[Plaintiff's Statement]
On December 17, 2021, I went to the dental department of the defendant's office for "shaking the left maxillary back tooth for more than half a month", and after the doctor's consultation, I was advised to stop taking aspirin tablets for a long time due to my high blood pressure, and it was recommended to stop taking the drug for one week and extract the tooth. On December 24, 2021, I went to the dental clinic of the defendant's office for the second time, and the attending doctor performed surgery on me to remove the left maxillary posterior tooth. After the injection of anesthetic drugs during the operation, I had difficulty opening my mouth.
I followed the doctor's instructions and massaged the left side of my cheek on my own, and the attending doctor removed the tooth. However, after the tooth was extracted, the attending doctor knew that the plaintiff had undergone "radical left breast surgery" chemotherapy in July 2011 and 10 years after radiotherapy for "breast cancer", but he did not give me antibiotic treatment after the tooth extraction, nor did he give me the operation of the "apical scratch and curettage" diagnosis and treatment program according to the diagnosis and treatment items, and did not explain the precautions after the operation.
On December 31, 2021, I went to the defendant's dental department for the third follow-up visit, and the attending doctor recommended temporary observation after a physical examination. On January 2, 2022, due to the aggravation of pain, I went to the outpatient clinic of the defendant's pain department for the fourth time, and the pain was not relieved by the medical plaster. On January 4, 2022, my pain continued to worsen, and I went to the dental department of a state hospital for the fifth time, and the doctor recommended that I buy dexamethasone and indomethacin orally by myself, but the pain was not relieved and the swelling did not go away.
On January 8, 2022, he went to the defendant's neurology department for the sixth time, but to no avail. On January 11, 2022, he went to the stomatology department of the defendant's department for the seventh time, and under local anesthesia, the left intraoral abscess was incised and drained (two incisions) to drain 15ml of pus. He was admitted to the Department of Stomatology for "maxillofacial space infection".
However, during the hospitalization, the defendant still delayed treatment, incomplete drainage, and gave the wrong treatment plan, which made my condition worse and worse after being hospitalized for 33 days, and I had no choice but to go to an affiliated hospital of a medical university for treatment on February 14, 2022, which was admitted to the hospital for "left mandibular osteomyelitis", and on February 22, 2022, I underwent "oral and maxillofacial soft tissue dissection, various deep soft tissue debridement and drainage, high condylar resection, and osteomyelitis lesion removal" under general anesthesia.
On March 2, under general anesthesia, "repair of oral and maxillofacial defect temporal muscle fascial flap and debridement of oral and maxillofacial soft tissue". On March 9, "oral and maxillofacial soft tissue debridement" was performed under local anesthesia, and the pathological diagnosis was as follows: fibrous hoof tissue hyperplasia, collagenization, acute and chronic inflammatory cell infiltration, and abscess formation.
He was discharged from the hospital on March 15, 2022 with the following diagnoses: chronic multifocal osteomyelitis (involving the ascending mandibular artery, condyle, and coracoid process), left mandibular osteomyelitis, condylar osteonecrosis, chronic septic osteomyelitis of the condyle, left masseter space infection involving the left condyle, inferior temporal space infection, and left mandibular necrotizing fasciitis.
[Plaintiff's opinion]
I only had one tooth extracted from the defendant, which caused the plaintiff to have difficulty opening his mouth and the removal of the condyle at a high level, and mentally endured severe pain that was unbearable for ordinary people. In accordance with the provisions of the law, I hereby appeal to the court and request that the defendant be ordered to pay me a total of 311,979.38 yuan in compensation.
