Can brain death within 48 hours of a sudden illness be considered a work-related injury?
The Bureau of Human Resources and Social Security refused to recognize the work-related injury, and the case was revoked by the court in two instances. Lawyers call for clarity on the application of brain death standards to deemed work-related injuries
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Employee Zhang Qiang died suddenly after suffering from a sudden illness at work. The local social affairs department issued a decision not to recognize the work-related injury on the grounds that the death occurred more than 48 hours ago. After two trials, the court revoked the decision not to recognize the work-related injury on the grounds that the brain death occurred within 48 hours. Lawyers call for further clarification on the application of brain death standards to the issue of deemed work-related injuries, so as to better protect the legitimate rights and interests of workers.
"This situation is in line with the basic connotation and legislative intent of the provisions of Article 15, Paragraph 1, Paragraph 1, of the Work Injury Insurance Regulations regarding 'Death within 48 hours after rescue efforts failed,' and should be applied." On March 21, see Zhang Qiang's family members shed tears of excitement when they read this passage in the final judgment issued by the Xi'an Railway Transport Intermediate People's Court of Shaanxi Province.
At about 13:30 on June 9, 2022, Zhang Qiang, an employee working at an automation equipment company in Xi'an, suddenly fell ill at work. After rescue efforts failed, he died on June 14 of that year at the age of 35. The Yanta District Human Resources and Social Security Bureau of Xi'an City (hereinafter referred to as the Yanta Human Resources and Social Security Bureau) issued a decision not to recognize a work-related injury on the grounds that Zhang Qiang died of a sudden illness more than 48 hours after resuscitation failed. Zhang Qiang's family members were dissatisfied with the decision not to recognize the work-related injury and sued the court to request that the decision not to be recognized as a work-related injury issued by the Yanta Human Resources and Social Security Bureau be revoked. After that, after the first and second instance procedures, the court finally revoked the decision of the Yanta Human Resources and Social Security Bureau not to recognize the work-related injury and ordered it to take specific administrative actions again.
The first-instance revocation of the decision not to recognize a work-related injury
According to the provisions of Article 15, Paragraph 1, of the "Regulations on Work-related Injury Insurance", if an employee dies of a sudden illness during working hours or at his workplace or dies after rescue fails within 48 hours, it will be regarded as a work-related injury.
Article 3 of the "Opinions on Several Issues Concerning the Implementation of the "Regulations on Work-related Injury Insurance" of the former Ministry of Labor and Social Security stipulates: Sudden diseases mentioned in the regulations include various diseases. The starting time of 48 hours is based on the time of initial diagnosis by the medical institution as the starting time for sudden illness.
The reporter saw from the first-instance judgment issued by the Xi'an Railway Transport Court that in this case, Zhang Qiang suffered a sudden illness and was sent to the emergency department of the local hospital. The emergency department diagnosed him with stroke and grade 3 hypertension. The hospital emergency department opened the case in June 2022. A serious illness notification was issued to the plaintiff at 14:05 on the 9th, and based on this, 14:05 on June 9, 2022 was determined to be the starting time of 48 hours. Zhang Qiang died after being discharged from hospital on June 14, 2022. The time of death was indeed more than 48 hours from the time of his initial diagnosis at 14:05 on June 9, 2022.
However, the court found that the patient was in a deep coma during ward rounds at 8:50 on June 11, the day after Zhang Qiang's surgery, with his pupils dilated and fixed, no spontaneous breathing, and the possibility of respiratory and cardiac arrest at any time. At 9:08 that day, Zhang Qiang suffered a sudden cardiac arrest and required continuous use of a ventilator to assist breathing after rescue. At that time, Zhang Qiang was already in a state of brain death, and his death was irreversible. Continuous treatment could only delay the time of cardiopulmonary death, but his family was unwilling to give up rescue until he died after being discharged from the hospital. It can also be seen from the specific process of Zhang Qiang's death despite ineffective rescue efforts that at 8:50 on June 11, 2022, after a doctor's ward check, many of Zhang Qiang's vital signs disappeared, and there was no possibility of treatment within 48 hours. His death was already Irreversible.
In 2023, the Xi'an Railway Transport Court made a first-instance judgment, revoking the Yanta Human Resources and Social Security Bureau's decision not to recognize a work-related injury and ordering it to take specific administrative actions again.
