First, the legal issues involved in medical personal injury compensation dispute cases

Medical personal injury compensation dispute cases mainly involve the following issues:

1. How to distribute the burden of proof that constitutes a medical accident?

2, constitute a medical accident, a party in accordance with the general medical disputes to the people's court, how should the people's court apply the law?

3. Should the infringer bear the responsibility for personal injury compensation disputes caused by medical actions that do not constitute medical accidents, and if so, according to what standards? [ 1]

These problems are mainly due to people's inconsistent understanding of the legal provisions, or the inconsistent compensation standards after the promulgation of the Interpretation of Several Issues Concerning the Application of Laws in the Trial of Personal Injury Compensation Cases published by the Supreme People's Court on February 26th, 2003.

With regard to the first question, that is, the distribution of burden of proof, Article 4, Paragraph 2, Item 8 of the Supreme People's Court Provisions on Evidence in Civil Proceedings, which came into effect on April/KLOC-0, 2002, stipulates that medical institutions should bear the burden of proof in tort litigation caused by medical actions, because there is no causal relationship between medical actions and damage results, and there is no medical fault. This provision is just the opposite of the way of "who advocates who gives evidence" in the civil procedure law. This means that since April 1 2002, the reform of the mode of proof has been initiated in China's medical tort litigation, and patients no longer bear the burden of proof of "causal relationship between medical behavior and damage results and no fault in medical process", and the above two responsibilities are borne by medical institutions.

Then, under this provision, does it mean that the burden of proof in medical damage infringement disputes is entirely borne by medical institutions? Let's not say whether this provision is reasonable or not, because the draft tort liability law has different provisions on this. [2] As far as this provision itself is concerned, I don't think we can understand it unilaterally. This special distribution of burden of proof is determined by the particularity of this legal relationship and the ability of both parties to provide evidence, and its purpose is to better embody the principles of fairness and good faith. Due to whether the doctors involved in this kind of litigation are at fault or not, and whether there is a causal relationship between medical behavior and damage results, most of these highly professional evidences are controlled in medical institutions, and it is difficult for patients to possess, approach and collect them. In the case of great disparity in the ability of both parties to provide evidence, judicial interpretation determines that medical institutions bear the burden of proof in this respect according to legal principles, which conforms to the inherent requirements of the burden of proof and the law of trial, and is also fair. There are three main reasons for the Supreme Court's interpretation of this regulation: First, patients' medical knowledge is very limited, and they are also in a passive position in the treatment process, while medical institutions grasp and understand patients' physiological and pathological conditions through examination, laboratory tests and other means, formulate treatment plans, and be familiar with the treatment process; Second, according to the entity distribution standard of the burden of proof, the burden of proof should be borne by the party who has the closest relationship with the evidence or controls the source of the evidence. The examination, laboratory tests and course records in the process of diagnosis and treatment are all implemented and mastered by medical institutions, which are the source of control evidence and the most closely related party; The third is the identification of causality and medical negligence, which involves special problems in the medical field and can only be identified through identification. In this case, all medical institutions need to do is to apply for appraisal and start the appraisal procedure. In this sense, the "inversion of burden of proof" has not excessively increased the burden of medical institutions. There will be no risk of "where is the burden of proof, that is, where is the loss". [3]

However, we can't make a one-sided understanding of this issue. This judicial interpretation only reverses part of the burden of proof in tort litigation caused by medical behavior. If a doctor does his duty, then his legitimate rights and interests can be protected by law if he exercises his right of proof correctly. As for whether there is a legal relationship between patients and medical institutions, whether patients have damage facts, whether there are actual losses, and how much they lose. The burden of proof lies with the patient. Only when the evidence provided by the patient meets the conditions for prosecution stipulated in Article 108 of the Civil Procedure Law will the people's court file a case for acceptance. After trial, only when patients provide sufficient evidence for some facts that they bear the burden of proof can their rights and interests be protected by law. In this sense, the principle of inversion of burden of proof stipulated in doctor-patient disputes is relative, not absolute.