Causing a traffic accident, but incurring huge losses in hospital treatment

Zhejiang Liqun Law Firm Zhou Hailong

On the evening of May 8, 2010, a traffic accident occurred at the Jiadong intersection of Gongren West Road, Jiaojiang District, Taizhou City, which caused the victim Huang to be disabled at the fifth level. The court confirmed that his medical expenses, lost time fees, nursing fees, disability compensation, disability aid equipment fees, and mental comfort payments totaled more than 650000 yuan, and decided that a hospital in Taizhou should bear 60% of the amount and a traffic accident party, Li, should bear 35% of the amount The victim Huang himself bears 5%.

At present, the hospital's compensation has been paid; The perpetrator has not yet made the payment, and the victim is applying to the court for compulsory execution. In disputes over compensation for personal injury in traffic accidents, it is reasonable for the party causing the accident to compensate the victim for their losses. However, why did a certain hospital in Taizhou, which treated the victim in this case, become a defendant and be sentenced to pay a huge amount of compensation?

A sudden disaster

On that day, when crossing the road from north to south at the Jiadong intersection of Gongren West Road, Jiaojiang District, Taizhou City, Mr. Huang was knocked down by Mr. Li driving a Zhejiang J5H072 ordinary two wheeled motorcycle. Later, Jiaojiang Brigade of Traffic police Detachment of Taizhou Public Security Bureau determined that Li was primarily responsible and Huang was secondary.

Later, Mr. Huang was immediately sent to a hospital in Taizhou for debridement and suture. After diagnosis, he was diagnosed as "Compressibility fracture of L1 vertebral body and fracture of the lateral platform of the right bone", and was hospitalized that day. On May 14 of the same year, a certain hospital in Taizhou performed a right tibial plateau fracture reduction and internal fixation surgery on the plaintiff under epidural anesthesia. On the afternoon of May 15th, the plaintiff experienced nausea and vomiting, low blood pressure, chest tightness and discomfort, obvious swelling in the right lower leg, and uncomfortable pain. A certain hospital in Taizhou administered intramuscular injection of 100mg of chlorpromazine hydrochloride to alleviate the pain. At 5am on May 16th, the plaintiff had obvious pain in his right calf. However, a hospital in Taizhou did not show any significant improvement after intramuscular injection of 75mg of dolantin. The skin of Huang's right calf was slightly black and purple, and there was a slight bloody exudation from the incision. A hospital in Taizhou was misdiagnosed as right calf compartment syndrome. On the afternoon of May 16, Mr. Huang developed nausea, low blood pressure, increased subcutaneous ecchymosis in the right calf, and bloody exudation at the upper edge of the surgical opening. After a medical consultation in a hospital in Taizhou, he was misdiagnosed as Deep vein embolism or osteofascial compartment syndrome. On the evening of May 16th at 18:00, he was transferred to Taizhou Hospital and diagnosed with "postoperative infection, gas gangrene, septic shock, sepsis, and liver and kidney dysfunction of the right tibial plateau fracture". He underwent "postoperative infection incision decompression, drainage, and necrotic tissue removal surgery for the right tibial plateau fracture". On May 17 of the same year, he underwent an open amputation of the middle and lower segments of the right thigh and was discharged on June 20 of the same year. On November 16, 2010, a district health bureau submitted an appraisal application to the Taizhou Medical Association. On February 23, 2011, the Taizhou Medical Association issued the Taizhou Medical Jian (2010) No. 0083 "Technical Appraisal Certificate for Medical Accidents". The appraisal conclusion was that it constituted a Class III and Class C medical accident, and the medical party bears slight responsibility for the patient's right lower limb amputation. On March 2, 2011, it was identified by the Judicial Expertise Institute of Taizhou University (Taizhou University) SJS (2011) LJZ No. 0181 Judicial Expertise Opinion, and the conclusion was that the loss above the knee joint of the right lower limb caused by Huang's injury constituted a level 5 disability.

Litigation in court

After the end of Huang's treatment, Zhou Hailong, a lawyer from Zhejiang Liqun Law Firm, was entrusted to fully represent the tort liability dispute, and the two defendants, a hospital in Taizhou and Li, were sued to the court, requesting the court to adjudge the two defendants to compensate them for various losses of more than 780000 yuan and bear the litigation costs of the case.