[Defendant State Hospital argues]
1. The appraisal opinion recorded that "yellow-brown purulent contents were found in the outpatient puncture on January 8, 2022" is inconsistent with the facts. The appraisal opinion recorded that "no obvious purulent contents were found at the two points punctured with the 20ml syringe", and the appraisal opinion recorded that "the doctor on duty prescribed a blood routine, CRP and facial ultrasound examination, and a puncture examination of the swollen area of the left cheek (20ml syringe), but no pus was pierced";
The above is recorded in the outpatient examination on January 8, 2022, and no yellow-brown purulent contents of the patient were found. It is not the case that "the doctor did not pay enough attention to the acute pain and discomfort during the outpatient treatment and the first inpatient treatment of the patient Liu, and did not improve the relevant auxiliary examinations in a timely manner", but the patient Liu had already undergone a comprehensive examination when he was in the outpatient treatment of a state people's hospital.
2. The appraisal agency confuses the hospital where the patient was hospitalized for the first time with the people's hospital of a certain state, which is an error in the determination of facts and imposes the inspection obligation of the hospital of a certain state. From January 4, 2022 to January 8, 2022, patient Liu was not hospitalized in a state people's hospital, but in a people's hospital in a city, and was only treated as an outpatient on January 8, 2022.
The appraisal opinion recorded that "from January 4, 2022 to January 8, 2022, he was hospitalized in the hospital for "chronic gastritis, breast malignant tumor", etc., and by January 11, 2022, imaging examination had shown "acute infection of the left maxillofacial area, masseter muscle, and perimaxillary space with pneumatosis", which is obviously inconsistent with the facts.
The first hospitalization of patient Liu in a state people's hospital was January 11, 2022, which is not the case recorded in the appraisal opinion, "the doctor did not pay enough attention to acute pain and discomfort during the outpatient treatment and first hospitalization of patient Liu Yuxia, and failed to improve the relevant auxiliary examinations in a timely manner", on the contrary, during the outpatient diagnosis and treatment on January 11, 2022, after it was found that patient Liu had buccal space infection, it was recommended that the abscess be cut and hospitalized.
3. The appraisal opinion recorded that "the maxillofacial examination recorded during hospitalization was negative (combined with the medical history data, it should be a positive manifestation at this time)" is inconsistent with the facts. In the medical records provided by a state people's hospital, the maxillofacial record of patient Liu's admission record was positive, not negative, and the appraisal agency determined that the state people's hospital had not completed the relevant auxiliary examinations, and there were errors in the delay in diagnosis and treatment.
4. On the same day, the abscess was drained, and the sample was sent for culture on the same day, which did not delay the treatment of patient Liu, and the appraisal agency believed that "the drainage did not leave a sample and sent it for culture" and delayed the treatment of patient Liu.
5. The appraisal opinion "On anti-infective treatment during rehospitalization" recorded that "as of January 18, 2022, the imaging has shown osteomyelitis of the left mandibular condyle" is incorrect. CT examination on January 18, 2022 showed that the patient's maxillary and maxillary cortex were continuous, and no signs of osteomyelitis were found.
【Appraisal opinion of the Medical Association】
After being discharged from the hospital, entrusted by the health commission of a certain state, a medical association of a certain state conducted a medical malpractice appraisal and issued a medical malpractice technical appraisal on June 22, 2022, determining that this case constituted a fourth-level medical malpractice (failure to do relevant examinations in a timely manner, failure to use antibiotics in a timely manner, and failure to consult a higher-level hospital in a timely manner).
【Judicial Appraisal Opinion】
1. The People's Hospital of a certain prefecture has a clear diagnosis and treatment fault (negligence) in Liu's diagnosis and treatment activities; There is a certain causal relationship between the hospital's negligence and fault and the damage consequences of patient Liu, which is the main causal force (the recommended participation is 60%-80%);
2. The person to be evaluated, Liu, female, born on May 15, 1958, has functional impairment due to osteomyelitis of the jaw and constitutes a grade 9 disability; The rest period (missed work period) is 180 days, the nursing period is 90 days, and the nutrition period is 90 days; It is not possible to assess the cost of follow-up treatment, and it is recommended to refer to the actual incurrence.
【Verdict】
On February 7, 2024, it was decided that the defendant, a state people's hospital, should bear 70% of the liability and pay compensation of RMB 139,752.69.
[Excerpt from judicial adjudication cases]