近10年来，随着我国医疗卫生事业不断发展，与医疗相关的法律法规日趋完善，公民维权的意识也逐步增强，医患之间出现的争端日渐增多，已经成为全社会关注的热点问题。

Nearly ten years,Along with the continuous development of medical and health services,And medical related laws and regulations is perfect,The rights of citizens consciousness also gradually increases,Doctor-patient dispute between appeared increasingly,The whole society has become the hot issues.

　　“近年来，医疗纠纷申诉案件受理数量大幅增加。”北京市西城区人民检察院的检察官通过调研发现，“随着人们的健康意识和法律意识不断强化，开始寻求多层次的法律支持，对医疗行为的质疑和不满从口角之争升级到对簿公堂，医疗侵权诉讼的数量呈上升的趋势。西城检察院民行处2011年和2012年受理审查医疗侵权申诉案件各占当年收案的10%以上，均为2008和2009两年审查该类案件总数的三倍”。

"In recent years,The medical dispute complaint case acceptance quantity increase."Beijing xicheng district people's procuratorate prosecutors through the survey found,"As people health consciousness and legal consciousness unceasingly strengthens,Began to seek for multi-level legal support,For medical behavior question and dissatisfaction from the Angle for upgrading to court,The number of medical tort litigation an upward trend.Wl MinHang procuratorate in 2011 and 2012 accepted review medical tort complaints that each account for more than 10% of the community,All for 2008 and 2009 two years review the cases of total three times".

　患方仍处医疗纠纷弱势地位 A party still at a disadvantage of medical disputes

　　通过调研曾经办理的医疗纠纷案件，西城检察院的检察官发现，医学的专业性及医疗手段的复杂性使医患双方在就诊治疗方面明显处于权利义务不对等的状态，“为了调整这种特殊关系，尽管民事诉讼证据规则将医疗行为是否存在过错的举证责任，以倒置的方式转移到医疗机构一方，侵权责任法将医疗损害责任确定为过错推定责任，但患者仍然负有对某些事实举证的责任。由此，我们发现，在参与诉讼的过程中，患方仍处于弱势地位”。

Through the investigation of the case have to deal with medical disputes,Wl procuratorate prosecutors found,Medical professional and medical means the complexity of doctor-patient both medical treatment obviously in rights and obligations of the unequal status,"In order to adjust the special relationship,Although civil action evidence rule medical behavior whether there is fault of the burden of proof,With inverted way to transfer to a party of medical institutions,Tort liability law medical liability for damage is determined as the presumption of fault liability,But patients still have to some facts onus of proof.this,We found,In the process of participating in the litigation,A party is still at a disadvantage".

　　调研检察官介绍说，前来检察机关申诉的医疗纠纷案件都是患者(或家属)一方，“其中绝大多数都缺少相关的医学知识，也不掌握参与诉讼的法律规则和诉讼技巧，未能通过诉讼达到获得赔偿的目的”。

Research prosecutors said,The procuratorial organs to the medical disputes are patients(Or family member)A party,"The vast majority of them are related to the lack of medical knowledge,Also not to participate in litigation of the rule of law and litigation skills,Not through the action to achieve the purpose of obtain compensation".

　　“最简单的例子，在陈某起诉某医院的案件中，在写被告名称的时候用的是口头常用的说法，却没有到相关部门查证医院的正式名称，结果被法院驳回起诉。还有些申诉人不懂法律专业术语，如王某在诉讼中完全不理解‘质证’的含义，认为只有医院用证据说服了自己才叫质证，如果说服不了自己，这份证据就没有法律效力，不能被法院采信。这些错误认识都会影响申诉人有效运用法律维护自身利益。”调研检察官举例说，另外比如按照《医疗事故处理条例》第十八条规定，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48小时内进行尸检，但由于缺乏收集和保存证据的意识，同时绝大多数患者家属没有尸检意识或不懂进行尸检有时间限制，导致医疗责任无法确定的现象在医疗诉讼中并不少见。

"The most simple example,Work his way up in a hospital charges in the case,Write the name of the defendant when use is oral common view,But not to the relevant department to verify the official name of the hospital,The result is court prosecution.Also some plaintiff don't understand legal terms,Such as wang mou in litigation completely don't understand‘confrontation’meaning,Think only hospitals evidence to convince himself was a confrontation,If to convince yourself,This evidence is no legal effect,Cannot be court admitted.These mistakes know will affect the plaintiff effective use the law to safeguard their own interests."The research for example,In addition, such as by[Medical accident treatment regulations]The provisions of article 18,Patients died,The two parties can not determine the cause of death patient or to have objections to the cause of death,Ought to be in patients died within forty-eight hours after an autopsy,But due to the lack of evidence collection and preservation of consciousness,At the same time, the vast majority of patients family members no autopsy consciousness or don't understand an autopsy was a time limit,Lead to the phenomenon of medical liability can not be sure in the medical litigation is not rare.

