The emergency department is the first place for hospital emergency diagnosis and treatment, and it is also an important part of the social medical service system. The emergency department generally accepts patients in an emergency, so the emergency department is also a high incidence area of medical disputes. The following is a brief legal analysis of the inducing factors of medical disputes based on the characteristics of the emergency department itself.
First, emergency doctors should have corresponding qualifications.
According to Article 16 of the Guidelines for the Construction and Management of Emergency Department (Trial), emergency doctors should have more than 3 years of clinical work experience except those who are undergoing standardized training for residents. Accordingly, emergency doctors should not only strictly abide by the relevant provisions of the Law of People's Republic of China (PRC) on Medical Practitioners, but also have more than 3 years of clinical work experience. With regard to the understanding of "clinical work experience", the author thinks that "clinical work experience" should refer to more than three years of clinical medical work, not necessarily more than three years of clinical medical work after obtaining the qualification of a doctor.
Article 15 of the Guidelines for the Construction and Management of Emergency Department (Trial) (hereinafter referred to as the Guidelines) stipulates that "the emergency department should be equipped with a sufficient number of medical personnel who have received special training, mastered the basic theory, basic knowledge and basic operational skills of emergency medicine, and have the ability to work independently." The Guide also puts forward clear requirements for the qualifications of emergency department directors, emergency nurses and head nurses, aiming at strengthening the construction and management of emergency departments, improving the level of emergency medical care, doing a good job in the first diagnosis and treatment of emergency patients, and ensuring medical quality and safety.
Second, emergency triage should abide by the diagnosis and treatment norms.
Article 24 of the Guide stipulates: "Emergency departments should formulate and strictly implement triage procedures and triage principles, triage patients according to their disease risks, and immediately rescue patients who may be life-threatening." The "Emergency Room Work System" is stipulated in the "Hospital Work System" in the form of a special section, in which the second article specifies in detail the "classified treatment" of patients: "Difficult and critical patients should immediately ask for instructions from their superiors or have an emergency consultation. For critically ill patients who are not suitable for moving, organize rescue in the emergency room on the spot and escort them out of the ward after their condition is stable. Patients who need immediate surgery should be sent to the operating room for surgery in time. Emergency doctors should hand over shifts directly to wards or surgeons. " According to the facts ascertained by the court in this case, although the hospital was initially diagnosed as "flustered and awaiting treatment", it did not check and record the patient's situation at that time. The hospital diverted the patient to another department without determining whether to implement immediate rescue or triage according to the danger degree of the patient's condition, which violated the relevant procedural provisions of the Emergency Triage Guide. Judicial expertise also believes that the patient's own sudden cardiac death is the root cause of his death, and the severity of his own disease and the severity of his illness have a direct causal relationship with death. In the process of rescuing patients, there is a fault of untimely rescue, which has no direct causal relationship with the death of patients. The participation rate of medical behavior faults in hospitals is 20%. To sum up, the court finally concluded that the defendant's hospital was at fault, and there was a causal relationship between the fault and the consequences of the patient's death, in combination with Article 24 of the Guide and Article 58, paragraph 1 (1) of the Tort Liability Law of People's Republic of China (PRC), and with reference to the appraisal opinions of judicial appraisal institutions.
Three, emergency medical records should be timely recorded and improved according to law.
Article 28 of the Guide stipulates: "Emergency medical personnel should write medical documents in accordance with the relevant provisions on medical record writing, ensure that every emergency patient has an emergency medical record, and record the whole process of diagnosis and treatment and the patient's whereabouts." Due to the particularity of the emergency department itself, it is often necessary to make up the medical records afterwards. The writing standard of medical records and the basic standard of Chinese medical records clearly stipulate the completion time of each part of medical records. Medical records are the most important evidence in medical disputes, and after the implementation of the Regulations on the Prevention and Treatment of Medical Disputes, medical personnel should complete medical records on time in strict accordance with the provisions of medical and health laws to avoid being at a disadvantage due to lack of medical records in this case.
legal ground
People's Republic of China (PRC) Basic Medical and Health Promotion Law Article 33 Citizens receiving medical and health services shall be respected. Medical and health institutions and medical and health personnel should care for and treat patients equally, respect their personal dignity and protect their privacy.
When receiving medical and health services, citizens should abide by the medical treatment system and the order of medical and health services, and respect medical and health personnel.