醫療事故與醫療糾紛處理法律適用研討會(一)
時 間:2003年7月25日至27日
地 點:國二招
主 辦:中國法官協會研究部
主 講 人:國務院法製辦科教文衛司司長史 敏
dajiazaoshanghao,gangcaijiangdezhexie,wojiaodegeiwoyalitebieda,womendegongzuoxingzhishigaowanyigefalvjiurengyigefalv,womenzijichangchangxingrongzijidegongzuoshigouxiongbaibangzi,jinnianSARS的時候,我們搞的是公共衛生、yiliaoshiguchulideng,suoyiduiyixiewentideyanjiu,womenbuganshuofeichangtouche,yinweiyixuefangmianshishuyugaoshenmocede,tadefazhanshixiangdangkuai。duiyuwomencongshilifagongzuodetongzhilaishuo,womenzhinengduiyixiefangmianlejieyixiepimao,womenbazhexielingyuzhongcunzaidewenti,taxuyaozenmeyangcongfalvshangjiayiguifan,tanagewentidebiaocengdedongxiwomenshaoweidilejieyixie。duiyujintiankenengdajiadexiwangzhihengao,wokenenghuirangdajiashiwang。weishenmezhemeshuo?yinweiwokandaolelianggelaoshigeiwochuanguolaideyoujian,namehoudewenti,wokanleyihou,wogandaowodoujiejuebule。danshiyouyixiewenti,tongguowomenzaitiaolideqicaoguochengzhongdeyixiesikao,kenenghuigeidajiajiejueyixiewenti。woweishenmeshuobunengdadaodajiadeyaoqiune?guanjianyouhenduoshisifadeshiwu。zhegetiaoliconggongbudaoxianzaiyijingyinianduole,congqunian9月1號實施到現在也有8、9個月。我從各方麵反饋的消息來說,總的印象,這個條例的效果應該說是好的,但是它確實有不盡人意的地方。總的來說,是比1987niandeyiliaoshiguchulibanfadadaqianjinleyibu。zhejiushiwomenconglifazhedejiaodulaikan,tashixinweide。xianzaimianduizhemeduodefaguan,chulilenameduodeyiliaoshigu,zuoweiwolaishuo,wozhishiyigexuexi。woxianzaijiuxiang,dajiageiwotideyaoqiu,woxiangzenmenenggoujinkenengdedadaodajiadeyaoqiu。wozhinengcongwomenlifashizenmexiangde,shizenmekaolvde,zhegetiaoliweishenmezhemegoujia,zenmeyanglaihuiqianhoudiandaoqilai,lianguanqilaikanzhegetiaoli。woxiangcongzhegefangmiangendajiajiangyijiang。
我(wo)今(jin)天(tian)想(xiang)講(jiang)一(yi)下(xia)醫(yi)療(liao)事(shi)故(gu)條(tiao)例(li)的(de)一(yi)些(xie)問(wen)題(ti)。主(zhu)要(yao)的(de)東(dong)西(xi)給(gei)你(ni)們(men)發(fa)的(de)單(dan)子(zi)上(shang)都(dou)有(you)。可(ke)能(neng)個(ge)別(bie)的(de)地(di)方(fang)我(wo)再(zai)講(jiang)解(jie)一(yi)下(xia)。我(wo)覺(jiao)得(de)我(wo)們(men)是(shi)屬(shu)於(yu)講(jiang)解(jie),我(wo)覺(jiao)得(de)時(shi)間(jian)這(zhe)麼(me)長(chang),我(wo)能(neng)不(bu)能(neng)準(zhun)確(que)地(di)反(fan)映(ying)當(dang)時(shi)立(li)法(fa)的(de)時(shi)候(hou)我(wo)們(men)所(suo)想(xiang)到(dao)的(de)情(qing)況(kuang),還(hai)有(you)當(dang)時(shi)我(wo)們(men)立(li)法(fa)這(zhe)麼(me)想(xiang),最(zui)後(hou)會(hui)引(yin)起(qi)什(shen)麼(me)樣(yang)時(shi)間(jian)上(shang)的(de)問(wen)題(ti)和(he)理(li)論(lun)上(shang)的(de)爭(zheng)論(lun),也(ye)有(you)一(yi)些(xie)是(shi)超(chao)出(chu)我(wo)們(men)當(dang)時(shi)立(li)法(fa)中(zhong)的(de)想(xiang)法(fa)。前(qian)麵(mian)講(jiang)的(de)東(dong)西(xi),你(ni)們(men)的(de)稿(gao)子(zi)上(shang)可(ke)能(neng)沒(mei)有(you)。因(yin)為(wei)我(wo)講(jiang)一(yi)個(ge)立(li)法(fa)的(de)過(guo)程(cheng)。
首(shou)先(xian)我(wo)想(xiang)說(shuo)一(yi)下(xia),立(li)法(fa)的(de)目(mu)的(de)。我(wo)們(men)的(de)條(tiao)例(li)中(zhong)已(yi)經(jing)非(fei)常(chang)明(ming)確(que)地(di)規(gui)定(ding)了(le)我(wo)們(men)立(li)法(fa)的(de)目(mu)的(de),我(wo)們(men)這(zhe)個(ge)條(tiao)例(li)就(jiu)是(shi)圍(wei)繞(rao)著(zhe)要(yao)正(zheng)確(que)地(di)處(chu)理(li)醫(yi)療(liao)事(shi)故(gu)。怎(zen)麼(me)來(lai)處(chu)理(li),在(zai)處(chu)理(li)醫(yi)療(liao)事(shi)故(gu)的(de)過(guo)程(cheng)中(zhong),一(yi)定(ding)要(yao)保(bao)護(hu)雙(shuang)方(fang)的(de)合(he)法(fa)權(quan)益(yi),通(tong)過(guo)醫(yi)療(liao)事(shi)故(gu)的(de)正(zheng)確(que)處(chu)理(li)來(lai)達(da)到(dao)維(wei)護(hu)醫(yi)療(liao)的(de)秩(zhi)序(xu)和(he)保(bao)障(zhang)醫(yi)療(liao)的(de)安(an)全(quan)。同(tong)時(shi)通(tong)過(guo)一(yi)些(xie)對(dui)於(yu)醫(yi)療(liao)事(shi)故(gu)發(fa)生(sheng)之(zhi)後(hou)的(de)研(yan)究(jiu),來(lai)推(tui)動(dong)我(wo)們(men)醫(yi)學(xue)科(ke)學(xue)的(de)發(fa)展(zhan),我(wo)覺(jiao)得(de)這(zhe)一(yi)點(dian)是(shi)非(fei)常(chang)重(zhong)要(yao)的(de)。如(ru)果(guo)我(wo)們(men)醫(yi)療(liao)事(shi)故(gu)不(bu)能(neng)得(de)到(dao)正(zheng)確(que)的(de)處(chu)理(li),當(dang)事(shi)人(ren)可(ke)能(neng)得(de)不(bu)到(dao)它(ta)合(he)法(fa)的(de)利(li)益(yi)保(bao)障(zhang),可(ke)能(neng)就(jiu)會(hui)糾(jiu)纏(chan)醫(yi)生(sheng)。醫(yi)生(sheng)就(jiu)不(bu)能(neng)集(ji)中(zhong)精(jing)力(li),就(jiu)沒(mei)有(you)辦(ban)法(fa)保(bao)證(zheng)給(gei)患(huan)者(zhe)看(kan)病(bing)。這(zhe)個(ge)對(dui)整(zheng)個(ge)醫(yi)療(liao)秩(zhi)序(xu)和(he)醫(yi)療(liao)安(an)全(quan)是(shi)非(fei)常(chang)重(zhong)要(yao)的(de)。我(wo)們(men)在(zai)研(yan)究(jiu)任(ren)何(he)一(yi)個(ge)條(tiao)例(li)的(de)時(shi)候(hou),我(wo)們(men)要(yao)考(kao)慮(lv),我(wo)們(men)到(dao)底(di)要(yao)解(jie)決(jue)什(shen)麼(me)問(wen)題(ti),這(zhe)是(shi)我(wo)們(men)立(li)法(fa)的(de)初(chu)衷(zhong)。所(suo)以(yi)我(wo)們(men)要(yao)研(yan)究(jiu)醫(yi)患(huan)雙(shuang)方(fang)到(dao)底(di)存(cun)在(zai)哪(na)些(xie)問(wen)題(ti),需(xu)要(yao)我(wo)們(men)從(cong)立(li)法(fa)上(shang)來(lai)加(jia)以(yi)解(jie)決(jue)。我(wo)們(men)要(yao)明(ming)白(bai),醫(yi)療(liao)事(shi)故(gu)及(ji)其(qi)爭(zheng)議(yi)的(de)處(chu)理(li)的(de)最(zui)終(zhong)的(de)目(mu)的(de)有(you)這(zhe)麼(me)幾(ji)點(dian)。一(yi)旦(dan)醫(yi)療(liao)事(shi)故(gu)被(bei)提(ti)出(chu)以(yi)後(hou),它(ta)到(dao)底(di)能(neng)不(bu)能(neng)是(shi)我(wo)們(men)本(ben)條(tiao)例(li)所(suo)規(gui)定(ding)的(de)醫(yi)療(liao)事(shi)故(gu)。因(yin)為(wei)醫(yi)療(liao)事(shi)故(gu)的(de)確(que)定(ding),主(zhu)要(yao)還(hai)是(shi)要(yao)解(jie)決(jue)賠(pei)償(chang),有(you)的(de)是(shi)我(wo)讓(rang)你(ni)道(dao)歉(qian),或(huo)者(zhe)是(shi)其(qi)他(ta)方(fang)式(shi)。但(dan)是(shi)我(wo)們(men)說(shuo)主(zhu)要(yao)要(yao)解(jie)決(jue)賠(pei)償(chang)等(deng)民(min)事(shi)責(ze)任(ren)。除(chu)了(le)這(zhe)個(ge)之(zhi)外(wai),衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)對(dui)醫(yi)院(yuan)進(jin)行(xing)管(guan)理(li),所(suo)以(yi)對(dui)發(fa)生(sheng)責(ze)任(ren)的(de)責(ze)任(ren)人(ren)員(yuan),或(huo)者(zhe)責(ze)任(ren)的(de)醫(yi)院(yuan)也(ye)要(yao)以(yi)行(xing)政(zheng)的(de)處(chu)罰(fa)。這(zhe)就(jiu)是(shi)我(wo)們(men)要(yao)追(zhui)究(jiu)有(you)關(guan)的(de)責(ze)任(ren)單(dan)位(wei)和(he)人(ren)員(yuan)。還(hai)有(you)一(yi)個(ge),要(yao)通(tong)過(guo)醫(yi)療(liao)事(shi)故(gu)的(de)解(jie)決(jue),現(xian)在(zai)為(wei)什(shen)麼(me)出(chu)現(xian)一(yi)些(xie)醫(yi)療(liao)事(shi)故(gu)的(de)糾(jiu)紛(fen),在(zai)於(yu)我(wo)們(men)確(que)實(shi)在(zai)醫(yi)療(liao)方(fang)麵(mian),服(fu)務(wu)的(de)質(zhi)量(liang)和(he)醫(yi)療(liao)的(de)水(shui)平(ping)還(hai)需(xu)要(yao)改(gai)進(jin)。所(suo)以(yi)我(wo)們(men)說(shuo),需(xu)要(yao)改(gai)進(jin)醫(yi)療(liao)服(fu)務(wu),來(lai)穩(wen)定(ding)社(she)會(hui)。
處chu理li醫yi療liao事shi故gu,要yao解jie決jue這zhe些xie問wen題ti,所suo以yi涉she及ji到dao立li法fa的de定ding位wei。我wo們men到dao底di應ying該gai搞gao一yi個ge什shen麼me樣yang的de法fa律lv,這zhe也ye是shi在zai法fa學xue界jie很hen多duo爭zheng論lun的de問wen題ti。醫yi患huan雙shuang方fang屬shu於yu民min事shi法fa律lv調tiao整zheng,這zhe是shi要yao搞gao法fa律lv還hai是shi搞gao行xing政zheng法fa規gui,這zhe是shi我wo們men在zai剛gang剛gang接jie觸chu條tiao例li的de時shi候hou麵mian臨lin的de一yi個ge問wen題ti。我wo們men當dang時shi確que實shi覺jiao得de,很hen多duo的de賠pei償chang跟gen民min法fa通tong則ze是shi銜xian接jie在zai一yi起qi。考kao察cha國guo外wai的de一yi些xie立li法fa,醫yi患huan關guan係xi都dou是shi通tong過guo民min法fa來lai調tiao整zheng。我wo們men當dang時shi搞gao醫yi療liao事shi故gu處chu理li法fa準zhun備bei列lie入ru人ren大da的de立li法fa計ji劃hua,做zuo了le一yi些xie工gong作zuo之zhi後hou,確que實shi感gan到dao問wen題ti比bi較jiao複fu雜za,人ren大da也ye認ren為wei,這zhe個ge問wen題ti教jiao科ke文wen衛wei的de同tong誌zhi認ren為wei需xu要yao進jin一yi步bu研yan究jiu,而er且qie在zai實shi踐jian中zhong急ji需xu要yao一yi部bu法fa律lv來lai調tiao整zheng。而er人ren大da的de立li法fa周zhou期qi比bi較jiao長chang。讓rang國guo務wu院yuan先xian行xing搞gao一yi個ge行xing政zheng。為wei什shen麼me我wo們men沒mei有you搞gao醫yi療liao事shi故gu處chu理li法fa,而er是shi先xian搞gao醫yi療liao事shi故gu處chu理li條tiao例li,是shi從cong這zhe兒er由you來lai的de。每mei一yi年nian人ren大da代dai表biao的de議yi案an相xiang當dang多duo,我wo們men要yao答da複fu上shang千qian個ge議yi案an,就jiu是shi關guan於yu醫yi療liao事shi故gu的de處chu理li,在zai這zhe種zhong情qing況kuang下xia,我wo們men著zhe手shou進jin行xing立li法fa工gong作zuo。前qian麵mian已yi經jing做zuo了le一yi段duan工gong作zuo,後hou來lai由you按an條tiao例li來lai搞gao了le一yi年nian多duo,從cong衛wei生sheng部bu門men醫yi療liao事shi故gu的de處chu理li的de立li法fa搞gao了le很hen多duo年nian。第di二er個ge,我wo們men要yao確que定ding衛wei生sheng行xing政zheng部bu門men的de職zhi責ze和he定ding位wei。要yao在zai醫yi患huan雙shuang方fang醫yi療liao事shi故gu處chu理li上shang,衛wei生sheng行xing政zheng部bu門men的de職zhi責ze在zai哪na兒er,應ying該gai怎zen麼me定ding位wei。而er在zai87年那個辦法中,衛生行政部門占著非常主要的地位。調節、處理,都是衛生行政部門,而且到法院訴訟,還要先作為鑒定前位有很多的規律。
第三,一定要研究怎麼樣去保障醫患雙方的合法權益,來妥善處理醫療事故的規定。
第四,我們麵臨著問題。如何保證不同的處理渠道的處理結果是大體相同的。我們帶著這些問題開始研究這個東西。
下xia麵mian講jiang立li法fa思si路lu。從cong各ge種zhong事shi件jian給gei我wo們men的de經jing驗yan的de總zong結jie,就jiu是shi一yi定ding要yao貫guan徹che,預yu防fang為wei主zhu這zhe樣yang的de思si路lu。包bao括kuo我wo們men說shuo突tu發fa事shi件jian,也ye是shi要yao預yu防fang為wei主zhu,把ba工gong作zuo做zuo在zai前qian麵mian。可ke以yi預yu防fang和he減jian少shao醫yi療liao事shi故gu的de發fa生sheng。因yin此ci我wo們men想xiang圍wei繞rao著zhe預yu防fang發fa生sheng醫yi療liao事shi故gu,衛wei生sheng行xing政zheng部bu門men應ying該gai怎zen麼me介jie入ru,再zai一yi個ge,處chu理li,很hen大da的de一yi部bu分fen要yao依yi仗zhang於yu鑒jian定ding結jie論lun,醫yi療liao技ji術shu鑒jian定ding機ji構gou的de參can與yu,這zhe麼me樣yang來lai規gui範fan,整zheng個ge構gou架jia我wo們men這zhe一yi個ge條tiao例li。在zai我wo們men構gou架jia條tiao例li的de時shi候hou,我wo們men又you要yao考kao慮lv這zhe個ge條tiao例li應ying當dang涉she及ji幾ji個ge方fang麵mian的de主zhu體ti。總zong體ti來lai說shuo,一yi個ge無wu非fei是shi醫yi患huan雙shuang方fang,醫yi療liao機ji構gou和he醫yi療liao人ren員yuan,再zai一yi個ge,患huan者zhe和he患huan者zhe的de近jin親qin屬shu,但dan是shi你ni們men從cong條tiao例li中zhong沒mei有you找zhao到dao患huan者zhe及ji其qi近jin親qin屬shu這zhe個ge概gai念nian。患huan者zhe是shi一yi個ge大da的de概gai念nian,在zai某mou些xie條tiao款kuan中zhong是shi特te定ding的de。再zai一yi部bu分fen是shi衛wei生sheng行xing政zheng部bu門men,還hai有you醫yi療liao事shi故gu鑒jian定ding機ji構gou。我wo們men知zhi道dao有you這zhe麼me幾ji個ge方fang麵mian的de主zhu體ti以yi後hou,各ge方fang麵mian的de主zhu體ti都dou應ying當dang做zuo哪na些xie工gong作zuo呢ne?這zhe樣yang就jiu需xu要yao我wo們men分fen清qing不bu同tong層ceng麵mian的de工gong作zuo。首shou先xian是shi醫yi療liao機ji構gou,我wo們men以yi貫guan徹che和he預yu防fang為wei主zhu的de方fang針zhen,它ta就jiu應ying該gai在zai預yu防fang中zhong做zuo大da量liang的de工gong作zuo,需xu要yao教jiao育yu和he培pei訓xun本ben單dan位wei的de工gong作zuo人ren員yuan,醫yi生sheng、hushi。haizhidingleyixieyiliaoshigufangfandeyuanhefangfandehoushi。diergefangmian,chuzhi,shiqingfashengzhihou,nizenmeyangjishilaichuzhi,jianshaozhegesunshidejixukuoda。weishengxingzhengbumenyingdangshuo,womengangcaiqianmianjiangdingwei,congyiwangshiduonianlai,87年醫療事故處理辦法經驗的總結,衛生行政部門在醫療事故的處理這方麵,它是兩方麵的職能。一個是行政職能。
