Give medical staff "housing risk" hospital and public security "one key linkage"

Beijing legislation provides solutions for hospital safety

● The “Regulations on the Administration of Beijing ’s Hospital Safety Order (Draft)” provides a series of innovative arrangements, the most refreshing of which is to clearly give medical staff “hazard avoidance”, which can be suspended when their personal safety is threatened by violence Diagnosis and treatment. This not only guarantees the interests of patients, but also ensures the safety of medical staff

● Regarding the provision of a police office in a hospital, the Beijing legislation further emphasizes “one-click linkage”. In the past, this system was more linked and unmoved, and it was not strong enough in the specific law enforcement process; now it requires high-speed, effective and fast processing, and there is linkage and movement

● The resolution of the contradiction between doctors and patients cannot only rely on police linkage, but comprehensive management. Medical security and graded diagnosis and treatment need to be further improved

□ Our reporter Zhao Li

□ Zhao Sicong, an intern in this newspaper

The topic of trauma doctor is hotter.

On March 26, the 20th meeting of the Standing Committee of the 15th Beijing Municipal People's Congress reviewed the "Regulations on the Administration of Beijing's Hospital Safety Order (Draft)" (hereinafter referred to as "Draft"). In order to avoid injury to the doctor, Beijing plans to legislate to establish a police office for hospitals at and above the second level. The hospital is equipped with a one-key alarm device to connect with public security organs. In the event of a violation of the safety of medical personnel, the hospital and public security organs can jointly handle and Seven categories of behaviors, such as setting up a mourning hall and laying a wreath in a hospital, are expressly prohibited.

Just as people praised Beijing ’s legislation, and even discussed whether it has national significance, the sentence of the injured victim made people more firm about their future expectations-"Someone asked me if I want to return to the clinic? Would you like to serve patients again? To be honest, I think. "

The speaker was Tao Yong, an ophthalmologist at Beijing Chaoyang Hospital who was injured by a patient. On March 28, more than two months after the injury, the injured Tao Yong faced the public for the first time in the form of a live-broadcast suit.

But then, a pot of cold water poured in-on March 30, some netizens broke the news that Huang Teng, a technician in the CT room of the People's Hospital of Hanchuan City, Hubei Province, was beaten by two new coronary pneumonia rehabilitation workers during working hours. On the afternoon of the same day, the media learned from the propaganda section of the People's Hospital of Hanchuan City that the matter was true and that the local public security organ had intervened in the investigation.

"Relevant laws and regulations have made many specific provisions, but the medical incident has not been cut off. This is not because the legal deterrent is not enough, but because it lacks detailed regulations. The provisions of the Beijing" Draft "have played a very effective demonstration. If these regulations can achieve good results in Beijing, then other provinces can learn from them, especially those related to the public security machine. "According to Zheng Xueqian, vice president of the Chinese Society of Health Law, the" Draft "has a national impact Demonstration significance of promotion.

This opinion was also recognized by the interviewed industry insiders.

Malignant injuries continue to occur

Governance measures are upgraded again

On January 20 this year, when 39-year-old Tao Yong was in the outpatient clinic 703, a man entered the clinic with a knife and cut him. His assistant Liu Ping was also cut.

This malignant wounded doctor incident caused a lot of public attention, and Tao Yong's treatment also affected people's hearts.

Although he has not fully recovered, Tao Yong's situation has clearly improved. Looking back on his injury and rescue experience, he described it as "a walk through a ghost gate."

Tao Yong recalled that during his injury hospitalization, he received the care of many colleagues and friends, and many strangers also expressed support for him. When he moved from the ICU to the general ward, he saw the flowers in the corridor, and his tears were almost gone.

In the process of treating patients, Tao Yong found that most people are caring, and doctors have been recognized by the vast majority of people while saving lives to help others. He also said that he did not want to indulge himself in hatred, hoping to return to work after recovery.

However, in the recent past, the injury incident has occurred again. At 12:45 on March 19, when Tang Mou, the attending physician in the blood purification room of the Ordos Central Hospital in Inner Mongolia, was preparing for the dialysis of patient Wang, Wang took advantage of Tang's inability to stab him. On March 23, the procuratorial organ conducted a legal review and approved the arrest of Wang Mou, a criminal suspect who committed murder, on suspicion of intentional homicide.

According to Deng Liqiang, director of the Legal Affairs Department of the Chinese Medical Doctors Association, there is still no way to prevent injuries or even killing doctors because "the poison has not been eliminated."

