Medical malpractice case of Li Jianxue, finally vindicated after eight years of trial
Compiled from: Red Star News, China.com, The Paper
On June 11, the Fuzhou Intermediate People's Court in Fujian Province delivered the final verdict on the 'Li Jianxue Medical Malpractice Case,' which lasted for 8 years, declaring obstetrician Li Jianxue of Changle City not guilty!
Case review
Afternoon of December 28, 2011, the parturient Chen was admitted on the third floor of the Obstetrics and Gynecology Department of Changle City Hospital, and later left the hospital to go home for labor. During this period, the hospital's obstetrician Wu, as the attending doctor, saw Chen, performed prenatal examinations, and issued laboratory test orders. The next morning when Wu finished work, some test report conclusions were not yet available, and Wu did not actively follow up or inform the on-duty doctor to check, resulting in abnormal test results on Chen's laboratory report, such as 'hematocrit 43.8%, fibrinogen 5.76 g/L, albumin 21.4 g/L, urine protein 3,' not being reviewed by any on-duty doctor before delivery.
December 31, 2011, Chen returned to the hospital to await childbirth and was sent to the delivery room at 9:00 PM that night. Li Jianxue did not make rounds to check Chen’s condition. Around 9:30 PM, after Chen gave birth to a baby girl naturally, she experienced continuous vaginal bleeding. Li Jianxue rushed to the delivery room to handle the situation and notified the second-line on-duty doctor, Wang, to come to the delivery room. During Chen’s delivery, Wang discovered that Chen did not have the pre-delivery laboratory test reports. After retrieving them from the computer, Wang found abnormal test results and instructed Li Jianxue to continue monitoring.
Early morning of January 1, 2012, Li Jianxue judged that the mother's vital signs were stable, and instructed the midwife and others to transfer her from the second-floor delivery room to the third-floor ward. At 2:45, the mother became restless. Hospital records show that at this time, her pulse was 144 beats/min, respiration 23 breaths/min, blood pressure 94/45 mmHg, and blood oxygen saturation 86%. Relevant investigative authorities later pointed out that these vital signs continued to worsen. At 3:20, the mother 'moved her hands restlessly, tossing and turning in bed,' with a pulse of 123 beats/min, respiration 23 breaths/min, blood pressure 110/50 mmHg, and blood oxygen saturation dropping to 76%. Li Jianxue arrived at the ward and again notified the second-line doctor Wang Chunlan to come, instructing the nurse to administer an IV and perform blood tests, but the mother suffered excessive blood loss. Li Jianxue issued a third blood request form, and the blood bank replied 'no blood.' Wang Chunlan arrived and saw that the mother was 'very agitated, breathing shallowly and irregularly, heart sounds dull, no response to solar plexus pressure, vomiting large amounts of ingested material.' An internal medicine doctor observed that the mother's conjunctiva was pale, pupils dilated, pulse undetectable, and heartbeats inaudible with a stethoscope. Despite various efforts, they were unable to restore the mother's heartbeat.
January 23, 2013, Li Jianxue had her medical license revoked because of this matter.
September 29, 2013, after the investigation was concluded by the Changle City Court, the case was transferred to the Changle City People's Court for prosecution, with the criminal suspects Li Jianxue and two others suspected of medical malpractice.
October 16, 2014Li Jianxue, the on-duty doctor that day, was individually prosecuted. The Cangshan District People's Court of Fuzhou City stated in the prosecution that the defendant Li Jianxue, as an obstetrician at Changle City Hospital, was seriously negligent in the diagnosis and treatment of the postpartum hemorrhage patient Chen, resulting in the death of the patient. Her actions violated Article 335 of the Criminal Law of the People's Republic of China. The facts of the crime are clear, the evidence is true and sufficient, and she should be held criminally responsible for the medical malpractice.