shenmejiaoxingzhengzhinengne?weishengxingzhengbumenyaoduiyiliaojigoujinxingrichangjianduguanli,zheshixingzhengguanlideneirong。ruguoyiyuanfashengleyiliaoshigu,tayouzerenduichuxianshigudeyiyuanhezerenrenyuanjinxingxingzhengshangdechuli。lingyifangmian,tashiweirenminfuwudeyizhongjuece,youxiedangshiren,yinweiwomenyaogoujiatadequdaoshihou,youxierenjiushiyaoweishengxingzhengbumenlaichuli,womenbunengshuoweishengxingzhengbumenzhijinxingxingzhengchuli,chuliyiyuanheyiwurenyuan,shejidaopeichangwomenbuguan。womenfujialeweishengxingzhengbumenyingdangshirendeqingqiu,takeyiduiyujutideyiliaoshigupeichangjiufendetiaojiehechuliyiliaoshiguzhengyi,womenshuozhuyaoshijiejuepeichangdewenti。
這個主要就是調解,不是像87年nian的de辦ban法fa中zhong做zuo出chu行xing政zheng處chu理li。我wo們men這zhe兒er調tiao解jie,調tiao解jie不bu成cheng你ni可ke以yi法fa律lv去qu處chu理li。確que實shi它ta不bu應ying當dang是shi衛wei生sheng行xing政zheng部bu門men的de職zhi責ze。下xia麵mian是shi醫yi療liao事shi故gu技ji術shu鑒jian定ding機ji構gou,純chun粹cui是shi從cong技ji術shu層ceng麵mian來lai做zuo出chu鑒jian定ding。這zhe個ge機ji構gou我wo們men有you一yi個ge對dui於yu鑒jian定ding機ji構gou的de定ding位wei問wen題ti。我wo們men這zhe個ge技ji術shu鑒jian定ding不bu再zai包bao括kuo責ze任ren事shi故gu,把ba這zhe些xie內nei容rong包bao含han在zai鑒jian定ding結jie論lun之zhi初chu。所suo以yi我wo們men說shuo,它ta是shi技ji術shu層ceng麵mian的de,是shi專zhuan家jia用yong他ta的de知zhi識shi,他ta的de技ji術shu手shou段duan,圍wei繞rao著zhe咱zan們men的de法fa律lv法fa規gui和he一yi些xie操cao作zuo的de規gui範fan,診zhen療liao規gui範fan,護hu理li規gui範fan來lai做zuo出chu決jue定ding的de。我wo們men對dui於yu這zhe個ge鑒jian定ding機ji構gou的de定ding位wei,我wo們men都dou知zhi道dao,原yuan來lai醫yi療liao事shi故gu鑒jian定ding委wei員yuan會hui是shi屬shu於yu衛wei生sheng行xing政zheng部bu門men設she立li的de,那na個ge就jiu屬shu於yu行xing政zheng的de色se彩cai。我wo們men現xian在zai的de這zhe個ge機ji構gou一yi定ding要yao從cong衛wei生sheng行xing政zheng部bu門men剝bo離li出chu來lai。我wo們men把ba它ta定ding位wei為wei中zhong介jie性xing質zhi。再zai一yi個ge鑒jian定ding的de任ren務wu,具ju體ti的de承cheng擔dan者zhe是shi誰shui。我wo們men說shuo它ta要yao是shi中zhong立li的de,我wo們men就jiu要yao尋xun找zhao一yi個ge真zhen正zheng能neng夠gou中zhong立li起qi來lai,而er且qie大da家jia又you公gong認ren,又you有you權quan威wei的de這zhe麼me樣yang一yi個ge機ji構gou。因yin此ci我wo們men找zhao到dao了le中zhong華hua醫yi學xue會hui,它ta非fei常chang支zhi持chi我wo們men的de工gong作zuo,他ta們men也ye知zhi道dao,非fei常chang難nan,尤you其qi是shi開kai始shi了le鑒jian定ding工gong作zuo之zhi後hou。我wo們men這zhe個ge具ju體ti的de工gong作zuo由you地di區qu一yi級ji的de醫yi學xue會hui和he省sheng一yi級ji的de醫yi學xue會hui來lai承cheng擔dan首shou次ci和he再zai次ci鑒jian定ding。中zhong華hua醫yi學xue會hui是shi對dui於yu一yi些xie疑yi難nan,這zhe樣yang鑒jian定ding機ji構gou的de任ren務wu,鑒jian定ding機ji構gou要yao完wan成cheng鑒jian定ding的de任ren務wu,首shou先xian必bi須xu有you一yi批pi專zhuan家jia,所suo以yi就jiu需xu要yao建jian立li專zhuan家jia戶hu。當dang事shi人ren提ti出chu這zhe個ge要yao求qiu鑒jian定ding,或huo者zhe是shi衛wei生sheng行xing政zheng部bu門men交jiao由you他ta鑒jian定ding的de時shi候hou,他ta就jiu需xu要yao組zu織zhi人ren員yuan進jin行xing鑒jian定ding,並bing且qie出chu具ju技ji術shu鑒jian定ding結jie論lun書shu。後hou來lai很hen多duo同tong誌zhi提ti到dao,在zai市shi政zheng時shi候hou誰shui出chu庭ting。
第di三san,什shen麼me叫jiao醫yi療liao事shi故gu?我wo們men必bi須xu科ke學xue地di鑒jian定ding醫yi療liao事shi故gu的de概gai念nian。就jiu是shi它ta構gou成cheng的de要yao素su有you哪na些xie?我wo們men前qian麵mian講jiang了le,要yao通tong過guo不bu同tong的de渠qu道dao來lai處chu理li,最zui後hou得de到dao的de結jie果guo應ying該gai大da體ti相xiang同tong,這zhe樣yang,就jiu需xu要yao我wo們men確que定ding一yi個ge統tong一yi的de賠pei償chang原yuan則ze、項xiang目mu和he計ji算suan標biao準zhun,我wo們men要yao帶dai著zhe這zhe些xie問wen題ti來lai設she計ji。怎zen麼me樣yang能neng夠gou正zheng確que地di處chu理li醫yi療liao事shi故gu,我wo們men必bi須xu要yao有you一yi個ge科ke學xue的de處chu理li的de原yuan則ze和he要yao求qiu。這zhe是shi我wo們men第di三san條tiao規gui定ding。一yi定ding要yao做zuo到dao公gong正zheng、公平、公(gong)開(kai),及(ji)時(shi)鑒(jian)定(ding)。要(yao)求(qiu)實(shi)事(shi)求(qiu)是(shi)。我(wo)們(men)一(yi)定(ding)要(yao)做(zuo)到(dao)實(shi)事(shi)求(qiu)是(shi),責(ze)任(ren)明(ming)確(que),處(chu)理(li)恰(qia)當(dang),因(yin)為(wei)在(zai)座(zuo)的(de)很(hen)多(duo)都(dou)是(shi)法(fa)官(guan),具(ju)體(ti)的(de)事(shi)實(shi),沒(mei)有(you)必(bi)要(yao)再(zai)細(xi)講(jiang)。還(hai)有(you)我(wo)們(men)要(yao)設(she)計(ji)一(yi)個(ge)科(ke)學(xue)的(de)處(chu)理(li)渠(qu)道(dao)。我(wo)們(men)原(yuan)來(lai)的(de)辦(ban)法(fa)是(shi)行(xing)政(zheng)部(bu)門(men)處(chu)理(li)前(qian)置(zhi)到(dao)後(hou)麵(mian),到(dao)法(fa)院(yuan)。我(wo)們(men)對(dui)於(yu)當(dang)事(shi)人(ren)的(de)處(chu)理(li)不(bu)應(ying)該(gai)有(you)所(suo)限(xian)製(zhi)。我(wo)們(men)設(she)立(li)了(le)一(yi)個(ge)開(kai)放(fang)性(xing)的(de)處(chu)理(li)渠(qu)道(dao)。可(ke)以(yi)自(zi)行(xing)處(chu)理(li),也(ye)可(ke)以(yi)請(qing)求(qiu)行(xing)政(zheng)處(chu)理(li),還(hai)可(ke)以(yi)向(xiang)人(ren)民(min)法(fa)院(yuan)訴(su)訟(song)。如(ru)果(guo)先(xian)行(xing)政(zheng)處(chu)理(li),不(bu)服(fu)以(yi)後(hou),再(zai)到(dao)法(fa)院(yuan),也(ye)可(ke)以(yi)直(zhi)接(jie)到(dao)法(fa)院(yuan)。正(zheng)因(yin)為(wei)我(wo)們(men)是(shi)行(xing)政(zheng)法(fa)規(gui),大(da)量(liang)的(de)醫(yi)療(liao)事(shi)故(gu)的(de)糾(jiu)紛(fen)爭(zheng)議(yi)是(shi)由(you)人(ren)民(min)法(fa)院(yuan)受(shou)理(li),行(xing)政(zheng)部(bu)門(men)處(chu)理(li)也(ye)可(ke)以(yi),這(zhe)樣(yang)我(wo)們(men)就(jiu)必(bi)須(xu)銜(xian)接(jie)好(hao)法(fa)院(yuan)審(shen)理(li)醫(yi)療(liao)事(shi)故(gu)爭(zheng)議(yi)案(an)件(jian)的(de)法(fa)規(gui)適(shi)用(yong)的(de)問(wen)題(ti)。我(wo)們(men)實(shi)踐(jian)中(zhong)出(chu)現(xian)了(le)很(hen)多(duo)問(wen)題(ti),就(jiu)是(shi)因(yin)為(wei)我(wo)們(men)行(xing)政(zheng)部(bu)門(men)處(chu)理(li)和(he)法(fa)院(yuan)處(chu)理(li)適(shi)用(yong)的(de)法(fa)律(lv)依(yi)據(ju)不(bu)一(yi)樣(yang),才(cai)造(zao)成(cheng)了(le)最(zui)後(hou)同(tong)樣(yang)一(yi)個(ge)醫(yi)療(liao)事(shi)故(gu)用(yong)不(bu)同(tong)的(de)渠(qu)道(dao)進(jin)行(xing)處(chu)理(li),造(zao)成(cheng)了(le)比(bi)較(jiao)大(da)的(de)區(qu)別(bie)。有(you)的(de)是(shi)相(xiang)當(dang)大(da)的(de)差(cha)異(yi)。這(zhe)樣(yang)我(wo)覺(jiao)得(de),社(she)會(hui)就(jiu)不(bu)容(rong)易(yi)穩(wen)定(ding)。
為(wei)什(shen)麼(me)很(hen)多(duo)經(jing)過(guo)行(xing)政(zheng)處(chu)理(li)之(zhi)後(hou),還(hai)要(yao)到(dao)法(fa)院(yuan)呢(ne)?這(zhe)是(shi)一(yi)個(ge)非(fei)常(chang)大(da)的(de)問(wen)題(ti)。所(suo)以(yi)我(wo)們(men)必(bi)須(xu)要(yao)銜(xian)接(jie)好(hao)這(zhe)個(ge)問(wen)題(ti)。因(yin)為(wei)行(xing)政(zheng)法(fa)規(gui)不(bu)能(neng)規(gui)定(ding)法(fa)院(yuan)怎(zen)麼(me)樣(yang),所(suo)以(yi)才(cai)有(you)一(yi)個(ge)銜(xian)接(jie)的(de)問(wen)題(ti)。如(ru)果(guo)搞(gao)醫(yi)療(liao)事(shi)故(gu)處(chu)理(li)法(fa),那(na)直(zhi)接(jie)明(ming)確(que)規(gui)定(ding)就(jiu)可(ke)以(yi)了(le)。因(yin)此(ci)條(tiao)例(li)在(zai)起(qi)草(cao)、研究過程中,就跟最高人民法院達成了統一的認識。做出相應的司法解釋,你要告訴怎麼個適用法,1月26號hao出chu來lai的de是shi,參can照zhao醫yi療liao事shi故gu處chu理li,醫yi療liao事shi故gu糾jiu紛fen的de這zhe樣yang一yi個ge通tong知zhi。怎zen麼me參can照zhao,規gui定ding了le四si條tiao。這zhe裏li頭tou要yao參can照zhao,實shi際ji上shang主zhu要yao是shi兩liang個ge方fang麵mian,一yi個ge就jiu是shi我wo們men跟gen法fa院yuan要yao統tong一yi什shen麼me,就jiu是shi一yi個ge賠pei償chang的de原yuan則ze和he賠pei償chang的de標biao準zhun和he計ji算suan的de方fang法fa。再zai一yi個ge就jiu是shi鑒jian定ding的de專zhuan家jia戶hu。這zhe兩liang個ge問wen題ti我wo們men跟gen法fa院yuan達da成cheng了le一yi致zhi,要yao用yong醫yi學xue會hui建jian立li,哪na怕pa法fa院yuan自zi行xing進jin行xing鑒jian定ding,也ye要yao從cong醫yi學xue會hui建jian立li的de專zhuan家jia部bu裏li抽chou取qu專zhuan家jia,賠pei償chang的de時shi候hou要yao按an照zhao我wo們men這zhe個ge條tiao例li所suo規gui定ding的de原yuan則ze、計算方法和標準。
zuigaofayuanfeichangzhichiwomendegongzuo,zaitadetongzhilimianjibenxiemingle,erqiebushixiangwomenkaishisuoshuode,jiandingyoufayuanzijilaizuo,fayuanhaishiweituoyixuehui。womendetiaoliyouzhemejigefangmiandezuoyong,womenzhongzaiyufang,jianliyigekaifangshiyiliaoshigudezhengyitujing,womenkuodaleyiliaoshigudeneihan,mingqueleguocuo,guanyuzhegegaikuoshiwomendegaikuo,youdetongzhirenwei,shisuoxiaole,tasuoxiaoshicongxiamiandejiaodujiang。yinweiquxiaolejishushiguhezerenshigudehuafen,tamenrenweishisuoxiaoneihan,erwomenrenweikuodaneihanshi,87年(nian)的(de)醫(yi)療(liao)事(shi)故(gu)處(chu)理(li)辦(ban)法(fa)分(fen)為(wei)三(san)級(ji),醫(yi)療(liao)過(guo)錯(cuo)不(bu)作(zuo)為(wei)醫(yi)療(liao)事(shi)故(gu)。這(zhe)樣(yang)的(de)話(hua),凡(fan)是(shi)醫(yi)療(liao)過(guo)錯(cuo),就(jiu)用(yong)人(ren)身(shen)傷(shang)害(hai)到(dao)法(fa)院(yuan)起(qi)訴(su)。反(fan)倒(dao)可(ke)以(yi)得(de)到(dao)高(gao)額(e)的(de)賠(pei)償(chang),真(zhen)正(zheng)的(de)醫(yi)療(liao)事(shi)故(gu)經(jing)過(guo)行(xing)政(zheng)部(bu)門(men)處(chu)理(li)大(da)概(gai)隻(zhi)有(you)幾(ji)萬(wan)人(ren)。因(yin)此(ci)我(wo)們(men)這(zhe)樣(yang),現(xian)在(zai)擴(kuo)大(da)了(le)內(nei)涵(han),我(wo)們(men)在(zai)沒(mei)有(you)醫(yi)療(liao)差(cha)錯(cuo)這(zhe)麼(me)一(yi)說(shuo)。這(zhe)裏(li)頭(tou),當(dang)時(shi)大(da)家(jia)給(gei)我(wo)提(ti)的(de)問(wen)題(ti)裏(li)有(you)很(hen)多(duo)。醫(yi)療(liao)事(shi)故(gu)分(fen)為(wei)四(si)級(ji),最(zui)低(di)的(de)基(ji)本(ben)是(shi)在(zai)第(di)四(si)級(ji)。這(zhe)樣(yang),我(wo)們(men)就(jiu)很(hen)好(hao)處(chu)理(li)這(zhe)個(ge)醫(yi)療(liao)事(shi)故(gu),基(ji)本(ben)是(shi)按(an)照(zhao)這(zhe)個(ge)來(lai)處(chu)理(li),我(wo)們(men)就(jiu)能(neng)夠(gou)使(shi)我(wo)們(men)今(jin)後(hou)的(de)醫(yi)療(liao)事(shi)故(gu)的(de)處(chu)理(li)得(de)到(dao)大(da)體(ti)的(de)平(ping)衡(heng)。我(wo)覺(jiao)得(de)現(xian)在(zai)社(she)會(hui)的(de)輿(yu)論(lun)和(he)熱(re)點(dian),慢(man)慢(man)會(hui)減(jian)弱(ruo)。