To sort out the relationship between doctors and patients, the law is of course indispensable. In April 2002 and June 2018, the State Council promulgated the "Regulations on the Handling of Medical Accidents" and "Regulations on the Prevention and Handling of Medical Disputes" to protect the legitimate rights and interests of doctors and patients, maintain medical order, ensure medical safety, and prevent medical disputes. And handling work are fully integrated into the rule of law. At the same time, people's mediation committees for medical disputes independent of the health department and hospitals have been established in various places to ensure that medical disputes are handled in accordance with the law in a fair and just manner.

This time, Beijing issued the "Draft", in the opinion of the industry, it is a further "upgrade" governance method based on the existing measures.

"The first bright spot of the" Draft "is the government's responsibility for the leadership of the hospital's security order. In the past, many people simply believed that the medical incident was completely the responsibility of the hospital, but did not think of the hospital as an important part of society, especially The safety of places where life is maintained is actually everyone ’s responsibility. ”Deng Liqiang said, at the same time, the face recognition technology, civil air defense, physical defense prevention system, the establishment of a risk identification system is also a bright spot.

Liu Xin, director of the Medical Law and Ethics Research Center of China University of Political Science and Law, also mentioned the establishment of a shared medical safety platform for medical institutions in the city as stipulated in the Draft.

"The establishment of a shared platform for medical safety means that if someone makes trouble in a hospital, other medical institutions can learn this information through the platform. From a certain perspective, this shared platform is a blacklist, but it is different from the traditional The blacklist is different. For patients who are on the blacklist, the hospital also needs to provide diagnosis and treatment services, but it needs to be cautious in the service process. "Liu Xin said.

It is particularly noteworthy that the "Draft" also provides a series of innovative arrangements, the most refreshing of which is to clearly give medical staff "hazard avoidance". Medical personnel can suspend diagnosis and treatment when their personal safety is threatened by violence. This formulation was rare in the past. It is understood that the doctor's "right to refuse diagnosis" has always been avoided in the medical system and public perception.

"Many doctors in the past faced relevant regulations and public opinion threats and could only continue diagnosis and treatment in some very dangerous situations. However, according to the provisions of the" Draft ", medical staff can refuse medical treatment or replace other medical treatments when there is a danger. . This not only guarantees the interests of patients, but also ensures the safety of medical staff. "Deng Liqiang analyzed that for patients who are drunk and emotional, they can be accompanied by security personnel for diagnosis and treatment, which is also to ensure the safety of medical staff in the emergency room.

According to Zheng Xueqian, in the face of violence, medical staff can avoid treatment. "Avoidance" emphasizes that when a violent incident occurs, medical staff can refuse to go to the clinic. This not only protects the rights of medical staff and avoids face-to-face risks, but also reflects the right of medical staff to defend properly in the face of violence.

Establish a safety inspection system

Related rules still need to be optimized

In 2013, Lian Enqing, a patient with air nose disease in Wenling, Zhejiang Province, also raised a hammer and threw it three times at the head of doctor Wang Yunjie because of the sequelae of the operation. After the hammer broke, he took out the sharp knife hidden in the sleeve of his left side and stabbed Wang Yunjie with a few knives on his back, causing him to die on the spot.

The Wenling murder case thus became a landmark event and turning point in the relationship between doctors and patients in China.

After the Wenling killing incident in Zhejiang, the call for strengthening hospital security increased again. Some local doctors in Wenling hope that the hospital will perform the necessary security checks on the items carried by patients like the airport.

In this draft, a noticeable rule is that the hospital should establish a safety inspection system to prevent articles from entering the hospital.

In this regard, Zheng Xueqian expressed this view to the reporter of "Legal System Daily". Of course, security can be set up in public places, but what can not be ignored is whether it is necessary for the hospital to set up a security check system.

"Security screening is very important at airports and stations because it involves the issue that prohibited items may endanger public safety. The complexity of the hospital is that there are many doors in the hospital, and heavy security screening will make patients feel unhappy. I think if the relationship between doctors and patients Harmony, there is no need to establish a security inspection system. "Zheng Xueqian said that although the law gives the right to public places, but each medical site should decide whether to install security gates according to its own characteristics.

