To be honest, over-medicalization (Part 2)

This is the 5269th article of Da Yi Xiao Hu

When I went out yesterday, I happened to meet Aunt Zhang next door who was going out, looking worried. "I've only been retired for a year, and I was diagnosed with diabetes. The doctor asked me to be hospitalized for a thorough checkup, and there are a lot of things going on at home..." Aunt Zhang said with a frown. Later, I asked around and found that my fasting blood sugar was 6.8mmmol/L for the first time, and my glycosylated hemoglobin was normal, so I could be treated in the outpatient clinic. Such cases of reducing the indications for hospitalization and over-medicalization often occur.

A search of illegal facts published in the administrative penalty notices of the health and medical insurance administrative departments shows that it is quite common for medical institutions to have package tests, such as the routine liver function series including adenosine deaminase assay and serum α-L-fucose; the routine renal function series including serum cystatin and urea assay; the routine urine test coupled with quantitative urine sediment test; the routine blood test coupled with C-reactive protein assay (CRP) and high-sensitivity C-reactive protein assay, etc., which are considered excessive tests.

The patient had metal implants in his body, and microwave therapy was still prescribed despite clear contraindications in the instruction manual of the microwave therapy device. The patient did not have a clear condition that warranted prolonged antibiotic use, but antibiotics were used unreasonably beyond the course of treatment. There are many similar cases of overdiagnosis and treatment.

Should medical institutions and their medical staff bear legal responsibility if excessive medical treatment is committed? If so, what legal responsibilities will they bear?

Article 17 of the "Medical Quality Management Measures" clearly stipulates that medical institutions and their medical personnel should carry out diagnosis and treatment in accordance with relevant requirements such as clinical diagnosis and treatment guidelines, clinical technical operation specifications, industry standards and clinical pathways, strictly abide by the core medical quality and safety system, and carry out reasonable examinations, reasonable use of drugs and reasonable treatment.

Article 56 of the Physician Law states that if a physician violates the provisions of this Law and commits any of the following acts in the course of his/her professional activities, the health and wellness administrative department of the people's government at or above the county level shall order him/her to make corrections, give him/her a warning, confiscate his/her illegal gains, and impose a fine of not less than RMB 10,000 yuan but not more than RMB 30,000 yuan; if the circumstances are serious, he/she shall be ordered to suspend his/her professional activities for not less than six months but not more than one year, or even have his/her physician's license revoked: (5) ... Violate the diagnosis and treatment standards and perform unnecessary examinations and treatments on patients, resulting in adverse consequences.

Article 38 of the Regulations on Supervision and Administration of the Use of Medical Insurance Funds stipulates that if a designated medical institution has any of the following circumstances, the medical insurance administrative department shall order it to correct the situation and may call in the relevant person in charge for a talk; if it causes losses to the medical insurance fund, it shall be ordered to return the funds and be fined not less than 1 times but not more than 2 times the amount of the loss; if it refuses to correct the situation or causes serious consequences, the designated medical institution shall be ordered to suspend the medical services involving the use of medical insurance funds by the relevant responsible department for not less than 6 months but not more than 1 year; if it violates other laws and administrative regulations, the relevant competent department shall handle it in accordance with the law: (2) Violation of diagnosis and treatment specifications through excessive diagnosis and treatment, excessive examination, split prescriptions, excessive prescriptions, repeated prescriptions, or provision of other unnecessary medical services.

It can be seen that medical institutions and their medical staff will bear corresponding administrative and legal responsibilities for excessive medical treatment, including warnings, confiscation of illegal gains, administrative fines, etc. Doctors with serious circumstances will be suspended from practice, and even have their medical licenses revoked. At the same time, medical insurance agencies can score the relevant responsible personnel according to the scoring standards for violations of service agreements and service commitments. Therefore, supervision and management by medical insurance departments is an important way to identify and deal with excessive medical treatment, and it is also an effective measure to prevent and avoid excessive medical treatment.

In this issue, we provide additional examples of excessive medical treatment. Since the number and scope of the medical treatment items involved are large, whether drugs, laboratory tests, or treatments, it is impossible to list all of them. If you find clues of excessive medical treatment, you can report it to the medical insurance administrative department. In the next issue, we will talk about the application of reasonableness appraisal of medical expenses in personal injury tort cases.

Author: Shanghai Boss & Young Law Firm

Lawyer Zheng Jun