zaiyige,baxingzhengjiandinghexingzhengchuliyangefenkai。womenquedingleminshifalvdediwei,tongyilexiangmuhefangfa。bingqiejiadaleyiyuandezeren,xingzhengbumendezerenhejiandingjigoudezeren,jiadalechufalidu。xianggendajiashuoyixia,womendesheji,zenmelaikanzhegefalv,zhegefalvgongqizhang,63條。第二條,我們突出了預防為主,一共用了11條(tiao)片(pian)子(zi)。為(wei)什(shen)麼(me)把(ba)醫(yi)療(liao)事(shi)故(gu)的(de)技(ji)術(shu)鑒(jian)定(ding)排(pai)在(zai)了(le)第(di)三(san)章(zhang),可(ke)能(neng)有(you)人(ren)說(shuo)我(wo)們(men)沒(mei)有(you)按(an)照(zhao)事(shi)情(qing)發(fa)展(zhan)的(de)邏(luo)輯(ji)順(shun)序(xu)來(lai)排(pai)序(xu),從(cong)法(fa)律(lv)上(shang)來(lai)說(shuo),邏(luo)輯(ji)順(shun)序(xu)有(you)兩(liang)種(zhong),一(yi)個(ge)可(ke)以(yi)按(an)照(zhao)事(shi)物(wu)的(de)發(fa)展(zhan)順(shun)序(xu),一(yi)個(ge)要(yao)考(kao)慮(lv)內(nei)在(zai)的(de)法(fa)律(lv)邏(luo)輯(ji)。我(wo)們(men)更(geng)多(duo)的(de)是(shi)考(kao)慮(lv)它(ta)內(nei)在(zai)的(de)法(fa)律(lv)邏(luo)輯(ji)。因(yin)為(wei)我(wo)們(men)曾(zeng)經(jing)也(ye)有(you)一(yi)段(duan),想(xiang)按(an)照(zhao)他(ta)的(de)順(shun)序(xu)寫(xie),先(xian)是(shi)預(yu)防(fang)和(he)處(chu)置(zhi),出(chu)事(shi)以(yi)後(hou),行(xing)政(zheng)部(bu)門(men)怎(zen)麼(me)受(shou)理(li),然(ran)後(hou)怎(zen)麼(me)樣(yang)去(qu)進(jin)行(xing)鑒(jian)定(ding),鑒(jian)定(ding)以(yi)後(hou),又(you)回(hui)到(dao)行(xing)政(zheng)部(bu)門(men)受(shou)理(li),受(shou)理(li)完(wan)了(le)還(hai)有(you)監(jian)督(du)。這(zhe)樣(yang)前(qian)後(hou)老(lao)是(shi)打(da)岔(cha),說(shuo)事(shi)的(de)時(shi)候(hou)這(zhe)樣(yang)說(shuo)非(fei)常(chang)清(qing)楚(chu),寫(xie)在(zai)法(fa)律(lv)上(shang)不(bu)明(ming)確(que)。所(suo)以(yi)我(wo)們(men)現(xian)在(zai)看(kan)的(de)就(jiu)是(shi)事(shi)情(qing)出(chu)現(xian)之(zhi)後(hou),我(wo)們(men)先(xian)引(yin)出(chu)來(lai)第(di)20條tiao,技ji術shu鑒jian定ding,雙shuang方fang當dang事shi人ren可ke以yi共gong同tong要yao求qiu醫yi學xue會hui進jin行xing鑒jian定ding,或huo者zhe是shi衛wei生sheng行xing政zheng部bu門men,接jie到dao醫yi療liao事shi故gu重zhong大da的de糾jiu紛fen,認ren為wei,可ke能neng是shi醫yi療liao事shi故gu的de,但dan需xu要yao進jin行xing鑒jian定ding的de可ke以yi交jiao由you有you關guan的de醫yi學xue會hui進jin行xing鑒jian定ding。所suo以yi這zhe一yi塊kuai我wo們men先xian講jiang鑒jian定ding的de這zhe一yi塊kuai。這zhe麼me一yi說shuo,你ni肯ken定ding要yao明ming白bai,這zhe個ge事shi已yi經jing發fa生sheng了le,有you人ren申shen訴su或huo者zhe要yao求qiu處chu理li,才cai會hui引yin起qi這zhe個ge事shi情qing。
還(hai)有(you)一(yi)個(ge)問(wen)題(ti),為(wei)什(shen)麼(me)要(yao)鑒(jian)定(ding)呢(ne)?因(yin)為(wei)我(wo)們(men)規(gui)定(ding)了(le)雙(shuang)方(fang)要(yao)協(xie)商(shang)解(jie)決(jue),不(bu)是(shi)先(xian)到(dao)法(fa)院(yuan)或(huo)者(zhe)先(xian)到(dao)行(xing)政(zheng)部(bu)門(men),如(ru)果(guo)協(xie)商(shang)解(jie)決(jue),我(wo)先(xian)把(ba)行(xing)政(zheng)部(bu)門(men)處(chu)理(li)寫(xie)在(zai)前(qian)麵(mian)就(jiu)不(bu)合(he)適(shi),雙(shuang)方(fang)協(xie)商(shang)也(ye)可(ke)以(yi)我(wo)們(men)去(qu)鑒(jian)定(ding),鑒(jian)定(ding)完(wan)了(le)我(wo)們(men)怎(zen)麼(me)做(zuo)。所(suo)以(yi)把(ba)鑒(jian)定(ding)放(fang)在(zai)前(qian)麵(mian),我(wo)們(men)覺(jiao)得(de)還(hai)是(shi)比(bi)較(jiao)順(shun)。因(yin)為(wei)這(zhe)樣(yang)照(zhao)顧(gu)了(le)幾(ji)種(zhong)不(bu)同(tong)的(de)情(qing)況(kuang)。技(ji)術(shu)鑒(jian)定(ding)裏(li)麵(mian)說(shuo)的(de)內(nei)容(rong),一(yi)個(ge)我(wo)們(men)設(she)了(le)這(zhe)個(ge)專(zhuan)家(jia)戶(hu)怎(zen)麼(me)設(she)立(li)。再(zai)一(yi)個(ge),受(shou)理(li)以(yi)後(hou)怎(zen)麼(me)樣(yang)進(jin)行(xing)工(gong)作(zuo),鑒(jian)定(ding)結(jie)論(lun)怎(zen)麼(me)做(zuo)出(chu),鑒(jian)定(ding)人(ren)員(yuan)怎(zen)麼(me)提(ti)取(qu),怎(zen)麼(me)樣(yang)需(xu)要(yao)回(hui)避(bi)。還(hai)有(you),最(zui)後(hou),鑒(jian)定(ding)結(jie)論(lun)書(shu)怎(zen)麼(me)製(zhi)作(zuo),怎(zen)麼(me)樣(yang)送(song)達(da)。如(ru)果(guo)不(bu)行(xing)的(de),可(ke)以(yi)再(zai)次(ci)申(shen)請(qing)鑒(jian)定(ding),以(yi)及(ji)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)審(shen)查(zha)以(yi)後(hou),不(bu)合(he)適(shi)可(ke)以(yi)要(yao)求(qiu)重(zhong)新(xin)鑒(jian)定(ding)。
第di四si章zhang,行xing政zheng處chu理li,就jiu是shi說shuo出chu現xian事shi情qing要yao報bao告gao,行xing政zheng部bu門men可ke以yi通tong過guo日ri常chang監jian督du發fa現xian醫yi療liao事shi故gu。鑒jian定ding機ji關guan的de鑒jian定ding結jie論lun出chu來lai以yi後hou,衛wei生sheng行xing政zheng部bu門men應ying該gai做zuo什shen麼me,應ying該gai怎zen麼me去qu審shen核he。凡fan是shi要yao求qiu行xing政zheng部bu門men做zuo出chu處chu理li的de話hua,行xing政zheng部bu門men應ying當dang怎zen麼me樣yang做zuo出chu決jue定ding。
第五章,賠償,我們具體講了很多的賠償辦法。需要把這些條結合起來看,我們最後確定賠償的時候,不是單獨用51條,50條來說。而是結合49條。我們想具體講一講,條例的主要的製度和措施。
首(shou)先(xian)是(shi)醫(yi)療(liao)事(shi)故(gu)的(de)概(gai)念(nian)。我(wo)們(men)條(tiao)例(li)中(zhong)所(suo)規(gui)定(ding)的(de)醫(yi)療(liao)事(shi)故(gu)的(de)法(fa)律(lv)的(de)概(gai)念(nian)。學(xue)者(zhe)們(men)現(xian)在(zai)去(qu)爭(zheng)論(lun),去(qu)談(tan),去(qu)發(fa)表(biao)各(ge)自(zi)的(de)見(jian)解(jie),怎(zen)麼(me)發(fa)表(biao)都(dou)可(ke)以(yi),但(dan)是(shi)我(wo)們(men)對(dui)於(yu)醫(yi)療(liao)事(shi)故(gu)處(chu)理(li),一(yi)定(ding)要(yao)按(an)照(zhao)我(wo)們(men)條(tiao)例(li)所(suo)規(gui)定(ding)的(de)概(gai)念(nian)進(jin)行(xing)。這(zhe)個(ge)概(gai)念(nian)不(bu)僅(jin)僅(jin)是(shi)行(xing)政(zheng)部(bu)門(men)應(ying)當(dang)了(le)解(jie)的(de),也(ye)不(bu)僅(jin)僅(jin)是(shi)法(fa)官(guan)和(he)律(lv)師(shi)們(men)需(xu)要(yao)了(le)解(jie)的(de),作(zuo)為(wei)當(dang)事(shi)人(ren),作(zuo)為(wei)醫(yi)患(huan)雙(shuang)方(fang)都(dou)應(ying)該(gai)了(le)解(jie)它(ta)的(de)內(nei)涵(han)是(shi)什(shen)麼(me)。我(wo)們(men)這(zhe)兒(er),醫(yi)療(liao)事(shi)故(gu)處(chu)理(li)條(tiao)例(li)的(de)第(di)二(er)條(tiao),我(wo)們(men)第(di)二(er)條(tiao)所(suo)規(gui)定(ding)的(de),什(shen)麼(me)叫(jiao)醫(yi)療(liao)事(shi)故(gu),醫(yi)療(liao)事(shi)故(gu)是(shi)指(zhi)醫(yi)療(liao)機(ji)構(gou)及(ji)其(qi)醫(yi)務(wu)人(ren)員(yuan)在(zai)診(zhen)療(liao)活(huo)動(dong)之(zhi)中(zhong),違(wei)反(fan)了(le)國(guo)家(jia)有(you)關(guan)醫(yi)療(liao)衛(wei)生(sheng)的(de)法(fa)律(lv),行(xing)政(zheng)法(fa)規(gui)和(he)部(bu)門(men)的(de)規(gui)章(zhang),以(yi)及(ji)診(zhen)聊(liao)護(hu)理(li)的(de)規(gui)範(fan)和(he)技(ji)術(shu)規(gui)範(fan)等(deng),過(guo)失(shi)造(zao)成(cheng)人(ren)身(shen)傷(shang)害(hai),這(zhe)樣(yang)的(de)行(xing)為(wei)我(wo)們(men)稱(cheng)之(zhi)為(wei)醫(yi)療(liao)事(shi)故(gu)。從(cong)這(zhe)一(yi)條(tiao),我(wo)們(men)可(ke)以(yi)分(fen)解(jie)出(chu)它(ta)有(you)這(zhe)麼(me)幾(ji)個(ge)要(yao)素(su)。首(shou)先(xian),醫(yi)療(liao)事(shi)故(gu)的(de)主(zhu)體(ti),它(ta)是(shi)醫(yi)療(liao)機(ji)構(gou)及(ji)其(qi)醫(yi)務(wu)人(ren)員(yuan),這(zhe)個(ge)醫(yi)療(liao)機(ji)構(gou)是(shi)按(an)照(zhao)我(wo)們(men)的(de)醫(yi)療(liao)機(ji)構(gou)管(guan)理(li)條(tiao)例(li)所(suo)登(deng)記(ji)在(zai)冊(ce),取(qu)得(de)了(le)合(he)法(fa)職(zhi)業(ye)許(xu)可(ke)的(de)這(zhe)樣(yang)的(de)醫(yi)療(liao)機(ji)構(gou)。它(ta)的(de)醫(yi)務(wu)人(ren)員(yuan)是(shi)在(zai)醫(yi)療(liao)機(ji)構(gou)裏(li)進(jin)行(xing)職(zhi)業(ye),現(xian)在(zai)包(bao)括(kuo)職(zhi)業(ye)醫(yi)師(shi),助(zhu)理(li)職(zhi)業(ye)醫(yi)師(shi),鄉(xiang)村(cun)的(de)衛(wei)生(sheng)人(ren)員(yuan)。一(yi)定(ding)要(yao)有(you)現(xian)在(zai)的(de)職(zhi)業(ye)資(zi)格(ge)這(zhe)樣(yang)的(de)人(ren)員(yuan)。它(ta)的(de)場(chang)合(he),這(zhe)個(ge)事(shi)故(gu)一(yi)定(ding)要(yao)在(zai)醫(yi)療(liao)活(huo)動(dong)之(zhi)中(zhong)發(fa)生(sheng)的(de)。它(ta)的(de)行(xing)為(wei)是(shi)什(shen)麼(me)樣(yang)的(de)特(te)點(dian)呢(ne)?它(ta)違(wei)反(fan)了(le)我(wo)們(men)國(guo)家(jia)為(wei)醫(yi)療(liao)衛(wei)生(sheng)法(fa)律(lv),行(xing)政(zheng)法(fa)規(gui),部(bu)門(men)的(de)規(gui)章(zhang),診(zhen)療(liao)、護hu理li規gui範fan的de常chang規gui。現xian在zai中zhong華hua醫yi學xue會hui已yi經jing出chu了le一yi些xie規gui範fan。還hai有you一yi個ge,我wo們men要yao考kao慮lv它ta的de後hou果guo,這zhe個ge後hou果guo就jiu是shi說shuo,是shi過guo失shi造zao成cheng患huan者zhe的de人ren身shen傷shang害hai,醫yi護hu人ren員yuan沒mei有you主zhu觀guan故gu意yi,是shi過guo失shi造zao成cheng的de,過guo失shi是shi因yin為wei違wei反fan了le規gui章zhang製zhi度du,法fa律lv法fa規gui。
這(zhe)種(zhong)行(xing)為(wei)和(he)後(hou)果(guo)應(ying)當(dang)有(you)因(yin)果(guo)關(guan)係(xi)。我(wo)覺(jiao)得(de)我(wo)們(men)可(ke)能(neng)要(yao)把(ba)握(wo)住(zhu)這(zhe)幾(ji)點(dian),來(lai)具(ju)體(ti)區(qu)分(fen)什(shen)麼(me)是(shi)醫(yi)療(liao)事(shi)故(gu)。當(dang)然(ran),你(ni)們(men)講(jiang),實(shi)踐(jian)中(zhong)出(chu)現(xian)的(de)案(an)子(zi)是(shi)非(fei)常(chang)複(fu)雜(za)的(de)。但(dan)我(wo)覺(jiao)得(de),我(wo)們(men)的(de)概(gai)念(nian)是(shi)通(tong)過(guo)很(hen)多(duo)大(da)量(liang)的(de)事(shi)例(li),從(cong)裏(li)頭(tou)規(gui)範(fan)和(he)提(ti)煉(lian)出(chu)來(lai),大(da)體(ti)上(shang)可(ke)以(yi)從(cong)這(zhe)幾(ji)個(ge)方(fang)麵(mian)來(lai)把(ba)握(wo),我(wo)想(xiang)這(zhe)個(ge)事(shi)是(shi)不(bu)是(shi)醫(yi)療(liao)事(shi)故(gu)呢(ne)?這(zhe)個(ge)符(fu)合(he)不(bu)符(fu)合(he)這(zhe)個(ge)概(gai)念(nian),大(da)概(gai)可(ke)以(yi)有(you)初(chu)步(bu)的(de)結(jie)論(lun)。但(dan)是(shi)最(zui)後(hou)是(shi)不(bu)是(shi)呢(ne)?看(kan)後(hou)麵(mian)的(de)鑒(jian)定(ding)。有(you)一(yi)些(xie)是(shi)比(bi)較(jiao)明(ming)顯(xian)的(de),一(yi)看(kan)就(jiu)知(zhi)道(dao)是(shi)不(bu)是(shi)醫(yi)療(liao)事(shi)故(gu),通(tong)過(guo)鑒(jian)定(ding)來(lai)判(pan)斷(duan)是(shi)不(bu)是(shi)存(cun)在(zai)這(zhe)些(xie)特(te)點(dian)。
第di二er,我wo們men要yao突tu出chu預yu防fang為wei主zhu的de原yuan則ze。醫yi療liao機ji構gou和he醫yi療liao人ren員yuan要yao遵zun守shou法fa律lv法fa規gui,要yao求qiu醫yi院yuan必bi須xu設she置zhi質zhi量liang監jian控kong部bu門men,醫yi院yuan小xiao,可ke以yi不bu設she置zhi部bu門men,質zhi量liang監jian控kong部bu門men也ye可ke以yi是shi兼jian製zhi,他ta們men設she置zhi這zhe個ge部bu門men和he人ren員yuan,主zhu要yao是shi監jian督du和he檢jian查zha醫yi療liao活huo動dong,接jie受shou患huan者zhe的de投tou訴su,並bing且qie給gei患huan者zhe提ti供gong谘zi詢xun。我wo看kan了le醫yi療liao事shi故gu處chu理li條tiao例li之zhi後hou,很hen多duo的de醫yi院yuan貼tie了le一yi些xie就jiu醫yi指zhi南nan,對dui於yu醫yi院yuan的de規gui範fan有you非fei常chang大da的de幫bang助zhu。再zai一yi個ge,要yao求qiu醫yi療liao機ji構gou一yi定ding要yao按an照zhao要yao求qiu書shu寫xie病bing例li,並bing且qie妥tuo善shan保bao管guan病bing例li資zi料liao。衛wei生sheng部bu配pei合he這zhe個ge條tiao例li,已yi經jing出chu了le醫yi療liao機ji構gou病bing例li管guan理li的de辦ban法fa,這zhe裏li,對dui於yu什shen麼me是shi病bing例li,病bing例li怎zen麼me形xing成cheng,什shen麼me情qing況kuang下xia可ke以yi複fu印yin,複fu印yin應ying該gai遵zun循xun什shen麼me樣yang的de規gui則ze。大da家jia可ke以yi看kan一yi下xia。
有you一yi個ge要yao求qiu,醫yi療liao機ji構gou一yi定ding要yao製zhi定ding防fang範fan醫yi療liao事shi故gu這zhe樣yang的de預yu案an。並bing且qie要yao建jian立li完wan善shan的de報bao告gao製zhi度du,這zhe個ge報bao告gao製zhi度du分fen為wei兩liang個ge層ceng次ci,一yi個ge是shi內nei部bu報bao告gao,一yi個ge是shi外wai部bu報bao告gao。內nei部bu的de報bao告gao就jiu是shi和he你ni發fa生sheng事shi情qing的de那na個ge小xiao單dan位wei和he人ren員yuan,你ni向xiang你ni的de院yuan部bu或huo者zhe向xiang質zhi量liang監jian控kong部bu門men報bao告gao。質zhi量liang監jian控kong部bu門men如ru果guo自zi己ji發fa覺jiao的de,也ye要yao向xiang領ling導dao報bao告gao,同tong時shi還hai要yao向xiang衛wei生sheng行xing政zheng部bu門men報bao告gao。就jiu是shi要yao健jian全quan內nei外wai報bao告gao。我wo們men具ju體ti看kan是shi13條到14條。
