徐权峰亲办案例：二次鉴定不予采信，医院被判赔近12万

<p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">一</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">、</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">案情简介</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">原告朱某某自2016年6月16日至2016年10月31日，先后7次在被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院进行产前检查，包括按照被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院要求多次进行产前超声检查和孕期胎儿唐氏征产前筛查，均未发现胎儿异常。2016年10月31日，原告朱某某入住被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院处，在连硬外麻醉下行子宫下段剖宫产术分娩一女婴，即患儿刘某。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">2016年10月31日，患儿刘某因“出生窒息、吸入性肺炎、低血糖”等收入该院新生儿科诊治，发现有“动脉导管未闭、卵圆孔未闭、肺动脉高压”。2016年11月7日，患儿转入</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">B</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院治疗，诊断出“室间隔缺损（干下型，双向分流）、房间隔缺损（Ⅱ孔型、两处）、动脉导管未闭（管型）、肺动脉高压”。后患儿刘某在</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">C</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院确诊，并行手术治疗上述先天性心脏病。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">2018年1月31日，患儿刘某因“头部摔伤4小时余，抽搐3-4次”入住</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">B</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院，诊断为“闭合性颅脑损伤”、“创伤性颅内出血”、“重度颅脑损伤”和“急性硬膜下血肿”。后于2018年2月6日死亡。 &nbsp;</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">原告朱某某认为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院在之前一系列诊疗过程中存在严重失职</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">没能尽到与当时医疗水平相应的诊疗义务</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">未能及时发现胎儿畸形情况</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">出生后未能及时进行正确诊断等过失</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">严重影响患儿刘某的生长发育</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">导致患儿在后期生活中极易摔倒</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">为了保护自己的权利</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">朱某某将医院诉至法院</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;"><br/></span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">二</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">、</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">办案经过</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">安徽金亚太律师徐权峰接受当事人朱某某的委托为其代理人，接受委托后，徐权峰律师通过反复查阅病历材料，认为被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院在诊疗过程中存在重大过失，与损害结果的发生存在因果关系，遂向法院申请医疗损害过错鉴定。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">第一次鉴定</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，D</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定机构出具的鉴定意见中指出</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">A</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院在患儿刘某出生后对其患有室间隔缺损等先天性心脏病的诊断上存在漏诊</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">在处置主要由先天性心脏病导致的心功能不全并及时转诊上级医院手术治疗上存在过错</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">其医疗过错行为与被鉴定人住院期间心功能不全的损害后果存在次要因果关系</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">参与度约为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">40%，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">与患儿医药费用等支出增多之间存在直接因果关系</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">评定其参与度约定为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">75%。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal;"><img src="http://d02.wanglv.vip/images/upload/site/27016/default/2022/02/20220215145259.png" alt="图片2"/></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">第二次鉴定</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，E</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定机构出具的鉴定意见认为被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">B</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院对患儿刘某的诊疗行为无过错</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">其鉴定意见认为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">：</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">患儿所患的复杂性先天性心脏病系自身发育异常的结果</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">...</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">由于胎儿本身的生理特点</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">某些疾病诊断十分困难</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">复杂性心脏畸形更因诊断困难而导致在胎儿期漏诊或误诊</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">...</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">综合分析认为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">患儿复杂性先天性心脏病延迟诊断</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">8</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">天</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">对新生儿的后续治疗无实质性影响</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;"><img src="http://d01.wanglv.vip/images/upload/site/27016/default/2022/02/20220215145323.png" alt="图片1"/></span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">徐权峰律师认为</span></strong><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">E</span></strong><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定机构所做的第二次鉴定</span></strong><span style="text-decoration: underline;"><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">不具有科学性和客观性</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">，</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">违背常情常理</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">，</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">不能作为认定案件的依据</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">，</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">遂向法院提出了异议</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; line-height: 24px; font-size: 16px;">。