The human resources and social security department is worried about affecting the safety of work-related injury insurance funds
In this regard, the Yanta Human Resources and Social Security Bureau appealed that there is no relevant legislation on brain death in our country. Our country's current law adopts a comprehensive standard theory, that is, spontaneous respiratory cessation, cardiac arrest, and pupillary reflex cessation. The new standard for determining death based on brain death has not yet been officially studied. It was announced that the first-instance judgment adopted an inappropriate view on brain death.
The bureau believes that on the second day after surgery, that is, at 8:50 on June 11, 2022, Zhang Qiang was found to be no longer breathing spontaneously after a doctor's ward check, and there was a possibility of respiratory and cardiac arrest at any time. This shows that Zhang Qiang's heartbeat did not stop. Zhang Qiang still had vital signs. As a common medical device in modern medicine, a ventilator only serves to assist breathing. There is no direct connection between using a ventilator to assist breathing and determining death. In addition, from the resident medical certificate of death (inference) issued by the hospital, it is recorded that Zhang Qiang died on June 14, 2022. It can be determined that Zhang Qiang's death indeed exceeded the "Work Injury Insurance Regulations" regarding death within 48 hours after rescue failed.
In addition, the Yanta Human Resources and Social Security Bureau believes that the deemed work-related injury clause in Article 15 of the Work-related Injury Insurance Regulations is a reasonable expansion of legislation that should be recognized as a work-related injury, and is an expanded protection for employees who meet the circumstances stipulated in this clause. Therefore, it cannot be repeated To expand the application, the application of Article 15 of the "Regulations on Work-related Injury Insurance" should be interpreted strictly from a literary and scientific perspective. If leniency is applied repeatedly, firstly, the scale of leniency will not be grasped, and secondly, it will seriously affect the safety of work-related injury insurance funds and the legitimate rights and interests of other workers injured at work.
Recently, the Xi'an Railway Transport Intermediate People's Court made a final judgment, rejecting the appeal and upholding the original judgment.
The application of brain death to deemed work-related injuries should be clarified
At present, the common death standards in medicine are brain death and cardiac death, but our country’s legislation only recognizes cardiac death standards. However, many medical experts and scholars believe that the standard of brain death is more scientific, because the heart is an organ that contracts independently. Even without cerebral nerve control, the heart can keep beating for a long time, but its death is irreversible and continues. Treatment can only delay cardiopulmonary death.
"It seems inhumane to ask the family members to give up treatment directly when the patient is brain dead. Recognizing brain death can largely prevent some family members from extubating the tube within 48 hours." Zhang Qiang's family representative, Yu Weian, a lawyer at Shaanxi Renhe Wanguo Law Firm, said.
The reporter noticed that courts in many places have recognized brain death. For example, in April 2021, a staff member in Baragon Town, Hangjin Banner, Ordos City, Inner Mongolia, fainted while working and was sent to a hospital where he died after treatment failed. The local Social Security Bureau refused to recognize a work-related injury because the time of "clinical death" was more than 48 hours from the onset of illness. The family appealed to the court dissatisfied with the determination. The verdicts of the two levels of courts in the banner and city were unanimous, revoking the Hangjin Banner Bureau of Human Resources and Social Security's decision not to recognize the work-related injury and ordering it to make a new determination on the grounds that the brain death occurred within 48 hours.
Yu Weian said that although many places, in order to protect the interests of workers, adopt the brain death standard to identify workers who die within 48 hours of illness due to illness at work, these are only a few cases after all. Judging from the current practice in various places, the identification of work-related injuries that are regarded as work-related injuries requires high investigation and evidence collection, and the nature determination is still relatively controversial. The case was won because, on the one hand, the trial court was able to explore the original intention of the legislation and conduct a fair trial, and on the other hand, the investigation and evidence collection work in this case was relatively solid.
"We hope that there will be more and more successful cases like this, and we also call for further clarification on the application of brain death standards to the issue of deemed work-related injuries, so as to better protect the legitimate rights and interests of workers." Yu Weian said.
So, if brain death within 48 hours of a sudden illness is considered a work-related injury, will it impact the work-related injury insurance fund? In this regard, Shen Jianfeng, director of the Academic Committee of the Law School of the China Institute of Labor Relations, told reporters that the increase in the possibility of payment by the work-related injury insurance fund cannot be considered to harm its interests. Expenditures that are in line with the goals of the system are in line with the interests of the work-related injury insurance fund. At present, the collection-to-payment ratio of my country's work-related injury insurance funds is generally very safe.
(To protect privacy, Zhang Qiang’s name is changed in this article)
(Our reporter Yang Zhaokui Workers’ Daily)