In January 2025, a medical dispute occurred in Wanning City, Hainan Province, and Ms. Yang had serious complications such as uterine perforation, intestinal perforation, and pelvic adhesions after painless abortion surgery in the hospital. The local court made a first-instance judgment on the case, requiring the hospital to pay Ms. Yang more than 130,000 yuan in compensation, which not only reflected the logic of fault determination in medical behavior, but also provided legal guidance with reference value for medical institutions and patients.
The core legal issue of this case lies in the determination of liability for medical damages. According to Article 1218 of the Civil Code, if a patient is damaged during diagnosis and treatment activities, and the medical institution or its medical staff is at fault, the medical institution shall be liable for compensation. Therefore, the establishment of liability for medical damage needs to meet four requirements: the medical institution has carried out the diagnosis and treatment act, the patient has been harmed, the medical institution is at fault, and there is a causal relationship between the fault and the damage.
The judicial appraisal opinion pointed out that a hospital in Wanning City had two faults:
First, "insufficient preoperative evaluation and insufficient high attention";
The second is that "there is improper operation during the operation of the operation, and the principle of 'gentleness' is not fulfilled".
The first fault does not meet the relevant requirements of the "Clinical Technical Operation Specification", that is, the patient's uterine status, previous pregnancy and childbirth history and other risk factors must be comprehensively evaluated before the abortion surgery is performed, and the second fault violates the basic duty of care during the surgical operation, both of which belong to the situation where the medical institution has not reached the "reasonable diagnosis and treatment level".
According to the opinion issued by the appraisal agency, the main factor in the emergence of uterine perforation, intestinal perforation and subsequent complications is the hospital's diagnosis and treatment errors, and Ms. Yang has a history of multiple pregnancies and abortions, which makes the uterine wall thin and elastic, which is a secondary factor in the occurrence of damage. The court referred to the appraisal conclusion to determine the proportion of liability, and the hospital should bear 70% of the main responsibility, and the remaining 30% of the secondary responsibility should be borne by the patient with special constitution. The division of liability in this case is in line with the relevant provisions of Article 1173 of the Civil Code, and corresponds to the negligence offset rule in the legal article that "if the infringed party is at fault for the occurrence of the same damage, the liability of the infringer may be reduced".
(1) Medical institutions should strengthen medical risk control measures
Medical institutions should start from multiple links and strengthen measures related to medical risk control.
First, the evaluation and notification process should be improved before surgery. Patients with high-risk factors such as a history of induced abortion, multiple pregnancies, and uterine surgery should complete ultrasound uterine wall thickness measurement, pelvic adhesion assessment, and adjust to medical abortion or laparoscopic surgery if necessary.
Second, the surgical operation link should standardize the process. Strictly follow the operation principle of "gentle, precise, and time-limited", and establish an intraoperative real-time ultrasound monitoring mechanism for high-risk patients.
Third, a rapid response mechanism for complications should be established after surgery. For abnormal symptoms such as dull pain in the lower abdomen on the day after surgery, it is necessary to formulate corresponding emergency treatment procedures to avoid delaying the treatment of early signals such as uterine perforation due to only arranging to return to the hospital for review the next day.
Fourth, it is necessary to do a good job in the management of medical documents. Ensure that medical records such as surgical records, disease course records, and informed consent forms are recorded, and the intraoperative conditions, special operations and decision-making basis are recorded in detail, providing core evidence for medical damage appraisal and proving that the hospital has fulfilled its reasonable duty of care.
(2) Patients should improve their own risk awareness
Before deciding to terminate the pregnancy, the patient should truthfully inform the doctor of the history of previous induced abortions, multiple pregnancies, uterine surgery, etc., and not conceal or omit it, so that the doctor can accurately assess the risk factors and choose the safest surgical method. Read the informed consent form carefully before surgery, take the initiative to ask about the individualized risks associated with yourself, and avoid "signing is a thing". If you feel obvious pain or abnormal conditions during the operation, you should report to the doctor in time. Once there are symptoms such as persistent lower abdominal pain, distension, abnormal bleeding or fever, do not wait for the time node of routine review, return to the original hospital or go to the nearest emergency department as soon as possible, and clearly inform the doctor of your own surgical history and postoperative time. Concealing medical history may affect the proportion of compensation for damages.
This case reflects that medical behavior is high-risk. The law establishes the principle of fault liability, aiming to balance the protection of patients' rights and interests with reasonable restraint on medical personnel, avoid excessive harshness, and maintain the stability of medical order. Medical institutions should strictly follow the existing diagnosis and treatment norms and improve the internal risk management system in order to reduce the probability of medical damage from the root, and patients should also form a rational understanding of the risks they may face in the diagnosis and treatment process.
Case Review:
On January 20, 2025, Ms. Yang went to a hospital in Wanning City to undergo "painless abortion surgery", and the doctor ordered her to return to the hospital for re-examination the next day. However, on the afternoon of the operation, she had dull pain in her lower abdomen for no obvious cause. At about 7 o'clock that night, Ms. Yang went to a hospital in Hainan for hospitalization, and was diagnosed with "uterine perforation, intestinal perforation, pelvic adhesions, etc. after abortion", and received laparoscopic repair and other treatments, and was hospitalized for 13 days, and then hospitalized again due to "intestinal obstruction and acute peritonitis".
Afterwards, Ms. Yang sued the hospital involved, claiming a total of 201,000 yuan for medical expenses and mental damage compensation. The judicial appraisal opinion pointed out that the hospital had insufficient preoperative evaluation, insufficient high attention, improper surgical operation, and failure to fulfill the principle of "gentleness", which led to perforation of Ms. Yang's uterus and small intestine and caused complications. The appraisal believes that the hospital's fault is the main factor and bears the main responsibility; Ms. Yang's history of multiple pregnancies and miscarriages caused by thinning of the uterine wall was a secondary factor. In addition, Ms. Yang's post-uterine perforation repair and small intestine perforation repair constituted a level 10 disability, respectively.
The Wanning Municipal People's Court held that according to the appraisal opinion, there was a causal relationship between the hospital's fault and the consequences of Ms. Yang's damage, and she should bear the main responsibility; Ms. Yang's own factors also have a certain causal relationship with the consequences of the damage. The court found that the hospital was responsible for 70% of the compensation, and Ms. Yang lost a total of 186,260.76 yuan, and ordered the hospital to compensate 130,382.53 yuan, rejecting other claims.
Editor-in-charge:lucy