　　例如在西城检察院办理的医疗纠纷中，孙某的儿子因病在某医院治疗后，回到家中进一步调养，不料半个月后孩子突然在家中摔倒死亡。巨大的悲痛使父母无法承受，却没有想到进行尸检。父母认为医院的治疗构成医疗事故，但最终由于无法确定孩子的死因而败诉。

For example, in xicheng procuratorate to deal with medical disputes,Sun son due to illness in a hospital after treatment,Home to improve further,But after half month child suddenly fall in home death.Great grief that parents cannot afford,Did not think of to autopsy.The parents believe that the hospital treatment constitute a medical accident,But finally unable to determine the death of the child and the losing.

　　“此外，许多患者家属认为自己是医疗活动的亲历者，自己眼睛看到的就是证据，却没有固定证据的意识。”调研检察官告诉记者，诊疗初期，患者不可能在医院就诊时对医生的治疗过程和谈话进行录音、录像。纠纷产生后，医学会和法院以院方提交的病历作为主要证据进行核对、分析，“许多申诉人在案件审查阶段都提出病历记载与治疗时客观情况不符，但均无法提供充分的证据予以证明。败诉后，申诉人心有不甘，难免怨天尤人，激化矛盾。这种现象的恶劣之处超出一案的成败，可能引发严重的公共信用危机”。

"In addition,Many patients families believe they are invaluable medical activities,His eyes see is the evidence,But no fixed evidence consciousness."Research prosecutor told reporters,Early diagnosis and treatment,Patients can't be in the hospital for the doctor's treatment process and talk to the recording/video.Dispute after the creation of,Medical association and the courts in the hospital medical records as the main evidence submitted for verification/analysis,"Many of the plaintiff in the case of review stage all proposed medical records and treatment with objective conditions,But are unable to provide sufficient evidence to prove it.After losing,The heart has unwilling,Hard to avoid being bitter,Sharpened contradictions.This kind of phenomenon bad place beyond the success or failure of a case,Could cause serious public credit crisis".

　　此外，如何能够及时取得医疗病历也成为困扰作为医疗纠纷当事一方的患者依法维权的“拦路虎”。

In addition,How can get timely medical is also a problem for medical dispute party a party of the patients' rights and interests"A lion in the way".

　　如西城检察院承办的案件中，秦某的丈夫在某医院就医去世，秦某认为医院抢救不及时，到医院要求复印病历。医院经过几次推脱后为秦某复印了病历，却不允许秦某把复印件取走，无奈之下，秦某将医院告上法院，才在丈夫去世一年后取得其在医院就诊的病历复印件。

Such as the west procuratorate in the case,QinMou husband died in a hospital,QinMou think in hospital,To the hospital medical records for copy.The hospital after a few times after put-off for QinMou copying the medical records,But don't allow the copy QinMou take away,Helpless under,QinMou hospital will be against the court,Only after her husband's death has a year later in the hospital medical records of copy.

　涉案医院普遍存在不规范问题 Involved in the hospital of common problems

　　在办理医疗纠纷的过程中，检察机关发现，作为当事一方的医疗机构普遍存在管理缺乏规范性的问题。

In the process of the medical disputes,Procuratorial organs found,As one party party medical institutions widespread lack of normative management problems.

　　“在办案过程中，我们发现，部分医疗机构病历管理欠缺规范。”调研检察官坦言，目前，医疗机构涂改、更换患者病历的现象依然存在。司法实践中，申诉人更是对涂改、更换病历的现象十分不满，特别是对鉴定部门将申诉人提出过错质疑的病历涂改定性为病历管理不当不能认可，“比如申诉人赵某发现自己在医院复印的病历与医院在法庭提交的病历不一致，有几页病历出现更换现象，于是就病历更换问题向法院起诉，最终法院判决医院对其更换病历行为向赵某赔礼道歉，并赔偿损失”。

"In the process of handling,We found,Part of the medical institutions lack of medical record management standard."Research prosecutors said,At present,Medical institutions alter/Replacement patients medical records phenomenon still exists.Judicial practice,Plaintiff is to alter/Change the phenomenon of medical records were unhappy,Especially for the identification of department will put forward the question of fault medical records for medical record management not alter qualitative cannot accept,"Such as the plaintiff ZhaoMou found himself in a hospital of medical records and hospital copy in court records submitted does not agree,There are a few pages in medical records change phenomenon,Then replace medical records to court,The final decision of the court hospital medical records to change behavior ZhaoMou offer an apology,And compensate for the losses".