</span></strong></span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;"><br/></span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">三</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">、</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">代理思路</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">徐权峰律师认为</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，E</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定中心出具的司法鉴定意见书不能作为本案的定案依据。该鉴定意见对被告</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">B</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">医院的过错认定错误，鉴定依据严重不足，鉴定程序严重违法</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span></p><p style="margin-right: 0px; margin-left: 0px; white-space: normal; text-indent: 32px; text-align: justify; line-height: 24px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">1.鉴定意见论述前后矛盾，存在明显的逻辑错误，违背基本的常情常识</span></strong><strong><span style="font-family: 宋体; line-height: 24px;"></span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">根据鉴定意见的描述“由于胎儿本身的生理特点、某些疾病诊断十分困难，如先天性心脏病中的单纯性房缺、室缺等在胎儿期漏诊率很高，复杂心脏畸形更因诊断困难而可能导致在胎儿期漏诊或误诊”，承认医院存在漏诊和误诊，却又说漏诊和误诊是因为疾病和胎儿的原因，不得不说该份鉴定意见前后矛盾，理由十分牵强，属于生搬硬套，逻辑上不足以使人信服，纯粹是为医院免于承担责任找借口。</span></p><p style="margin-right: 0px; margin-left: 0px; white-space: normal; text-indent: 32px; text-align: justify; line-height: 24px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">2.鉴定意见遗漏、延迟诊断等过失应当作为“过错”进行评价，而不是以“没有实质影响”这个“因果关系”的概念来否认“过错”的存在。鉴定意见在确认存在“延误诊断”过错事实的情况，继而作出“无过错”的结论，前后矛盾。</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">“对新生儿的后续治疗并无实质性影响”是对“因果关系”的表述，不是对过错的反驳。对于客观存在的过错，应在鉴定结论中体现</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">；</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定意见直接在没有论证、没有推理的情况下，在认定确有“延误治疗八天”的情况下，对“后续治疗”没有实质影响，如何得出对新生儿后续治疗没有影响呢？那除了“后续治疗”外，对其“生命健康”、“生长发育”是否有影响呢？对“损害后果”是否有影响呢？鉴定意见选择了回避，而原告申请鉴定的委托事项是包括“因果关系”的鉴定。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><strong><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">3.鉴定听证程序严重违法</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">在现场听证时，听证专家并非司法鉴定意见书中载明的鉴定人，其中有两名鉴定人并未参加听证会、听取双方陈述意见，对案件和双方陈述的理由未予听取，对双方的诉求未予充分听取。作为直接鉴定本案的三名鉴定人，应当出席听证会，对双方争议的问题和理由，充分听取，否则其做出的鉴定意见只能是偏听偏信、有失客观的意见。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;"><br/></span></p><p style="margin-right: 0px; margin-left: 0px; white-space: normal; text-indent: 32px; text-align: justify; line-height: 24px;"><strong><span style="font-family: 宋体;">四、</span><span style="font-family: 宋体; line-height: 24px;">裁判结果</span></strong></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px; text-indent: 32px; line-height: 21px;"><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">在庭审过程中</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">徐权峰律师向法庭明确说明了对于</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">E</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定机构所出具的第二份鉴定意见的异议</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">经过审理</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">法院认定</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">E</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">鉴定机构的第二份鉴定意见书不具有客观真实性</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">，</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">不予采信</span><span style="font-family: 宋体; line-height: 24px; font-size: 16px;">。</span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px;"><span style="font-family: 宋体; font-size: 16px;">最终，法院认定</span><span style="text-decoration: underline;"><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">被告</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">B</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">医院与患儿医药费用支出增多之间存在直接因果关系</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">，</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">评定参与度约为</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">75%，</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">被告</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">B</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">医院赔付原告朱某某各项损失合计</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">115220</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">.</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">93</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">元</span></strong><strong><span style="text-decoration: underline; font-family: 宋体; font-size: 16px;">。</span></strong></span></p><p style="margin-right: 15.078125px; margin-left: 15.078125px; white-space: normal; text-align: justify; font-family: Calibri; font-size: 14px;"><strong><span style="font-family: 宋体; font-size: 16px;"><img src="http://d02.wanglv.vip/images/upload/site/27016/default/2022/02/20220215145422.png" alt="图片3"/></span></strong></p><p><strong><span style="font-family: 宋体; font-size: 16px;"><br/></span></strong></p><p><br/></p>