我們的目的是要正確處理醫療事故,一定要建立一個公正、公平、公gong開kai的de原yuan則ze。這zhe個ge原yuan則ze主zhu要yao體ti現xian在zai要yao尊zun重zhong患huan者zhe的de權quan利li和he怎zen麼me樣yang來lai確que定ding醫yi療liao機ji構gou的de權quan利li。對dui於yu患huan者zhe來lai說shuo,他ta有you哪na些xie權quan利li呢ne?我wo們men的de條tiao例li規gui定ding,一yi個ge是shi知zhi情qing權quan。有you些xie醫yi院yuan反fan映ying,對dui知zhi情qing權quan非fei常chang難nan以yi把ba握wo,尤you其qi是shi有you些xie病bing人ren得de癌ai症zheng等deng難nan以yi治zhi愈yu的de病bing,是shi告gao訴su患huan者zhe本ben人ren,還hai是shi告gao訴su患huan者zhe家jia屬shu。這zhe個ge問wen題ti我wo們men曾zeng經jing也ye考kao慮lv過guo,這zhe個ge可ke能neng要yao根gen據ju醫yi院yuan規gui定ding一yi些xie具ju體ti的de措cuo施shi。從cong原yuan則ze來lai說shuo,尊zun重zhong病bing人ren本ben身shen的de權quan利li,應ying該gai告gao訴su病bing人ren,但dan是shi有you些xie情qing況kuang的de病bing可ke能neng不bu適shi宜yi馬ma上shang告gao訴su病bing人ren,可ke能neng要yao根gen據ju具ju體ti的de情qing況kuang來lai加jia以yi分fen析xi。這zhe些xie事shi我wo覺jiao得de要yao根gen據ju具ju體ti情qing況kuang來lai對dui待dai。我wo們men對dui於yu一yi些xie大da的de手shou術shu,或huo者zhe是shi大da的de事shi情qing,比bi較jiao重zhong大da的de醫yi療liao行xing為wei,一yi定ding要yao使shi患huan者zhe知zhi道dao,假jia如ru是shi做zuo手shou術shu,他ta的de風feng險xian在zai哪na兒er,他ta的de治zhi愈yu度du,這zhe些xie都dou要yao根gen據ju具ju體ti的de情qing況kuang來lai告gao知zhi,還hai有you一yi些xie可ke能neng要yao根gen據ju病bing情qing的de進jin展zhan程cheng度du,這zhe些xie我wo覺jiao得de都dou是shi操cao作zuo中zhong的de問wen題ti,我wo們men法fa律lv不bu可ke能neng規gui定ding那na麼me細xi,但dan是shi總zong的de一yi條tiao必bi須xu要yao告gao知zhi。
再(zai)一(yi)個(ge),患(huan)者(zhe)可(ke)有(you)權(quan)按(an)照(zhao)規(gui)定(ding)來(lai)複(fu)印(yin)或(huo)者(zhe)複(fu)製(zhi)病(bing)例(li)資(zi)料(liao),不(bu)一(yi)定(ding)是(shi)在(zai)醫(yi)療(liao)事(shi)故(gu)發(fa)生(sheng)之(zhi)後(hou),想(xiang)知(zhi)道(dao),它(ta)是(shi)可(ke)以(yi)複(fu)印(yin)的(de),但(dan)是(shi)不(bu)是(shi)說(shuo)所(suo)有(you)醫(yi)院(yuan)形(xing)成(cheng)的(de)病(bing)例(li)資(zi)料(liao)全(quan)都(dou)能(neng)複(fu)印(yin),我(wo)們(men)的(de)條(tiao)例(li)中(zhong)有(you)規(gui)定(ding)。我(wo)們(men)具(ju)體(ti)的(de)第(di)十(shi)條(tiao)規(gui)定(ding),實(shi)際(ji)上(shang)醫(yi)院(yuan)形(xing)成(cheng)的(de)病(bing)例(li),醫(yi)療(liao)機(ji)構(gou)和(he)醫(yi)務(wu)人(ren)員(yuan)告(gao)訴(su)我(wo)們(men),醫(yi)院(yuan)的(de)病(bing)例(li)分(fen)為(wei)兩(liang)類(lei),一(yi)個(ge)是(shi)所(suo)謂(wei)的(de)客(ke)觀(guan)病(bing)例(li),一(yi)個(ge)是(shi)主(zhu)觀(guan)病(bing)例(li),客(ke)觀(guan)病(bing)例(li)就(jiu)是(shi)所(suo)謂(wei)形(xing)成(cheng)的(de)就(jiu)診(zhen)的(de)時(shi)候(hou)記(ji)錄(lu)的(de)病(bing)人(ren)字(zi)數(shu),就(jiu)醫(yi)或(huo)開(kai)的(de)病(bing)的(de)藥(yao)方(fang),還(hai)有(you)影(ying)像(xiang)資(zi)料(liao),還(hai)有(you)化(hua)驗(yan)單(dan)。但(dan)是(shi)主(zhu)觀(guan)病(bing)例(li)資(zi)料(liao)不(bu)可(ke)以(yi)複(fu)印(yin)。主(zhu)觀(guan)病(bing)例(li)資(zi)料(liao)主(zhu)要(yao)是(shi)我(wo)們(men)醫(yi)院(yuan)對(dui)以(yi)南(nan)性(xing)質(zhi)病(bing)症(zheng)的(de)討(tao)論(lun),因(yin)為(wei)這(zhe)是(shi)在(zai)討(tao)論(lun)階(jie)段(duan),沒(mei)有(you)最(zui)後(hou)的(de)定(ding)性(xing),不(bu)可(ke)能(neng)作(zuo)為(wei)依(yi)據(ju)。到(dao)醫(yi)療(liao)事(shi)故(gu)真(zhen)正(zheng)發(fa)生(sheng)的(de)時(shi)候(hou),這(zhe)一(yi)部(bu)分(fen)病(bing)例(li)也(ye)要(yao)提(ti)供(gong),但(dan)這(zhe)不(bu)是(shi)由(you)病(bing)人(ren)來(lai)做(zuo)。
再(zai)一(yi)個(ge),醫(yi)療(liao)措(cuo)施(shi),醫(yi)療(liao)風(feng)險(xian)這(zhe)些(xie)事(shi)情(qing),同(tong)時(shi)醫(yi)療(liao)機(ji)構(gou)要(yao)保(bao)障(zhang)病(bing)人(ren)可(ke)以(yi)投(tou)訴(su),也(ye)可(ke)以(yi)向(xiang)誰(shui)谘(zi)詢(xun)它(ta)有(you)道(dao)。這(zhe)個(ge)要(yao)求(qiu)醫(yi)療(liao)機(ji)構(gou)要(yao)設(she)置(zhi)這(zhe)些(xie)部(bu)門(men)來(lai)保(bao)障(zhang)患(huan)者(zhe)權(quan)利(li)的(de)實(shi)現(xian)。但(dan)是(shi)另(ling)一(yi)方(fang)對(dui)於(yu)醫(yi)療(liao)機(ji)構(gou)和(he)醫(yi)療(liao)人(ren)員(yuan)的(de)合(he)法(fa)權(quan)益(yi),我(wo)們(men)也(ye)是(shi)保(bao)證(zheng)的(de)。我(wo)們(men)的(de)宗(zong)旨(zhi)是(shi)保(bao)證(zheng)雙(shuang)方(fang)的(de)合(he)法(fa)權(quan)益(yi)。我(wo)這(zhe)裏(li)寫(xie)的(de)比(bi)較(jiao)簡(jian)單(dan)。明(ming)確(que)部(bu)署(shu)醫(yi)療(liao)事(shi)故(gu)的(de)情(qing)形(xing),這(zhe)是(shi)第(di)33條(tiao)的(de)規(gui)定(ding)。規(gui)定(ding)了(le)六(liu)種(zhong)行(xing)為(wei),在(zai)第(di)二(er)款(kuan)規(gui)定(ding),不(bu)屬(shu)於(yu)醫(yi)療(liao)事(shi)故(gu)的(de)醫(yi)療(liao)機(ji)構(gou),不(bu)承(cheng)擔(dan)賠(pei)償(chang)責(ze)任(ren)。我(wo)們(men)當(dang)時(shi)在(zai)立(li)法(fa)中(zhong)曾(zeng)經(jing)有(you)一(yi)條(tiao)寫(xie)的(de)是(shi),不(bu)屬(shu)於(yu)醫(yi)療(liao)事(shi)故(gu)的(de),不(bu)承(cheng)擔(dan)醫(yi)療(liao)事(shi)故(gu)賠(pei)償(chang)責(ze)任(ren)。實(shi)際(ji)合(he)法(fa)權(quan)益(yi)的(de)保(bao)護(hu),我(wo)們(men)在(zai)這(zhe)裏(li)條(tiao)文(wen)中(zhong)的(de)體(ti)現(xian),對(dui)於(yu)患(huan)者(zhe)和(he)醫(yi)療(liao)機(ji)構(gou)是(shi)用(yong)不(bu)同(tong)的(de)方(fang)式(shi)來(lai)表(biao)現(xian)的(de)。患(huan)者(zhe)是(shi)列(lie)名(ming),患(huan)者(zhe)有(you)什(shen)麼(me)權(quan)利(li),對(dui)於(yu)醫(yi)療(liao)機(ji)構(gou),你(ni)應(ying)當(dang)做(zuo)好(hao)什(shen)麼(me)工(gong)作(zuo),這(zhe)樣(yang)來(lai)體(ti)現(xian)的(de)。如(ru)果(guo)法(fa)律(lv)所(suo)要(yao)求(qiu)你(ni)做(zuo)到(dao)的(de)東(dong)西(xi),你(ni)都(dou)做(zuo)到(dao)了(le),醫(yi)療(liao)機(ji)構(gou)就(jiu)是(shi)一(yi)個(ge)自(zi)我(wo)的(de)保(bao)護(hu)。就(jiu)是(shi)用(yong)這(zhe)種(zhong)方(fang)式(shi)來(lai)自(zi)我(wo)保(bao)護(hu)合(he)法(fa)權(quan)益(yi)。同(tong)時(shi)我(wo)覺(jiao)得(de),明(ming)確(que)的(de)部(bu)署(shu)醫(yi)療(liao)事(shi)故(gu)的(de)情(qing)形(xing),這(zhe)是(shi)對(dui)於(yu)醫(yi)療(liao)機(ji)構(gou)和(he)醫(yi)務(wu)人(ren)員(yuan)一(yi)個(ge)最(zui)大(da)的(de)保(bao)證(zheng)。作(zuo)為(wei)醫(yi)療(liao)機(ji)構(gou)的(de)保(bao)護(hu)是(shi)兩(liang)條(tiao),一(yi)個(ge)是(shi)你(ni)應(ying)當(dang)按(an)照(zhao)法(fa)律(lv)的(de)規(gui)定(ding)做(zuo)好(hao)你(ni)應(ying)該(gai)做(zuo)的(de)事(shi)。第(di)二(er)明(ming)確(que)部(bu)署(shu)醫(yi)療(liao)事(shi)故(gu)的(de)情(qing)形(xing)。並(bing)且(qie)規(gui)定(ding)了(le)不(bu)負(fu)擔(dan)賠(pei)償(chang)這(zhe)樣(yang)的(de)原(yuan)則(ze)。
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前麵是規定的條件,下麵規定了符合條件人員的義務,因為從87年那個辦法中,因為我們當時87niandeyiliaoshiguchulibanfashejideshinameyizhongzhidu,henduodezhuanjiabuyuanyizaijiandingweiyuanhui,pashoudaji,ruguowomenzhexieyouxueshi,youjinengdezhuanjiabujinwomendezhuanjiaku,womendejishujiumeiyoubiaozhun。fanshiweishengyiliaozhuanyederenyuanfayiyingyiwushoupinzhuanjiahu,congmuqianzujiandeqingkuangkan,jijixinghaibushihengao。wojiaodezheshiyizhongzeren。
下xia麵mian就jiu講jiang一yi下xia行xing政zheng的de處chu理li程cheng序xu,我wo們men為wei什shen麼me不bu再zai更geng多duo地di講jiang雙shuang方fang和he自zi願yuan,和he到dao法fa院yuan調tiao解jie,後hou麵mian我wo可ke以yi有you一yi個ge示shi意yi圖tu說shuo一yi下xia,我wo們men整zheng個ge三san個ge圖tu是shi怎zen麼me來lai運yun轉zhuan的de,包bao括kuo鑒jian定ding。我wo們men的de重zhong點dian還hai是shi在zai於yu醫yi療liao事shi故gu的de行xing政zheng處chu理li方fang麵mian。我wo這zhe裏li所suo說shuo的de行xing政zheng處chu理li程cheng序xu,概gai括kuo並bing不bu很hen準zhun確que。我wo來lai解jie釋shi一yi下xia,如ru果guo很hen準zhun確que的de話hua,我wo們men前qian麵mian說shuo的de,行xing政zheng處chu理li隻zhi是shi對dui於yu確que實shi是shi衛wei生sheng行xing政zheng部bu門men看kan,以yi行xing政zheng職zhi能neng做zuo的de行xing政zheng處chu理li。我wo這zhe兒er所suo說shuo行xing政zheng處chu理li程cheng序xu實shi際ji上shang是shi行xing政zheng處chu理li渠qu道dao,包bao括kuo當dang事shi人ren要yao求qiu行xing政zheng部bu門men給gei我wo調tiao解jie,一yi個ge說shuo咱zan們men純chun粹cui講jiang的de行xing政zheng受shou理li,就jiu是shi爭zheng議yi,我wo們men講jiang的de醫yi療liao事shi故gu爭zheng議yi。前qian麵mian都dou說shuo的de是shi醫yi療liao事shi故gu的de概gai念nian,我wo在zai講jiang課ke之zhi中zhong,很hen多duo的de醫yi務wu人ren員yuan當dang麵mian跟gen我wo談tan交jiao流liu,你ni規gui定ding的de醫yi療liao事shi故gu根gen本ben就jiu不bu對dui,他ta還hai沒mei有you最zui後hou確que定ding,你ni怎zen麼me就jiu能neng規gui定ding。你ni必bi須xu得de先xian規gui定ding,它ta應ying當dang有you哪na些xie要yao素su,然ran後hou出chu事shi以yi後hou,是shi不bu是shi醫yi療liao事shi故gu,還hai得de有you一yi個ge判pan斷duan的de標biao準zhun。在zai這zhe個ge時shi候hou,這zhe個ge出chu來lai以yi後hou,我wo們men用yong的de是shi爭zheng議yi,需xu要yao進jin行xing一yi係xi列lie的de判pan定ding才cai能neng知zhi道dao是shi不bu是shi醫yi療liao事shi故gu。
出(chu)了(le)事(shi)以(yi)後(hou),雙(shuang)方(fang)引(yin)起(qi)爭(zheng)議(yi),引(yin)起(qi)爭(zheng)議(yi)由(you)誰(shui)來(lai)受(shou)理(li),我(wo)們(men)實(shi)際(ji)上(shang)法(fa)院(yuan)說(shuo)的(de)管(guan)轄(xia),管(guan)轄(xia)是(shi)由(you)縣(xian)一(yi)級(ji)的(de)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)堅(jian)持(chi)的(de)。但(dan)我(wo)們(men)國(guo)家(jia)的(de)行(xing)政(zheng)體(ti)製(zhi),有(you)一(yi)些(xie)直(zhi)轄(xia)市(shi)怎(zen)麼(me)辦(ban),直(zhi)轄(xia)市(shi)就(jiu)是(shi)由(you)西(xi)城(cheng)區(qu),海(hai)澱(dian)區(qu)等(deng)等(deng)這(zhe)樣(yang)的(de)區(qu)縣(xian)衛(wei)生(sheng)局(ju)直(zhi)接(jie)受(shou)理(li)。第(di)二(er),我(wo)們(men)先(xian)受(shou)理(li)下(xia)來(lai),未(wei)必(bi)就(jiu)是(shi)最(zui)後(hou)我(wo)完(wan)全(quan)是(shi)由(you)我(wo)來(lai)管(guan)轄(xia),還(hai)要(yao)區(qu)分(fen)不(bu)同(tong)的(de)情(qing)況(kuang)。前(qian)麵(mian)的(de)規(gui)定(ding)就(jiu)是(shi)要(yao)方(fang)便(bian)當(dang)事(shi)人(ren),衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)是(shi)什(shen)麼(me)樣(yang)的(de)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men),實(shi)際(ji)上(shang)是(shi)醫(yi)療(liao)機(ji)構(gou)所(suo)在(zai)地(di)的(de)縣(xian)級(ji)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)。我(wo)們(men)縣(xian)一(yi)級(ji)的(de)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)先(xian)把(ba)要(yao)求(qiu)處(chu)理(li)糾(jiu)紛(fen)的(de)申(shen)請(qing)先(xian)受(shou)下(xia)來(lai)以(yi)後(hou),然(ran)後(hou)再(zai)根(gen)據(ju)情(qing)況(kuang)判(pan)斷(duan)。凡(fan)是(shi)有(you)這(zhe)麼(me)幾(ji)種(zhong),剛(gang)才(cai)上(shang)麵(mian)所(suo)說(shuo)的(de),我(wo)們(men)需(xu)要(yao)往(wang)上(shang)提(ti)訴(su)。移(yi)送(song)的(de),要(yao)求(qiu)患(huan)者(zhe)死(si)亡(wang)的(de),根(gen)據(ju)這(zhe)個(ge)情(qing)況(kuang)一(yi)下(xia)判(pan)斷(duan),可(ke)能(neng)為(wei)二(er)級(ji)以(yi)上(shang)醫(yi)療(liao)事(shi)故(gu),還(hai)有(you)符(fu)合(he)衛(wei)生(sheng)部(bu)和(he)省(sheng)衛(wei)生(sheng)廳(ting)規(gui)定(ding)的(de)一(yi)些(xie)情(qing)形(xing),這(zhe)些(xie)要(yao)上(shang)訴(su)。
