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    醫療事故分級標準

    醫療事故分級標準 醫療事故是指醫療機構及其醫務人員在醫療活動中,違反醫療衛生管理法律、行政法規、部門規章和診療護理規范、常規,過失造成患者人身損害的事故。醫療事故根據對患者人身造成的損害程度分為四級:一級醫療事故:造成患者死亡、重度殘疾的;二級醫療事故:造成患者中度殘疾、器官組織損傷導致嚴重功能障礙的;三級醫療事故:造成患者輕度殘疾、器官組織損傷導致一般功能障礙的;四級醫療事故:造成患者明顯人身損害的其他后果的。接下來小編就為您詳細的介紹相關的知識。

    1最新醫療事故分級標準

    (一)一級甲等醫療事故

    死亡。

    (二)一級乙等醫療事故

    重要器官缺失或功能完全喪失,其他器官不能代償,存在特殊醫療依賴,生活完全不能自理。例如造成患者下列情形之一的:

    1.植物人狀態;

    2.極重度智能障礙;

    3.臨床判定不能恢復的昏迷;

    4.臨床判定自主呼吸功能完全喪失,不能恢復,靠呼吸機維持;

    5.四肢癱,肌力0級,臨床判定不能恢復。

    (三)二級甲等醫療事故

    器官缺失或功能完全喪失,其他器官不能代償,可能存在特殊醫療依賴,或生活大部分不能自理。例如造成患者下列情形之一的:

    1.雙眼球摘除;或雙眼經客觀檢查證實無光感;

    2.小腸缺失90%以上,功能完全喪失;

    3.雙側有功能腎臟缺失或孤立有功能腎缺失,用透析替代治療;

    4.四肢肌力Ⅱ級(二級)以下(含Ⅱ級),臨床判定不能恢復;

    5.上肢一側腕上缺失或一側手功能完全喪失,不能裝配假肢,伴下肢雙膝以上缺失。

    (四)二級乙等醫療事故

    存在器官缺失、嚴重缺損、嚴重畸形情形之一,有嚴重功能障礙,可能存在特殊醫療依賴,或生活大部分不能自理。例如造成患者下列情形之一的:

    1.重度智能障礙;

    2.單眼球摘除或經客觀檢查證實無光感;另眼球結構損傷,閃光視覺誘發電位(VEP)P100波潛時延長>160ms(毫秒),矯正視力<0.02,視野半徑<50;

    3.雙側上頜骨或雙側下頜骨完全缺失;

    4.一側上頜骨及對側下頜骨完全缺失,并伴有顏面軟組織缺損大于30cm2;

    5.一側全肺缺失并需胸改術;

    6.肺功能持續重度損害;

    7.持續性心功能不全,心功能四級;

    8.持續性心功能不全,心功能三級伴有不能控制的嚴重心律失常;

    9.食管閉鎖,依賴造瘺;

    10.肝缺損3/4,并有肝功能重度損害;

    11.膽道損傷致肝功能重度損害;

    12.全胰缺失;

    13.小腸缺損大于3/4,普通膳食不能維持營養;

    14.腎功能部分損害不全失代償;

    15.兩側睪丸、副睪缺損;

    16.陰莖缺損或性功能嚴重障礙;

    17.雙側卵巢缺失;

    18.未育婦女子宮全部缺失或大部分缺損;

    19.四肢癱,肌力Ⅲ級(三級)或截癱、偏癱,肌力Ⅲ級以下,臨床判定不能恢復;

    20.雙上肢腕關節以上缺失、雙側前臂缺失或雙手功能完全喪失,不能裝配假肢;

    21.肩、肘、髖、膝關節中有四個以上(含四個)關節功能完全喪失;

    22.重型再生障礙性貧血(Ⅰ型)。

    (五)二級丙等醫療事故

    存在器官缺失、嚴重缺損、明顯畸形情形之一,有嚴重功能障礙,可能存在特殊醫療依賴,或生活部分不能自理。例如造成患者下列情形之一的:

    1.面部重度毀容;

    2.單眼球摘除或客觀檢查無光感,另眼球結構損傷,閃光視覺誘發電位(VEP)>155ms(毫秒),矯正視力<0.05,視野半徑<10o;

    3.一側上頜骨或下頜骨完全缺失,伴顏面部軟組織缺損大于30cm2;

    4.同側上下頜骨完全性缺失;

    5.雙側甲狀腺或孤立甲狀腺全缺失;

    6.雙側甲狀旁腺全缺失;

    7.持續性心功能不全,心功能三級;

    8.持續性心功能不全,心功能二級伴有不能控制的嚴重心律失常;

    9.全胃缺失;

    10.肝缺損2/3,并肝功能重度損害;

    11.一側有功能腎缺失或腎功能完全喪失,對側腎功能不全代償;

    12.永久性輸尿管腹壁造瘺;

    13.全膀胱缺失;

    14.兩側輸精管缺損不能修復;

    15.雙上肢肌力IV級(四級),雙下肢肌力0級,臨床判定不能恢復;

    16.單肢兩個大關節(肩、肘、腕、髖、膝、踝)功能完全喪失,不能行關節置換;

    17.一側上肢肘上缺失或肘、腕、手功能完全喪失,不能手術重建功能或裝配假肢;

    18.一手缺失或功能完全喪失,另一手功能喪失50%以上,不能手術重建功能或裝配假肢;

