Because no fever outpatient rejects fever patient, the patient dies unexpectedly, the medical side is claimed 300 thousand!How hard is it to be an er doctor?Medical eye views

2022-06-27 0 By

The emergency departments of most hospitals are getting worse.This article is published by the author’s authorization, please do not reprint without authorization.Can patients with fever be rejected when there is no fever clinic?With the advent of the epidemic, how should we deal with strict management regulations?Case review of patients with senile male, born in 1937, a winter night in 2013 at 20:40, was taken to a family with fever 3 armour hospital which combines traditional Chinese medicine with western medicine prescriptions) (hereinafter referred to as the emergency department visits, prescriptions of emergency triage nurse told machine prescriptions has suspended fever clinic accept appointment, should the fever MenZhenChu to other hospital.The patient left the hospital at 21:40 and arrived at the emergency room of another class A hospital at 21:40. The medical record of the emergency room said: “Chief complaint: he died when he arrived;History: Renal insufficiency;Signs: improper breathing, blood pressure 0, respiratory arrest, blood pressure unmeasured;Main diagnosis: dead on arrival.At 22:30, the patient’s heart rate was zero, blood pressure could not be measured, respiratory arrest, ecg wave straight line, family members gave up further invasive medicine rescue, the patient was declared clinically dead.”After the death of the patient, the patient puts forward opinions to the medical side, and the medical side issues “Reply Opinions on the complaint of the patient’s family”.The patient then sued the doctor to the court for compensation of more than 300,000 yuan.Of party said that night hire cars to the prescriptions of the emergency department visits, prescriptions emergency medical personnel citing the fever outpatient service has been cancelled, refused to timely treatment of patients, not to take any emergency measures, requires patients to other hospitals, patients continue to ride from prescriptions rushed to the hospital after the lost time.Prescriptions pretended to shuffle, refused to rescue in time, the father of the plaintiff’s cause of death in patients with inaction, in violation of the professional medical act, the regulations on the administration of medical institutions, the nurses ordinance and a series of laws, regulations and rules such as expressly provided otherwise, shall, in accordance with the rules of the tort liability act as its wrongdoing and assume tort liability to pay compensation.The medical side argued that the facts about the patient’s visit to the hospital could not be checked, and the medical side’s registration record did not contain this person’s registration record.We cannot confirm that the deceased was admitted to the hospital.The time period referred to the plaintiff in hospital of fever clinics TingZhen transformation, what reason is because after SARS, prescriptions according to established guidelines for fever clinics for facilities have not been able to improve, in September 2012, the city’s fire department recognized in the fire control safety inspection for the serious fire hazard and give temporarily closed down.The fire department asked the medical side during this period, must start to rectify, otherwise will be punished according to law.To this end, the doctor submitted the relevant request report to the administrative competent department to suspend the fever clinic, and posted relevant notices on the hospital’s website in the outpatient hall, outside the gate and in the emergency room, asking patients to go to other fever clinics.Based on the above situation, it is estimated that if patients come to the hospital for treatment, the hospital’s guidance staff will remind them to pay attention to the corresponding notification and notification.If this situation exists, it is not the hospital refusing treatment, but due to the particularity of objective conditions. The hospital’s behavior conforms to the provisions of relevant laws and regulations, and should not bear any liability for fault, so it does not agree with the plaintiff’s claim.Trial, prescriptions submitted area public security fire control team temporary attachment of a copy of the decision, the direction of medical health bureau to apply for instructions for disease control and prevention, the prescriptions of the moratorium on fever clinic instruct “copy and the patients informed papers, to prove that the prescriptions fever outpatient TingZhen reason and time, and has the related department instruction, and does the corresponding to the general patients.After the trial, the court held that, according to the national emergency management regulations, emergency patients should be held responsible for the first visit. Emergency patients should not be refused or shirk their responsibilities for any reason. The critical emergency patients should be treated in accordance with the principle of timely treatment to ensure the timely and effective emergency treatment.In emergency cases, triage procedures and principles shall be formulated and strictly implemented, and patients shall be triaged according to their disease risk, and patients who may endanger their lives shall be rescued immediately.In this case, the patient came to the emergency department of the medical party, and the medical staff only had a preliminary understanding of the patient’s disease situation, that is, required him to be transferred to the hospital for treatment, but did not make corresponding diagnosis and treatment for the patient, so as to take corresponding measures according to the severity of the patient’s disease. The medical party’s behavior violated the relevant provisions.The patient was later transferred to another hospital for treatment and died when he arrived at the hospital. The medical side has some faults for the patient’s diagnosis and treatment and should bear the corresponding compensation liability.In the end, the doctor was ordered to compensate the patient 40,000 yuan and the legal costs 5,500 yuan, half of which should be borne by both the doctor and the patient.Is it impossible to refuse emergency treatment?No excuse?On December 10, 