剛gang才cai說shuo的de這zhe一yi點dian,是shi行xing政zheng受shou理li。行xing政zheng受shou理li以yi後hou怎zen麼me來lai處chu理li,就jiu要yao回hui到dao前qian麵mian說shuo的de,我wo們men可ke能neng是shi需xu要yao鑒jian定ding,那na就jiu要yao移yi交jiao鑒jian定ding,鑒jian定ding完wan了le以yi後hou,鑒jian定ding機ji關guan再zai把ba它ta的de鑒jian定ding結jie論lun給gei衛wei生sheng行xing政zheng部bu門men,衛wei生sheng行xing政zheng部bu門men要yao根gen據ju法fa律lv的de規gui定ding,對dui於yu鑒jian定ding結jie論lun加jia以yi審shen核he,刑xing事shi審shen核he符fu不bu符fu合he刑xing事shi要yao件jian,當dang事shi人ren要yao求qiu你ni接jie著zhe進jin行xing處chu理li的de,要yao進jin行xing賠pei償chang。如ru果guo發fa現xian確que實shi屬shu於yu醫yi療liao事shi故gu的de,衛wei生sheng行xing政zheng部bu門men要yao對dui醫yi療liao機ji構gou和he醫yi務wu人ren員yuan做zuo出chu行xing政zheng處chu罰fa。
下(xia)麵(mian)講(jiang)一(yi)下(xia)醫(yi)療(liao)事(shi)故(gu)鑒(jian)定(ding)和(he)處(chu)理(li)的(de)事(shi)故(gu)圖(tu)。想(xiang)把(ba)整(zheng)個(ge)的(de)醫(yi)療(liao)事(shi)故(gu)是(shi)怎(zen)麼(me)來(lai)運(yun)行(xing)的(de),跟(gen)大(da)家(jia)稍(shao)微(wei)講(jiang)解(jie)一(yi)下(xia)。我(wo)們(men)前(qian)麵(mian)講(jiang)了(le)那(na)麼(me)多(duo),我(wo)們(men)現(xian)在(zai)就(jiu)說(shuo),一(yi)個(ge)真(zhen)正(zheng)的(de)醫(yi)療(liao)事(shi)故(gu),爭(zheng)議(yi)發(fa)生(sheng)之(zhi)後(hou),到(dao)底(di)應(ying)當(dang)怎(zen)麼(me)去(qu)運(yun)行(xing)。第(di)一(yi),發(fa)生(sheng)之(zhi)後(hou),我(wo)們(men)先(xian)講(jiang)自(zi)行(xing)協(xie)商(shang)的(de)怎(zen)麼(me)辦(ban)?發(fa)生(sheng)事(shi)故(gu)以(yi)後(hou),我(wo)們(men)說(shuo)可(ke)以(yi)協(xie)商(shang),我(wo)們(men)可(ke)以(yi)自(zi)行(xing)寫(xie),需(xu)要(yao)鑒(jian)定(ding)的(de)和(he)不(bu)需(xu)要(yao)鑒(jian)定(ding)的(de)達(da)成(cheng)一(yi)致(zhi)就(jiu)行(xing)。如(ru)果(guo)需(xu)要(yao)鑒(jian)定(ding)的(de),要(yao)雙(shuang)方(fang)共(gong)同(tong)來(lai)申(shen)請(qing),讓(rang)醫(yi)療(liao)機(ji)構(gou)所(suo)在(zai)地(di)的(de)那(na)個(ge)地(di)區(qu)的(de)醫(yi)學(xue)會(hui)申(shen)請(qing),大(da)家(jia)一(yi)定(ding)要(yao)看(kan)看(kan)是(shi)雙(shuang)方(fang)當(dang)事(shi)人(ren)提(ti)出(chu)申(shen)請(qing)的(de)話(hua),一(yi)定(ding)需(xu)要(yao)共(gong)同(tong)申(shen)請(qing)。如(ru)果(guo)不(bu)是(shi)共(gong)同(tong)申(shen)請(qing)的(de)話(hua),那(na)個(ge)醫(yi)學(xue)會(hui)就(jiu)不(bu)受(shou)理(li)。如(ru)果(guo)決(jue)定(ding)是(shi)共(gong)同(tong)申(shen)請(qing)的(de),應(ying)當(dang)受(shou)理(li),那(na)怎(zen)麼(me)做(zuo)呢(ne)?我(wo)們(men)就(jiu)要(yao)到(dao)專(zhuan)家(jia)庫(ku)抽(chou)取(qu)專(zhuan)家(jia)。抽(chou)取(qu)專(zhuan)家(jia)是(shi)在(zai)醫(yi)學(xue)會(hui)的(de)工(gong)作(zuo)人(ren)員(yuan)的(de)主(zhu)持(chi)之(zhi)下(xia),由(you)雙(shuang)方(fang)隨(sui)機(ji)抽(chou)取(qu)。我(wo)們(men)現(xian)在(zai)要(yao)求(qiu)鑒(jian)定(ding)專(zhuan)家(jia)組(zu)組(zu)成(cheng)人(ren)員(yuan)必(bi)須(xu)是(shi)單(dan)數(shu),所(suo)以(yi)雙(shuang)方(fang)當(dang)事(shi)人(ren)各(ge)抽(chou)取(qu)三(san)名(ming),另(ling)一(yi)名(ming)由(you)醫(yi)學(xue)會(hui)的(de)工(gong)作(zuo)人(ren)員(yuan)在(zai)雙(shuang)方(fang)當(dang)事(shi)人(ren)在(zai)場(chang)的(de)情(qing)況(kuang)下(xia)隨(sui)機(ji)抽(chou)取(qu),然(ran)後(hou)組(zu)成(cheng)專(zhuan)家(jia)鑒(jian)定(ding)組(zu)。
鑒定是有時限的,鑒定機構收取了雙方需要鑒定的資料,按照條例的第28條的規定,提取的有關的資料之後,45tianzhineiyaonachujiandingjielun。zuchenglezhuanjiakuzhihou,zhuanjiayaojinxingyixiebiyaodetiaozha。dajiayaokanziliao,ruguoziliaobugou,xuyaotiaozha。beitiaozharenyingdangjijidipeihe。ranhouzhuanjiazaijinxingjutijianding,womendeyaoqiushiyizhaofalvdeguiding,youguizhang,haiyouzhenliaoguifan,caozuodeguicheng,yijitadezhuanyezhishihejishushouduanlaijinxingjianding。congwomenweishengbufadeguizhangyaoqiujianding,zaijiandingdeshihou,shuangfangdangshirenyaozaichang,tamenzaichangzhiyouyiduanshijian,yinweizhuanjiajinxingjiandingdeshihouyaowenqingqingkuang,jiuxiangfayuanyaoqiushensurenshuoqingchuyiyang。zhuanjiagenjuqingkuanglaijinxingjutidejiandinghetichutamendeyijian。jiandingzuzhiyaoyouheyizhi,zheshidi25條規定。主要的學科專家不得少於二分之一。如果涉及傷殘體係的話,一定要通過法醫。法醫從醫學會的專家庫抽取的。
我們條例第27條tiao規gui定ding,專zhuan家jia組zu獨du立li進jin行xing技ji術shu鑒jian定ding,任ren何he單dan位wei和he個ge人ren不bu得de幹gan擾rao,但dan是shi為wei什shen麼me在zai衛wei生sheng部bu的de鑒jian定ding辦ban法fa中zhong,雙shuang方fang當dang事shi人ren要yao有you一yi定ding的de參can加jia呢ne。剛gang才cai講jiang了le共gong同tong協xie商shang,共gong同tong分fen析xi。還hai有you一yi個ge,我wo要yao求qiu行xing政zheng部bu門men解jie決jue的de,我wo即ji使shi要yao求qiu行xing政zheng部bu門men解jie決jue,我wo也ye可ke以yi共gong同tong去qu要yao求qiu鑒jian定ding組zu織zhi進jin行xing鑒jian定ding。不bu通tong過guo行xing政zheng部bu門men,也ye是shi可ke以yi的de。鑒jian定ding結jie論lun做zuo完wan之zhi後hou,專zhuan家jia有you簽qian名ming,然ran後hou製zhi定ding了le鑒jian定ding結jie論lun書shu,鑒jian定ding結jie論lun書shu的de內nei容rong包bao括kuo哪na些xie方fang麵mian,我wo們men條tiao例li中zhong有you規gui定ding,我wo們men的de鑒jian定ding辦ban法fa中zhong也ye有you具ju體ti規gui定ding。專zhuan家jia說shuo一yi定ding要yao按an照zhao這zhe個ge要yao求qiu來lai進jin行xing鑒jian定ding。鑒jian定ding結jie論lun出chu來lai之zhi後hou,是shi雙shuang方fang自zi行xing協xie商shang的de,就jiu應ying當dang及ji時shi送song達da雙shuang方fang當dang事shi人ren,確que定ding是shi醫yi療liao事shi故gu的de,鑒jian定ding費fei用yong由you醫yi療liao機ji構gou承cheng擔dan。這zhe是shi講jiang的de第di一yi個ge渠qu道dao。
第(di)二(er)個(ge)渠(qu)道(dao),發(fa)生(sheng)爭(zheng)議(yi)以(yi)後(hou),通(tong)過(guo)行(xing)政(zheng)渠(qu)道(dao)來(lai)解(jie)決(jue)。行(xing)政(zheng)渠(qu)道(dao)就(jiu)是(shi)有(you)兩(liang)種(zhong)情(qing)況(kuang)需(xu)要(yao)進(jin)行(xing)受(shou)審(shen),要(yao)求(qiu)有(you)移(yi)送(song)的(de)鑒(jian)定(ding)機(ji)構(gou)進(jin)行(xing)鑒(jian)定(ding)。一(yi)個(ge)是(shi)剛(gang)才(cai)說(shuo),當(dang)事(shi)人(ren)要(yao)求(qiu)通(tong)過(guo)行(xing)政(zheng)渠(qu)道(dao)來(lai)處(chu)理(li)的(de),行(xing)政(zheng)部(bu)門(men)覺(jiao)得(de)要(yao)進(jin)行(xing)鑒(jian)定(ding)。要(yao)移(yi)交(jiao)他(ta)們(men)用(yong),具(ju)體(ti)的(de)程(cheng)序(xu)和(he)剛(gang)才(cai)講(jiang)的(de)是(shi)一(yi)樣(yang)的(de),所(suo)不(bu)同(tong)是(shi)由(you)行(xing)政(zheng)部(bu)門(men)移(yi)交(jiao)的(de)鑒(jian)定(ding)結(jie)論(lun)出(chu)來(lai)之(zhi)後(hou),鑒(jian)定(ding)組(zu)織(zhi)應(ying)當(dang)把(ba)這(zhe)個(ge)鑒(jian)定(ding)結(jie)論(lun)及(ji)時(shi)送(song)達(da),或(huo)交(jiao)由(you)他(ta)進(jin)行(xing)鑒(jian)定(ding)的(de)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)。還(hai)有(you)一(yi)種(zhong),它(ta)發(fa)現(xian)了(le)醫(yi)療(liao)事(shi)故(gu),收(shou)到(dao)以(yi)後(hou),他(ta)認(ren)為(wei)需(xu)要(yao)進(jin)行(xing)鑒(jian)定(ding)的(de),他(ta)可(ke)以(yi)自(zi)己(ji)移(yi)交(jiao)。我(wo)們(men)行(xing)政(zheng)機(ji)關(guan)再(zai)根(gen)據(ju)鑒(jian)定(ding)的(de)結(jie)論(lun)來(lai)做(zuo)出(chu)行(xing)政(zheng)處(chu)理(li)。如(ru)果(guo)當(dang)事(shi)人(ren)要(yao)求(qiu)調(tiao)解(jie)、賠償的,就按照我們條例的規定第49條,50條,51條,52條規定進行賠償。調解成功就按照這個做,調解不成功的再繼續解決。如果不要求調解的話,行政部門也要對於醫療機構做出決定。
disangequdao,womentongguominshisusongdaofayuanqisu,keyizhijieqisu,yekeyitiaojiebuchengdeqisu。ruguoyijingzuoguojiandingde,keyibazhegejiandingjielunzhijiegeifayuan,fayuanzhizheng,zhizhengrenkekeyibujinxingjianding,ruguomeiyoujinxingjianding,zhijiedaozheerlai,haiyouzaiminshisusongzhongdangshirenyaoqiuqujianding,shuangfangdangshirengongtongtiqi,yekeyi。zhegejianding,ruguoshifayuanweituode,keyiyoujiandingjielunchulaizhihoufangeiweituodefayuan,fayuananzhaominshisusongchengxujinxing。zuihouruguoquedingweiyiliaoshigude,yaopeichangchuli,haishiyaoqiuanzhaozanmenzhegetiaolide49,50,51,52條,規定的標準,賠償的原則和計算方法。我覺得是整個醫療事故,除了前期的預防,後麵這一塊做一個簡要的概括。
休息一刻鍾。
主持人:
下麵我們請史老師給我們繼續講。
史敏:
大家提的問題很多。總的來說,我覺得醫療事故確實很熱點,醫院關心、法fa院yuan關guan注zhu,媒mei體ti也ye關guan注zhu,大da家jia提ti的de有you些xie問wen題ti涉she及ji到dao對dui於yu高gao法fa的de通tong知zhi的de理li解jie,這zhe個ge理li解jie也ye許xu有you不bu同tong的de認ren識shi,高gao法fa內nei部bu大da概gai也ye有you不bu同tong認ren識shi,因yin為wei我wo也ye跟gen院yuan長chang交jiao換huan過guo意yi見jian,我wo前qian麵mian為wei什shen麼me要yao特te意yi講jiang一yi講jiang,什shen麼me是shi醫yi療liao事shi故gu的de構gou成cheng要yao素su,我wo覺jiao得de那na個ge要yao跟gen大da家jia說shuo清qing楚chu,一yi定ding要yao以yi那na個ge來lai判pan斷duan,在zai判pan斷duan是shi不bu是shi醫yi療liao事shi故gu的de時shi候hou,既ji要yao看kan我wo們men第di二er條tiao的de規gui定ding,可ke能neng還hai要yao參can考kao第di33條的規定。第33條所說的是不屬於醫療事故的情形,那要具體地判斷。
任(ren)何(he)一(yi)個(ge)事(shi)情(qing),我(wo)們(men)看(kan)一(yi)部(bu)法(fa)律(lv)或(huo)者(zhe)法(fa)規(gui),並(bing)不(bu)是(shi)說(shuo)看(kan)懂(dong)了(le)文(wen)字(zi)就(jiu)行(xing),每(mei)一(yi)個(ge)法(fa)條(tiao)後(hou)麵(mian)都(dou)有(you)深(shen)刻(ke)的(de)背(bei)景(jing)和(he)它(ta)豐(feng)富(fu)的(de)內(nei)涵(han),我(wo)之(zhi)所(suo)以(yi)要(yao)講(jiang)一(yi)講(jiang),當(dang)時(shi)我(wo)們(men)怎(zen)麼(me)考(kao)慮(lv),為(wei)什(shen)麼(me)要(yao)串(chuan)著(zhe)跟(gen)大(da)家(jia)說(shuo)一(yi)說(shuo),我(wo)們(men)盡(jin)可(ke)能(neng)地(di)想(xiang)通(tong)過(guo)我(wo)自(zi)己(ji)的(de)體(ti)會(hui)使(shi)大(da)家(jia)對(dui)於(yu)條(tiao)例(li)的(de)理(li)解(jie)有(you)所(suo)幫(bang)助(zhu)。如(ru)果(guo)對(dui)於(yu)條(tiao)例(li)理(li)解(jie)給(gei)予(yu)執(zhi)行(xing),我(wo)想(xiang)可(ke)能(neng)會(hui)有(you)很(hen)大(da)的(de)益(yi)處(chu)。咱(zan)們(men)下(xia)麵(mian)接(jie)著(zhe)還(hai)說(shuo)這(zhe)個(ge),賠(pei)償(chang)的(de)數(shu)額(e),怎(zen)麼(me)確(que)定(ding)賠(pei)償(chang)數(shu)額(e),確(que)定(ding)賠(pei)償(chang)數(shu)額(e)時(shi)應(ying)當(dang)考(kao)慮(lv)的(de)因(yin)素(su),賠(pei)償(chang)的(de)項(xiang)目(mu)和(he)計(ji)算(suan)的(de)標(biao)準(zhun)。考(kao)慮(lv)的(de)因(yin)素(su)是(shi)第(di)49條的規定。
第49tiaoguiding,yiliaoshigupeichangyingdangkaolvxialieyinsu,quedingjutipeichangshue,diyi,yiliaoshigudengji,zanmenqianmianjiang,tafenweisideng,meigelitouyouxieqingchu,douyounaxiebiaoxian,wojisuanleyixia,dayueshi230多(duo)條(tiao),然(ran)後(hou)這(zhe)幾(ji)類(lei)怎(zen)麼(me)樣(yang)劃(hua)分(fen)傷(shang)殘(can)等(deng)級(ji),劃(hua)分(fen)十(shi)級(ji)是(shi)有(you)相(xiang)應(ying)的(de)對(dui)照(zhao)標(biao)準(zhun)。我(wo)關(guan)注(zhu)的(de)是(shi)醫(yi)療(liao)機(ji)構(gou)的(de)病(bing)例(li)書(shu)寫(xie)我(wo)看(kan)了(le)。醫(yi)療(liao)事(shi)故(gu)技(ji)術(shu)鑒(jian)定(ding)辦(ban)法(fa),我(wo)看(kan)了(le)。有(you)些(xie)內(nei)容(rong)我(wo)剛(gang)才(cai)跟(gen)大(da)家(jia)簡(jian)單(dan)說(shuo)了(le)一(yi)下(xia),隨(sui)著(zhe)醫(yi)療(liao)事(shi)故(gu)等(deng)級(ji),這(zhe)個(ge)等(deng)級(ji)是(shi)根(gen)據(ju)鑒(jian)定(ding)結(jie)論(lun)做(zuo)出(chu)的(de)。鑒(jian)定(ding)結(jie)論(lun)要(yao)講(jiang),這(zhe)個(ge)是(shi)什(shen)麼(me)等(deng)級(ji),所(suo)要(yao)負(fu)的(de)責(ze)任(ren)在(zai)哪(na)兒(er),這(zhe)是(shi)需(xu)要(yao)寫(xie)的(de)。
