Civil and Commercial Perspective | How much responsibility does the hospital bear for a patient who has developed a secondary disability after a cerebral infarction surgery?
Published:
2025-02-26
Patient Zhang reported to the hospital due to "dizziness accompanied by numbness in the left upper limb for 7 days, worsening for 2 days," and was subsequently hospitalized for treatment. After treatment, Zhang's left upper limb muscle strength was at level 1, and left lower limb muscle strength was at level 0, with low muscle tone. Currently, he cannot sit or stand, ultimately leading to disability. Zhang believes that there was medical malpractice during the treatment process and has entrusted the author to represent him in the lawsuit.
Case Summary
Patient Zhang presented to the hospital with "dizziness accompanied by numbness in the left upper limb for 7 days, worsening for 2 days," and was subsequently hospitalized for treatment. After treatment, Zhang's left upper limb muscle strength was rated at level 1, and left lower limb muscle strength at level 0, with low muscle tone. Currently, he is unable to sit or stand, ultimately leading to disability. Zhang believes that there was medical malpractice by the medical institution during the treatment process and has entrusted the author to represent him in the lawsuit.
Zhang's medical record states: Admission diagnosis: 1. Acute cerebral infarction 2. Hypertension stage 3 (extremely high risk) 3. Type 2 diabetes. On May 10, 2023, the hospital performed "cerebral angiography" on the patient under local anesthesia. During the procedure, due to severe stenosis of the right carotid artery segment, the degree of stenosis was assessed, and even with optimal medication treatment, there remained a high risk of recurrent cerebral infarction. On May 16, 2023, the hospital performed a percutaneous balloon dilation and stenting of the internal carotid artery's ophthalmic segment on the patient. It was recommended to perform "percutaneous balloon dilation and stenting of the internal carotid artery's ophthalmic segment," and on the same day, the hospital conducted the procedure. Post-surgery, Zhang's left upper limb muscle strength was rated at level 1, left lower limb muscle strength at level 0, with low muscle tone. Based on the medical records provided by Zhang, we believe that the hospital made errors during the diagnosis and treatment process, which have a certain causal relationship with the patient's final damage outcome, and the hospital should bear compensation responsibility. During the trial process, the patient applied to the court for an expert evaluation, and the evaluation agency concluded that the hospital's medical malpractice and the patient's damage outcome were of equal causation.
Lawyer's Analysis
1. The key to medical damage liability disputes lies in determining through expert opinions whether the hospital's diagnostic and treatment actions involved malpractice and whether there is a causal relationship and degree of causation between the damage and the patient.
Medical damage liability disputes are not as simple as the average person imagines, where the law protects the weak, and a patient can just make a fuss in the hospital to obtain compensation. The key to compensation in such cases lies in the evaluation: whether the hospital's diagnostic and treatment actions involved malpractice, whether there is a causal relationship and degree of causation between the malpractice and the harm suffered by the patient; whether the patient qualifies for a disability rating, the duration of hospitalization and post-discharge care, nutrition period, and loss of work period, etc.
2. Issues to pay attention to during the evaluation process
(1) Identify flaws in the treatment process from the medical records and write a statement.
1. From the content recorded in the medical records submitted by the hospital, it can be seen that the patient's symptoms upon admission were mild, only numbness in the left upper limb. After the hospital performed surgery on him, thrombotic symptoms immediately appeared, and the hospital also believed it was due to thrombosis within the stent.
2. In the discussion of difficult cases on page 33 of the medical records, the hospital's physician stated, "The main consideration for the cause of cerebral infarction is thrombosis within the stent."
The hospital believes that thrombosis within the stent is a common complication after percutaneous balloon dilation and stenting of the internal carotid artery's ophthalmic segment, mainly due to the patient's unique physical constitution and poor sensitivity to antiplatelet drugs. The patient acknowledges that the direct cause of the adverse outcome is thrombosis within the stent.
First, thrombosis within the stent is not an unavoidable complication of percutaneous balloon dilation and stenting of the internal carotid artery's ophthalmic segment.
Second, the hospital has no evidence to prove that the patient has a unique physical constitution.
Finally, if poor sensitivity to antiplatelet drugs leads to post-operative thrombosis within the stent, it means that this physical constitution is a contraindication for the surgery, and the hospital should have checked this function of the patient's body before the surgery. If the formation of the thrombus was caused by the hospital's failure to conduct this examination, then the hospital's erroneous diagnostic and treatment actions are the direct cause of the adverse outcome.
(2) Identify flaws from the actual treatment process and record them in the statement.
