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Original title: To provide a solid legal guarantee for the prevention and resolution of medical disputes, the Beijing No. 3 Intermediate People's Court has established ten mechanisms to promote the resolution of disputes at the source

□ Our reporter Huang Jie and Xu Weilun

At the end of 2023, the Beijing No. 3 Intermediate People's Court established a "Legal Education Station" at the Chaoyang District Health Commission, which became another positive measure for the two units to implement the ten cooperation mechanisms after signing the "Agreement on Building a Harmonious Doctor-Patient Relationship and Resolving Doctor-Patient Conflicts". With the continuous increase in the number of medical disputes in recent years and the high rate of hospitals being sentenced to bear responsibility, how to use the government-court linkage to solve the deep-seated problems behind the frequent occurrence of medical disputes and promote the resolution of such disputes at the source has become a direction that the Beijing No. 3 Intermediate People's Court has been thinking about and actively exploring.

Xue Qiang, deputy director of the Beijing No. 3 Intermediate People's Court, said that the court started from the problems found in the systematic investigation, and jointly with the grassroots courts in the jurisdiction and the health and family planning commissions of each district, explored the establishment of ten working mechanisms for the coordination between the government and the court, including interconnected consultation, case reporting, supervision and implementation, and judicial suggestions. It discussed with the health and family planning departments ways to resolve medical disputes at the source, and jointly promoted medical institutions to improve management and enhance the level of rule of law operation.

Directly address the difficulties of medical disputes

The number of medical disputes has increased year by year, and hospitals have been found to be responsible for 70% of them. The current process of resolving and preventing medical disputes faces prominent problems such as the incomplete specific notification obligations of medical institutions, the need to further strengthen the standardization of medical records, and the need to further improve the medical appraisal mechanism... In the "White Paper on Government-Court Joint Resolution and Prevention of Medical Disputes" jointly issued by the Beijing No. 3 Intermediate People's Court, the Chaoyang District People's Court, and the Chaoyang District Health Commission, the current situation of medical disputes in the district was presented to the public.

According to Chen Xiaodong, president of the First Civil Court of the Beijing No. 3 Intermediate People's Court, from 2018 to 2023, Beijing courts heard a total of 6,044 medical dispute cases, of which 74.4% were medical damage liability disputes. Medical dispute cases have significant characteristics such as long trial cycles, high litigation costs, and strong professionalism. However, in daily work, judicial organs and health administrative departments have little intersection and insufficient information sharing. The common problems found by the courts in medical institutions during case handling are difficult to be widely known within the medical system, causing similar problems to recur in different hospitals or even different departments of the same hospital.

In response to the above situation, the Beijing No. 3 Intermediate People's Court is seeking a solution, namely, government-court collaboration. In October 2021, the Beijing No. 3 Intermediate People's Court, based on the opinions of the health administrative departments and medical institutions in the jurisdiction, launched three convenient mechanisms for medical disputes, namely, a notification mechanism for typical medical dispute cases, a judicial suggestion mechanism for medical disputes, and a mechanism for urging the implementation of effective legal documents for medical disputes. With the help of the "one-to-many" supervision and management model of the health administrative departments, it promotes information sharing between departments within medical institutions and between different medical institutions, improves the legitimacy of overall medical activities, and avoids the recurrence of similar medical disputes.

In October 2023, the Beijing No. 3 Intermediate People's Court reported the third batch of typical cases to the health and medical departments. In this case, the patient, Ms. Liu, fainted suddenly while visiting a Chinese medicine clinic due to miscarriage. She was then urgently transferred to a higher-level hospital for treatment and was out of danger after surgery. Afterwards, Ms. Liu sued the clinic and the hospital together. During the trial, the court found that the Chinese medicine clinic did not have the family planning qualifications required to perform a curettage on Ms. Liu. "This case exposes the problem that medical institutions have arbitrarily carried out medical technical services beyond the scope of practice, and there are still loopholes in the supervision of this phenomenon by the health administrative department. The court has also made targeted suggestions for improvement." Chen Xiaodong said that since the establishment of the typical case reporting mechanism, the Beijing No. 3 Intermediate People's Court has reported a total of 53 typical cases to the health and medical departments, issued 20 judicial suggestions, and promoted relevant medical institutions to establish and improve medical rules and regulations and improve medical service standards.

A combination of measures to resolve disputes at the source

The reporter learned that the introduction of three convenient mechanisms for medical disputes has enabled the courts, health departments and medical institutions to find the "key" to solving common problems.

Continued on the second edition

Continued from the first edition

Soon, this mechanism was enriched and developed in actual combat. Based on the summary of previous experience, the Beijing No. 3 Intermediate People's Court signed the "Government-Court Cooperation Agreement on Building Harmonious Doctor-Patient Relationships and Resolving Doctor-Patient Conflicts" with six grassroots courts in the jurisdiction and the health and family planning commissions of each district. It added specific measures such as "interconnected consultation", "joint research", "legal publicity", "demonstration adjudication" and "multi-party dispute resolution" to the government-court cooperation framework, forming ten specific working mechanisms and launching a combination of measures to resolve medical disputes.