第(di)二(er)醫(yi)療(liao)過(guo)錯(cuo)行(xing)為(wei)在(zai)醫(yi)療(liao)事(shi)故(gu)損(sun)害(hai)後(hou)果(guo)中(zhong)的(de)責(ze)任(ren)程(cheng)度(du)。實(shi)際(ji)上(shang)要(yao)分(fen)清(qing)楚(chu),哪(na)個(ge)是(shi)原(yuan)始(shi)的(de)原(yuan)發(fa)地(di)。其(qi)他(ta)的(de)可(ke)能(neng)有(you)基(ji)礎(chu)病(bing),可(ke)能(neng)不(bu)會(hui)引(yin)起(qi)死(si)亡(wang),又(you)得(de)了(le)其(qi)他(ta)病(bing),在(zai)其(qi)他(ta)病(bing)的(de)治(zhi)療(liao)中(zhong),可(ke)能(neng)加(jia)劇(ju)了(le)死(si)亡(wang)的(de)程(cheng)度(du),那(na)就(jiu)要(yao)看(kan),都(dou)是(shi)由(you)於(yu)治(zhi)某(mou)種(zhong)病(bing)所(suo)引(yin)起(qi)的(de)死(si)亡(wang),最(zui)後(hou)承(cheng)擔(dan)的(de)責(ze)任(ren)並(bing)不(bu)相(xiang)同(tong)。要(yao)考(kao)慮(lv)基(ji)礎(chu)病(bing)的(de)因(yin)素(su)。這(zhe)一(yi)塊(kuai),我(wo)們(men)這(zhe)裏(li)實(shi)際(ji)上(shang)在(zai)判(pan)定(ding),怎(zen)麼(me)樣(yang)具(ju)體(ti)賠(pei)償(chang),我(wo)們(men)要(yao)看(kan)準(zhun)。再(zai)一(yi)個(ge),醫(yi)療(liao)損(sun)害(hai)後(hou)果(guo)與(yu)原(yuan)有(you)疾(ji)病(bing)之(zhi)間(jian)是(shi)不(bu)是(shi)存(cun)在(zai)因(yin)果(guo)關(guan)係(xi)。剛(gang)才(cai)說(shuo)的(de)損(sun)害(hai)後(hou)果(guo)中(zhong)的(de)責(ze)任(ren)程(cheng)度(du),他(ta)做(zuo)了(le)這(zhe)個(ge)事(shi),做(zuo)錯(cuo)了(le),就(jiu)是(shi)這(zhe)個(ge)事(shi)到(dao)底(di)錯(cuo)在(zai)哪(na)兒(er),是(shi)這(zhe)麼(me)一(yi)種(zhong)行(xing)動(dong)導(dao)致(zhi)的(de)後(hou)果(guo)就(jiu)是(shi)那(na)麼(me)大(da)。本(ben)來(lai)應(ying)該(gai)這(zhe)麼(me)操(cao)作(zuo),另(ling)外(wai)一(yi)種(zhong)操(cao)作(zuo)可(ke)能(neng)引(yin)起(qi)的(de)後(hou)果(guo)是(shi)十(shi)分(fen)鍾(zhong)裏(li)的(de)八(ba)分(fen),還(hai)是(shi)六(liu)分(fen)。那(na)要(yao)具(ju)體(ti)看(kan)它(ta)的(de)行(xing)為(wei),哪(na)一(yi)塊(kuai)違(wei)規(gui)操(cao)作(zuo)。雖(sui)然(ran)有(you)這(zhe)麼(me)大(da)的(de)後(hou)果(guo),它(ta)的(de)責(ze)任(ren)分(fen)擔(dan)不(bu)完(wan)全(quan)是(shi)醫(yi)務(wu)人(ren)員(yuan)本(ben)人(ren)。剛(gang)才(cai)說(shuo)要(yao)看(kan)原(yuan)有(you)疾(ji)病(bing),這(zhe)個(ge)原(yuan)有(you)疾(ji)病(bing)是(shi)不(bu)是(shi)有(you)關(guan)係(xi),如(ru)果(guo)有(you)關(guan)係(xi)就(jiu)要(yao)看(kan)這(zhe)個(ge)關(guan)係(xi),如(ru)果(guo)沒(mei)有(you)關(guan)係(xi),就(jiu)要(yao)看(kan)責(ze)任(ren)程(cheng)度(du)的(de)確(que)定(ding)。並(bing)且(qie)明(ming)確(que)指(zhi)出(chu),不(bu)屬(shu)於(yu)醫(yi)療(liao)事(shi)故(gu)的(de)醫(yi)療(liao)機(ji)構(gou)不(bu)屬(shu)於(yu)賠(pei)償(chang)範(fan)圍(wei)。
第50條,一共列舉了11項(xiang)賠(pei)償(chang)的(de)項(xiang)目(mu),我(wo)想(xiang)重(zhong)點(dian)解(jie)釋(shi)幾(ji)種(zhong),一(yi)個(ge)是(shi)醫(yi)療(liao)費(fei)用(yong),條(tiao)例(li)是(shi)這(zhe)麼(me)規(gui)定(ding)的(de),按(an)照(zhao)醫(yi)療(liao)事(shi)故(gu)對(dui)患(huan)者(zhe)造(zao)成(cheng)的(de)人(ren)身(shen)傷(shang)害(hai)進(jin)行(xing)治(zhi)療(liao)所(suo)發(fa)生(sheng)的(de)醫(yi)療(liao)費(fei)用(yong)計(ji)算(suan)。而(er)且(qie)還(hai)說(shuo)了(le)憑(ping)據(ju)支(zhi)付(fu),但(dan)是(shi)不(bu)包(bao)括(kuo)原(yuan)發(fa)病(bing)治(zhi)療(liao)費(fei)用(yong),如(ru)果(guo)結(jie)案(an)後(hou)確(que)需(xu)繼(ji)續(xu)治(zhi)療(liao)的(de)按(an)照(zhao)基(ji)本(ben)醫(yi)療(liao)費(fei)用(yong)支(zhi)付(fu)。先(xian)講(jiang)一(yi)講(jiang),醫(yi)療(liao)費(fei)用(yong)的(de)支(zhi)付(fu)問(wen)題(ti),為(wei)什(shen)麼(me)要(yao)寫(xie)清(qing)楚(chu)呢(ne)?要(yao)按(an)照(zhao)醫(yi)療(liao)事(shi)故(gu)對(dui)他(ta)的(de)人(ren)身(shen)損(sun)害(hai),對(dui)損(sun)害(hai)進(jin)行(xing)治(zhi)療(liao)所(suo)發(fa)生(sheng)的(de)費(fei)用(yong),不(bu)能(neng)說(shuo)因(yin)為(wei)我(wo)發(fa)生(sheng)事(shi)了(le),其(qi)他(ta)什(shen)麼(me)看(kan)病(bing)都(dou)拿(na)單(dan)子(zi)報(bao)銷(xiao),這(zhe)是(shi)不(bu)可(ke)以(yi)的(de)。一(yi)個(ge)是(shi)事(shi)發(fa)生(sheng)之(zhi)後(hou),沒(mei)有(you)結(jie)案(an)之(zhi)前(qian),這(zhe)一(yi)段(duan)的(de)費(fei)用(yong),結(jie)案(an)之(zhi)後(hou)有(you)一(yi)些(xie)傷(shang)害(hai)比(bi)較(jiao)重(zhong),不(bu)是(shi)憑(ping)據(ju)支(zhi)付(fu),就(jiu)是(shi)按(an)照(zhao)基(ji)本(ben)醫(yi)療(liao)保(bao)險(xian),不(bu)是(shi)說(shuo)我(wo)現(xian)在(zai)發(fa)生(sheng)這(zhe)個(ge)事(shi),當(dang)時(shi)治(zhi)療(liao),多(duo)少(shao)費(fei)用(yong),就(jiu)拿(na)這(zhe)個(ge)憑(ping)據(ju)報(bao)銷(xiao)。
dier,wugongfei,guiding,huanzheyougudingshourude,haiyoumeiyougudingshourude。yougudingshourudeanzhaobenrenyinwugongjianshaodegudingshourulaijisuan。zhelitouyoufenleyige,ruguoduiyushourugaoyuyiliaoshigufashengdi,napanizaiqinghaigongzuo,nizaibeijingkanbingfashengdeshi,anfashengdi,shangyinianduzhigongpingjungongzisanbei,gaoyuzhegeansanbeijisuan,shijishangwodeyiliaofeiyong,wugongfeishizuihougaodebiaozhunshiyiliaoshigufashengdishangyinianzhigongpingjunshourudesanbeijisuan。womendelijie,zanmenxianzaishigongziheshourushibuwanquanxiangtongde,youshihoushourudayugongzi,youdeshihoushourudengyugongzi。suoyiwomenshianzhaogongzi,nageshourubaokuoqitadeshouru。ranhouzhuyuanhuoshibuzhufei,shangcanshenghuobuzhufei。zhegeshenghuobuzhufeishigenjushangcandengji,anzhaoyiliaoshigufashengdijuminpingjunshenghuofei,qianmianzanmenjiangdeshigongzishouru,shizhigongshouru,zhemianjiangdeshijuminpingjunshenghuofeilaijisuan,zidingcanzhiyueqizuichangpeichang30年,根據你的傷殘情況來付。最高是30年,但是還有限定。60歲以上的最高賠付不過15年,70歲以上的最高不超過5年。這個計算的方法,我們現在記得是人的平均生命預期按75歲。再一個,是殘疾費用,隻能按照你的補償功能器具,要根據醫療單位的證明,隻是普及型的。
diba,guanyufuyangrendeshenghuofei,yisizheshengqianhuozhecanjizhesangshilaodongnenglizhiqian,shijifuyangqiemeiyoulaodongnengliderenweixian。jisuanshianzhaoqihujisuozaidihuozhejusuodi,juminzuidishenghuobaozhangjisuan。duibuman16歲的撫養到16歲,對年滿16歲,但無勞動能力的撫養20年,但是60周歲以上不超過15,70周歲以上的不超過5年nian。就jiu是shi說shuo被bei撫fu養yang人ren的de生sheng活huo費fei,不bu是shi什shen麼me人ren都dou可ke以yi付fu,限xian定ding的de條tiao件jian,死si者zhe或huo者zhe是shi傷shang殘can者zhe喪sang失shi勞lao動dong能neng力li,是shi在zai喪sang失shi勞lao動dong能neng力li死si亡wang前qian實shi際ji撫fu養yang的de幾ji個ge。我wo實shi際ji撫fu養yang了le兩liang個ge人ren,還hai有you其qi他ta的de父fu母mu,他ta生sheng前qian實shi際ji撫fu養yang了le幾ji個ge。還hai有you這zhe些xie人ren是shi沒mei有you勞lao動dong能neng力li的de,有you勞lao動dong能neng力li的de還hai要yao另ling說shuo。
如果你在戶籍所在地生活的,你就在戶籍所在地,如果你在另外的地方生活,你就在居住地的居民最低生活保障線算。對於不滿16歲的撫養到16歲是什麼意思呢?16歲以前,你沒有勞動能力。還有一個方麵,我雖然到了16歲了,我不能正常勞動怎麼辦?雖然我到了16歲,但是沒有勞動能力的撫養20年,20年的計算不是從16歲開始的,假如我13歲當時沒有勞動能力,從13歲以後計算20年。但是如果你超過60歲,最長不能超過15年。這個也是考慮到醫院的承受能力,考慮到當事人的需要,生活的保障,兩方麵兼顧。
再講一下11項xiang,精jing神shen損sun害hai賠pei償chang金jin,這zhe就jiu是shi咱zan們men通tong常chang所suo說shuo的de精jing神shen賠pei償chang費fei。我wo們men也ye有you限xian製zhi,按an照zhao醫yi療liao事shi故gu發fa生sheng地di,居ju民min平ping均jun生sheng活huo費fei計ji算suan,分fen成cheng兩liang檔dang,造zao成cheng死si亡wang的de,賠pei償chang年nian限xian最zui長chang不bu超chao過guo6年,假如我兒子被傷,但是我不能沒完沒了的要求精神補償,最長是6年。造成殘疾的最長年限不超過3年。我們列了11項,這些標準怎麼計算,也寫清楚。大部分實際上賠償就是看49和51條。為什麼剛才說51條,52條,因為它也是跟這個相關,51條有一個交通費,參加醫療事故處理的患者,近親屬所需要的這些交通費。要參照第50條有關規定計算,但計算費用不能說我來了8個人全算,或者來了40個人全算。醫療事故造成患者死亡的,參加喪葬活動的患者的配偶,直係近親屬所需要的交通費、誤工費也要參照第50條規定,但是計算費用的人數不超過兩人。
第52tiaoshuodeshipeichangyinggaizenmegeifudewenti。yiliaofeiyongdepeichangfeiyongshiyicixingjiesuan。youchengdanyiliaoshiguzerendeyiliaojiegou。zenmeyanggenzuigaorenminfayuanxianjie,zuigaorenminfayuanshifazi2003年20號,1月6haofabude。zuigaorenminfayuanguanyucanzhaoyiliaoshiguchulitiaolishenliyiliaojiufenminshianjiandetongzhi,woxiangbazhegegendajiashaoweinianyibian,ranhouyitiaotiaoshuo。zuihouzhemeshuo,wokenengyouyixieweibigenfayuandetongzhirenshiyizhi。yinweiwobulejietamenzhegejutidehanyi,yinweiwozhishigenyouguanrenyuangoutongleyixia,womenjieguozhegetiaoli,womenzenmelijiefayuanzhegetongzhi。2002年4月4日,國務院發布了醫療事故處理條例,自2002年9月1日ri起qi實shi行xing,條tiao例li對dui於yu妥tuo善shan解jie決jue醫yi療liao糾jiu紛fen,保bao護hu醫yi患huan雙shuang方fang的de合he法fa權quan益yi,維wei護hu醫yi療liao秩zhi序xu具ju有you重zhong要yao意yi義yi,現xian就jiu人ren民min法fa院yuan參can照zhao條tiao例li審shen理li醫yi療liao糾jiu紛fen民min事shi案an件jian的de有you關guan問wen題ti通tong知zhi如ru下xia。
第di一yi,條tiao例li實shi行xing後hou發fa生sheng的de醫yi療liao事shi故gu引yin起qi的de醫yi療liao賠pei償chang糾jiu紛fen,到dao法fa院yuan訴su訟song的de參can照zhao條tiao例li有you關guan規gui定ding辦ban理li。因yin醫yi療liao事shi故gu以yi外wai的de原yuan因yin引yin起qi的de其qi他ta醫yi療liao賠pei償chang糾jiu紛fen,適shi用yong民min法fa通tong則ze規gui定ding。人ren民min法fa院yuan在zai實shi行xing法fa律lv之zhi前qian,已yi經jing按an照zhao民min法fa通tong則ze,其qi他ta的de依yi法fa進jin行xing再zai審shen不bu適shi合he條tiao例li規gui定ding。剛gang才cai大da家jia老lao來lai問wen,醫yi療liao差cha錯cuo的de問wen題ti,我wo們men剛gang才cai講jiang的de,我wo們men的de醫yi療liao事shi故gu已yi經jing不bu再zai存cun在zai醫yi療liao差cha錯cuo這zhe個ge概gai念nian。87niandebanfa,yiliaoshigufenweisanji,ranhouhaijiangleyiliaochacuozenmeyang。womenxianzaiyijingquandouguizaiyiliaoshigudechulibanfali。yiliaoshigufendengfenji,disiji,shijishangjiushi,yiliaochacuoyijingbaohanzaiyiliaoshigudedisijizhong。nameshenmejiaoyiliaoshiguyiwaideyuanyinyinqideqitayiliaopeichang。jiushishuogenzanmensuoshuodeyiliaoshigunajigegainiantaobuzhebian,weilebuyinqiqiyi,huozhewodexiangfabudui,geidajiawudao。zheyidian,yaomingquedeshi,zaiyiliaoshiguzhongbucunzaiyiliaochacuodewenti。suoyibunengyiyiliaochacuozaidaorenminfayuanqugao。dajiahaikeyizaiqitafangmianjinxingtantao。
第di二er人ren民min法fa院yuan在zai民min事shi審shen判pan中zhong根gen據ju當dang事shi人ren的de申shen請qing或huo者zhe依yi職zhi權quan決jue定ding進jin行xing醫yi療liao事shi故gu司si法fa鑒jian定ding的de交jiao由you條tiao例li所suo規gui定ding的de醫yi學xue會hui組zu織zhi鑒jian定ding。因yin醫yi療liao事shi故gu以yi外wai原yuan因yin引yin起qi的de其qi他ta醫yi療liao賠pei償chang糾jiu紛fen需xu要yao進jin行xing鑒jian定ding。但dan是shi要yao按an照zhao人ren民min法fa院yuan對dui外wai和he司si法fa鑒jian定ding管guan理li規gui定ding鑒jian定ding。人ren民min法fa院yuan對dui司si法fa鑒jian定ding申shen請qing和he司si法fa鑒jian定ding結jie論lun的de審shen查zha按an照zhao最zui高gao人ren民min法fa院yuan關guan於yu民min事shi訴su訟song的de若ruo幹gan規gui定ding進jin行xing。