　　“目前，基于对病历真实性产生怀疑，进一步对医疗行为产生怀疑，最终对鉴定结论和法院判决不服，成为部分申诉人申诉的主要原因之一。”调研检察官说，另外由于医疗机构的风险告知意识仍较为欠缺，“可以说，医疗机构在治疗和手术等医疗活动的风险告知过程中存在的不足已成为引发医疗纠纷的诱因之一”。

"At present,Based on the medical record authenticity suspicions,Further to the medical behavior suspicions,Ultimately for appraisal conclusion and decision of the court refuses to accept,Be part of one of the main causes of the plaintiff."Research prosecutors say,Plus, because of the risk of medical institutions told consciousness is still relatively lack,"Can say,Medical institutions in the treatment and surgical medical activities of the risks to the defect existing in the process has become one of the factors caused by medical disputes".

　　此外，同时由于医学会鉴定组成结构不完善、申诉人对鉴定检材的客观性理解不清等，造成作为重要证据的医疗鉴定也是屡受争议。

In addition,At the same time because medical association structure identification is not perfect/If the test material identification the objectivity of the understanding is not clear, etc,As an important cause of medical evidence identification is often controversial.

　　调研检察官介绍说，在法院审理阶段，由当事人申请，并由双方协商或法院依职权决定委托各级医学会组织进行医疗事故的技术鉴定。鉴定结论是法院认定医疗机构是否应该承担医疗责任的关键证据之一，也是绝大多数民事申诉案件的焦点矛盾之一。

Research prosecutors said,In the court trial stage,By the application of the parties concerned,And by both parties in accordance with the authority or the court decided to entrust organization at all levels of medical association medical accident technical appraisal.Appraisal conclusion is that the court recognized medical institutions should bear the responsibility if the key one of medical evidence,And the vast majority of civil appeal case one of the focus of contradiction.

　　“我们审查的医疗纠纷案件中，有些申诉人在法院审理阶段对负责进行医疗事故鉴定的医学会组成人员持有一定的怀疑。”西城检察院的检察官说，根据《医疗事故技术鉴定暂行办法》规定，负责首次医疗事故技术鉴定工作的医学会原则上聘请本行政区域内的专家建立专家库，“但各医院都是医学会的成员，医疗事故鉴定的组成人员与各医疗机构之间存在密切的关系，甚至是医疗机构的医生。这种鉴定体制下的公正性是多年来争论不休的话题”。

"We review of medical dispute case,Some of the plaintiff in the court stage to responsible for medical accident identification of medical association members hold some doubt."Wl procuratorate prosecutors said,According to the[Medical accident technical appraisal interim measures]provisions,Responsible for the first medical accident technical appraisal of medical work within their respective administrative areas, in principle, hire experts to establish expert database,"But the hospital are all members of the medical association,Medical accident identification of members of the medical institutions and between the close relationship,Even the doctors medical institutions.The appraisal system of justice is the topic of debate for many years".

　　目前，法院根据当事人申请委托鉴定机构就医疗机构进行是否存在医疗过错，以及该过错对损害后果参与度的司法鉴定，成为让越来越多当事人较为认可的鉴定方式。

At present,The court according to the application of the parties concerned entrust appraisal institutions medical institutions whether there is medical treatment fault,And the fault to injury consequence of participation in the judicial authentication,Let more and more become the more approved identification mode.

　　据介绍，司法部《司法鉴定人管理办法》第二十九条已经规定了司法鉴定人员按时出庭义务，但医疗事故鉴定人员出庭质证却无法律规定。

According to introducing,The justice department[The measures for the administration of the judicial appraiser]Article 29 has stipulated the judicial appraisal personnel on duty to appear in court,But medical accident appraisal personnel confrontation to appear in court without law.

　　由此，调研检察官建议，当鉴定结论与其他证据之间存在矛盾，特别是病历中出现添加、涂改等情形时，请鉴定人员出庭对鉴定结论作出更为详尽的解释，有利于法官查明案件事实，进行公正的裁决，也有利于患者一方客观了解医方的治疗活动，减少内心的疑惑和不解，消除对医疗机构的不满情绪，彻底化解医患争端。

this,The survey suggested,When the appraisal conclusion and other evidence that there is a conflict between,Especially in the medical records appear to add/Be the case,Please the judges to appear in court to appraisal conclusion to make more detailed explanation,To find out the facts of the case,A fair decision,Also to help patients party objective understanding of the required treatment activity,Reduce the inner doubt and don't understand,Medical institutions to eliminate the discontent,Thoroughly solve the doctor-patient dispute.

　　“我们还建议医疗机构完善风险告知制度、尸检申请告知制度、病历修改说明制度等各项制度。”调研检察官说。(记者赵丽 通讯员宋蕾谭小颖)

"We also suggested that medical institutions perfect risk disclosure system/Autopsy application told system/Medical records that modify the system and other rules and regulations."Research prosecutors say.(Reporter ZhaoLi correspondent SongLei TanXiaoYing)