Gynecological consultation: How to deal with the medical malpractice of fetal death

by fuukee0019 on 2011-04-28 10:57:02

Case:

After becoming pregnant, Xiao Zhao had been getting regular check-ups at a certain maternal and child health hospital. As her abdomen grew day by day, Xiao Zhao looked forward to the birth of her baby. When the due date arrived, Xiao Zhao was admitted to the same maternal and child health hospital. However, after being pregnant for ten months, Xiao Zhao did not get the result she hoped for as her baby did not come into the world as expected, leaving her hope of becoming a mother unfulfilled because she delivered a stillborn baby. Xiao Zhao could not accept the fact that the little life she had nurtured inside her body had disappeared before being born. Reflecting on the entire birthing process, she believed that the maternal and child health hospital was irrefutably responsible for the death of the fetus.

However, the maternal and child health hospital argued that from fertilization to delivery, the fetus and the mother's body are always in a dynamic, contradictory yet unified system of mutual rejection and coexistence. At any time, there is the possibility of pregnancy either continuing or terminating, leading to two completely opposite outcomes. For example, some fetuses with partially umbilical cord around their necks float in amniotic fluid during pregnancy. Although the umbilical cord is wrapped around the neck, it is loose and does not affect the growth, development, and position of the fetus. However, during delivery, as the uterus contracts and the fetus enters the birth canal, the umbilical cord tightens and causes strangulation, leading to the death of the fetus. This qualitative change can happen instantly and cannot be prevented by others. In fact, the reasons for fetal death in utero are extremely complex. The most common causes in clinical obstetrics alone exceed a hundred. These causes may stem from physiological and pathological aspects of the pregnant woman, or from the fetus itself; they may be natural factors or human-induced factors; direct or indirect factors. They may even include non-biological factors such as psychological, socio-cultural, and economic factors. Therefore, it is necessary to strictly define the nature of fetal death in utero and objectively and fairly distinguish between medical-related factors and non-medical-related factors, especially in analyzing the cause of death of the fetus during labor. To determine the cause of fetal death, the hospital suggested performing an autopsy on the fetus and conducting a technical appraisal of the medical accident. In order to seek justice for her deceased fetus, Xiao Zhao agreed with the hospital's suggestion.

Soon, the autopsy report of the fetus came out. The report analyzed that the fetus had a history of one week of umbilical cord around the neck. Pathological examination revealed inflammation of the umbilical vessel wall, thrombosis formation in the umbilical vein, focal infarction and inflammation of the placenta, congestion and edema of both lungs, inhalation of amniotic fluid, and focal inflammation. Based on the medical history and autopsy findings, the fetus died from intrauterine infection leading to inflammation of the umbilical vessels, thrombosis causing focal infarction and inflammation of the placenta, resulting in oxygen deficiency and aspiration pneumonia.

Subsequently, a certain Medical Association conducted a medical accident appraisal regarding the death of Xiao Zhao's fetus. The appraisal analysis concluded: 1) The pregnant woman was admitted beyond her due date, with high-floating fetal head noted upon admission. After admission, she reported twice that fetal movement had decreased and disappeared. An ultrasound suggested umbilical cord around the neck, indicating high-risk factors. The hospital did not give adequate attention and did not terminate the pregnancy in a timely manner. 2) After two vaginal operations, medical staff did not use antibiotics to prevent infection, violating medical operation routines, leading to high fever in the pregnant woman. The fetal death in utero was caused by hypoxia combined with intrauterine infection. Therefore, there is no doubt that the medical behavior of the maternal and child health hospital had a causal relationship with the death of the fetus. However, the appraisers encountered difficulties in determining whether this medical incident constituted a medical accident and if so, what level of accident it would constitute. The reason is that the current "Regulations on Handling Medical Accidents" (hereinafter referred to as the "Regulations") and related provisions have not clearly defined the characterization and grading of accidents involving fetal death in utero. According to the "Regulations", a medical accident refers to an incident where medical institutions and their medical personnel violate laws, administrative regulations, departmental rules, and diagnostic and nursing norms and routines in medical activities, negligently causing personal injury to patients. This means that a medical accident must involve personal injury, implying that it concerns harm to individuals. However, according to Chinese law, the civil rights capacity of a natural person begins at birth, meaning that a fetus that has not been born is obviously not a legal person. Therefore, strictly speaking, medical institutions do not commit a medical accident regarding a fetus that dies in the womb. Medical accidents are divided into four levels, with patient death constituting Level A Grade 1, while Levels B Grade 1 to Grade 3 require disability symptoms in the patient. Xiao Zhao's ten-month pregnancy ended without fruition, causing undeniable physical and psychological damage to her. However, she did not exhibit any residual symptoms or disabilities. Therefore, the medical institution clearly does not constitute a medical accident above Grade 3. Only Grade 4 medical accident remains. A Grade 4 medical accident refers to other consequences causing obvious personal injury to the patient. The "Grading Standard for Medical Accidents" lists scenarios constituting Grade 4 medical accidents, including 15 items related to fetal problems, such as fetal injury caused by cesarean section, but does not specify cases of fetal death in utero. After discussion, the appraisers determined the medical incident as a Grade 4 medical accident, with the hospital bearing primary responsibility.

Analysis:

According to the "Regulations on Handling Medical Accidents", the compensation period for mental distress damages for causing patient disability shall not exceed three years of the average annual living expenses in the area where the medical accident occurred. That is to say, even if the patient constitutes a Grade 1 disability, such as being in a vegetative state, the mental distress damages would be three years' living expenses, and no mental distress damages would be compensated if there is no disability. A Grade 4 medical accident is the level where the patient does not constitute a disability. Therefore, according to the compensation provisions of the "Regulations", Xiao Zhao would not receive compensation for mental distress. However, the hardships of ten months of pregnancy and the disappearance of the fruit of love undoubtedly dealt Xiao Zhao a significant blow, primarily on a spiritual level. For this reason, Xiao Zhao decided to challenge the provisions of the "Regulations" and filed a lawsuit against the court, demanding that the hospital compensate her 60,000 yuan for mental distress damages in addition to the compensation items stipulated in the "Regulations".

After accepting the case, the court also encountered legal issues because the law clearly states that the civil subject qualification of a natural person begins at birth, implying that a fetus in China does not possess civil rights such as the right to health or personality. Therefore, there is no legal basis for compensating for the death of a fetus in utero. However, a fetus that has not been born is part of the mother's body. Legally, damage to the fetus is considered an infringement on the mother's right to health. According to existing legal provisions, citizens whose right to health is violated can request compensation for mental distress. Therefore, the court believed that the medical accident caused by the defendant hospital resulted in the plaintiff delivering a stillborn baby, shattering her beautiful wish of becoming a mother after ten months of pregnancy. The trauma inflicted on the plaintiff's mind is evident, so her claim for mental distress damages should be supported. However, the compensation amount should be considered based on factors such as the extent of the damage, the degree of fault, the method of infringement, and the local standard of living, and was set at 50,000 yuan. Xiao Zhao successfully challenged the "Regulations" and received the compensation for mental distress as she wished.

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