    19.一手腕上缺失,另一手拇指缺失,不能手術重建功能或裝配假肢;

    20.雙手拇、食指均缺失或功能完全喪失無法矯正;

    21.雙側膝關節或者髖關節功能完全喪失,不能行關節置換;

    22.一下肢膝上缺失,無法裝配假肢;

    23.重型再生障礙性貧血(II型)。

    (六)二級丁等醫療事故

    存在器官缺失、大部分缺損、畸形情形之一,有嚴重功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.中度智能障礙;

    2.難治性癲癇;

    3.完全性失語,伴有神經系統客觀檢查陽性所見;

    4.雙側重度周圍性面癱;

    5.面部中度毀容,或全身瘢痕面積大于70%;

    6.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>155ms(毫秒),矯正視力<0.05,視野半徑<10o;

    7.雙耳經客觀檢查證實聽力在原有基礎上損失大于91dbHL(分貝);

    8.舌缺損大于全舌2/3;

    9.一側上頜骨缺損1/2,顏面部軟組織缺損大于20cm2;

    10.下頜骨缺損長6cm以上的區段,口腔、顏面軟組織缺損大于20cm2;

    11.甲狀旁腺功能重度損害;

    12.食管狹窄,只能進流食;

    13.吞咽功能嚴重損傷,依賴鼻飼管進食;

    14.肝缺損2/3,功能中度損害;

    15.肝缺損1/2伴有膽道損傷致嚴重肝功能損害;

    16.胰缺損,胰島素依賴;

    17.小腸缺損2/3,包括回盲部缺損;

    18.全結腸、直腸、肛門缺失,回腸造瘺;

    19.腎上腺功能明顯減退;

    20.大、小便失禁,臨床判定不能恢復;

    21.女性雙側乳腺缺失;

    22.單肢肌力Ⅱ級(二級),臨床判定不能恢復;

    23.雙前臂缺失;

    24.雙下肢癱;

    25.一手缺失或功能完全喪失,另一手功能正常,不能手術重建功能或裝配假肢;

    26.雙拇指完全缺失或無功能;

    27.雙膝以下缺失或無功能,不能手術重建功能或裝配假肢;

    28.一側下肢膝上缺失,不能手術重建功能或裝配假肢;

    29.一側膝以下缺失,另一側前足缺失,不能手術重建功能或裝配假肢;

    30.雙足全肌癱,肌力Ⅱ級(二級),臨床判定不能恢復。

    (七)三級甲等醫療事故

    存在器官缺失、大部分缺損、畸形情形之一,有較重功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.不完全失語并伴有失用、失寫、失讀、失認之一者,同時有神經系統客觀檢查陽性所見;

    2.不能修補的腦脊液瘺;

    3.尿崩,有嚴重離子紊亂,需要長期依賴藥物治療;

    4.面部輕度毀容;

    5.面頰部洞穿性缺損大于20cm2;

    6.單側眼球摘除或客觀檢查無光感,另眼球結構損傷,閃光視覺誘發電位(VEP)>150ms(毫秒),矯正視力0.05—0.1,視野半徑<15o;

    7.雙耳經客觀檢查證實聽力在原有基礎上損失大于81dbHL(分貝);

    8. 鼻缺損1/3以上;

    9.上唇或下唇缺損大于1/2;

    10.一側上頜骨缺損1/4或下頜骨缺損長4cm以上區段,伴口腔、顏面軟組織缺損大于10cm2;

    11.肺功能中度持續損傷;

    12.胃缺損3/4;

    13.肝缺損1/2伴較重功能障礙;

    14.慢性中毒性肝病伴較重功能障礙;

    15.脾缺失;

    16.胰缺損2/3造成內、外分泌腺功能障礙;

    17.小腸缺損2/3,保留回盲部;

    18.尿道狹窄,需定期行尿道擴張術;

    19.直腸、肛門、結腸部分缺損,結腸造瘺;

    20.肛門損傷致排便障礙;

    21.一側腎缺失或輸尿管狹窄,腎功能不全代償;

    22.不能修復的尿道瘺;

    23.膀胱大部分缺損;

    24.雙側輸卵管缺失;

    25.陰道閉鎖,喪失性功能;

    26.不能修復的III度(三度)會陰裂傷;

    27.四肢癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    28.單肢癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    29.肩、肘、腕關節之一功能完全喪失;

    30.一手全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    31.一手拇指缺失,另一手拇指功能喪失50%以上;

    32.一手拇指缺失或無功能,另一手除拇指外三指缺失或無功能,不能手術重建功能;

    33.雙下肢肌力III級(三級)以下,臨床判定不能恢復。大、小便失禁;

    34.下肢雙膝以上缺失伴一側腕上缺失或手功能部分喪失,能裝配假肢;

    35.一髖或一膝關節功能完全喪失,不能手術重建功能;

    36.雙足全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    37.雙前足缺失;

    38.慢性再生障礙性貧血。

    (八)三級乙等醫療事故

    器官大部分缺損或畸形,有中度功能障礙,可能存在一般醫療依賴,生活能自理。

    1.輕度智能減退;

    2.中度癲癇;

    3.不完全性失語,伴有神經系統客觀檢查陽性所見;

    4.頭皮、眉毛完全缺損;

    5.一側完全性面癱,對側不完全性面癱;

    6.面部重度異常色素沉著或全身瘢痕面積達60%—69%;

