Research On Current Medical Malpractice Dispute Situation,Problem And Countermeasure Of Shanghai Huangpu District

BackgroundIt has been nine years since "Medical Malpractice Regulation" being promulgated in September2002, and the incidence of medical dispute were in upward trend. The practice environment deteriorates continuously, and the ’hospital violator’ was normalized in medical malpractice dispute. For instance, there were6000-7000incidence of medical malpractice dispute occurred in Shanghai annually,86.5%of medical institutes have experienced medical malpractice dispute, above70%experienced mobbing,62%of staff been abused,17%been beat up, meanwhile70%of medical dispute still stranded in medical institute. How to solve the problem and establish a harmonious doctor-patient relationship becomes a hotspot issue for the researchers.ObjectiveThe objective of research was to analyze the main causes, top high-risk medical institute, department, staff of medical malpractice and dispute, based on the their current status, compensation, program, punishment and inspection of Shanghai Huangpu District from year2004to2011, and then raised some suggestions on how to improve the administration settlement and inspection of medical malpractice and dispute.MethodComparative analysis method and literature analysis method were used on the document to compare analysis and synthesize. The Epidata software was use to input data on medical dispute reception2004to2011from Health Bureau Medical Malpractice Manipulate Office of Huangpu District. Microsoft Excel software was used to collect data from all26public general hospitals on medical malpractice and compensation, and to gather information of survey on15medical institutes, then analyzed by the statistical method. The Category analysis method was used to gather data from interviewing with6medical institutes.Results1. For all the medical malpractice and dispute occurred in Huangpu District, the top high-risk medical institute was level Ⅲ hospital, the top high-risk departments, in sequences, were Department of Surgical, Department of Obstetrics and Gynecology and Department of Dentistry, the top high-risk staff, in sequences, were Deputy Chief Physician, Attending Physician, Chief Physician from level Ⅲ hospitals and Attending Physician from level Ⅱ hospitals. The main causes of medical malpractice were communication and diagnosis procedure.2. The number of compensation settled by negotiations accounted for84.9%of the total compensation cases, while accounted for3/4of the total amount. The number of compensation settled by judiciary accounted for15.1%of the total compensation cases, while accounted for1/4of the total amount.3. The average compensation amount for single case increased year after year, so did the negotiated cases. The gap between the average compensation amount of the negotiated cases and the judicial cases became narrower.4. The number of medical dispute, compensation cases and compensation amount in Huangpu District grow continuously.5. The punishment rate in Huangpu District was72.2%.ConclusionMost public medical institutes ’conceals’ or ’left-out’ the medical malpractice to avoid from executive punishment and disrepute. Because the Regulation lack of operability, having no negotiation related parts, also the legal effect was too low, all these makes the health administration’s influence weaker. Although the judiciary settlement had eliminated the’dualistic’ phenomenon in application of law and compensation standard, the procedure was so tough, expensive and time-consuming, thus negotiation was the main pathway. But as the people’s mediation commission established, this rapid method has accepted by most people. Because of the punishment inefficiency, identification difficulties in malpractice procedure and responsible person, the punishment rate remained in low level in Huangpu District.SuggestionFirstly, the management of medical institute should pay more attention on the information report system and establish reward and deterrent mechanism to reduce the ’conceals’ or ’left-out’. Secondly, should improve the medical institute regulations and enhance the efficient communication between doctors and patients, make the high-risk department follow the regulation strictly, improve the technical and communication skill of the high-risk staff. Co-operate with Health Administration, focus on the main institutes, departments and staff, and improve the inspection method to strengthen the health quality management. Thirdly, should establish and improve third party mediation committee mechanism on medical malpractice and dispute, and establish medical malpractice and dispute arbitration system. Fourthly, should improve regulations on medical malpractice and dispute, eliminate defects of the regulation, establish unified appraisal system which considering the credibility and neutrality in the same time, improve appraisal supervise system, use expert court testimony and allopathic appraisal for instance. Fifthly, should raise punishment rate through means like take conducting prosecution date as the discovery date of illegal act, identifying the malpractice procedure explicitly in the expertise report which was issued by expert by law, establishing expert advisory system on administration punishment of medical malpractice.