disan,yinyiliaoshigusuoyinqidejianding,fayuanyaojiaoyouyixuehuizuzhijianding。disan,tiaolishixinghou,renminfayuanshenliyinyiliaoshiguyinqideyiliaopeichangjiufenminshianjian,zaiquedingyiliaoshigupeichangzerenshi,canzhaotiaolidi49條,第50條,第51條,52tiaodeguidingbanli。suoyi,congwomenkaishilifadeshihou,genzuigaorenminfayuansuodachengdeyizhi,yijihuihoufadetongzhi,zaijutiquedingpeichangdeshihou,womenyaoanzhaozhejitiaoyikuaierlaikan。womenbukenengzaiquedingjutipeichangshuedeshihou,bunengjinjinandi50條賠償的標準計算。因為在按照第50條tiao賠pei償chang標biao準zhun計ji算suan,任ren何he一yi個ge事shi情qing,都dou可ke以yi算suan出chu來lai是shi一yi樣yang的de標biao準zhun。但dan最zui後hou,因yin為wei責ze任ren的de不bu同tong,所suo以yi它ta計ji算suan出chu的de賠pei償chang的de標biao準zhun是shi不bu一yi樣yang的de。因yin此ci我wo們men必bi須xu把ba49條和50條捆在一起看。
第45條tiao實shi際ji就jiu是shi計ji算suan公gong式shi上shang的de那na一yi個ge調tiao解jie係xi數shu,事shi故gu的de等deng級ji不bu同tong,你ni責ze任ren的de程cheng度du不bu同tong,因yin果guo關guan係xi的de不bu同tong,最zui後hou計ji算suan出chu來lai的de賠pei償chang的de標biao準zhun,它ta的de數shu目mu,計ji算suan出chu來lai具ju體ti的de賠pei償chang數shu額e肯ken定ding是shi不bu同tong的de。
再(zai)跟(gen)大(da)家(jia)說(shuo)一(yi)說(shuo),應(ying)當(dang)注(zhu)意(yi)的(de)問(wen)題(ti)。為(wei)了(le)準(zhun)確(que)判(pan)定(ding)是(shi)否(fou)醫(yi)療(liao)事(shi)故(gu)和(he)正(zheng)確(que)地(di)處(chu)理(li)醫(yi)療(liao)事(shi)故(gu),一(yi)個(ge)法(fa)律(lv)定(ding)得(de)再(zai)好(hao),它(ta)的(de)製(zhi)度(du)設(she)計(ji)再(zai)全(quan)麵(mian),如(ru)果(guo)我(wo)們(men)不(bu)能(neng)夠(gou)準(zhun)確(que)把(ba)握(wo)住(zhu)這(zhe)個(ge)法(fa)律(lv)條(tiao)文(wen)的(de)精(jing)髓(sui),我(wo)們(men)不(bu)能(neng)夠(gou)準(zhun)確(que)地(di)把(ba)握(wo)醫(yi)療(liao)事(shi)故(gu)的(de)特(te)征(zheng),以(yi)及(ji)圍(wei)繞(rao)醫(yi)療(liao)事(shi)故(gu)應(ying)當(dang)做(zuo)哪(na)些(xie)預(yu)防(fang)和(he)處(chu)置(zhi)的(de)活(huo)動(dong)。我(wo)們(men)就(jiu)沒(mei)有(you)辦(ban)法(fa)正(zheng)確(que)和(he)公(gong)正(zheng)地(di)處(chu)理(li)醫(yi)療(liao)事(shi)故(gu)。所(suo)以(yi)我(wo)覺(jiao)得(de),應(ying)當(dang)準(zhun)確(que)地(di)把(ba)握(wo)醫(yi)療(liao)事(shi)故(gu)的(de)法(fa)律(lv)特(te)征(zheng)。還(hai)要(yao)了(le)解(jie)部(bu)署(shu)醫(yi)療(liao)事(shi)故(gu)的(de)這(zhe)個(ge)行(xing)為(wei)。同(tong)時(shi),我(wo)覺(jiao)得(de)對(dui)於(yu)醫(yi)院(yuan),一(yi)定(ding)要(yao)依(yi)法(fa)辦(ban)事(shi),我(wo)們(men)在(zai)審(shen)理(li)醫(yi)療(liao)事(shi)故(gu)糾(jiu)紛(fen)案(an)件(jian)的(de)時(shi)候(hou),或(huo)者(zhe)行(xing)政(zheng)部(bu)門(men)在(zai)處(chu)理(li)醫(yi)療(liao)事(shi)故(gu)糾(jiu)紛(fen)案(an)件(jian)的(de)時(shi)候(hou),也(ye)要(yao)去(qu)看(kan)一(yi)看(kan),醫(yi)療(liao)機(ji)構(gou)是(shi)不(bu)是(shi)按(an)照(zhao)法(fa)律(lv)的(de)規(gui)定(ding)做(zuo)了(le)。醫(yi)療(liao)機(ji)構(gou)的(de)內(nei)部(bu)管(guan)理(li)是(shi)非(fei)常(chang)重(zhong)要(yao)的(de),醫(yi)療(liao)事(shi)故(gu)處(chu)理(li)條(tiao)例(li)對(dui)於(yu)醫(yi)院(yuan),規(gui)範(fan)他(ta)的(de)醫(yi)療(liao)行(xing)為(wei),加(jia)強(qiang)他(ta)的(de)內(nei)部(bu)管(guan)理(li)起(qi)著(zhe)非(fei)常(chang)重(zhong)要(yao)的(de)作(zuo)用(yong)。我(wo)們(men)要(yao)求(qiu)它(ta)設(she)置(zhi)質(zhi)檢(jian)控(kong)製(zhi)機(ji)構(gou),配(pei)備(bei)相(xiang)應(ying)的(de)人(ren)員(yuan),要(yao)研(yan)究(jiu)預(yu)防(fang)補(bu)救(jiu)的(de)措(cuo)施(shi),這(zhe)個(ge)都(dou)是(shi)能(neng)進(jin)一(yi)步(bu)完(wan)善(shan)的(de)醫(yi)療(liao)機(ji)構(gou)。為(wei)什(shen)麼(me)要(yao)按(an)照(zhao)規(gui)定(ding)書(shu)寫(xie)病(bing)例(li)和(he)保(bao)管(guan)病(bing)例(li)。比(bi)如(ru)說(shuo)補(bu)記(ji)的(de)問(wen)題(ti)。我(wo)們(men)有(you)時(shi)候(hou)因(yin)為(wei)搶(qiang)救(jiu)病(bing)人(ren),來(lai)不(bu)及(ji)馬(ma)上(shang)記(ji)病(bing)例(li),這(zhe)個(ge)是(shi)需(xu)要(yao)事(shi)後(hou)追(zhui)記(ji)的(de),但(dan)是(shi)有(you)些(xie)醫(yi)療(liao)機(ji)構(gou)沒(mei)有(you)這(zhe)麼(me)做(zuo)。補(bu)記(ji)應(ying)該(gai)是(shi)在(zai)6個小時內補記。我們第八條規定,因搶救危患病者,未能及時書寫的,有關機構應該在6小xiao時shi內nei補bu記ji。要yao求qiu我wo們men培pei訓xun和he提ti高gao醫yi務wu人ren員yuan的de素su質zhi,保bao證zheng患huan者zhe對dui病bing例li的de複fu製zhi權quan,患huan者zhe也ye應ying該gai知zhi道dao,它ta在zai哪na些xie範fan圍wei內nei可ke以yi複fu製zhi,不bu能neng違wei反fan法fa律lv的de規gui定ding去qu要yao求qiu,提ti出chu過guo分fen的de要yao求qiu,複fu製zhi主zhu觀guan病bing例li,那na是shi不bu行xing的de。如ru果guo封feng存cun,當dang時shi還hai要yao治zhi療liao的de需xu要yao,封feng存cun也ye可ke以yi先xian把ba這zhe個ge複fu印yin一yi份fen。
還hai有you發fa生sheng醫yi療liao事shi故gu的de時shi候hou,一yi定ding要yao注zhu意yi現xian場chang實shi物wu的de保bao護hu,對dui於yu證zheng據ju的de保bao護hu,這zhe個ge對dui於yu雙shuang方fang當dang事shi人ren都dou有you好hao處chu。有you些xie時shi候hou,一yi些xie血xue樣yang和he花hua樣yang的de樣yang品pin確que實shi是shi需xu要yao保bao存cun,如ru果guo不bu保bao存cun的de話hua,你ni說shuo不bu清qing楚chu。現xian在zai在zai大da家jia的de問wen題ti上shang涉she及ji到dao證zheng據ju怎zen麼me保bao存cun的de問wen題ti,這zhe個ge屬shu於yu證zheng據ju學xue的de問wen題ti,我wo們men正zheng在zai搞gao一yi個ge電dian子zi鮮xian明ming法fa,我wo想xiang法fa院yuan也ye在zai做zuo這zhe個ge問wen題ti。這zhe個ge可ke能neng,一yi個ge在zai實shi踐jian中zhong怎zen麼me樣yang通tong過guo第di三san方fang認ren證zheng,現xian代dai科ke學xue技ji術shu對dui我wo們men所suo提ti出chu的de問wen題ti。不bu光guang是shi在zai醫yi療liao係xi統tong方fang麵mian,我wo覺jiao得de最zui大da的de挑tiao戰zhan是shi網wang絡luo傳chuan輸shu的de問wen題ti。這zhe個ge我wo覺jiao得de很hen多duo問wen題ti還hai要yao再zai加jia以yi製zhi定ding,有you些xie事shi情qing,在zai實shi踐jian中zhong咱zan們men還hai需xu要yao研yan究jiu更geng多duo的de辦ban法fa。我wo提ti供gong不bu出chu更geng多duo的de東dong西xi,我wo隻zhi知zhi道dao商shang標biao局ju,商shang標biao的de登deng記ji注zhu冊ce,很hen多duo是shi用yong電dian子zi注zhu冊ce。電dian子zi注zhu冊ce的de內nei容rong還hai有you第di三san方fang保bao護hu。這zhe個ge實shi踐jian中zhong咱zan們men需xu要yao進jin一yi步bu完wan善shan的de東dong西xi。因yin為wei當dang時shi這zhe號hao人ren沒mei有you在zai規gui定ding,我wo們men實shi踐jian中zhong沒mei有you更geng多duo地di提ti出chu這zhe個ge問wen題ti,但dan是shi現xian在zai大da家jia提ti出chu這zhe個ge問wen題ti,要yao加jia強qiang。
haiyouyige,zuoweiyiyuan,dianzibinglihaishiyoudianzishuju,shibushicongjishujiaoduzuobunenggenggai,zongdelaishuo,tishidajia,weilejinhoudechuli,duixianchangshiwudebaohu,duiyuzhengjudebaocun,duiyubinglidebaoguan,duiyuhuanzhequanlidebaozhengdouyaoyifafuze。guanyuyiliaoshigujianding,shuangfangdangshirenyidingyaoanzhaotiaolidi28條tiao規gui定ding來lai提ti供gong鑒jian定ding所suo需xu要yao的de資zi料liao,要yao如ru實shi反fan映ying情qing況kuang,在zai這zhe裏li,確que實shi給gei醫yi療liao機ji構gou加jia大da了le更geng多duo的de難nan度du。因yin為wei患huan者zhe可ke能neng頂ding多duo提ti供gong客ke觀guan證zheng據ju的de證zheng件jian,而er主zhu觀guan病bing例li是shi需xu要yao醫yi院yuan來lai提ti供gong的de,因yin此ci28條tiao對dui於yu醫yi療liao機ji構gou應ying當dang提ti供gong的de證zheng據ju規gui定ding的de非fei常chang詳xiang細xi。大da家jia可ke以yi看kan,一yi個ge是shi,醫yi學xue會hui在zai受shou理li鑒jian定ding之zhi日ri起qi五wu日ri內nei要yao通tong知zhi雙shuang方fang當dang事shi人ren提ti交jiao醫yi療liao事shi故gu進jin行xing限xian定ding所suo需xu的de材cai料liao。而er當dang事shi人ren接jie到dao通tong知zhi之zhi後hou,十shi天tian之zhi內nei,要yao提ti交jiao有you關guan醫yi療liao事shi故gu鑒jian定ding的de材cai料liao。因yin為wei有you一yi些xie是shi患huan者zhe得de不bu著zhe的de,醫yi療liao機ji構gou還hai要yao提ti供gong下xia列lie東dong西xi,住zhu院yuan患huan者zhe的de病bing程cheng記ji錄lu,病bing例li死si亡wang討tao論lun記ji錄lu,疑yi難nan病bing症zheng討tao論lun記ji錄lu,上shang級ji醫yi師shi查zha房fang記ji錄lu,病bing例li資zi料liao原yuan件jian,住zhu院yuan患huan者zhe的de住zhu院yuan製zhi,體ti溫wen單dan,化hua驗yan單dan,醫yi學xue影ying響xiang資zi料liao,特te殊shu檢jian查zha同tong意yi書shu,手shou術shu書shu,手shou術shu及ji麻ma醉zui單dan。
三,搶救急危病患者,在規定時間內統計的病例資料。
四,封存保留的書頁,注射為物品的物品或者血液,藥物的實物或者依法具有檢驗資格的檢驗機構,對這些物品、實物做出的檢驗報告。
五,與醫療事故鑒定有關的其他材料。這一點規定得非常好,以至於大家對於2001年12月21日(ri),最(zui)高(gao)人(ren)民(min)法(fa)院(yuan)做(zuo)出(chu)的(de)民(min)事(shi)訴(su)訟(song)證(zheng)據(ju)的(de)規(gui)定(ding)第(di)四(si)條(tiao)第(di)八(ba)項(xiang)到(dao)底(di)怎(zen)麼(me)來(lai)概(gai)括(kuo)它(ta),怎(zen)麼(me)來(lai)理(li)解(jie)它(ta),可(ke)能(neng)各(ge)方(fang)有(you)不(bu)同(tong)的(de)認(ren)識(shi)。從(cong)學(xue)術(shu)上(shang)來(lai)講(jiang),很(hen)多(duo)同(tong)誌(zhi)概(gai)括(kuo)為(wei)舉(ju)證(zheng)責(ze)任(ren)道(dao)具(ju),我(wo)不(bu)讚(zan)成(cheng)這(zhe)種(zhong)關(guan)係(xi),醫(yi)院(yuan)告(gao)訴(su)他(ta),咱(zan)們(men)這(zhe)一(yi)條(tiao)是(shi)怎(zen)麼(me)說(shuo)的(de)呢(ne)?因(yin)醫(yi)療(liao)行(xing)為(wei)引(yin)起(qi)的(de)侵(qin)權(quan)訴(su)訟(song),由(you)醫(yi)療(liao)機(ji)構(gou)及(ji)醫(yi)療(liao)行(xing)為(wei)與(yu)損(sun)害(hai)結(jie)果(guo)之(zhi)間(jian)不(bu)存(cun)在(zai)因(yin)果(guo)關(guan)係(xi),及(ji)不(bu)存(cun)在(zai)醫(yi)療(liao)過(guo)錯(cuo),承(cheng)擔(dan)舉(ju)證(zheng)責(ze)任(ren)。怎(zen)麼(me)來(lai)理(li)解(jie)這(zhe)句(ju)話(hua)。我(wo)們(men)剛(gang)才(cai)說(shuo),在(zai)鑒(jian)定(ding)的(de)時(shi)候(hou),醫(yi)療(liao)機(ji)構(gou)應(ying)當(dang)提(ti)哪(na)些(xie)材(cai)料(liao),對(dui)於(yu)醫(yi)療(liao)機(ji)構(gou)我(wo)們(men)規(gui)定(ding)是(shi)非(fei)常(chang)客(ke)觀(guan)的(de)。當(dang)事(shi)人(ren)隻(zhi)能(neng)提(ti)供(gong)某(mou)一(yi)些(xie),他(ta)就(jiu)必(bi)須(xu)提(ti)供(gong)他(ta)那(na)些(xie),他(ta)能(neng)夠(gou)得(de)到(dao)的(de)複(fu)印(yin)件(jian),他(ta)可(ke)以(yi)提(ti)供(gong)。他(ta)得(de)不(bu)到(dao)的(de)這(zhe)些(xie)是(shi)醫(yi)院(yuan)必(bi)須(xu)提(ti)供(gong)。我(wo)們(men)從(cong)訴(su)訟(song),主(zhu)張(zhang),如(ru)果(guo)我(wo)主(zhu)張(zhang)說(shuo)醫(yi)院(yuan)發(fa)生(sheng)了(le)醫(yi)療(liao)事(shi)故(gu),我(wo)是(shi)不(bu)是(shi)應(ying)該(gai)提(ti)供(gong)我(wo)的(de)證(zheng)據(ju),醫(yi)院(yuan)提(ti)供(gong)的(de)是(shi)什(shen)麼(me)呢(ne)?我(wo)要(yao)證(zheng)明(ming)我(wo)沒(mei)有(you)發(fa)生(sheng)醫(yi)療(liao)事(shi)故(gu),我(wo)的(de)舉(ju)證(zheng)責(ze)任(ren)就(jiu)是(shi)證(zheng)明(ming)我(wo)沒(mei)有(you)發(fa)生(sheng)醫(yi)療(liao)事(shi)故(gu)。這(zhe)個(ge)是(shi)我(wo)的(de)舉(ju)證(zheng)責(ze)任(ren)。我(wo)覺(jiao)得(de),用(yong)舉(ju)證(zheng)責(ze)任(ren),學(xue)術(shu)上(shang)的(de)爭(zheng)議(yi)概(gai)括(kuo),而(er)且(qie)不(bu)加(jia)過(guo)多(duo)的(de)說(shuo)明(ming),會(hui)在(zai)老(lao)百(bai)姓(xing)中(zhong)引(yin)起(qi)誤(wu)解(jie)。因(yin)為(wei)這(zhe)個(ge)舉(ju)證(zheng)責(ze)任(ren)是(shi)有(you)一(yi)係(xi)列(lie)的(de)要(yao)件(jian)。所(suo)以(yi)我(wo)說(shuo),醫(yi)療(liao)機(ji)構(gou)為(wei)什(shen)麼(me)法(fa)院(yuan)要(yao)規(gui)定(ding)這(zhe)些(xie),就(jiu)是(shi)這(zhe)些(xie)有(you)很(hen)多(duo)的(de)東(dong)西(xi),患(huan)者(zhe)沒(mei)有(you)辦(ban)法(fa),你(ni)就(jiu)要(yao)證(zheng)明(ming),你(ni)來(lai)證(zheng)明(ming)這(zhe)些(xie),無(wu)非(fei)是(shi)你(ni)有(you)主(zhu)觀(guan)的(de)客(ke)觀(guan)的(de)東(dong)西(xi)都(dou)要(yao)說(shuo)。這(zhe)件(jian)事(shi)情(qing)在(zai)學(xue)理(li)上(shang)有(you)各(ge)種(zhong)各(ge)樣(yang)的(de)爭(zheng)論(lun)。我(wo)隻(zhi)是(shi)從(cong)證(zheng)據(ju)學(xue)的(de)角(jiao)度(du)來(lai)講(jiang)的(de)。從(cong)民(min)事(shi)訴(su)訟(song)來(lai)說(shuo),誰(shui)主(zhu)張(zhang),誰(shui)主(zhu)動(dong),對(dui)於(yu)醫(yi)療(liao)機(ji)構(gou),法(fa)律(lv)規(gui)定(ding)它(ta)有(you)一(yi)些(xie)特(te)殊(shu)的(de)要(yao)求(qiu),但(dan)是(shi)從(cong)它(ta)本(ben)身(shen)來(lai)說(shuo),它(ta)隻(zhi)是(shi)更(geng)多(duo)地(di)證(zheng)明(ming)他(ta)沒(mei)有(you),如(ru)果(guo)他(ta)有(you)醫(yi)療(liao)事(shi)故(gu),他(ta)不(bu)能(neng)說(shuo)證(zheng)明(ming)我(wo)沒(mei)有(you)。這(zhe)個(ge)可(ke)以(yi)提(ti)出(chu)大(da)家(jia)的(de)看(kan)法(fa)。