    7.面部軟組織缺損大于20cm2;

    8.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>150ms(毫秒),矯正視力0.05—0.1,視野半徑<15o;

    9.雙耳經客觀檢查證實聽力損失大于71dbHL(分貝);

    10.雙側前庭功能喪失,睜眼行走困難,不能并足站立;

    11.甲狀腺功能嚴重損害,依賴藥物治療;

    12.不能控制的嚴重器質性心律失常;

    13.胃缺損2/3伴輕度功能障礙;

    14.肝缺損1/3伴輕度功能障礙;

    15.膽道損傷伴輕度肝功能障礙;

    16.胰缺損1/2;

    17.小腸缺損1/2(包括回盲部);

    18.腹壁缺損大于腹壁1/4;

    19.腎上腺皮質功能輕度減退;

    20. 雙側睪丸萎縮,血清睪丸酮水平低于正常范圍;

    21.非利手全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能;

    22.一拇指完全缺失;

    23.雙下肢肌力IV級(四級),臨床判定不能恢復。大、小便失禁;

    24.一髖或一膝關節功能不全;

    25.一側踝以下缺失或一側踝關節畸形,功能完全喪失,不能手術重建功能;

    26.雙足部分肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能;

    27.單足全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能。

    (九)三級丙等醫療事故

    器官大部分缺損或畸形,有輕度功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.不完全性失用、失寫、失讀、失認之一者,伴有神經系統客觀檢查陽性所見;

    2.全身瘢痕面積50—59%;

    3.雙側中度周圍性面癱,臨床判定不能恢復;

    4.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>140ms(毫秒),矯正視力0.1—0.3,視野半徑<20o;

    5.雙耳經客觀檢查證實聽力損失大于56dbHL(分貝);

    6.喉保護功能喪失,飲食時嗆咳并易發生誤吸,臨床判定不能恢復;

    7.頸頦粘連,影響部分活動;

    8.肺葉缺失伴輕度功能障礙;

    9.持續性心功能不全,心功能二級;

    10.胃缺損1/2伴輕度功能障礙;

    11.肝缺損1/4伴輕度功能障礙;

    12.慢性輕度中毒性肝病,伴輕度功能障礙;

    13.膽道損傷,需行膽腸吻合術;

    14.胰缺損1/3伴輕度功能障礙;

    15.小腸缺損1/2伴輕度功能障礙;

    16.結腸大部分缺損;

    17.永久性膀胱造瘺;

    18.未育婦女單側乳腺缺失;

    19.未育婦女單側卵巢缺失;

    20.育齡已育婦女雙側輸卵管缺失;

    21.育齡已育婦女子宮缺失或部分缺損;

    22.陰道狹窄不能通過二橫指;

    23.頸部或腰部活動度喪失50%以上;

    24.腕、肘、肩、踝、膝、髖關節之一喪失功能50%以上;

    25.截癱或偏癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    26.單肢兩個大關節(肩、肘、腕、髖、膝、踝)功能部分喪失,能行關節置換;

    27.一側肘上缺失或肘、腕、手功能部分喪失,可以手術重建功能或裝配假肢;

    28.一手缺失或功能部分喪失,另一手功能喪失50%以上,可以手術重建功能或裝配假肢;

    29.一手腕上缺失,另一手拇指缺失,可以手術重建功能或裝配假肢;

    30.一手全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    31.單手部分肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    32.除拇指外3指缺失或功能完全喪失;

    33.雙下肢長度相差4cm以上;

    34.雙側膝關節或者髖關節功能部分喪失,可以行關節置換;

    35.單側下肢膝上缺失,可以裝配假肢;

    36.雙足部分肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    37.單足全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復。

    (十)三級丁等醫療事故

    器官部分缺損或畸形,有輕度功能障礙,無醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.邊緣智能;

    2.發聲及言語困難;

    3.雙眼結構損傷,較好眼閃光視覺誘發電位(VEP)>130ms(毫秒),矯正視力0.3—0.5,視野半徑<30o;

    4.雙耳經客觀檢查證實聽力損失大于41dbHL(分貝)或單耳大于91dbHL(分貝);

    5.耳郭缺損2/3以上;

    6. 器械或異物誤入呼吸道需行肺段切除術;

    7.甲狀旁腺功能輕度損害;

    8.肺段缺損,輕度持續肺功能障礙;

    9.腹壁缺損小于1/4;

    10.一側腎上腺缺失伴輕度功能障礙;

    11.一側睪丸、附睪缺失伴輕度功能障礙;

    12.一側輸精管缺損,不能修復;

    13.一側卵巢缺失,一側輸卵管缺失;

    14.一手缺失或功能完全喪失,另一手功能正常,可以手術重建功能及裝配假肢;

    15.雙大腿肌力近V級(五級),雙小腿肌力III級(三級)以下,臨床判定不能恢復。大、小便輕度失禁;

    16.雙膝以下缺失或無功能,可以手術重建功能或裝配假肢;

    17.單側下肢膝上缺失,可以手術重建功能或裝配假肢;

    18.一側膝以下缺失,另一側前足缺失,可以手術重建功能或裝配假肢。

    (十一)三級戊等醫療事故

    器官部分缺損或畸形,有輕微功能障礙,無醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.腦葉缺失后輕度智力障礙;

    2.發聲或言語不暢;