After the court accepted the case, upon the joint application of the plaintiff and defendant, the court entrusted the Judicial Appraisal Institute of Zhejiang Greentown Hospital to conduct judicial appraisal in accordance with the law. On November 17, 2011, the Judicial Appraisal Institute issued a Forensic Clinical Appraisal Opinion No. 777 [2011] of Zhejiang Greentown Hospital, which determined that there is a causal relationship between the consequences of Huang's left right lower limb being amputated, which constitutes a fifth level road traffic disability, and the medical negligence of a certain hospital in Taizhou. Medical negligence is the main responsibility, while car accidents, injuries, and the individual's own disease factors are secondary responsibilities.

Plaintiff Huang filed a lawsuit: The plaintiff was injured in a traffic accident caused by the defendant Li and was admitted to a hospital in Taizhou for treatment. As a national second class A hospital, the defendant Taizhou hospital did not fulfill its due obligations in treating the plaintiff and contracted gas gangrene after an external bone surgery. There is a causal relationship between their medical behavior and the plaintiff's damage results. Based on the degree of fault of the two defendants and the degree of cause and effect of the damage, The defendant, a hospital in Taizhou, bears the main responsibility, while the defendant, Li, bears secondary responsibility.

The defendant, a certain hospital in Taizhou, argues that this case is a multi outcome tort liability dispute, and the damages to the plaintiff are caused by various reasons, including a traffic accident causing the plaintiff's tibial plateau fracture; The plaintiff himself suffers from diabetes, and his immunity is inferior to that of ordinary people; The defendant's diagnosis behavior and other reasons after surgery at a certain hospital in Taizhou. Given the unique nature of the plaintiff's infection with gas gangrene bacteria, and the fact that this condition is a severe acute specific infection that progresses rapidly and is relatively rare in clinical practice, ordinary clinical doctors often cannot make a clear diagnosis in the first place. For the consequences of the damage, the defendant, a certain hospital in Taizhou, is only responsible for the immediate consequences.

Defendant Li argued that in the event of a traffic accident, the plaintiff bears secondary responsibility and should first bear 20% of the total loss. The plaintiff's current left lower limb has been amputated, which constitutes a fifth degree disability in a road traffic accident. The consequences are related to the defendant's medical negligence at a certain hospital in Taizhou, with medical negligence being the main responsibility, while traffic accidents and injuries, as well as the individual's own disease factors, account for secondary responsibility. Therefore, regarding the disability compensation originally claimed. Disability assistive devices and maintenance costs should be borne by a certain hospital in Taizhou, the defendant. The plaintiff should bear 90% of the responsibility for other losses, medical negligence, and 10% of the responsibility for car accidents, injuries, and the identified person's own disease factors.

Responsibility 64

The People's Court of Jiaojiang District held after hearing that: the defendant Li drove the Zhejiang J5H072 ordinary two wheeled motorcycle and collided with the pedestrian plaintiff Huang, causing the plaintiff Huang to be injured. The defendant Li should bear the main responsibility for the traffic accident, and the plaintiff Huang should bear the secondary responsibility; The plaintiff Huang suffered from vertebral and right tibial plateau fractures and deep trauma to his right calf due to a traffic accident. Due to the complications of gas gangrene, he recently left his lower limb amputated, which constitutes a level 5 disability in a traffic accident. There is a causal relationship between the consequences and the medical negligence of the defendant Taizhou hospital. The medical negligence of the defendant Taizhou hospital is the main responsibility, while the plaintiff Huang's accident injury and his own disease factors are secondary responsibilities. Therefore, for the reasonable losses suffered by the plaintiff Huang, the defendant Taizhou Hospital bears 60% of the responsibility; Among the remaining 40%, the plaintiff Huang bears 5% of the burden due to his own illness, and the accident injury factor is 35%. Considering that the defendant Li caused a traffic accident while driving a motorcycle that was not covered by compulsory traffic insurance, the defendant Li should compensate 35% of the plaintiff Huang's reasonable losses in full within the compulsory traffic insurance liability limit, and bear 80% of the plaintiff Huang's other reasonable losses exceeding the compulsory traffic insurance liability limit.