Zheng Xueqian believes that the security inspection system not only emphasizes the installation of security gates, but also means that key people can be inspected. "The" Draft "also needs to be further refined. The contradiction between doctors and patients cannot be completely resolved by security inspection, security inspection is only a means. In the whole society People have not yet reached the situation where they can restrain themselves and defend themselves, the necessary measures are still needed. "

Regarding the security inspection system, some people in the industry have suggested that it is not necessary for all types of hospitals to carry out security inspections, and some hospitals cannot afford it. It is recommended that security inspections be conducted in hospitals with more medical disputes and more concentrated medical safety incidents.

"In fact, these opinions have been taken into account in the" Draft ". The" Draft "stipulates that due to special reasons, there is no way to accept technical security inspections can be hand-checked. This is a consideration for a special place such as a hospital, and it must also be implemented in the specific implementation. It will be taken into account that in the implementation process, it will ensure that the patient's diagnosis and treatment will not be affected. "Deng Liqiang told the" Legal Daily "reporter.

Deng Liqiang also reminded that it should be noted that regarding the hospital security inspection system, if there are exceptions, there will be a gap in the entire system of measures.

Deng Liqiang told reporters from the Legal Daily: "The" Draft "contains all medical institutions. The initial capital and other investment should be acceptable to the hospital. The community or hospitals of low rank can be disbursed from the administrative finances. Yes. It ’s important to emphasize that the value of a doctor ’s life is more important than money. Increased personnel expenses or burden cannot be compared with the safety of a doctor. "

Re-emphasize one-click linkage

Execution needs to be increased

At the same time, when the "Draft" clearly stipulates that there is a violation of the safety of medical personnel, the hospital and the public security organ may jointly handle it. The hospital shall perform five duties including the establishment and improvement of the hospital safety management system, the medical personnel safety prevention system, and the medical dispute risk assessment system, the establishment of a special security agency, the organization of daily safety order maintenance, and the emergency handling of medical-related safety incidents.

Setting up a police office in a hospital is not a legislative creation. The state and Beijing had relevant regulations many years ago. In practice, Beijing has established a total of 101 police offices in most tertiary hospitals and some conditional secondary hospitals. . However, from the perspective of practical effects, the role of some police offices is not enough, and the effective linkage with the hospital security department is not close enough.

"Hospital surveillance can help police quickly collect evidence and deal with it on the spot. This is one of the benefits of linkage. Surveillance can directly contact the public security bureau, which is very effective. Therefore, there is no need to bring the disputed parties to the police station. "" Zheng Xueqian said.

According to Zheng Xueqian, at present, although the hospital security has been granted certain rights, there is still a big difference between security and public security. Public security has the power of law enforcement and can play a certain role of warning. Some big problems require public security to go to the scene for disciplinary treatment. The security guard plays a protective role, and the security guard can deal with small problems in a timely manner. Especially in the case of limited police power, security has played a powerful role.

The provisions of the "Draft" on the police office further emphasize "one-click linkage". "In the past, this system was more linked and unmoved. At the same time, it was not strong enough in the specific law enforcement process. But now it is handled quickly and efficiently, and there is linkage and movement." Zheng Xueqian said.

"The" Draft "also emphasizes the exemption of security personnel for law enforcement. In the past, when the hospital had a problem, the security did not have the right to enforce the law, so it was difficult for the security to deal with it. The security right is now given in legislation. It is exempt from liability. "Zheng Xueqian told the" Legal Daily "reporter.

Zheng Xueqian suggested that public security organs and hospitals should jointly develop a series of standards, "For example, some plans can be formulated to specify treatment plans in different situations. If drills and training are carried out under these specific rules, they can be handled efficiently, the police When dealing with specific cases, we can have a basis. "

Supervisory authorities made many moves

Severely punish medical behavior

According to the “White Paper on the Practice of Chinese Physicians” published by the Chinese Medical Doctors Association in 2018, 66% of physicians in China have experienced personal conflicts between doctors and patients, and over 30% of doctors have experienced violent treatment by patients.

Faced with an increasing number of medical incidents, the regulatory authorities have repeatedly made moves in recent years.

In 2014, the Supreme People's Law and other five departments jointly issued the "Opinions on Punishing Medical-related Offenses According to Law and Maintaining Normal Medical Order", which clearly punishes six types of medical-related crimes such as harming medical personnel.

Among them, assaulting medical personnel in a medical institution or intentionally injuring the medical personnel, etc., which have not yet caused serious consequences, will be punished as a security case, and deliberate killing of medical personnel will be convicted and punished in accordance with the relevant provisions of the Criminal Law.