    3.雙眼結構損傷,較好眼閃光視覺誘發電位(VEP)>120ms(毫秒),矯正視力<0.6,視野半徑<50o;

    4.淚器損傷,手術無法改進溢淚;

    5.雙耳經客觀檢查證實聽力在原有基礎上損失大于31dbHL(分貝)或一耳聽力在原有基礎上損失大于71dbHL(分貝);

    6.耳郭缺損大于1/3而小于2/3;

    7.甲狀腺功能低下;

    8.支氣管損傷需行手術治療;

    9.器械或異物誤入消化道,需開腹取出;

    10.一拇指指關節功能不全;

    11.雙小腿肌力IV級(四級),臨床判定不能恢復。大、小便輕度失禁;

    12.手術后當時引起脊柱側彎30度以上;

    13.手術后當時引起脊柱后凸成角(胸段大于60度,胸腰段大于30度,腰段大于20度以上);

    14.原有脊柱、軀干或肢體畸形又嚴重加重;

    15.損傷重要臟器,修補后功能有輕微障礙。

    (十二)四級醫療事故

    系指造成患者明顯人身損害的其他后果的醫療事故。例如造成患者下列情形之一的:

    1、雙側輕度不完全性面癱,無功能障礙;

    2、面部輕度色素沉著或脫失;

    3、一側眼瞼有明顯缺損或外翻;

    4、拔除健康恒牙;

    5、器械或異物誤入呼吸道或消化道,需全麻后內窺鏡下取出;

    6、口周及顏面軟組織輕度損傷;

    7、非解剖變異等因素,拔除上頜后牙時牙根或異物進入上頜竇需手術取出;

    8、組織、器官輕度損傷,行修補術后無功能障礙;

    9、一拇指末節1/2缺損;

    10、一手除拇指、食指外,有兩指近側指間關節無功能;

    11、一足拇趾末節缺失;

    12、軟組織內異物滯留;

    13、體腔遺留異物已包裹,無需手術取出,無功能障礙;

    14、局部注射造成組織壞死。成人大于體表面積2%,兒童大于體表面積5%;

    15、剖腹產引起胎兒損傷;

    16、產后胎盤殘留引起大出血,無其他并發癥。

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    2醫療事故等級賠償標準

    《標準》將一級乙等醫療事故至三級戊等醫療事故對應的傷殘等級為一至十級:

    (1)一級乙等醫療事故為一級傷殘,賠償指數100%;

    (2)二級甲等醫療事故為二級傷殘,賠償指數90%;

    (3)二級乙等醫療事故為三級傷殘,賠償指數80%;

    (4)二級丙等醫療事故為四級傷殘,賠償指數70%;

    (5)二級丁等醫療事故為五級傷殘,賠償指數60%;

    (6)三級甲等醫療事故為六級傷殘,賠償指數50%;

    (7)三級乙等醫療事故為七級傷殘,賠償指數40%;

    (8)三級丙等醫療事故為八級傷殘,賠償指數30%;

    (9)三級丁等醫療事故為九級傷殘,賠償指數20%;

    (10)三級戊等醫療事故為十級傷殘,賠償指數10%。

    患者及其家屬在與醫療機構協商解決或訴諸法律時,應注意一級甲等醫療事故不屬于殘疾,應當向醫療機構主張喪葬費、被扶養人生活費、死亡賠償金、精神損害撫慰金以及死者配偶和直系親屬所需交通費、誤工費和住宿費,但是計算費用的人數不宜超過2人。

    對于鑒定為四級醫療事故的,不能按照殘疾的標準索賠,只能主張醫療費、誤工費、住院伙食補助費、陪護費、交通費和住宿費等必要的合理的費用。

    醫療事故給患者造成的各種損失,法院會根據醫療機構和患者在整個醫療事故中的過錯程度來承擔一定的責任,如完全責任、主要責任、同等責任和次要責任。

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    3一級甲等醫療事故賠償標準

    (一)醫療費:按照醫療事故對患者造成的人身損害進行治療所發生的醫療費用計算,憑據支付,但不包括原發病醫療費用。結案后確實需要繼續治療的,按照基本醫療費用支付。

    (二)誤工費:患者有固定收入的,按照本人因誤工減少的固定收入計算,對收入高于醫療事故發生地上一年度職工年平均工資3倍以上的,按照3倍計算;無固定收入的,按照醫療事故發生地上一年度職工年平均工資計算。

    (三)住院伙食補助費:按照醫療事故發生地國家機關一般工作人員的出差伙食補助標準計算。

    (四)陪護費:患者住院期間需要專人陪護的,按照醫療事故發生地上一年度職工年平均工資計算。

    (五)殘疾生活補助費:根據傷殘等級,按照醫療事故發生地居民年平均生活費計算,自定殘之月起最長賠償30年;但是,60周歲以上的,不超過15年;70周歲以上的,不超過5年。

    (六)殘疾用具費:因殘疾需要配置補償功能器具的,憑醫療機構證明,按照普及型器具的費用計算。

    (七)喪葬費:按照醫療事故發生地規定的喪葬費補助標準計算。

    (八)被扶養人生活費:以死者生前或者殘疾者喪失勞動能力前實際扶養且沒有勞動能力的人為限,按照其戶籍所在地或者居所地居民最低生活保障標準計算。對不滿16周歲的,扶養到16周歲。對年滿16周歲但無勞動能力的,扶養20年;但是,60周歲以上的,不超過15年;70周歲以上的,不超過5年。

