Left brain hemorrhage was opened to the right skull, and the family’s claim was unsuccessful

59-year-old Zhang Xin’an was admitted to the Second People’s Hospital of Jingdezhen, Jiangxi Province (hereinafter referred to as “Jingdezhen Second Hospital”) for an acute left cerebral hemorrhage, and on the same day received He underwent “hematoma removal for left basal ganglia hemorrhage,” but the doctor opened his right skull first. The surgical record recorded that “the approved CT revealed that the intracerebral hematoma was in the left basal ganglia area, and the operation was stopped immediately”. On the same day, the doctor opened his left brain again and performed an intracerebral hematoma removal.

The day after the surgery, Zhang Xin’an’s left basal ganglia area was again bleeding heavily, and he was once again wheeled into the operating room for craniotomy to stop the bleeding.

The first surgery took place on January 1, 2020, and two surgeries were performed to help Zhang Xin’an recover his Life, but he is still not fully conscious.

On December 28, 2020, Zhang Xin’an’s Family commissioned the Jiangxi Jingdezhen Forensic Identification Center to conduct an Appraisal and issue an opinion, assessing Zhang Xin’an’s brain injury and persistent vegetative survival state, as a first-degree disability.

Zhang Xin’an’s son Zhang Min told reporters that as a medical student who had trained at Jingdezhen Second Hospital, he had entered the operating room to accompany his father to open the skull, “not long after the surgery began, they pulled me aside and told me to open the wrong one, but let me keep quiet “.

Zhang Min believes that the surgery error caused what impact, how to compensate, the hospital should give a clear statement. He said that for more than a year, the chapter family constantly to the local health care commission to reflect the situation, the response is “recommended mediation”.

On March 17, Jingdezhen Second Hospital, deputy chief of medical administration Huang Xin said in an interview with reporters, surgery does not exist “open wrong side”, because the Zhang Xin’an brain bleeding volume is very large. The day of surgery in the main surgeon evaluation of bilateral craniotomy, first open the right brain is to reduce the probability of the left brain “brain expansion”. “If you must give a statement and the corresponding compensation, need to be judged by a third-party identification agencies and decision-making, the hospital has done its best”.

For the hospital’s explanation, an authoritative expert in the industry has a different view, he said, cerebral hematoma removal in neurosurgery is very common, usually choose the hematoma from the surface of the nearest and avoid the important functional area of the bone flap open skull, “is certainly which side of the bleeding open which side. “November 4, 2020, Jingdezhen Health Care Commission to accept the letter of Zhang Xin’an’s wife to inform the matter.

For the hospital’s explanation, an authoritative expert in the industry has a different view, he said, cerebral hematoma removal in neurosurgery is very common, usually choose the hematoma from the surface of the nearest and avoid the important functional area of the bone flap open cranial, “certainly which side bleeding open which side. “

On New Year’s Day 2020, Zhang Xin’an had a sudden headache while out walking after breakfast, and then vomited and passed out, his wife Chen wallflower immediately sent him to Jingdezhen Second Hospital.

Zhang Min told reporters that he was a medical student, majoring in orthopedics, and was in the Jingdezhen Second Hospital for training internship from 2017 to September 2020, and then left because of the examination to Shantou University, so he was relatively familiar with the hospital’s situation.

Zhang Xin’an’s physical examination report upon admission showed that he had no voluntary movement of his limbs, hemiparesis of the right limb, and cranial CT suggesting hemorrhage in the left basal ganglia. At the same Time, Zhang Xin’an had hypertension (grade 3), which was considered high-risk.

The neurosurgeon who saw him at the time diagnosed that Zhang Xin’an needed immediate surgery to stop the hemorrhage. Zhang Min said that during the preoperative talk, the bedside doctor told him two options, one was to remove the hematoma by traditional craniotomy, and the other was to use a more advanced minimally invasive approach. Considering the family’s economic situation, Zhang Min chose the former.

During the preoperative conversation, the doctor informed him of the possible risks of the operation, but remained generally optimistic about his father’s prognosis, Zhang Min said. “The doctor said before the operation that the problem was not big, the general hematoma removal, about a week after the operation can wake up. “Zhang Min said he had witnessed many similar patients during his internship at the hospital, and the worst outcome was only the sequelae of hemiplegia caused by the surgery, but he was also able to recover through later rehabilitation.

On the day of January 1, 2020, after doing the pre-operative examination, Zhang Xin’an was pushed into the operating room, and Zhang Min, as a family member, also entered accompanied.

The surgical records of Jingdezhen Second Hospital show that the personnel involved in Zhang Xin’an’s surgery for “hematoma removal of left basal ganglia hemorrhage” that day included attending physician Liu Longmao, bedside doctor The first thing you need to do is to get a good idea of what you are doing.

