Ms. Wang, a pregnant woman, has been doing pregnancy tests in the city hospital since she was pregnant. During this period, she had two color Doppler ultrasound examinations and two four-dimensional color Doppler ultrasound examinations, and no abnormalities were found in the examination results. Later, Ms. Wang gave birth to a baby girl by caesarean section in the obstetrics and gynecology department of the city hospital. After the baby girl is born, her right hand has short fingers and unclear knuckles. Ms. Wang believes that the city hospital should have found the fetal finger deformities during the ultrasound examination, and the staff seriously neglected their duties, infringing on their right to know and depriving them of the right to choose prenatal and postnatal care. They sued the court, demanding that the municipal hospital compensate the right hand deformity repair surgery and mental damage for economic losses of 300,000 yuan.
Appraised by the Municipal Medical Association, the defendant's diagnosis and treatment process conforms to the standard; Infantile right finger deformity belongs to congenital developmental abnormality and has no direct causal relationship with ultrasound examination. Fetal finger deformities is a difficult problem in prenatal ultrasound at present, which does not belong to the six major malformations that should be preliminarily screened by routine prenatal ultrasound examination, and the diagnosis and treatment behavior of municipal hospitals does not constitute a medical accident.
The court found that the city hospital informed in the report when conducting routine prenatal four-dimensional color Doppler ultrasound examination: "The contents described by ultrasound in this main examination report are not within the scope of examination. For example, due to the current technical conditions, many human structures such as fetal ears, eyes, fingers, toes, thyroid, internal and external genitalia can not be examined as routine items, and ultrasound can not display fetal chromosomes, let alone detect fetal intelligence, hearing and vision. The doctor has informed me in writing and orally of the limitations of ultrasound examination, and I expressed my understanding and signed: "Ms. Wang signed the above contents.
The court of first instance held that the municipal hospital had fulfilled its obligation to inform Ms. Wang of the contents of routine prenatal ultrasound examination and should not be liable for compensation. According to the opinion of Chinese Medicine Association, with the current medical level, it is difficult to detect fetal finger-toe malformation by routine prenatal ultrasound examination, and this part of the content does not belong to the scope of fetal malformation that should be screened by routine prenatal ultrasound examination, so it is not a fault for municipal hospitals to screen fetal finger-toe malformation. The judgment rejected the plaintiff Ms. Wang's claim.
Ms. Wang refused to accept the appeal, and the court of second instance ruled that the appeal was rejected and the original judgment was upheld.
Abnormal babies are born after normal physical examination, which is called "improper birth" or "birth defect". It refers to the embryonic development disorder caused by genetic and/or environmental factors during the formation of maternal organs, which generally includes abnormal morphological structure, physiological and metabolic dysfunction, congenital mental retardation and intrauterine growth retardation. China is one of the countries with high incidence of birth defects, and the number of new birth defects is as high as 800,000-65438+200,000 every year, which brings heavy economic burden and mental pressure to families and society. According to the National Big Data Report on Medical Damage Liability Disputes in 2020 of Medical Law Exchange, obstetrics and gynecology have occupied the first place in the department with high incidence of medical damage liability disputes for many years, and "birth defect" is also one of the factors of high incidence of medical disputes in obstetrics and gynecology.
Prenatal examination is a routine pregnancy examination for every pregnant woman and an important method to find fetal abnormalities. Its purpose is to find the abnormality of mother and fetus in time and deal with it accordingly. 20 19 Ultrasound Medical Branch of Chinese Medical Doctor Association revised the Guidelines for Prenatal Ultrasound Examination (version 20 12) and issued the Guidelines for Obstetric Ultrasound Examination in China (version 20 19), in which the examinations in the second and third trimesters are divided into five categories: the first category is ultrasound examination, which mainly measures fetal growth diameter and fetal amniotic fluid. The second-level ultrasound examination, besides the first-level ultrasound examination, should also examine six kinds of malformations, such as anencephaly, encephalocele, open spina bifida, chest wall defect entropion, single-chamber heart and fatal skeletal dysplasia; ⅲ ultrasound examination (systematic screening), based on ⅱ ultrasound, according to various fetal systems to check the corresponding structure, including: fetal number, fetal heart rate, fetal size, screening fetal structural abnormalities, placental position, amniotic fluid; Four-level ultrasound examination, which aims at the high-risk factors of the fetus or pregnant women, or the abnormalities found or suspected by the first, second and third-level ultrasound examination, and carries out purposeful detailed ultrasound examination; Single ultrasound examination refers to the examination of a certain item or a certain structure, such as fetal position, fetal heart, placental position, amniotic fluid, etc. Neither the Guidelines for Prenatal Ultrasound Examination (version 20 12) nor the Guidelines for Obstetrics Ultrasound Examination in China (version 20 19) included fingers and toes in the ultrasound screening of fetal macrosomia in the second trimester.
On the other hand, fetal dysplasia is caused by many reasons. In addition to the hereditary diseases that parents will bring to their children, there are many factors that will affect the embryo before conception and during the pregnancy of the mother. Prenatal examination is only a response to objective conditions, and this behavior will not have a substantial impact on the development of the fetus. Ultrasound examination is a non-invasive and safe imaging examination technology for fetus, but the instrument has certain limitations, like other examination methods, it is not a universal examination. In ultrasound examination, it will be affected by ultrasound artifacts, ultrasound resolution, maternal condition, fetal gestational age, fetal position, amniotic fluid volume, fetal activity, fetal bone sound shadow, pregnant women's abdominal wall thickness and other factors, so many organs and parts can not be displayed or displayed clearly, so prenatal ultrasound examination is difficult to find hand and foot deformities, and the accuracy of ultrasound diagnosis can not reach 100%.
There are two kinds of medical damage liability disputes arising from prenatal examination. One is that the fetus is injured by the tort of medical institutions before birth, resulting in defects after birth; Second, medical institutions violate laws, administrative regulations, rules and other medical norms and fail to find out or should inform them. In the first case, medical institutions not only infringe on the personal rights and interests of the fetus, but also infringe on the property rights and interests of the parents of the fetus; In the second case, in the case of abnormal fetus, the attending physician must clearly inform the pregnant woman in writing of the possible results of continuing pregnancy and terminating pregnancy and further treatment opinions, and the pregnant woman and her husband and wife will choose the treatment plan by themselves and sign the informed consent form. If the medical institution violates the legal obligation, it only infringes on the parents' right to know and have the right to choose children, and there is no infringement on the fetus. Fetal physical defects are congenital defects and have no causal relationship with the diagnosis behavior of medical institutions.
In this case, there was no abnormality in the results of prenatal examination. A hospital had informed Ms. Wang about the relevant risks, and Ms. Wang had also known and signed the agreement. After identification, the municipal hospital was not at fault, so the patient's claim was rejected according to law. For medical institutions, medical staff should continue to learn, strengthen legal awareness, attach great importance to the abnormal situation indicated in the prenatal examination report, faithfully fulfill their obligation to inform the limitations of ultrasound examination, the actual technical level of the hospital and various factors affecting the results of ultrasound examination, fully protect parents' right to know and their right to choose their children, and avoid such medical disputes.
(This article is the original edition of the medical law collection, adapted from a real case, and uses a pseudonym to protect the privacy of the parties. )
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The hospital went beyond the operation and intervened in violation of regulations, and the patient claimed150,000 yuan.