1. The size of the balloon chosen by the hospital for the patient was inappropriate.
The author believes that the true cause of the patient's thrombosis within the stent during this medical activity is not the hospital's claim of the patient's unique physical constitution, but rather that the hospital chose a balloon that was too small for the patient, leading to poor wall apposition of the stent, inducing thrombosis, and subsequently resulting in the patient's left upper limb muscle strength being rated at level 1, left lower limb muscle strength at level 0, with low muscle tone. Despite long-term rehabilitation treatment, the patient still suffers from severe functional defects, unclear speech, and has been left with a lifelong disability.
2. Based on the surgical record on page 46 of the medical records, it can be seen that the hospital "introduced a 2.0mm✕12mm balloon to the stenosis of the right internal carotid artery's ophthalmic segment." Because the balloon model chosen by the hospital was too small, it led to poor wall apposition of the stent, inducing thrombosis, which is the true cause of the patient's thrombosis within the stent.
(3) Issues to pay attention to regarding the evaluation procedure
1. To reflect fairness and justice, it is recommended to choose an evaluation agency from another region.
In this case, during the trial process, based on Zhang's application, the court legally entrusted a certain judicial appraisal center in Nanjing to evaluate whether there was malpractice in the hospital's treatment of Zhang, whether there was a causal relationship and degree of causation between the malpractice and the harm suffered by Zhang; Zhang's disability rating, the duration of hospitalization and post-discharge care, nutrition period, and loss of work period.
2. Fully articulate the hospital's malpractice during the hearing.
During the statement of the treatment process, try to present the hospital's diagnostic and treatment malpractice, allowing experts to fully hear opinions before questioning the hospital. Combine the prepared statements and the opinions during the hearing process to ensure that the evaluation experts fully understand the objective facts. The statements during the evaluation process should be as detailed and comprehensive as possible, with clear viewpoints.
3. Evaluation Opinion
In this case, the evaluation agency accepted part of the patient's requests, believing that the balloon model chosen by the hospital was too small, leading to poor wall apposition of the stent, inducing thrombosis, and constituting medical malpractice. On September 19, 2024, a certain judicial appraisal center in Nanjing issued judicial appraisal opinion No. 19, stating: 1. The hospital's medical behavior involved malpractice, and there is a causal relationship between this and Zhang's current damage outcome, suggesting that the degree of causation should be considered equal. 2. Zhang's medical damage constitutes a level 2 disability. 3. It is recommended that Zhang's loss of work period and care period be from the date of injury until the day before this evaluation, and the nutrition period should total 180 days. The hospital raised written objections to this judicial appraisal opinion, and the Nanjing appraisal center responded in writing on October 11, 2024, without changing the evaluation opinion.
The court believes
Zhang suffered from "dizziness accompanied by numbness in the left upper limb for 7 days, worsening for 2 days" and went to the hospital for treatment. The hospital, as the implementer of medical behavior, has the obligation to provide Zhang with necessary, reasonable, timely, and effective treatment. The judicial appraisal opinion issued by a certain judicial appraisal center in Nanjing was made according to Zhang's application and entrusted by law. The appraisers and the appraisal institution have the corresponding qualifications, the appraisal procedure is legal, and there is no obvious lack of appraisal basis, which should be accepted. According to the judicial appraisal opinion issued by the Nanjing judicial appraisal center, the hospital made medical errors during the diagnosis and treatment of Zhang, which has a certain causal relationship with Zhang's final damage consequences, belonging to the same cause. Article 1218 of the Civil Code of the People's Republic of China states: "If a patient suffers damage during medical treatment activities, and the medical institution or its medical staff is at fault, the medical institution shall bear the liability for compensation." According to the judicial appraisal opinion, the degree of causal force between the hospital's medical error and Zhang's damage consequences is of the same cause, therefore, this court determines that the hospital shall bear 50% of the civil compensation responsibility for Zhang's damage consequences.
Conclusion
Regarding the issue of whether the hospital is liable for the disability caused by the patient's cerebral infarction surgery, it should be analyzed on a case-by-case basis. If the hospital fails to fully fulfill its duty of care, such as not taking appropriate preoperative examination measures and preventive measures, the hospital may be considered at fault. Even if the hospital clearly informs the risks of surgery and complications that may occur during the surgery in the preoperative notice, including intraoperative and postoperative bleeding, and the risk of cerebral infarction, and this risk notification has been signed by the patient's family, it does not completely exempt the hospital from legal liability. If the hospital fails to take appropriate preventive measures or improperly handles the complications that arise, it may still bear responsibility.
When the court hears the case, it also considers whether the hospital's diagnosis and treatment behavior complies with medical norms, whether necessary preventive measures were taken in a timely manner, and whether there is a causal relationship between the hospital's fault and the patient's disability.
(Statement: This article is the author's viewpoint summarized based on experience, for communication and discussion only)
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