    (九)交通費:按照患者實際必需的交通費用計算,憑據支付。

    (十)住宿費:按照醫療事故發生地國家機關一般工作人員的出差住宿補助標準計算,憑據支付。

    (十一)精神損害撫慰金:按照醫療事故發生地居民年平均生活費計算。造成患者死亡的,賠償年限最長不超過6年;造成患者殘疾的,賠償年限最長不超過3年。

    參加醫療事故處理的患者近親屬所需交通費、誤工費、住宿費,參照有關規定計算,計算費用的人數不超過2人。

    醫療事故造成患者死亡的,參加喪葬活動的患者的配偶和直系親屬所需交通費、誤工費、住宿費,參照有關規定計算,計算費用的人數不超過2人。

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    4一級醫療事故分級標準

    一級甲等醫療事故

    死亡。

    一級乙等醫療事故

    重要器官缺失或功能完全喪失,其他器官不能代償,存在特殊醫療依賴,生活完全不能自理。例如造成患者下列情形之一的:

    1.植物人狀態;

    2.極重度智能障礙;

    3.臨床判定不能恢復的昏迷;

    4.臨床判定自主呼吸功能完全喪失,不能恢復,靠呼吸機維持;

    5.四肢癱,肌力0級,臨床判定不能恢復。

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    5二級醫療事故分級標準

    二級甲等醫療事故

    器官缺失或功能完全喪失,其他器官不能代償,可能存在特殊醫療依賴,或生活大部分不能自理。例如造成患者下列情形之一的:

    1.雙眼球摘除或雙眼經客觀檢查證實無光感;

    2.小腸缺失90%以上,功能完全喪失;

    3.雙側有功能腎臟缺失或孤立有功能腎缺失,用透析替代治療;

    4.四肢肌力Ⅱ級(二級)以下(含Ⅱ級),臨床判定不能恢復;

    5.上肢一側腕上缺失或一側手功能完全喪失,不能裝配假肢,伴下肢雙膝以上缺失。

    二級乙等醫療事故

    存在器官缺失、嚴重缺損、嚴重畸形情形之一,有嚴重功能障礙,可能存在特殊醫療依賴,或生活大部分不能自理。例如造成患者下列情形之一的:

    1.重度智能障礙;

    2.單眼球摘除或經客觀檢查證實無光感,另眼球結構損傷,閃光視覺誘發電位(VEP)P100波潛時延長>160ms(毫秒),矯正視力<0.02,視野半徑<5°;

    3.雙側上頜骨或雙側下頜骨完全缺失;

    4.一側上頜骨及對側下頜骨完全缺失,并伴有顏面軟組織缺損大于30cm2;

    5.一側全肺缺失并需胸改術;

    6.肺功能持續重度損害;

    7.持續性心功能不全,心功能四級;

    8.持續性心功能不全,心功能三級伴有不能控制的嚴重心律失常;

    9.食管閉鎖,攝食依賴造瘺;

    10.肝缺損3/4,并有肝功能重度損害;

    11.膽道損傷致肝功能重度損害;

    12.全胰缺失;

    13.小腸缺損大于3/4,普通膳食不能維持營養;

    14.腎功能部分損害不全失代償;

    15.兩側睪丸、副睪丸缺損;

    16.陰莖缺損或性功能嚴重障礙;

    17.雙側卵巢缺失;

    18.未育婦女子宮全部缺失或大部分缺損;

    19.四肢癱,肌力Ⅲ級(三級)或截癱、偏癱,肌力Ⅲ級以下,臨床判定不能恢復;

    20.雙上肢腕關節以上缺失、雙側前臂缺失或雙手功能完全喪失,不能裝配假肢;

    21.肩、肘、髖、膝關節中有四個以上(含四個)關節功能完全喪失;

    22.重型再生障礙性貧血(I型)。

    二級丙等醫療事故

    存在器官缺失、嚴重缺損、明顯畸形情形之一,有嚴重功能障礙,可能存在特殊醫療依賴,或生活部分不能自理。例如造成患者下列情形之一的:

    1.面部重度毀容;

    2.單眼球摘除或客觀檢查無光感,另眼球結構損傷,閃光視覺誘發電位(VEP)>155ms(毫秒),矯正視力<0.05,視野半徑<10°;

    3.一側上頜骨或下頜骨完全缺失,伴顏面部軟組織缺損大于30cm2;

    4.同側上下頜骨完全性缺失;

    5.雙側甲狀腺或孤立甲狀腺全缺失;

    6.雙側甲狀旁腺全缺失;

    7.持續性心功能不全,心功能三級;

    8.持續性心功能不全,心功能二級伴有不能控制的嚴重心律失常;

    9.全胃缺失;

    10.肝缺損2/3,并肝功能重度損害;

    11.一側有功能腎缺失或腎功能完全喪失,對側腎功能不全代償;

    12.永久性輸尿管腹壁造瘺;

    13.膀胱全缺失;

    14.兩側輸精管缺損不能修復;

    15.雙上肢肌力IV級(四級),雙下肢肌力0級,臨床判定不能恢復;

    16.單肢兩個大關節(肩、肘、腕、髖、膝、踝)功能完全喪失,不能行關節置換;