December 4, 2017The Fuzhou Cangshan District People's Court of the first instance held that Li Jianxue did not diligently analyze the test results and did not even check the mother's test report. As a result, Li Jianxue could not understand the condition in a timely manner, which led to insufficient preparation for the prevention and treatment of postpartum hemorrhage. This reflects a lack of awareness of the patient, resulting in the inability to detect the situation promptly and to take immediate rescue measures, causing the mother's condition to continue to deteriorate and ultimately leading to her death. The court of first instance convicted Li Jianxue of medical malpractice but exempted her from criminal punishment. Li Jianxue was dissatisfied with the judgment and filed an appeal.
June 26, 2019, the Fuzhou Intermediate People's Court conducted a public trial of Li Jianxue's appeal.
Relevant Laws
Article 335 of the Criminal Law of the People's Republic of China
Medical personnel who, due to serious negligence, cause the death of a patient or seriously harm the health of a patient, shall be sentenced to fixed-term imprisonment of up to three years or criminal detention.
Focus of Dispute
1. Cause of maternal death;
2. Whether Li Jianxue's diagnosis and treatment of the parturient woman conformed to medical standards and whether she performed her duties properly.
[1] Court Opinion
The court of first instance：
Li Jianxue only conducted rounds once for newly admitted, undiagnosed postpartum women, did not focus on intense inspections, and did not proactively check laboratory tests, violating standard medical practices. This resulted in insufficient understanding of the patients' conditions, incorrect diagnoses, and failure to take measures to prevent postpartum hemorrhage. She should bear medical responsibility for these consequences.
The court of second instance：
1. Cause of death of the mother: The Fuzhou Medical Association appraisal concluded that "since no autopsy was performed in this case, the cause of death is uncertain. Based on the existing information, it is highly possible that the patient died from postpartum hemorrhagic shock or acute pulmonary embolism"; the Fujian Medical Association appraisal concluded that "the mother died from hemorrhagic shock caused by postpartum hemorrhage"; expert witness Chen Dunjin stated that "without autopsy results, it is difficult to determine the cause of death"...... This court believes that the Fujian Medical Association's appraisal opinion, which states that the cause of death was hemorrhagic shock caused by postpartum hemorrhage, is an inference based on the symptoms, a clinical diagnosis. No forensic autopsy was performed, and no pathological diagnosis was carried out. The determination of the cause of death does not have uniqueness or exclusivity and cannot be used as a basis for the final verdict. This court does not accept it.
2. Whether Li Jianxue fulfilled her duties: Li Jianxue performed her duties as the on-duty physician of the day, and her medical practices did not violate standard medical procedures. The medical accident appraisal opinions from the Fujian Medical Association have issues regarding the evaluation of the early severe diagnosis of Quxian, the amount of bleeding and fluid replacement, the timing of vital sign measurements, and the causes of postpartum hemorrhage; the hospital does not accept the appraisal opinions on these aspects. In addition, the medical accident appraisal opinion holds that the medical party should bear the primary responsibility, but the first-instance court directly equating the medical party's responsibility with Li Jianxue's personal responsibility lacks basis.
[1] The author's perspective
The author believes that nowadays the doctor-patient relationship is tense, and being a doctor has become a "high-risk" profession. If a doctor is innocent but is convicted and sentenced, the doctor would live in fear. This kind of fear is not beneficial to the doctor-patient relationship; it makes doctors more cautious toward patients, undermines trust, and affects the relationship between doctors and patients. How to correctly determine a doctor's responsibility in cases of patient death is a very serious matter that requires a scientific and rigorous attitude. The key element for establishing a crime is that relevant evidence with medical authority must meet legal requirements. In this case, the second-instance court held that, based on the existing evidence, it is impossible to directly prove the establishment of medical malpractice, and therefore, Li Jianxue was acquitted.
Society should objectively and fairly view the adverse outcomes that occur in actual medical practice; not every bad outcome is a medical malpractice incident. Therefore, not every unfavorable outcome should result in legally holding the doctor responsible. If there is no sufficient evidence proving that the doctor is directly responsible for the patient's death, it should not be lightly judged as a medical malpractice crime. Only when medical workers and patients' families can assume their respective rights and obligations under the fairness of the law can similar problems be prevented from happening again.
