen Meigu  Edit: medical consultant

 

21Patients with hard packing medicine, accidental death

 

Case

Lu Mou by edema, patients with polyuria, treatment of a three level of first-class hospital in Shanghai City, a diagnosis of "localized scleroderma", after the treatment of symptoms. The doctor was opened for the patient of the discharge notice informing patients discharged from hospital the following day, Lu mou. The nurse on duty was a release for patients Lu Sheng in a small basin9Pill (including3Pill with hard packing). Patients with a dose of Shandong9Pill shortly after the vomiting, cough, shortness of breath. In the evening, with a home Lu, but not alleviate cough symptoms; the original ward in the morning with a return to the lu. Two days later, Lu Mou because patients with aspiration pneumonia, respiratory failure and death. Then the medical disputes caused by.

 

Analytical

The case for the patients in the ward with taking the nurse with hard packed grain, then vomiting, cough, shortness of breath, the final result of aspiration pneumonia, respiratory failure and death due to medical service contract disputes.

 

In the case of medical staff in the process of care for patients, operating in accordance with the "three out of seven of the relevant provisions of the notice", has a legal obligation to do, so there is no fault liability. At the same time, Lu Mou is in18Older adults, and non mental patients, and therefore has full capacity for civil conduct. For a package3Pills should can be identified, except with stripping capacity packaging, medication, patients because of negligence by, family members of patients requires medical institutions shall bear civil liability for compensation request, because of the lack of factual basis and legal basis, the court rejected.

 

Preventing points

 

Although in this case the fault is not in the nurses, but also worthy of medical personnel reference.

In nursing, the nurse in addition to clear responsibility, conscientiously fulfill the "three out of seven on the outside of a note" principle, should also pay close attention to the emotional state of patients, especially the elderly, children or paying special attention to the psychological abnormal tendency to crowd, according to provide more attentive service, in order to avoid the accident.

 

22, improper nursing disputes

 

Case

56- year-old female patient with Wu "cough, expectoration10Day, shortness of breath3One day in the Department of internal medicine "City Center Hospital, hospital with chest tightness, shortness of breath, difficulty in breathing, body weakness. Check the lungs can smell and dry rales, heart border left slightly larger, rhythm of the heart qi, no noise, double lower limbs is pitting edema. Admission diagnosis of pulmonary infection, coronary heart disease, hypothyroidism cardiopathy. On the day of admission, Wu toilet occurrence faint, after the rescue. The next morning, Wu Mouzun orders to the shooting, shooting their way back and sudden fainting, shortness of breath, breathing difficulties, family emergency cart back ward, immediately given oxygen treatment, but patients still feeling shortness of breath and breathing difficulties, at the same time appear cyanotic lips;15Loss of consciousness minutes, breathe out do not answer, rescue35Minutes after death. The hospital said the cause of his death was respiratory and circulatory failure, cardiogenic sudden death. Death diagnosis:1. coronary heart disease: heart failure, cardiac arrest;2. pericardial effusion? Cardiac arrest;3. cardiomyopathy? Cardiac arrest.

 

 

Analytical

 

In this case the forensic identification of Wu's death to die of disease. But attention should also be paid to the hospital, to Wu treatment process is obviously insufficient, the admission day Wu Mouceng fainted, enough attention but this did not cause the hospital; second, still let the patients themselves to shooting, no medical staff to accompany, do not carry oxygen bag, due to inadequate preparation, rescue is very busy. In this case, Wu died of an illness, but because the hospital negligence, the court hospital bear the main responsibility.

 

 

 

Preventing points

 

1. patients after admission, the medical staff should pay close attention to the patient's condition, compliance with the medical routine. Especially for patients with heart failure, must reduce the physical activity and mental stress, serious person have to rest in bed. Medical and nursing doctors should be aware of this point. Such patients out ward (such as shooting, check), to arrange for nursing, prevent accidents.

 

   2To the state of illness. Medical staff should be estimated, emergency preparedness, in case of emergencies should take further measures to rescue.

 

   3Emergency rescue personnel. To raise the level of business, skilled rescue process, accurate operation.

 

Medical disputes and accidents caused by care very much see, link is more also, such as sputum, hot or cold, injection, medicine and so on, medical personnel should cause enough attention, do be prepared against want, combining point, make the medical disputes in earnest, and reduce the occurrence of disputes.

 

 

  

23, blood transfusion infected with viral hepatitis a dispute

 

Case

 

Patients occurred in the county hospital, surgery, male,50Years old, due to lumbar disc herniation underwent operation treatment. The preoperative indexes of liver test normal, a, B serum marker negative. Operation smoothly, much blood loss during the operation. Postoperative fever reaction when in transfusion, blood pressure dropped to the level of shock, the doctor on duty to the patient transfusion therapy. Unified management of non local area because of blood transfusion, blood donors for nearby farmers transfusion team, according to the normal distribution of blood, blood transfusion for patients300Ml, and give the treatment of fever, fluid replacement and other measures, the patient's condition improves, successfully discharged.

 

After recovery2Months, conscious patients with right upper quadrant abdominal discomfort, loss of appetite, fatigue, yellow urine, successively in the city hospital and a military hospital diagnosis of viral hepatitis B, hepatitis C, superinfection, although after treatment, patients in the original operation hospital transfusion hepatitis virus infection, claim to the hospital, causing medical the dispute.