    17.一側上肢肘上缺失或肘、腕、手功能完全喪失,不能手術重建功能或裝配假肢;

    18.一手缺失或功能完全喪失,另一手功能喪失50%以上,不能手術重建功能或裝配假肢;

    19.一手腕上缺失,另一手拇指缺失,不能手術重建功能或裝配假肢;

    20.雙手拇、食指均缺失或功能完全喪失無法矯正;

    21.雙側膝關節或者髖關節功能完全喪失,不能行關節置換;

    22.一下肢膝上缺失,無法裝配假肢;

    23.重型再生障礙性貧血(II型)。

    二級丁等醫療事故

    存在器官缺失、大部分缺損、畸形情形之一,有嚴重功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.中度智能障礙;

    2.難治性癲癇;

    3.完全性失語,伴有神經系統客觀檢查陽性所見;

    4.雙側重度周圍性面癱;

    5.面部中度毀容或全身瘢痕面積大于70%;

    6.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>155ms(毫秒),矯正視力<0.05,視野半徑<10°;

    7.雙耳經客觀檢查證實聽力在原有基礎上損失大于91dbHL(分貝);

    8.舌缺損大于全舌2/3;

    9.一側上頜骨缺損1/2,顏面部軟組織缺損大于20cm2;

    10.下頜骨缺損長6cm以上的區段,口腔、顏面軟組織缺損大于20cm2;

    11.甲狀旁腺功能重度損害;

    12.食管狹窄只能進流食;

    13.吞咽功能嚴重損傷,依賴鼻飼管進食;

    14.肝缺損2/3,功能中度損害;

    15.肝缺損1/2伴有膽道損傷致嚴重肝功能損害;

    16.胰缺損,胰島素依賴;

    17.小腸缺損2/3,包括回盲部缺損;

    18.全結腸、直腸、肛門缺失,回腸造瘺;

    19.腎上腺功能明顯減退;

    20.大、小便失禁,臨床判定不能恢復;

    21.女性雙側乳腺缺失;

    22.單肢肌力Ⅱ級(二級),臨床判定不能恢復;

    23.雙前臂缺失;

    24.雙下肢癱;

    25.一手缺失或功能完全喪失,另一手功能正常,不能手術重建功能或裝配假肢;

    26.雙拇指完全缺失或無功能;

    27.雙膝以下缺失或無功能,不能手術重建功能或裝配假肢;

    28.一側下肢膝上缺失,不能手術重建功能或裝配假肢;

    29.一側膝以下缺失,另一側前足缺失,不能手術重建功能或裝配假肢;

    30.雙足全肌癱,肌力Ⅱ級(二級),臨床判定不能恢復。

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    6三級醫療事故分級標準

    三級甲等醫療事故

    存在器官缺失、大部分缺損、畸形情形之一,有較重功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.不完全失語并伴有失用、失寫、失讀、失認之一者,同時有神經系統客觀檢查陽性所見;

    2.不能修補的腦脊液瘺;

    3.尿崩,有嚴重離子紊亂,需要長期依賴藥物治療;

    4.面部輕度毀容;

    5.面頰部洞穿性缺損大于20cm2;

    6.單側眼球摘除或客觀檢查無光感,另眼球結構損傷,閃光視覺誘發電位(VEP)>150ms(毫秒),矯正視力0.05—0.1,視野半徑<15°;

    7.雙耳經客觀檢查證實聽力在原有基礎上損失大于81dbHL(分貝);

    8.鼻缺損1/3以上;

    9.上唇或下唇缺損大于1/2;

    10.一側上頜骨缺損1/4或下頜骨缺損長4cm以上區段,伴口腔、顏面軟組織缺損大于10cm2;

    11.肺功能中度持續損傷;

    12.胃缺損3/4;

    13.肝缺損1/2伴較重功能障礙;

    14.慢性中毒性肝病伴較重功能障礙;

    15.脾缺失;

    16.胰缺損2/3造成內、外分泌腺功能障礙;

    17.小腸缺損2/3,保留回盲部;

    18.尿道狹窄,需定期行尿道擴張術;

    19.直腸、肛門、結腸部分缺損,結腸造瘺;

    20.肛門損傷致排便障礙;

    21.一側腎缺失或輸尿管狹窄,腎功能不全代償;

    22.不能修復的尿道瘺;

    23.膀胱大部分缺損;

    24.雙側輸卵管缺失;

    25.陰道閉鎖喪失性功能;

    26.不能修復的III度(三度)會陰裂傷;

    27.四肢癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    28.單肢癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    29.肩、肘、腕關節之一功能完全喪失;

    30.利手全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    31.一手拇指缺失,另一手拇指功能喪失50%以上;

    32.一手拇指缺失或無功能,另一手除拇指外三指缺失或無功能,不能手術重建功能;

    33.雙下肢肌力III級(三級)以下,臨床判定不能恢復。大、小便失禁;

    34.下肢雙膝以上缺失伴一側腕上缺失或手功能部分喪失,能裝配假肢;

    35.一髖或一膝關節功能完全喪失,不能手術重建功能;

    36.雙足全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    37.雙前足缺失;

    38.慢性再生障礙性貧血。

    三級乙等醫療事故

    器官大部分缺損或畸形,有中度功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.輕度智能減退;

    2.癲癇中度;

    3.不完全性失語,伴有神經系統客觀檢查陽性所見;