Zhang Min recalled to the reporter that the surgery had not long started, the physician assistant took him from the operating room to the corridor, saying that the main surgeon had opened the right side of his father’s skull by mistake, “but only a little bit, the wound is already being closed, and will continue the original surgical plan, please make sure he did not make a sound, the doctor said it was important to save lives first. “Zhang Min said, thinking of the operating table waiting for emergency father, coupled with the previous experience of having interned, he did not tell his mother first.

According to Jingdezhen Second Hospital’s January 1, 2020 surgical records, after the completion of anesthesia, the physician “take the right modified question mark incision”, after cutting the dura mater After the dura was cut, “approved head CT, determined that the intracerebral hematoma was in the left basal ganglia area, immediately stopped the operation, and asked Dr. Song Bo, the chief physician, to go on the operating table and take part of the right temporalis fascia for dural reconstruction and repair, bone flap retraction, and placed a drainage tube under the temporalis skin flap. “The surgical record also states that the operation was truthfully explained to the family during the operation.

In Zhang Xin’an’s case file, there is another surgical record of intracerebral hematoma removal on the same day. The record states that after anesthesia, the physician “took a modified question mark incision on the left side”, cut the scalp layer by layer, removed the bone flap and cut the dura, and then removed the left At the end of the record of the operation, it was shown that “the operation was completed and the operation went well”.

The hospital said the condition was serious enough to require bilateral craniotomy, but experts believe it was a mistake.

The day after the operation, Zhang Xin’an’s condition did not improve, re-examining the cranial CT, found that his left basal ganglia hematoma again.

This time, Jingdezhen Second Hospital invited a professor of neurosurgery from the First Affiliated Hospital of Nanchang University to perform another surgery to remove the intracerebral hematoma in the left basal ganglia area and decompress the bone flap in the left frontotemporoparietal area.

The surgical record of January 2, 2020 shows that the personnel involved in the second day of surgery were Jiang Zhiqun, a professor of neurosurgery at the First Affiliated Hospital of Nanchang University, Song Bo, the chief physician previously involved in the first day of surgery, and Liao Rongfang, the deputy chief physician of neurosurgery at Jingdezhen Second Hospital.

After the surgery, Zhang Xin’an was admitted to the intensive care unit. The patient’s condition was still unstable and “critical”, and was given cardiac monitoring and ventilator-assisted breathing, as well as anti-infection, hemostasis, intracranial pressure, and seizure prevention, according to the course record. The patient was given anti-infection, hemostasis, intracranial pressure, seizure prevention and other supportive symptomatic treatment.

After two successive brain surgeries, Zhang Xin’an lay in the intensive care unit for more than 10 days, during which he also received bedside local anesthesia with tracheotomy to enhance airway management and postoperative lumbar puncture to release blood cerebrospinal fluid, but he remained in a coma with no voluntary consciousness or activity.

On January 17, 2020, due to the need for equipment, Zhang Xin’an was transferred to a hospital in Hangzhou under the arrangement of Jingdezhen Second Hospital for treatment. This go is more than three months, until April 2020, Zhang Xin’an only returned to Jingdezhen.

Zhang Min said, this time back, the hospital’s attitude toward their family has changed, “they no longer admit to opening the wrong cranium.

Zhang Min said that, at present, Zhang Xin’an in Jingdezhen Second Hospital Chinese Medicine rehabilitation department inpatient treatment, he did not respond to the family’s shouts, lying in bed all day, often fever to the body rolling.

After the surgery, Zhang Min and his mother repeatedly searched for the hospital, hoping they could give an account of his father’s January 1, 2020 surgery in which the right skull was opened first.

March 17, Jingdezhen Second Hospital, deputy chief of medical administration Huang Xin responded in an interview with reporters that Zhang Xin’an family members have repeatedly reflected to the medical administration section to question the surgical process, they have also repeatedly to the surgical team to understand the situation. According to the investigation, Zhang Xin’an sent to the hospital, brain bleeding has reached 80ml, is a particularly critical situation, for him to operate on the judgment of Dr. Liu Longmao must carry out bilateral craniotomy.

In response to the chapter people asked why in the pre-operative conversation did not explain this surgical program, Huang Xin said that this link of communication is indeed flawed, but the surgical program itself does not exist. Huang Xin revealed to reporters, the implementation of pre-operative talk Luo Yunhua doctor has resigned for family reasons and left the second hospital in Jingdezhen.

Huang Xin in an interview also explained the reasons for bilateral craniotomy first open right side, because the left side of Zhang Xin’an brain basal layer bleeding, first open the right side of the brain can reduce the left brain “brain expansion The reason for opening the right side of the brain first was that the left side of Zhang Xin’an’s brain had a large basal hemorrhage, so opening the right side of the brain first could reduce the probability of “brain expansion” in the left side.

For the current rehabilitation status of Zhang Xin’an, Huang Xin said the hospital has tried its best, and also actively to Hangzhou, Shanghai experts consulted, “indeed, the condition is too serious, can only recover to the current state “.

For the chapter family family proposed more than three million yuan high compensation requirements, Huang Xin said the hospital such as must give a statement and the corresponding compensation, need to be judged by a third-party appraisal body and decision-making.