2012, the Beijing municipal health bureau released the notice on further strengthening emergency work of medical institutions, make clear a regulation “of various medical institutions at various levels must strictly enforce laws and regulations about medical and health services, earnestly perform their duties, are strictly prohibited for any reason to refuse and shuffle patients, ensure rights to the patient.””Hospitals at or above level II must set up emergency departments that are open 24 hours a day and ready for treatment, and ensure timely and coherent services such as pharmacy, laboratory and medical imaging for patients according to the functional tasks of the hospital.””Doctors at the first visit are not allowed to transfer patients to another hospital until their condition stabilizes.”When the bureau of Health issued this notice, it was also because there were often cases of “shirking death by emergency treatment” that made headlines and triggered hot discussions in the whole society.As a health management department, in order to avoid the recurrence of “malignant events”, we must strengthen “management”.The content of this notice is not groundless.Regulations on the management of medical institutions stipulate: “Medical institutions shall rescue critically ill patients immediately.”The Law on Medical Practitioners states: “Doctors shall take emergency measures to treat patients with acute and life-threatening diseases;Emergency treatment should not be refused.”The core system of the hospital also has detailed regulations on emergency treatment, emergency consultation and hospital transfer.What needs to be emphasized here is that the provisions of the emphasis can not shirk, refuse patients, patients here refer to “urgent, critical and severe patients”, rather than all patients who want to see a doctor, can outpatient treatment.When all kinds of systems and regulations stipulate that emergency doctors cannot shirk responsibility or refuse to treat patients, critically ill patients need to be treated actively before being referred.However, there are still endless cases of refusing treatment and prevarication. No one further asks: why do hospitals refuse treatment?Why did the hospital refuse?In the hospital, it is said that there is a “chain of contempt” for each department divided into seven layers.Emergency departments are definitely the lowest rung in the chain of contempt, along with pediatrics.Due to the poor working environment, high work intensity, high risk and low income of emergency department, emergency department has always been a shortage of personnel, especially medical personnel with emergency work experience is difficult to recruit and retain.In addition to the lack of personnel, emergency resources are occupied, and the lack of a bed in the third grade a hospital is also the reason why the emergency department is forced to “reject” patients.After all, emergency medical resources are limited and patients cannot be admitted without limit.To put it simply, beds, monitoring, oxygen inhalation, ventilator and so on are limited, and many emergency beds in grade A hospitals are occupied by end-stage patients for a long time, which makes the already tense emergency treatment worse.Many non-emergency patients go to the emergency department for various reasons, occupying emergency resources.In addition, emergency department is a department with high incidence of infectious diseases, and the management of infection control department is more strict, especially during the epidemic period.In the strict implementation of various rules and regulations at the same time, there may be some critically ill patients have not been identified, and were rejected.After all, all kinds of reasons lead to emergency department is always in a variety of predicament, helpless medical care, patient anger, complaints, disputes.Faced with the predicament of emergency, although the health administration has done some things, made some rules, requiring medical institutions to strengthen the construction and investment of emergency, but little effect.With the exception of some third class a hospitals, the emergency department has significantly improved under the strong investment accident, most of the emergency departments are getting worse and worse.Due to the shortage of emergency physicians, many hospitals have canceled pediatric emergencies, relied on ward duty doctors for surgical emergencies, and rotated emergency physicians for internal medicine.The epidemic has been going on for more than two years. Due to the NOVEL coronavirus outbreak, hospitals have many management rules, making the treatment and hospitalization procedures quite complicated.Many medical staff have been transferred to do public health work, the department staff shortage, operation difficulties.It’s getting harder and harder to follow the rules, protect yourself, avoid nosocomial infections and avoid disputes.In recent years, how many patients have been rejected, shunned, emergency patients can be timely and effective treatment?Every medical staff in the frontline struggle have a feeling in their hearts, but can only be helpless.How to avoid these risks?How do emergency medical staff avoid risks?Identifying critically ill patients is particularly important.Patients who do not need emergency treatment can wait, block and recommend direct transfer to a hospital.The emergency department cannot refuse patients with unstable vital signs and critical conditions who need immediate treatment.The so-called “do not”, this is the principle.As long as the patient walks into the emergency room, the doctor and the patient also establish some kind of contractual relationship, the doctor has the obligation to ensure the life safety of the patient, no matter whether the patient has a family member or not, whether to pay the registration fee.Surviving in an emergency department requires a good eye, a good mouth and a bit of luck.Lao Liu is ready to evacuate and wishes his colleagues good luck.Consultant lawyer Xiang Haiman, a lawyer of Beijing Quanzhi Law Firm (formerly Beijing Renchuang Law Firm), has long been engaged in the research and practice of medical law and has rich experience in medical law practice.This case comes from Jing Min, the editor of Beijing Court trial information Network