The Statute on Handling Medical Accidents, issued by the State Council, will come into effect as of September 1. At the same time, Measures on Medical Accidents Handling, published on June 29, 1987, will be abolished. During an interview with northeast.com.cn, Yang Song, an official with the Heilongjiang Health Bureau who participated in the drafting of the Statute, describes the differences between the two regulations and how the new Statute is likely to benefit patients.
Patients Can Seek Direct Judicial Assistance
According to the Measures now in force, only Health Administrators have the right to appraise medical accidents. A patient can bring a lawsuit against a hospital only after the cause of a medical accident is identified. But the new Statute stipulates that patients can appeal directly to a court for judicial help.
Medical Association to Appraise Medical Accidents
Fair and objective appraisals carried out by an impartial organization are crucial for settling medical disputes, determining malpractice, and categorizing accidents. The Heilongjiang Provincial Medical Association will replace the provincial health administration to assume the responsibility for accident appraisal on September 1. The association will establish a body of experts, from which appraisal teams will be randomly selected as required. Appraisals will be made by the medical association at city or provincial level. When necessary, the Chinese Medical Association will organize technical appraisal of any medical accident dispute which is complicated and influential nationwide.
Classification of Medical Accidents
Until now, medical accidents have been categorized as either ‘responsibility accidents’ or ‘technological accidents’, and divided into three grades. The punishments for responsibility accidents were more severe than those for technological accidents. The Statute no longer differentiates between responsibility and technological accidents, but now divides accidents into four grades. The first grade identifies patients who are dead or seriously disabled. The second grade identifies patients who are partially disabled or suffering serious organ malfunction. The third grade identifies patients as slightly disabled or suffering moderate organ malfunction, and the fourth grade classifies patients who are clearly suffering from mental and physical illness, or medical errors which are not currently included under medical accidents. The new division in the Statute allows more objective consideration of accidents and improved protection for patients.
Appraisal Team Members to be Selected at Random
The Medical Association in charge of medical accidents will create a body of experts composed of senior technicians with high technical ability and moral integrity. They should have over three years experience in either medical, teaching, or scientific research organizations. Appraisal teams are then created by hospital staff and patients who randomly select members form the Medical Association’s expert body. If the appraisal is related to the serious disability or death of a patient, legal medical experts are essential. In addition, if the circumstances surrounding the affair are considered unusual, the medical experts may be selected from other regions.
Introduction of ‘Code of Ethics’ for Appraisal Team Members
To ensure appraisals are fair and objective, the new Statute states that members of the appraisal team should not be party to the accident, be a relative of a party to the accident, have an opportunity to gain an advantage in the proceedings, or have a relationship with the litigant which may affect the outcome of the appraisal. The Measures had only a single sentence regarding a code of ethics for appraisal team members. Appraisal committee members should withdraw from proceedings if they are party to the affair or in a position to gain unfair advantage. In addition to a new code of ethics, the Statute outlines administrative and criminal punishments for those in breach of the new regulations.
Patients Have the Right to their Medical History
An ongoing contention between hospitals and patients is whether to provide medical records to patients. In the past, some patients had to conceal their medical records in an attempt to gain an advantage in legal cases. The Statute requires medical organizations to provide authenticated copies of medical records to patients, clearly outlining their case history. Refusal to provide requested records and the altering of records will result in administrative or principal punishments.
Doctors’ Duties Increase as Medical Accident Jurisdiction Expands
The Statute defines medical accidents as those committed by medical organizations and staff in breach of administrative and departmental regulations, negligence resulting in misdiagnosis, and poor medical treatment resulting in physical or mental harm as outlined in the medical accident’s regulations. The Measures defined medical accidents as medical errors caused by staff that result in misdiagnosis or poor treatment causing death, disability, or the malfunction of bodily organs. The Statute adds that medical organizations in which serious medical accidents have occurred may be required to temporarily suspend business operations for a specified period of time while the situation is rectified, or have their license revoked. Medical staff responsible will be subject to criminal, administrative or disciplinary punishments.
Patient Injury due to Illegal Medical Practice Excluded from Medical Accidents
The Statute states that patient injury resulting from illegal medical practice is not considered a medical accident. Practitioners in breach of the law will receive criminal punishment and the victims must appeal to the courts for compensation. The following cases are not included in medical accidents: harm due to urgent medical assistance for patients in emergency situations; accidents caused by patients’ abnormal conditions or unusual illnesses; harm not anticipated or prevented by existing medical technologies; harm caused by infections during regular blood transfusion; and harm caused by patients’ decisions or unwillingness to accept medical intervention.
Increased Damages
The Measures adopted in 1987 stipulate damages for first, second and third grade medical accidents as 3,000 yuan (US$362), 2,000 yuan (US$241) and 1,000 yuan (US$120) respectively. The Statute clearly identifies items included as part of standard indemnity. Items listed include medical expenses, nursing fees, food during the patient’s stay in hospital, damages for disability, compensation for psychological trauma, and others, totalling 11. If the patient dies or is unable to work, compensation and child support payments for children younger than 16 will also be included as part of the indemnity. The amount of compensation is determined by the local standard of living. For example, in Harbin the maximum compensation is 50,000 yuan (US$6033) over 6 years in the case of death, or over 3 years for disability.
Urgent Treatment Records to Be Amended Within Six Hours
Medical case records have led to some opposition. The time allowed by doctors to complete urgent treatment medical records was previously 24 hours. It is held that such an extended period of time allows the opportunity for doctors to alter records and to reflect on the outcome of the treatment. The Statute reduced this time to six hours, further restricting doctors while benefiting patients.
Autopsies Made Easier
Examination of the body is an important measure in ascertaining the cause of death. However, previously the Measures restricted the number of facilities qualified to carry out the procedure, and imposed a time limit of 48 hours after death. An autopsy can be carried out up to seven days after death under the new Statute.
(china.org.cn translated by Feng Yikun, Junly 27, 2002)