On the evening of March 17, the reporter interviewed an authoritative expert in the field of domestic neurosurgery, after a complete reading of the chapter Xinan case and the three aforementioned surgical records, the expert believes that Jingdezhen Second Hospital in the first operation last New Year’s Day did mistakenly open the right skull, and soon found and corrected the “Approved head CT, determine the area of intracerebral hematoma, immediately stop the operation, consult the chief physician” and other records are proof of this.

The expert also added that cerebral hematoma removal in neurosurgery is very common, usually choose the hematoma from the surface of the nearest and avoid the important functional areas of the bone flap open skull, “certainly which side of the bleeding open which side, there will be no left brain hemorrhage open right skull, the hospital argued that the right skull first to reduce the occurrence of brain bulge The probability of the argument is not reliable. “

The expert also pointed out to reporters that the currently visible “surgical safety verification form” only two signatures of the operating room nurses and anesthesiologists, the surgeon’s signature column shows This means that the safety verification may not be done.

The health care commission: the family is advised to find medical mediation center, the court and other institutions to deal with

In Zhang Xin’an rehabilitation days, his wife Chen wall flower and brother Zhang Xinjin repeatedly to the Jingdezhen Health Care Commission to reflect the situation, hoping that the relevant departments can set up a task force to investigate thoroughly.

The paperwork produced by Zhang Xinjin to the reporter shows that the Jingdezhen Health Care Commission accepted their petition on November 4, 2020, and gave a written response on December 17, 2020.

The reply said that the petitioners reflect the situation belongs to the medical dispute, according to the “Jiangxi Province Medical Dispute Prevention and Treatment Regulations” Article 30, 42, medical dispute mediation channels are three: First, after the occurrence of medical disputes, the two parties can negotiate between the doctor and the patient to resolve the consensus, the parties reached a written settlement agreement. Second, the patient and his next of kin or agent requesting compensation of 20,000 yuan or more medical disputes, medical institutions should inform the patient and his agent can apply to the People’s Mediation Committee for medical disputes mediation. Medical disputes between the parties to apply for mediation, the amount of claims of more than 20,000 yuan and less than 100,000 yuan and medical disputes between the two sides of medical liability, medical disputes people’s mediation committee to apply for mediation should be entrusted to its pool of experts in the relevant experts to consult; experts out of the written advice should be clear that the responsibility of both doctors and patients. For claims of more than 100,000 yuan and medical disputes between doctors and patients on medical liability, should first be the technical identification of medical incidents or medical damage identification, clear responsibility. Identification should be entrusted to the medical association and other qualified appraisal institutions. Identification fee by the doctor and the patient in proportion to the responsibility. Third, to the court of law.

The end of the reply also states that, if not convinced by the processing of this opinion, can be in the next day after the receipt of the reply to the people’s government to apply for review within 30 days, after the application for review, the processing of the reply is the final opinion, such as the same facts and reasons for the complaint request will no longer be accepted.

Zhang Min told reporters that the father since the onset of the disease, the accumulated medical expenses have been more than 600,000 yuan, has not been paid off, belongs to the “claim amount of more than 100,000 yuan and the medical dispute between the two sides of the medical liability dispute The medical dispute is a “medical dispute with a claim amount of more than 100,000 yuan and a dispute between the doctor and the patient over medical liability”, and should first be subject to technical identification of medical incidents or medical damage identification to clarify liability.

In December 2020, Zhang Min commissioned the Jiangxi Jingdezhen Judicial Appraisal Center to identify his father, the agency issued an appraisal opinion on December 28 of that year, said the appraisee Zhang Xin’an brain injury and left a persistent vegetative survival state, so assessed as a level of disability. At the same time, his current level of care is total care dependency, and he still needs about 40,000 yuan for skull repair and 1,500 yuan per month for two years for rehabilitation.

Zhang Min said that his father’s illness has made the family lost the backbone, he is still studying in graduate school, the economy is really difficult, he hopes that Jingdezhen Second Hospital can give the official results of the investigation. He said he did not rule out legal means to defend his father’s rights.

The aforementioned industry experts said that objectively speaking, the wrong right skull and Zhang Xin’an’s recovery status may not be directly related, but the hospital should face up to the mistake, the relevant personnel to make the appropriate punishment.

On March 17, the reporter called the Jingdezhen Health Care Commission to ask about the handling of the letter, the staff said they had gone to Jingdezhen Second Hospital to investigate, has given three medical disputes coordination channel (as mentioned above), but in view of “Zhang Xin’an is still in treatment, the patient has not Form a certain result, difficult to accept”.

Jingdezhen Health Care Commission staff also said that, according to current regulations, medical disputes, whether the hospital is at fault need to be judicially identified, the Health Care Commission can now do only mediation, “suggesting that the family had better find medical mediation center, the court and other institutions to deal with “.

(Chapter people in the text is a pseudonym)