The Amendment to the Criminal Law (9) promulgated in 2015 also included for the first time the act of disrupting medical order as a crime of gathering crowds to disturb social order, and stipulated that “primary elements shall be sentenced to more than three years but not more than seven years in prison”.

In June 2018, the State Council passed the Regulations on the Prevention and Handling of Medical Disputes, requiring the Ministry of Public Security and other relevant departments to severely crack down on medical-related crimes and crimes, and advocated more ways to resolve medical disputes.

In October 2018, 28 departments such as the National Development and Reform Commission and the National Health and Health Commission jointly issued the Memorandum of Understanding on Joint Disciplinary Actions for Persons Responsible for Dishonest Acts That Seriously Endanger the Normal Medical Order, clearly stating that “due to implementation or participation in medical-related violations of laws For criminal activities, natural persons severely jeopardized by the public security organs for administrative detention or severely jeopardized by the judicial organs for criminal responsibility will be jointly punished. "

On December 28, 2019, the Basic Health Care and Health Promotion Law passed by the National People ’s Congress Standing Committee will be officially implemented on June 1, this year, which emphasizes that "the personal safety and personal dignity of medical and health personnel are not violated. The lawful rights and interests are protected by law ”, and in particular, it is forbidden for any organization or individual to threaten or endanger the personal safety of medical and health personnel, or violate the personal dignity of medical and health personnel. Anyone who violates the provisions of this law and constitutes a crime shall be investigated for criminal responsibility according to law; If the property is damaged, it shall bear civil liability according to law. "

Liu Xin believes that the introduction of relevant legal systems and policy measures has indeed eliminated the malignant medical disputes, and the phenomenon of medical trouble has been significantly reduced, but ordinary medical disputes still occur frequently, but patients will take some legal ways to protect their rights.

At the same time, the reporter of Legal Daily also noted that in addition to Beijing's review of the "Draft", in order to enhance the institutionalization and legalization of the protection of the rights and interests of medical personnel, the Shanghai Judicial Bureau proposed to the Shanghai Municipal Government the formulation of municipal government regulations Recommendations of the "Measures for the Protection of Rights and Interests of Medical Staff in Shanghai (Provisional Name)". Recently, the legislative kick-off meeting of the "Measures for the Protection of Rights and Interests of Medical Workers in Shanghai (Provisional Name)" was held.

On March 20, the nation ’s first resolution on effectively protecting and caring for medical personnel and building a good fashion of respecting doctors and protecting health was approved by the 17th meeting of the Standing Committee of the Fujian Provincial People ’s Congress. The resolution emphasizes to ensure the implementation of various legal systems and policy measures in accordance with the law and regulations, and strive to form a long-term mechanism for protecting and caring for medical personnel.

Establish damage compensation fund

Improve the medical security mechanism

Regarding hospital safety, the central and local governments are providing various guarantees of the rule of law, but how to make the documents be implemented has become the focus of social concern.

"I think the lack of detailed rules has led to different situations in implementation. The purpose of maintaining hospital order is to better provide medical services to patients. The Beijing" Draft "was issued in a timely manner, drawing on the experience of the hospital for many years. , Integrated relevant national documents, and provided specific solutions to existing problems. "Zheng Xueqian said.

At the same time, Zheng Xueqian mentioned that the resolution of the doctor-patient contradiction cannot only rely on police linkage, but comprehensive management. Medical security and graded diagnosis and treatment need to be further improved.

"In addition, the relevant departments should also establish a compensation fund for medical damage, because medical incidents often occur not only because of the responsibility of the hospital, but also because of some uncontrollable factors such as technical level. For uncontrollable factors and accidents such as medical risks The consequences of the situation cannot be borne by the hospital alone, so it is necessary to establish a compensation fund for medical damage. At the same time, the protection mechanism should be further improved. The patient can purchase accident insurance and share the pressure through the insurance. "Zheng Xueqian told the" Legal Daily "reporter The rights are two sides, and patients should also restrain their own behavior while observing the clinic and observe the order of the hospital.

Liu Xin suggested that both government departments, medical managers, medical staff and the public should treat doctor-patient disputes correctly. Medical managers should also avoid the factors that cause medical disputes, and make improvements and improvements in procedures and procedures as much as possible. At the national level, these problems should be avoided in the design of the system and the possible contradictions should be diluted.

Cartography / Gao Yue