    4.頭皮、眉毛完全缺損;

    5.一側完全性面癱,對側不完全性面癱;

    6.面部重度異常色素沉著或全身瘢痕面積達60%—69%;

    7.面部軟組織缺損大于20cm2;

    8.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>150ms(毫秒),矯正視力0.05—0.1,視野半徑<15°;

    9.雙耳經客觀檢查證實聽力損失大于71dbHL(分貝);

    10.雙側前庭功能喪失,睜眼行走困難,不能并足站立;

    11.甲狀腺功能嚴重損害,依賴藥物治療;

    12.不能控制的嚴重器質性心律失常;

    13.胃缺損2/3伴輕度功能障礙;

    14.肝缺損1/3伴輕度功能障礙;

    15.膽道損傷伴輕度肝功能障礙;

    16.胰缺損1/2;

    17.小腸缺損1/2(包括回盲部);

    18.腹壁缺損大于腹壁1/4;

    19.腎上腺皮質功能輕度減退;

    20.雙側睪丸萎縮,血清睪丸酮水平低于正常范圍;

    21.非利手全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能;

    22.一拇指完全缺失;

    23.雙下肢肌力IV級(四級),臨床判定不能恢復。大、小便失禁;

    24.一髖或一膝關節功能不全;

    25.一側踝以下缺失或一側踝關節畸形,功能完全喪失,不能手術重建功能;

    26.雙足部分肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能;

    27.單足全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復,不能手術重建功能。

    三級丙等醫療事故

    器官大部分缺損或畸形,有輕度功能障礙,可能存在一般醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.不完全性失用、失寫、失讀、失認之一者,伴有神經系統客觀檢查陽性所見;

    2.全身瘢痕面積50—59%;

    3.雙側中度周圍性面癱,臨床判定不能恢復;

    4.雙眼球結構損傷,較好眼閃光視覺誘發電位(VEP)>140ms(毫秒),矯正視力0.1—0.3,視野半徑<20°;

    5.雙耳經客觀檢查證實聽力損失大于56dbHL(分貝);

    6.喉保護功能喪失,飲食時嗆咳并易發生誤吸,臨床判定不能恢復;

    7.頸頦粘連,影響部分活動;

    8.肺葉缺失伴輕度功能障礙;

    9.持續性心功能不全,心功能二級;

    10.胃缺損1/2伴輕度功能障礙;

    11.肝缺損1/4伴輕度功能障礙;

    12.慢性輕度中毒性肝病伴輕度功能障礙;

    13.膽道損傷,需行膽腸吻合術;

    14.胰缺損1/3伴輕度功能障礙;

    15.小腸缺損1/2伴輕度功能障礙;

    16.結腸大部分缺損;

    17.永久性膀胱造瘺;

    18.未育婦女單側乳腺缺失;

    19.未育婦女單側卵巢缺失;

    20.育齡已育婦女雙側輸卵管缺失;

    21.育齡已育婦女子宮缺失或部分缺損;

    22.陰道狹窄不能通過二橫指;

    23.頸部或腰部活動度喪失50%以上;

    24.腕、肘、肩、踝、膝、髖關節之一喪失功能50%以上;

    25.截癱或偏癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    26.單肢兩個大關節(肩、肘、腕、髖、膝、踝)功能部分喪失,能行關節置換;

    27.一側肘上缺失或肘、腕、手功能部分喪失,可以手術重建功能或裝配假肢;

    28.一手缺失或功能部分喪失,另一手功能喪失50%以上,可以手術重建功能或裝配假肢;

    29.一手腕上缺失,另一手拇指缺失,可以手術重建功能或裝配假肢;

    30.利手全肌癱,肌力Ⅳ級(四級),臨床判定不能恢復;

    31.單手部分肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    32.除拇指外3指缺失或功能完全喪失;

    33.雙下肢長度相差4cm以上;

    34.雙側膝關節或者髖關節功能部分喪失,可以行關節置換;

    35.單側下肢膝上缺失,可以裝配假肢;

    36.雙足部分肌癱,肌力Ⅲ級(三級),臨床判定不能恢復;

    37.單足全肌癱,肌力Ⅲ級(三級),臨床判定不能恢復。

    三級丁等醫療事故

    器官部分缺損或畸形,有輕度功能障礙,無醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.邊緣智能;

    2.發聲及言語困難;

    3.雙眼結構損傷,較好眼閃光視覺誘發電位(VEP)>130ms(毫秒),矯正視力0.3—0.5,視野半徑<30°;

    4.雙耳經客觀檢查證實聽力損失大于41dbHL(分貝)或單耳大于91dbHL(分貝);

    5.耳郭缺損2/3以上;

    6.器械或異物誤入呼吸道需行肺段切除術;

    7.甲狀旁腺功能輕度損害;

    8.肺段缺損,輕度持續肺功能障礙;

    9.腹壁缺損小于1/4;

    10.一側腎上腺缺失伴輕度功能障礙;

    11.一側睪丸、附睪缺失伴輕度功能障礙;

    12.一側輸精管缺損,不能修復;

    13.一側卵巢缺失,一側輸卵管缺失;

    14.一手缺失或功能完全喪失,另一手功能正常,可以手術重建功能及裝配假肢;

    15.雙大腿肌力近V級(五級),雙小腿肌力III級(三級)以下,臨床判定不能恢復。大、小便輕度失禁;