關於賠償的問題,尤其是自願協商解決,我們不能按照花錢買平安那樣來算。對於這個條例的理解,要跟87年的辦法,要有一個比較大的觀念上的變化,要跳出87年(nian)那(na)條(tiao)辦(ban)法(fa)上(shang)的(de)一(yi)些(xie)規(gui)定(ding)。我(wo)們(men)這(zhe)個(ge)條(tiao)例(li)從(cong)製(zhi)度(du)上(shang)的(de)設(she)計(ji)已(yi)經(jing)完(wan)全(quan)從(cong)原(yuan)來(lai)的(de)那(na)個(ge)辦(ban)法(fa)中(zhong)跳(tiao)了(le)出(chu)來(lai)。我(wo)們(men)不(bu)是(shi)把(ba)醫(yi)療(liao)事(shi)故(gu)全(quan)都(dou)按(an)行(xing)政(zheng)法(fa)規(gui)來(lai)規(gui)定(ding),而(er)我(wo)們(men)原(yuan)來(lai)的(de)辦(ban)法(fa),是(shi)整(zheng)個(ge)這(zhe)一(yi)些(xie)是(shi)衛(wei)生(sheng)行(xing)政(zheng)部(bu)門(men)在(zai)一(yi)定(ding)的(de)情(qing)況(kuang)下(xia)他(ta)要(yao)處(chu)於(yu)行(xing)政(zheng)訴(su)訟(song)的(de)原(yuan)告(gao),我(wo)們(men)這(zhe)裏(li)是(shi)沒(mei)有(you)的(de)。我(wo)們(men)規(gui)定(ding)的(de)是(shi)你(ni)要(yao)依(yi)法(fa)行(xing)使(shi)你(ni)的(de)行(xing)政(zheng)的(de)職(zhi)能(neng),又(you)要(yao)同(tong)時(shi)為(wei)人(ren)民(min)服(fu)務(wu),或(huo)者(zhe)是(shi)三(san)個(ge)代(dai)表(biao),從(cong)這(zhe)個(ge)角(jiao)度(du)怎(zen)麼(me)樣(yang)更(geng)好(hao)地(di)為(wei)老(lao)百(bai)姓(xing)提(ti)供(gong)服(fu)務(wu),來(lai)規(gui)定(ding),老(lao)百(bai)姓(xing)要(yao)求(qiu)你(ni)解(jie)決(jue)賠(pei)償(chang)調(tiao)解(jie)的(de)時(shi)候(hou),你(ni)不(bu)能(neng)拒(ju)之(zhi)門(men)外(wai)不(bu)幹(gan)。
還hai有you我wo們men的de鑒jian定ding,確que實shi要yao把ba它ta作zuo為wei中zhong介jie,脫tuo離li行xing政zheng部bu門men,剛gang才cai有you些xie同tong誌zhi跟gen我wo講jiang,實shi際ji上shang,你ni這zhe樣yang的de設she計ji是shi換huan湯tang不bu換huan藥yao,可ke能neng在zai實shi踐jian操cao作zuo中zhong,會hui有you在zai初chu步bu起qi步bu的de階jie段duan,會hui有you這zhe樣yang的de問wen題ti。為wei什shen麼me呢ne?因yin為wei我wo看kan了le一yi些xie醫yi學xue會hui,我wo看kan了le一yi些xie衛wei生sheng行xing政zheng部bu門men,尤you其qi是shi地di方fang的de衛wei生sheng行xing政zheng部bu門men,當dang時shi醫yi學xue會hui是shi掛gua靠kao在zai地di方fang的de衛wei生sheng行xing政zheng部bu門men的de,但dan是shi法fa律lv賦fu予yu你ni醫yi學xue會hui這zhe樣yang重zhong大da的de職zhi責ze。就jiu要yao求qiu行xing政zheng部bu門men盡jin快kuai地di幫bang助zhu醫yi學xue會hui組zu建jian起qi來lai,然ran後hou徹che底di脫tuo鉤gou。有you些xie地di方fang的de醫yi學xue會hui說shuo,隻zhi有you五wu個ge人ren,老lao弱ruo病bing殘can,而er且qie是shi衛wei生sheng行xing政zheng部bu的de部bu長chang擔dan任ren醫yi學xue會hui的de會hui長chang,我wo們men從cong法fa律lv製zhi度du上shang設she計ji,最zui後hou使shi他ta真zhen正zheng地di走zou向xiang正zheng軌gui,他ta就jiu不bu能neng是shi這zhe樣yang的de。如ru果guo不bu允yun許xu我wo們men在zai實shi踐jian中zhong和he法fa律lv製zhi度du設she計ji,他ta會hui有you偏pian差cha,或huo者zhe逐zhu步bu地di走zou向xiang正zheng軌gui化hua,那na我wo們men的de法fa律lv製zhi度du沒mei有you辦ban法fa進jin行xing。
這zhe就jiu像xiang我wo們men的de立li法fa和he我wo們men的de執zhi法fa中zhong間jian有you差cha距ju是shi一yi樣yang的de,我wo們men的de立li法fa需xu要yao執zhi法fa維wei護hu,我wo們men的de執zhi法fa需xu要yao執zhi法fa環huan境jing,但dan是shi執zhi法fa環huan境jing是shi怎zen麼me創chuang造zao的de呢ne?我wo們men在zai製zhi定ding法fa律lv製zhi度du的de時shi候hou,要yao考kao慮lv執zhi法fa的de基ji礎chu,要yao考kao慮lv到dao我wo們men現xian在zai怎zen麼me樣yang能neng更geng可ke操cao作zuo,還hai要yao有you適shi度du的de前qian瞻zhan性xing,怎zen麼me應ying該gai規gui範fan。因yin此ci需xu要yao培pei養yang全quan社she會hui的de法fa律lv意yi識shi,有you關guan的de執zhi法fa部bu門men要yao加jia強qiang執zhi法fa。其qi他ta的de部bu門men,涉she及ji方fang方fang麵mian麵mian,都dou應ying該gai認ren真zhen地di學xue習xi這zhe個ge法fa律lv,去qu理li解jie它ta的de精jing神shen。理li解jie每mei一yi條tiao法fa律lv規gui定ding的de含han義yi,因yin為wei我wo們men的de立li法fa,法fa製zhi確que實shi有you一yi個ge不bu斷duan完wan善shan的de進jin程cheng,我wo們men的de醫yi療liao事shi故gu處chu理li條tiao例li,邁mai出chu了le很hen大da的de一yi步bu,但dan我wo們men並bing不bu是shi說shuo這zhe一yi個ge法fa律lv,整zheng個ge的de製zhi度du設she計ji的de都dou是shi盡jin善shan盡jin美mei,他ta是shi需xu要yao不bu斷duan地di完wan善shan的de,但dan是shi我wo們men必bi須xu先xian邁mai出chu這zhe一yi步bu,我wo們men才cai可ke能neng進jin一yi步bu在zai執zhi行xing中zhong不bu斷duan完wan善shan。這zhe是shi一yi個ge問wen題ti。
還hai有you,大da家jia說shuo醫yi療liao保bao險xian的de問wen題ti。這zhe個ge不bu可ke能neng強qiang製zhi醫yi療liao機ji構gou參can加jia醫yi療liao管guan理li。我wo們men曾zeng經jing在zai起qi草cao中zhong談tan到dao這zhe個ge問wen題ti,也ye形xing成cheng了le一yi些xie法fa律lv條tiao文wen,因yin為wei現xian在zai有you些xie地di方fang已yi經jing在zai實shi行xing,比bi如ru上shang海hai,他ta們men在zai試shi點dian,我wo們men目mu前qian要yao把ba它ta作zuo為wei一yi條tiao,我wo們men法fa律lv上shang的de應ying當dang,就jiu是shi必bi需xu了le,你ni要yao去qu參can加jia醫yi療liao保bao險xian,要yao在zai實shi踐jian中zhong不bu斷duan地di推tui進jin,保bao險xian的de發fa展zhan也ye有you一yi個ge過guo程cheng,要yao我wo們men理li解jie。國guo外wai基ji本ben是shi各ge種zhong保bao險xian都dou有you,有you醫yi生sheng的de保bao險xian,病bing人ren的de保bao險xian等deng,保bao險xian市shi場chang還hai要yao逐zhu步bu開kai發fa,這zhe個ge在zai實shi踐jian中zhong可ke以yi逐zhu步bu做zuo。
womenchuliyiliaoshiguzheyangdezhengyianjian,daodiyijushenmefalv,kebukeyiyijuxiaofeizhequanyibaohufa,wojiaodezaihuidazhegewentizhiqian,womenxianyaoqingchu,yihuanguanxishiyigeshenmeyangdeguanxi。yihuanguanxishibushiwanquanpingdengdeminshizhuti,womenyaokanyikanxiaofeizhequanyibaohufasuoguidingdezhuyaodelilunjichushishenme。xiaofeizhequanyibaohufa,wojiaodeshuangfangshiwanquanziyuanpingdengdeminshizhuti,henduodeqingkuangshiyihetongdexingshi,koutouhetong、書shu麵mian合he同tong的de形xing式shi訂ding立li。而er醫yi患huan關guan係xi不bu全quan是shi這zhe兩liang方fang麵mian。如ru果guo是shi這zhe樣yang的de話hua,咱zan們men可ke不bu可ke以yi這zhe麼me說shuo,我wo有you病bing求qiu到dao你ni醫yi院yuan了le,醫yi院yuan看kan這zhe個ge病bing很hen難nan,我wo不bu給gei你ni看kan,醫yi院yuan有you沒mei有you拒ju絕jue病bing人ren的de權quan利li,如ru果guo有you這zhe個ge權quan利li,咱zan們men就jiu可ke以yi協xie商shang簽qian定ding合he同tong,咱zan們men就jiu可ke以yi按an照zhao消xiao費fei者zhe權quan益yi保bao護hu法fa進jin行xing。這zhe是shi我wo的de觀guan點dian。我wo歡huan迎ying大da家jia有you不bu同tong的de觀guan點dian。我wo們men考kao慮lv法fa律lv適shi用yong的de時shi候hou,要yao考kao慮lv民min事shi法fa律lv關guan係xi的de法fa律lv基ji礎chu是shi什shen麼me,我wo們men每mei一yi個ge法fa律lv所suo製zhi定ding的de依yi據ju和he它ta的de法fa律lv基ji礎chu是shi什shen麼me。它ta有you沒mei有you平ping等deng的de地di方fang,醫yi患huan關guan係xi非fei常chang複fu雜za,它ta在zai患huan者zhe就jiu醫yi的de時shi候hou不bu是shi平ping等deng的de,醫yi生sheng不bu能neng拒ju絕jue病bing人ren,拒ju絕jue病bing人ren要yao追zhui究jiu醫yi院yuan的de責ze任ren,咱zan們men為wei什shen麼me要yao規gui定ding不bu屬shu於yu醫yi療liao事shi故gu的de那na些xie行xing為wei呢ne?就jiu講jiang,因yin搶qiang救jiu病bing人ren,當dang時shi條tiao件jian不bu夠gou,但dan是shi為wei了le搶qiang救jiu病bing人ren所suo發fa生sheng的de事shi要yao排pai除chu在zai外wai。這zhe就jiu說shuo明ming我wo們men有you一yi些xie醫yi療liao機ji構gou的de水shui平ping比bi較jiao低di,但dan是shi我wo突tu然ran出chu事shi,我wo現xian得de把ba病bing人ren穩wen住zhu了le,才cai能neng送song到dao高gao水shui平ping的de地di方fang就jiu醫yi,如ru果guo不bu緊jin急ji處chu置zhi,可ke能neng就jiu會hui死si。我wo必bi須xu先xian緊jin急ji處chu置zhi,但dan是shi我wo能neng力li確que實shi有you限xian,有you可ke能neng會hui出chu現xian死si亡wang。這zhe個ge需xu要yao排pai除chu。
yiyuanyoujiusifushangdezeren,danshizhenzhengfashengyiliaoshiguyihou,yaojiejuepeichangqitawentishuangfangdequanyi,zaipingdengzhong,youyoubupingdeng,tigongzhengjudeshihou,nenglisuozai,jiuduiyiliaojigoudejuzhengyaojiashangteshudezeren。zhegeshiqingdajiadouyingdangjutifenxi,yongyijuhuagaikuo,womenzongshishuowomendelingdaozaikaolvfalvwentideshihou,shizhemeshuode,zaikaolvwenleshihou,jiandanwentifuzahua,jiushikaolvqianyinhouguo,huiyinqishenmeyangdemaodun,zhelianggefanganchulaiyihou,huidaozhishenmeyangdehouguo,nalianggemaodunchulaiyihouhuidaozhishenmeyangdehouguo。danshichuliwentideshihou,womenyouyaoqiu,yaofuzawentijiandanhua,jiandanhuayoubushiyijujiandandejiaorenkanbumingbai,womenyaoanzhaoguijujiandannengkandeqingchu,tiaoliluoji,suoyinenggoujiandandewenti,womenbuyaoxiandehenluosuo,danshibunengjiandandewenti,qiejiyijulaigaikuo。weishenmewobuzanchengjuzhengzerendaozhi,yeshizhegedaoli。
我們實踐中出現的問題和法律的規定是千差萬別的。法律隻能把這些大塊的東西通過提煉、概gai括kuo,加jia以yi規gui範fan,而er實shi踐jian要yao根gen據ju這zhe一yi點dian延yan伸shen看kan,這zhe一yi條tiao到dao底di在zai實shi踐jian中zhong怎zen麼me樣yang去qu實shi施shi,這zhe樣yang有you一yi些xie法fa院yuan才cai會hui有you一yi些xie司si法fa權quan。很hen多duo法fa院yuan的de同tong誌zhi給gei我wo提ti了le很hen多duo問wen題ti,我wo覺jiao得de,我wo雖sui然ran在zai法fa院yuan幹gan過guo,但dan是shi畢bi竟jing是shi幾ji十shi年nian前qian的de事shi,醫yi療liao事shi故gu和he審shen理li和he現xian在zai不bu一yi樣yang,我wo沒mei有you辦ban法fa具ju體ti回hui答da大da家jia很hen具ju體ti的de問wen題ti。但dan是shi在zai法fa院yuan審shen理li的de時shi候hou,我wo覺jiao得de法fa院yuan審shen判pan是shi有you規gui矩ju的de,民min事shi訴su訟song該gai怎zen麼me辦ban?它ta的de證zheng據ju應ying該gai怎zen麼me樣yang認ren定ding,都dou有you規gui矩ju。同tong時shi,要yao求qiu我wo們men對dui於yu審shen理li醫yi療liao事shi故gu這zhe個ge爭zheng議yi案an件jian,法fa律lv適shi用yong怎zen麼me銜xian接jie,我wo們men的de條tiao例li有you規gui定ding。我wo覺jiao得de,有you些xie事shi情qing要yao根gen據ju具ju體ti的de案an例li來lai分fen析xi,我wo們men到dao底di概gai括kuo得de準zhun確que不bu準zhun確que,如ru果guo概gai括kuo的de準zhun確que,但dan是shi掌zhang握wo的de事shi實shi是shi不bu是shi還hai有you些xie偏pian差cha,或huo者zhe沒mei有you調tiao查zha清qing楚chu。你ni說shuo的de這zhe個ge情qing況kuang是shi在zai這zhe個ge框kuang框kuang之zhi內nei,答da複fu就jiu在zai這zhe個ge框kuang框kuang之zhi內nei。這zhe些xie事shi情qing需xu要yao具ju體ti問wen題ti具ju體ti分fen析xi。
wotebiegaoxingnenggougenfayuandepengyou,lvshijiedepengyou,yiyuandepengyou,weishengxingzhengbumendepengyoumentanyitanwomenduiyuzhegetiaolideyixiexiangfaherenshi。woxiwangkeyijiaoliu,danwobuyidingnenggougeidajiajiaoliunameduo,huozheshitebiezhunque,yinweiwomenhaiyouyigerenwu,lifazhihou,womenyaoyouyigefalvdegenzong。wosuolejiede,xianzaiyiyuandepengyoumenduitiaoliderenshihedangchuduitiaoliderenshiyouyixiebijiaodadebianhua。yuanlairenwei,nigaozhegetiaoliyemeiyong,xianzaihenduoyiyuanrenwei,yeshiweihuleyiyuandequanyi。suoyiwogentongzhishuo,zanmenyaoanzhaotiaolideguidingzuo。wojiangdedagaishizhexie,haikeyiliuyidianshijiangeidajiatiwen。wogangcaishuo,duiyuzhegetiaoliyaogenzongfankuiyixieyijian。 |