Lawyer Evaluation

Lawyer Zhou Hailong from Zhejiang Liqun Law Firm, who represented this case, conducted an analysis.

There are two aspects of negligence in treating hospitals:

1、 There was a mistake in the early treatment of the victim Huang

Due to the fact that gas gangrene is an acute, specific, and severe infectious disease characterized by muscle tissue necrosis, it is caused by the "Clostridium" bacteria, which are anaerobic bacteria (easy to grow and reproduce in hypoxic environments) and widely exist in soil and human and animal feces, making it easy to enter injured human wounds. The victim Huang was injured in a car accident, resulting in a 3.0cm curved wound on the outer side of the distal right calf, reaching as deep as the deep fascia. Based on the injury environment and wound morphology, there are objective conditions for infection with gas gangrene bacteria. As a medical institution, the most reliable way to effectively prevent and avoid the spread of infection for wounds suspected of gas gangrene is to thoroughly debridement as soon as possible (within 6 hours after the injury), wash and wet compress the wound with 3% hydrogen peroxide (hydrogen peroxide) or 1:1000 Potassium permanganate and other solutions, and remove the suture for the stitched wound to open the wound to facilitate oxygen entry. However, a certain hospital in Taizhou had a record of "flushing wounds with hydrogen peroxide and iodine solution" during the emergency department on the same day, but after 6 days of "suturing wounds" during the "internal fixation" surgery, there was a record of "repeatedly flushing wounds with physiological saline", but no record of using hydrogen peroxide to flush wounds was found. Afterwards, the skin was "sutured in sequence" and the wounds were not opened. The above treatment can cause hypoxia within the wound or create a hypoxic environment due to the consumption of oxygen by other bacteria, which is conducive to the growth and reproduction of gas gangrene bacteria. From this, it can be seen that a certain hospital in Taizhou was negligent due to ineffective prevention or control of the proliferation and spread of gas gangrene bacteria during early treatment.

2、 Early diagnosis error after the occurrence of illness

On May 14, 2010, after undergoing internal fixation surgery at a certain hospital in Taizhou, the wound showed unusual "severe pain", obvious local swelling with cyanosis, and "twisted sounds" on the surrounding skin. The general condition was poor, and symptoms of septic shock occurred. A certain hospital in Taizhou is a national second class A hospital, responsible for the diagnosis and treatment of common, frequently occurring, and difficult diseases in the area. Especially on June 2, 2008, the General Office of the Ministry of Health issued a notice on the diagnosis and treatment of Clostridium muscular necrosis (gas gangrene), issuing detailed explanations on its pathophysiology, clinical manifestations, diagnosis, specimen collection and transportation, differential diagnosis, prevention, and treatment. However, a certain hospital in Taizhou lacked early diagnostic awareness, which led to the rapid development of the condition and serious life-threatening consequences, ultimately leading to the amputation of the victim Huang's right lower limb.

According to Article 3 of the Interpretation of the Supreme People's Court on Several Issues Concerning the Application of Law in the Trial of Cases of Personal Injury Compensation, if two or more people jointly intentionally or negligently cause harm to others, or if their infringing acts directly combine to cause the same damage consequence, they constitute joint infringement and shall bear joint and several liability in accordance with Article 130 of the General Principles of the Civil Law. If two or more people have no joint intention or fault, but their respective actions have indirectly combined to cause the same damage consequence, they shall bear corresponding compensation responsibilities based on the magnitude of the fault or the proportion of the causal force. Based on this, in the absence of joint intent or fault, the hospital and the party causing the traffic accident indirectly combined their actions, resulting in the loss of the victim's right lower limb, which constitutes a fifth degree disability. The hospital and the party causing the traffic accident should bear corresponding compensation responsibilities based on their respective fault size or proportion of the original cause. According to Article 5 of the Opinions of the High people's court of Zhejiang Province on Several Issues Concerning the Trial of Medical Dispute Cases (Trial), if a patient goes to hospital due to a traffic accident or other injuries, and one of the patients claims compensation on the ground that the medical behavior of the medical institution is wrong and the patient suffers damage, the people's court should generally regard the medical institution and other infringers as co defendants; Each defendant shall bear corresponding compensation responsibilities in accordance with the law.