    16.雙膝以下缺失或無功能,可以手術重建功能或裝配假肢;

    17.單側下肢膝上缺失,可以手術重建功能或裝配假肢;

    18.一側膝以下缺失,另一側前足缺失,可以手術重建功能或裝配假肢。

    三級戊等醫療事故

    器官部分缺損或畸形,有輕微功能障礙,無醫療依賴,生活能自理。例如造成患者下列情形之一的:

    1.腦葉缺失后輕度智力障礙;

    2.發聲或言語不暢;

    3.雙眼結構損傷,較好眼閃光視覺誘發電位(VEP)>120ms(毫秒),矯正視力<0.6,視野半徑<50°;

    4.淚器損傷,手術無法改進溢淚;

    5.雙耳經客觀檢查證實聽力在原有基礎上損失大于31dbHL(分貝)或一耳聽力在原有基礎上損失大于71dbHL(分貝);

    6.耳郭缺損大于1/3而小于2/3;

    7.甲狀腺功能低下;

    8.支氣管損傷需行手術治療;

    9.器械或異物誤入消化道,需開腹取出;

    10.一拇指指關節功能不全;

    11.雙小腿肌力IV級(四級),臨床判定不能恢復。大、小便輕度失禁;

    12.手術后當時引起脊柱側彎30度以上;

    13.手術后當時引起脊柱后凸成角(胸段大于60度,胸腰段大于30度,腰段大于20度以上);

    14.原有脊柱、軀干或肢體畸形又嚴重加重;

    15.損傷重要臟器,修補后功能有輕微障礙。

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    7四級醫療事故分級標準

    四級醫療事故系指造成患者明顯人身損害的其他后果的醫療事故。例如造成患者下列情形之一的:

    1.雙側輕度不完全性面癱,無功能障礙;

    2.面部輕度色素沉著或脫失;

    3.一側眼瞼有明顯缺損或外翻;

    4.拔除健康恒牙;

    5.器械或異物誤入呼吸道或消化道,需全麻后內窺鏡下取出;

    6.口周及顏面軟組織輕度損傷;

    7.非解剖變異等因素,拔除上頜后牙時牙根或異物進入上頜竇需手術取出;

    8.組織、器官輕度損傷,行修補術后無功能障礙;

    9.一拇指末節1/2缺損;

    10.一手除拇指、食指外,有兩指近側指間關節無功能;

    11.一足拇趾末節缺失;

    12.軟組織內異物滯留;

    13.體腔遺留異物已包裹,無需手術取出,無功能障礙;

    14.局部注射造成組織壞死,成人大于體表面積2%,兒童大于體表面積5%;

    15.剖宮產術引起胎兒損傷;

    16.產后胎盤殘留引起大出血,無其他并發癥。

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    8醫療事故等級是怎么確定的

    根據《醫療事故處理條例》第4條的規定,劃分醫療事故等級的依據是“對患者人身造成的損害程度”。

    1.醫療事故損害的是患者人身這一客體,這種損害可能是死亡,可能是殘疾,也可能是由于器質性損害導致的功能障礙,這種損害是客觀的,是可以檢查、檢測到的。在醫療事故的分級中沒有考慮精神損害問題。

    2.醫療事故等級的劃分依據是醫療行為對患者人身的損害程度。損害程度是通過損害的后果來體現的。根據《醫療事故處理條例》第49條的規定,醫療過失行為在醫療事故損害后果中的責任程度是決定醫療事故具體賠償數額的因素之一。

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    9醫療事故等級與傷殘等級的計算

    醫療事故分級標準(試行)

    為了科學劃分醫療事故等級,正確處理醫療事故爭議,保護患者和醫療機構及其醫務人員的合法權益,根據《醫療事故處理條例》,制定本標準。

    專家鑒定組在進行醫療事故技術鑒定、衛生行政部門在判定重大醫療過失行為是否為醫療事故或醫療事故爭議雙方當事人在協商解決醫療事故爭議時,應當按照本標準確定的基本原則和實際情況具體判定醫療事故的等級。

    本標準例舉的情形是醫療事故中常見的造成患者人身損害的后果。

    本標準中醫療事故一級乙等至三級戊等對應傷殘等級一至十級。

    一、一級醫療事故

    系指造成患者死亡、重度殘疾。

    (一)一級甲等醫療事故:死亡。

    (二)一級乙等醫療事故:重要器官缺失或功能完全喪失,其他器官不能代償,存在特殊醫療依賴,生活完全不能自理。例如造成患者下列情形之一的:

    1、植物人狀態;

    2、極重度智能障礙;

    3、臨床判定不能恢復的昏迷;

    4、臨床判定自主呼吸功能完全喪失,不能恢復,靠呼吸機維持;

    5、四肢癱,肌力0級,臨床判定不能恢復。

    二、二級醫療事故

    系指造成患者中度殘疾、器官組織損傷導致嚴重功能障礙。

    ..........

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    10優秀律師解答

    找什么部門鑒定醫療事故等級和傷殘等級
    你好,根據《醫療事故處理條例》第十四條 發生醫療事故的,醫療機構應當按照規定向所在地衛生行政部門報告。
    我的鑒定結果為構成四級醫療事故,醫方付輕微責任,我應該怎么做這種等級事故應該怎么計算賠償?
    搜集證據可以向法院提起訴訟,訴訟過程中法官會進行調解。

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