 

 

 

Analytical

 

The cases of medical disputes, the doctor should be fully aware that there is a risk of blood transfusion therapy, the indications should be strictly controlled, the indications for transfusion is also need to complement the red blood cell and blood volume (plasma) condition. For many patients with no operation, occurring fever and hypotension after infusion, should be a corresponding processing treatment of fever reaction, there is no clear indications for transfusion. The blood transfusion risk issues, should be carefully to patients and their families do clear explanation before blood transfusion. Blood transfusion is the treatment of high risk measures, some risk can not predict and prevent, doctors, nurses must strictly according to the operating rules of transfusion, the patient must also fully understand and cooperate, therefore, signed the agreement on blood transfusion before transfusion, is necessary for risk bear their respective obligations.

 

Preventing points

1． Clear indications for transfusion.

2． Should be to the patients and their family members showed the need for transfusion, risks and possible complications before transfusion, made of patients and their families to understand, conscientiously in accordance with the provisions of the agreement signed a blood transfusion.

3． Surgical operation should improve the technological level of operation, reduce the bleeding in the operation, in order to reduce the chance of blood transfusion.

4． The relevant regulations strictly abide by blood transfusion, blood transfusion and strict implementation of conventional treatment.

5． Timely detection and correct treatment of complication of blood transfusion, blood transfusion complications master routine procedure.

6． Fill out and sign the transfusion treatment consent.

  

24The doctor, without identification error compensation The court also

 

Case

 

Kim suffered from abdominal pain please Liu visits, the diagnosis of gastroenteritis, as Liu Jin Mou intravenous drug treatment, observation of a few minutes, Liu for emergency leave. After the payment of a chest pain please call Liu, and Liu arrived a gold has died. The town government organized public security, justice, health and other departments of investigation and evidence collection, and coordinate, the mediation agreement is reached, the Liu Wei a one-time compensation of a family35000Yuan, after Liu Moufu the. Then the Public Security Bureau commissioned a forensic autopsy, the conclusion: the outer membrane due to rupture of aortic dissecting aneurysm, cause sudden death caused by cardiac tamponade. After the identification of Tongzhou City Medical Malpractice Technical Appraisal Committee, the identification of that: ① Liu visits, according to Kim abdominal pain, diarrhea and unclean diet history, diagnosis for "gastroenteritis," and the use of antibiotics and spasmolysis analgesic treatment, no error in the diagnosis and treatment. The aortic dissecting aneurysm is a kind of rare disease, diagnosis is difficult, visit patients have no complaints and provide the related history, can not make a diagnosis of the disease. Rupture of the patient with aortic dissection, causing cardiac tamponade and death, is a disease caused by the patients themselves, belongs to the patient's condition is special, There's no telling and prevention. ④ Liu for infusion of patients had some influence on the aortic dissecting aneurysm rupture, but Kim's death and no direct relation with transfusion, the identification conclusion does not belong to medical accidents. Understand the cause of death after a gold, Liu believes that the payment35000Yuan was a major misunderstanding, has filed a lawsuit to a relative return.

 

Analytical

 

The court held that, according to the two identification, Liu no error in a gold at the time of diagnosis and treatment. Liu in the cause of death was not yet on a gold made the identification of cases, mistaken for the infusion caused a death, it agreed to pay a compensation 35 000Element, this is a major misunderstanding, according to the relevant provisions in our civil law, civil significant misunderstanding may be revoked. The court verdict Kim family returned to Liu35000Element.

 

Preventing points

 

1In this case, told the medical institutions and medical personnel in medical accident disputes appear to be calm, do not blindly compensation in order to make concessions to avoid trouble, should according to legal procedures to clarify the cause of death, the compensation to compensation, the compensation is not determined not to compensation, in order to safeguard the dignity of the law, protect the legitimate rights and interests of medical institutions.

2, encountered such events, suggest that doctors should actively, reflect to the relevant departments in the hospital, the hospital legal counsel to negotiate solutions in private, avoid hasty end, because it often left many hidden dangers, not only can not make concessions to avoid trouble, and the doctor himself on a more disadvantageous position, cause more damages.

  

25Delivery room, women died in childbirth Medical staff should bear the responsibility

Case

Pregnant Du Mou (the plaintiff) in a hospital (the defendant) in obstetrics and gynecology outpatient service, everything is normal, pre production period10Month20Day.10Month19Nissan Fu Du Mou in obstetrics and gynecology hospital labor. Through the admission procedures, check the maternal liver function, blood, urine and other functions were normal, color display of fetal umbilical cord around the neck for two weeks, a week around the abdominal symptoms. 10Month20On the evening ofSuddenly, the maternal appear bosom frowsty, lips purple, breathing difficulties during childbirth, after rescue invalid death. Inform the family after the pregnant woman Du Mou of amniotic fluid embolism.

 

Analytical                 

Du Mou in the hospital to be produced and the defendant has formed the medical service contract, maternal fetal death because of amniotic fluid embolism, not survival. The county medical accident Technical Identification Commission belongs to the medical accident identification (amniotic fluid embolism is a severe complication, a parturient sudden high mortality rate). The hospital has no obvious fault, but prenatal diagnosis has been found the original "fetal umbilical cord around the neck for two weeks, a week around the abdomen, amniotic fluid is slightly high, floating head" and other symptoms, should foresee vaginal delivery can be dangerous, but failed to predict and guarantee the implementation measures, with errors. The court to order the defendant to compensate the plaintiff hospital Du Mou medical expenses, death compensation etc.34000Yuan, dismissed the plaintiff's other claims.

 

Preventing points

1． Medical staff should pay attention to prenatal examination, the examination of patients with hidden trouble, easy burst problems objective informing family members.

2． For the problems of attention, take corresponding measures to protect, to prepare for contingencies. In this dispute case, may suggest families choose caesarean operation, but to inform the risk also exists, let the family members of patients choose.

3． In an effort to save, if still unable to recall. With the family the full communication, particularity, inform the condition of clear responsibilities, said the hospital has to. (medicine consultant)