[Plaintiff's Statement]
On November 15, 2021, Zhang (female) went to the defendant's hospital for treatment due to a space-occupying lesion of the right kidney, and was hospitalized with minimally invasive eradication (total renal removal of the right kidney) after being diagnosed by the defendant. On November 16, 2021, Zhang was admitted to the hospital and underwent surgery on the afternoon of November 18.
Due to continuous bleeding, he underwent laparotomy on the afternoon of November 19, and the postoperative surgical team reported that no bleeding points were found, and returned to the ICU for rescue. At 8 a.m. on November 20, the plaintiff went to the hospital to learn about the situation and was told that his condition had improved, his oxygen saturation and blood pressure had stabilized. At 2 p.m. that day, the plaintiff was informed that due to the change in Zhang's condition, his family went to the hospital. At 4 p.m. on the 20th, Zhang died due to ineffective rescue, and the cause of death was hemorrhagic shock and multiple organ failure.
[Plaintiff's opinion]
1. During the whole treatment process, the defendant failed to fulfill his duty of prudence and was overconfident, resulting in heavy bleeding during the operation and tampering with the medical history of the operation. The plaintiff believes that the defendant deliberately concealed or tampered with the medical history records under the following abnormal circumstances:
2. On November 18, the surgical recorder (Hou Mouguo) and the surgical personnel (Lu Moujun) recorded in the inpatient medical record were inconsistent, and they were also inconsistent with the surgical signatories (Lu and Lu Moujun) in the anesthesia record;
3. The anesthesia Fan Mouhua in the operation record on November 18 is inconsistent with the anesthesia person (Xu Mouyuan) in the inpatient medical record, and it is also inconsistent with the surgical signatory (Xu Mouyuan) in the anesthesia record;
4. The anesthesia personnel (Fan Mouhua) recorded in the inpatient case on November 19 are inconsistent with the anesthesia signatories (Xu Mouyuan and Chen Chunting) in the anesthesia records;
5. During the period of admission, the defendant's medical staff never found the bleeding point, resulting in the death of the patient due to hemorrhagic shock in the hospital, whether the hospital was at fault for the untimely blood supply, the plaintiff held that the failure to find the cause of bleeding was not caused by the defect of existing medical technology, but was the result of the plaintiff's major negligence in surgery.
6. Zhang's death was entirely due to the defendant's hospital in the treatment of this kidney extraction, improper treatment, major surgical errors during the operation, and failure to find bleeding points in time after the operation, which eventually caused Zhang's death due to hemorrhagic shock and multiple organ failure, and the defendant covered up and shirked his responsibility afterwards, so the plaintiff sued the court and requested that the defendant be sentenced to bear 60% of the tort liability and compensate for various losses totaling RMB 708,652.92.
[Defendant hospital argues]
The defendant bears 60% of the responsibility too heavily, and should bear 50% according to the results of the appraisal report, and has no objection to the calculation standards for death compensation, medical expenses, funeral expenses, and appraisal fees, and half of the mental damage should be calculated according to the standard of 50,000 yuan.
【Appraisal opinion of a municipal medical association】
A hospital has a medical fault in the medical activities of postoperative hemorrhagic complications and the laparotomy exploration is not timely enough, and the causal force in the damage consequences is the same reason.
【Medical Error】
1. Laparotomy is not timely. At 18:15 on November 18, the operation ended, and due to the consideration of 900ml of bleeding during the operation, he was admitted to the ICU in accordance with medical standards. According to the critical care record, at 22:50 on November 18, his blood pressure was 81/54mmHg, and the doctor was informed that norepinephrine was given a boost. 23:00 Blood pressure 141/65mmHg.
At 0:00 on November 19, the blood pressure was 73/55mmHg, and the dosage of norepinephrine was raised. At 0:30, the patient's blood pressure did not rise significantly, and 500ml of succinyl gelatin was given intravenous drip, and the patient's drainage drip rate in the drainage bulb was fast, so please consult the urology department and ask him to continue observation. This is followed by infusion of cryoprecipitate clotting factors, suspension red blood cells, plasma, and hemostatic drugs.
5:02 Long-term medical advice is critically ill. During this period, the patient's blood pressure is low, the heart rate is fast, and the hemoglobin is progressively declining on the follow-up examination, and exploratory laparotomy should be performed in time to identify and resolve the cause of bleeding. The doctor performed laparotomy at 15:30 on November 19, but the operation was not timely.
2. There is no violation of the operation again. On the afternoon of November 19, laparotomy was performed, and the surgical records showed that "about 3000ml of blood was found in the abdominal cavity on exploration, and no abnormalities were found in the liver exploration, and no obvious bleeding points were found; There was no obvious bleeding from the surgical wound of the right kidney, and there was no obvious abnormality in the abdominal organs such as the small intestine and colon. The abdominal cavity was flushed with warm water, and no active bleeding was detected, and a double abdominal cannula was placed in the right renal fossa.
A hole is poked into the right abdominal wall. Flush the abdominal cavity again with warm water, aspirate, and check again for no active bleeding in the abdominal cavity. The operation record showed that the bleeding was about 4000ml, and a total of 1000ml of red blood cell suspension, 1500ml of hydroxyethyl starch, and 100m1 of sodium bicarbonate were transfused. According to the surgical records, the patient's postoperative bleeding was clear, and the doctor's reoperation was not violated.
3. The medical history record is not standardized. On November 18, there was a discrepancy between the person recording the operation and the person who signed the operation in the inpatient medical record and the person who signed the operation in the anesthesia record. The anesthesia staff in the Nov. 18 surgery record and the anesthesia staff in the inpatient record and the signatory in the anesthesia record are inconsistent. The person who signed the anesthesia on November 19 recorded in the inpatient medical record and the person who signed the anesthesia record were inconsistent. The medical history record is not standardized, but this deficiency has no causal relationship with the patient's death.
4. The patient said that after the patient's death, the patient sent a text message asking to seal the medical history, and the doctor said "yes"; The doctor said that there was such a circumstance, saying that the subsequent patient did not arrive at the hospital to start the sealing procedure. There was insufficient communication between the doctor and the patient on the sealing of the medical history, but this deficiency had no causal relationship with the patient's death.
【Verdict】
On January 29, 2024, it was decided that the defendant hospital should bear 50% of the liability for damages in accordance with the law and compensate the plaintiff 565,544.1 yuan.
[Excerpt from judicial adjudication cases]