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1、第二十一章 医疗纠纷与医疗事故-教学纲要教学要求：1.掌握：医疗纠纷的概念与特点；医疗事故的概念与构成的条件；医疗纠纷的类型和发生原因；医疗事故的类型和发生的原因；法医在医疗纠纷和医疗事故鉴定中的作用；法医尸体解剖在医疗纠纷处理中的作用；非法行医的概念与常见类型。2.熟悉：医疗事故的分级；医疗纠纷或医疗事故的处理程序； 鉴定及鉴定程序；医疗纠纷法医病理学鉴定考前须知。3了解：医疗纠纷和医疗事故民事责任确实定；医疗纠纷和医疗事故行政责任确实定；医疗纠纷中的刑事责任。【教学内容】第一节概述一、医疗纠纷的概念与特点二、医疗事故的概念与构成条件第二节医疗纠纷与医疗事故的类型和发生原因一、医疗纠纷的类型
2、和发生原因二、医疗事故的类型和发生原因三、医疗事故的分级第三节医疗纠纷与医疗事故的责任类型一、医疗纠纷或医疗事故民事责任确实定二、医疗纠纷或医疗事故行政责任确实定三、医疗纠纷中的刑事责任第四节医疗纠纷或医疗事故的处理与鉴定一、医疗纠纷或医疗事故的处理程序二、法医在医疗纠纷和医疗事故鉴定中的作用三、法医尸体解剖在医疗纠纷处理中的作用第五节非法行医与非法行医罪一、非法行医的概念与常见类型二、非法行医罪一、单项选择题1、?医疗事故处理条例?规定患者死亡，医患双方当事人不能确定死因或者对死因有异议的，应当在患者死亡后小时内进行尸检。拒绝或者拖延尸检，超过规定时间，影响对死因判定的，由拒绝或者拖延的一方
3、承当责任。A、96 B、72 C、48 D、24二、名词解释1、医疗纠纷medical tangle2、医疗事故medical negligence或medical malpractice3、医源性医疗纠纷iatrogenic medical tangle4、医疗过失纠纷tangle from medical fault5、非医源性医疗纠纷noniatrogenic medical tangle6、医疗意外medical accident7、一级甲等医疗事故8、一级乙等医疗事故9、假药10、劣药11、非法行医illegal medical practice三、问答题1、医疗事故的构成条件有哪几
4、点？Italy: medical negligence as a crimeMedical negligence claims in Italy are on the increase. In the absence of legal aid, most claimants pursue doctors via the criminal justice system but with a standard not of “beyond all reasonable doubt but merely “on the balance of probability. As a result, mos
5、t cases are settled out of court, often regardless of merit. Most doctors now live in fear that the next “informing warrant may be for them.The Italian health-care system has undergone significant change in recent years. For example, the former USLs (local health authorities) are now called “firms a
6、nd the balance of income/expenditure is a measure of performance. A share of the “profits is allocated to management and health workers in some units. The handling of medical negligence has altered too. On June 2, 1999, Italys civil justice system reverted to a two-track procedure. Italy provides no
7、 legal aid and most cases of alleged medical negligence are pursued via the criminal courts at no cost to the claimant. Alternative dispute resolution is seeing some growth.Civil procedureFor claimants who can afford civil litigation, there are no particular regulations or protocols that might deliv
8、er a fast, efficient, effective, and economical service. The process can be slow and bureaucratic, some cases taking many years to come to trial. The Codice Civile regulates the relations between doctor and patient but with rules applicable to any intellectual profession.Before 1995 there were only
9、two routes, the Pretura and the Tribunale (sitting with three magistrates). Then a three-track system was established to speed up civil justice and in a manner similar to the recent Woolf reforms in the UK.1 The system aimed to allocate cases appropriately to one of three tracks and attempted to int
10、roduce some rules and guidelines for the active management of each particular case. The three tracks were: the giudice di pace (a justice of the peace, often a lawyer); the pretore, a judge sitting alone; and the tribunale civile, with three judges, for more complex cases. The giudice di pace largel
11、y achieved the objectives of speeding up proceedings so that claims up to 5 million lire (1700) could be heard within a year. Doctors specialising in medical law were often called to estimate damages.The pretore heard cases up to 30 million lire (10000). Again the proportion of cases dealt with in l
12、ess than a year increased significantly between 1995 and 1999. Claimant and defendant called experts and the judge called his own medicolegal court-appointed doctor and specific experts. The medicolegal doctor was asked to give his opinion of current best practice. However, this was not the Bolam st
13、andard, where the doctor is judged against the reasonable and acceptable practice of the time (not best practice). Deciding what contemporary best practice is can be difficult enough, and it is even more difficult to say what best practice was at the time of the event complained of. This pretore lev
14、el was abolished from June, 1999.The two-track system introduced in June last year retains the giudice di pace but the tribunals now sit with a single judge. Having one judge instead of three reduces the time taken for cases to come to court and the cost of individual cases. To access the new system
15、 a patient seeking compensation via the civil justice system usually has to get a second opinion from another consultant or from the specialist medicolegal doctor (see below) to establish whether or not there is a prima facie case of negligence.Within the civil system problems remain, despite the recent changes. There is no strict case management; vast numbers of experts may be called; the absence of legal aid prompts claimants to pursue doctors via the criminal route, leading to criminal charges, guilty verdicts, and on occasion prison sentences; the standard of proof (best pra