Chaoyang District is the largest and most populous central urban area in Beijing. It has more than 1,900 medical institutions under its jurisdiction, accounting for 18.14% of the total number of medical treatments in the city, and medical disputes also account for a high proportion. With the help of the Beijing No. 3 Intermediate People's Court, the Chaoyang District Health Commission and the court jointly built a Chaoyang District medical dispute source prevention, mediation and resolution sub-platform, concentrating professional forces to resolve medical disputes, and jointly organized more than 10 special seminars on legal issues related to medical disputes in the jurisdiction to discuss solutions.

"The establishment of a multi-party dispute resolution mechanism is an important way to prevent and reduce medical disputes at the source." Chen Xiaodong told reporters that starting from Chaoyang District, relying on the government-court linkage mechanism, the Beijing No. 3 Intermediate People's Court has continuously promoted the establishment and improvement of a special mediation platform for medical disputes. Up to now, grassroots courts in the jurisdiction have transferred more than 230 cases to these platforms, of which 15 were successfully mediated and 35 were transferred for appraisal. Initial results have been shown.

Among the administrative penalties imposed on tertiary hospitals and their medical staff, 59.1% were related to medical records. When hearing the case of Xu suing a medical institution for infringement of privacy rights, the Beijing No. 3 Intermediate People's Court found that a medical institution illegally leaked patient medical records, resulting in the leakage of patient personal information. In order to prevent and reduce the recurrence of related disputes, in June 2024, the Beijing No. 3 Intermediate People's Court issued a judicial suggestion to the local health and health commission, suggesting that medical institutions in the jurisdiction be urged to improve the medical record management system, strictly implement relevant regulations on medical record writing, management, and use, and protect the legitimate rights and interests of patients in accordance with the law...

Since the ten mechanisms were put into operation two years ago, the Third Intermediate People's Court and the grassroots courts in the jurisdiction have issued a total of 20 similar judicial suggestions, each of which directly points to the prominent problems in the medical industry found during the trial of the case. Health and medical departments at all levels attach great importance to this and actively reply to the letters, and use this as a guide to urge relevant medical institutions to establish and improve medical regulations and systems and improve medical service standards. With the joint efforts of the courts and health and medical departments, the phenomena of irregular medical record writing, illegal disclosure of patient personal information, and unregistered intravenous infusion in medical institutions within the jurisdiction of the Beijing Third Intermediate People's Court have been effectively reversed.

The reporter learned that under the framework of the government-court linkage mechanism, the Beijing No. 3 Intermediate People's Court has proactively selected representative medical dispute cases for exemplary adjudication, and provided demonstration guidance for potential regional disputes. Currently, two similar cases have been upgraded by the court for trial. In addition, judges will also visit communities, hospitals, and medical companies from time to time to conduct circuit trials or popularize the law, and provide "customized" legal support. Recently, a green channel for resolving medical disputes has also been opened in the court. For medical dispute cases that are mediated and agreed upon by a third-party platform, the court can, upon application by the parties, grant rapid judicial confirmation after review.

Source governance improves implementation rate

Fan Sidi, assistant judge of the First Civil Court of Beijing No. 3 Intermediate People's Court, came to the hospital at the agreed time and urged the patient to complete the discharge procedures. The hospital paid the patient the full amount of compensation, and witnessed the successful settlement of this eight-year medical dispute. Fan Sidi told reporters that because the dispute was not resolved, the patient in this case stayed in the hospital for eight years. After the case was appealed to Beijing No. 3 Intermediate People's Court, the judge did a lot of work and the two parties finally reached a settlement. She went to the hospital this time to follow the requirements of the "supervision and implementation mechanism" to ensure the implementation of the mediation agreement.

The reporter learned that the supervision and performance mechanism, one of the ten mechanisms of government-court linkage, requires that the judge hearing the case cannot just make a judgment and leave it at that, but must continue to urge the obligor to fulfill the payment obligation within the performance period stipulated in the effective legal document. According to statistics, the Beijing No. 3 Intermediate People's Court has currently completed 422 civil cases of first and second instance in cooperation with the grassroots courts in the jurisdiction to urge medical institutions to perform their obligations, with a total amount of more than 100 million yuan to be performed, effectively ensuring that the rights and interests of the parties are realized in a timely and effective manner.

Zhang Zhaoxia, Party Secretary and President of Beijing No. 3 Intermediate People's Court, told reporters that after two years of exploration, the ten working mechanisms of the government-court linkage have formed a set of standardized, orderly, systematic and mature long-term mechanisms, which provide a solid legal guarantee for building a harmonious doctor-patient relationship and effectively preventing and resolving medical disputes. (Huang Jie and Xu Weilun)

(Legal Daily)