1. The patient's complaint
Before May 15, 2023, Zhao Mouen (male, born on June 14, 1970) had undergone hemodialysis (kidney dialysis) several times in X County People's Hospital due to uremia, and the dialysis time was every Monday, Wednesday and Friday. At about 6 o'clock on May 15, 2023 (Monday), Zhao Mouen went to the People's Hospital of X County to wait for kidney dialysis at the usual appointment time.
Until 13:40 in the afternoon of the same day, Zhao Mouen had severe asthma, consciousness disorder appeared after 20 minutes of treatment, cardiac arrest and respiratory arrest occurred at 14:05, and the rescue continued until 14:40, Zhao Mouen still had no spontaneous heartbeat, and was declared clinically dead at 14:50.
2. Patient's point of view
Zhao Mouen went to the People's Hospital of X County for hemodialysis many times before his death, and he and the People's Hospital of X County have formed a medical service contract relationship, and the People's Hospital of X County should earnestly perform its duties and obligations to provide safe and effective diagnosis and treatment services for Zhao Mouen, but the People's Hospital of X County, as a tertiary B general hospital with hemodialysis capabilities, does not have an emergency plan for emergency use of hemodialysis patients after the water is stopped.
As a medical institution with a high duty of care, its conduct was grossly negligent, causing great physical and mental harm to the plaintiff, and should bear the corresponding liability for compensation in accordance with law. The special lawsuit was filed with the court, and the lawsuit was filed for compensation of 1,006,859.6 yuan.
3. The defendant X County People's Hospital argued
The underlying cause of death is heart failure due to the continued deterioration of chronic renal failure. The patient's non-compliance with the doctor's instructions and the acceleration of the deterioration of the patient's condition due to irregular life are the secondary causes of death.
On the day of the patient's death, the patient and his family refused CRRT treatment and did not go to the X County Hospital of Traditional Chinese Medicine for treatment, which was another cause of his heart failure, which was caused by himself, and the X County People's Hospital should not be held liable. The People's Hospital of X County carried out timely rescue when the patient had severe asthma, and there was no fault in the rescue process.
In summary, the X County People's Hospital believes that the patient's death was caused by the progress of his disease, his irregular life, and his refusal to further treatment. The People's Hospital of X County should not be held responsible for the outcome of its death. Even if the People's Hospital of X County should be held liable, it should only bear no more than 10% of the liability.
4. Appraisal opinions
The fault of the People's Hospital of X County for Zhao Mouen's diagnosis and treatment was a secondary reason. Zhao Moulin objected to the appraisal opinion, arguing that the appraisal opinion determined that the doctor's fault was a secondary cause that was too light. X forensic appraisal agency made a written reply to Zhao Moulin's objection.
5. Medical fault analysis
1. Combined with the information submitted for appraisal and the statement will be understood, the appraised person Zhao Mouen was diagnosed with chronic renal failure in 2020, and regularly went to the People's Hospital of X County for hemodialysis treatment, three times a week (Monday, Wednesday, Friday), and the patient routinely went to the doctor for hemodialysis treatment before 08 o'clock on 2023-05-15, and was told that the emergency plan was not activated due to the low water pressure in the dialysis room (water pipe rupture and water stopping).
2. At 09 o'clock, the patient complained of chest tightness and asthma, the doctor listened to the lungs and had rales, and the blood pressure was high, during which the patient did not dare to lie down, and sat upright, the patient had repeatedly checked pro-BNP during the previous dialysis period, and the frequency of dialysis increased compared with the usual one in the early stage of the visit (about one month), and the previous dialysis got off the machine early due to discomfort, and the blood pressure was higher when getting off the plane, indicating that the patient's chronic kidney disease was not well controlled.
3. For patients who have been treated on dialysis for chronic kidney disease for a long time, the doctor did not pay attention to the impact of the disease on other organs such as the cardiovascular system, resulting in the failure to treat the abnormal manifestations of the patients, which is at fault.
4. The patient was already in chronic renal failure at the time of this visit, belonging to the advanced stage of chronic kidney disease, and had been regularly dialysed three times a week before, and the frequency of dialysis increased in the early stage of this visit, and the dialysis showed that the dehydration ultrafiltration was about 4-5kg, and the weight increased by about 4kg during dialysis, indicating that the patient's water volume control was poor.
Patients eventually die due to heart failure, and cardiovascular disease is a common complication and cause of death of chronic kidney disease, and the patient's ultimate death is mainly related to the long-term impact of chronic kidney disease on the cardiovascular system and heart failure. In the event of a water outage in the hemodialysis room of the doctor, the emergency plan was not activated in time.
For patients who have uncomfortable symptoms and abnormal signs while waiting for hemodialysis treatment, do not pay enough attention to them, do not consult relevant departments in time and improve relevant examinations to evaluate the patient's condition, or timely inform patients of the necessity of CRRT treatment and the possible risks of refusing CRRT treatment, and even recommend that they go to other hospitals for treatment as soon as possible.
6. The Court's decision
On January 19, 2024, it was decided that the People's Hospital of X County should bear 30% of the liability and compensate 373,582.35 yuan.
【Judicial Adjudication Cases】