[Direct answer]In the Beijing area, the burden of proof in medical disputes is not entirely borne by patients. The law distributes this responsibility between patients and medical institutions. According to Article 121 of the Civil Code of the People's Republic of China (effective January 1, 2021), if a patient suffers harm during a medical procedure and the medical institution or its medical staff are at fault, the medical institution shall bear the liability for compensation. Article 122 stipulates the presumption of fault, which means that if medical staff fail to fulfill their obligations corresponding to the prevailing medical standards during the diagnosis and treatment process, causing harm to the patient, the medical institution shall bear the liability for compensation. Therefore, in the determination of fault, the law alleviates the burden of proof on patients through the presumption of fault. However, patients still need to provide preliminary evidence of the harm, the existence of the diagnosis and treatment process, and the causality between the harm and the diagnosis and treatment process. In addition, since medical records are kept by medical institutions, their integrity and authenticity directly affect the determination of fault. Patients should promptly apply to copy and seal the medical records. For reference, please refer to the following link:Personal injury and medical disputesThe service description in the column.

I. Problem Background and Typical Scenarios

Most of those seeking advice on this issue are family members of patients who are preparing to sue medical institutions. There are three common scenarios: severe postoperative complications with an unclear cause; lack of informed consent or obvious operational issues during the treatment process; and suspected consequences of delayed treatment. In practice, the most common dilemma is that patients have limited information: the treatment process is dominated by medical institutions, making it difficult for patients to understand the specific details of the operation, and the medical records are kept by the hospital. At this time, the key to providing evidence lies in exercising the rights granted by law: the right to request a copy of the medical records, the right to request the seal-up of the medical records, and the right to request that the medical records be kept by a neutral third party in the event of a dispute. Mastering these rights is often more important than debating the allocation of responsibilities afterwards.

II. Key points of dispute

First, the patient needs to bear the burden of proof for which facts. Second, the applicable conditions and scope of presumption of fault. Third, the rules for sealing and copying medical records and entrusting them to third parties. Fourth, the performance of the informed consent and disclosure obligations during the medical treatment process. Fifth, the distinction between causality and the patient's own disease factors. Sixth, the weight of appraisal opinions in determining fault. Seventh, the basis for calculating the items and amounts of damages. Eighth, the determination of the statute of limitations and the starting point. The time points for fixing and preserving evidence can be referred to for reference.Special services and other casesThe description of the column.

III. Professional analysis by Henglue Lawyers

Judging from the experience of handling medical dispute cases, the distribution of the burden of proof determines the design of the case strategy. The first step is to fix the medical records: apply for a copy of all medical records as soon as possible after the treatment ends and request a stamp. If any alterations, missing pages, or inaccurate records are found, a written objection should be raised on the spot and the records should be preserved; if necessary, apply to the People's Mediation Committee for Medical Disputes or a notary office for third-party sealing. The second step is to design the appraisal: the appraisal matters should be professional issues rather than legal application issues, and they should cover the focus of the dispute, such as whether there is a violation of medical treatment norms, whether there is a delay, and how the causality is involved. The third step is to demonstrate the causality in layers: since the patient's own disease often contributes to the formation of damage, it is necessary to determine the existence and degree of participation of the causality through appraisal, and then analyze the institution's faults based on the medical records and the treatment process. The fourth step is to design the request comprehensively: medical damage compensation involves multiple items, and it is necessary to deduct the part of the original disease. Professional calculation can significantly improve the credibility of the claim.

IV. Practical suggestions and legal basis

Action recommendations: 1. Apply to copy and seal all medical records as soon as possible, and verify the number of pages and content; 2. Submit written objections to any alterations or missing pages in the medical records on the spot; 3. Preserve all communication records and notification documents from the entire treatment process; 4. Apply for a medical damage appraisal after the treatment ends; 5. Organize a list of damage items and amounts, and provide supporting documents; 6. Assess the need to apply for property preservation; 7. Pay attention to the commencement and calculation of the statute of limitations. Legal basis: Articles 116, 179, 212, 213, and 221 of the Civil Code of the People's Republic of China (effective January 1, 2021); Currently valid regulations on the prevention and handling of medical disputes; Currently valid laws, regulations, and judicial rulings shall prevail in specific cases.

5. Henglu Law Firm's Reminder

Firstly, medical records are the core evidence in medical disputes, and it is essential to secure them as soon as possible. Secondly, although the law stipulates presumption of fault in certain circumstances, patients still need to provide preliminary evidence of the damage and the medical treatment. Thirdly, the scope of application of presumption of fault is limited, and specific claims and explanations are required. Fourthly, if there are missing or altered pages in the medical records, timely raise written objections and, if necessary, apply for third-party custody. Fifthly, the degree of causal involvement directly affects the liability ratio, and this needs to be fully expressed in the appraisal. Sixthly, attention should be paid to the fact that the patient's own illness factors may affect the determination of the compensation amount. Seventhly, the issue of the statute of limitations needs to be evaluated separately to avoid losing rights due to the appraisal period.

VI. Frequently Asked Questions

Q1: Do patients have to provide all the evidence in medical disputes?

No. In medical disputes, the burden of proof is shared: patients need to bear the initial burden of proof for the existence of the damage, the existence of the medical treatment, and the correlation between the damage and the medical treatment; while medical institutions bear the corresponding burden of proof for whether the medical treatment complies with the norms, whether there is any fault, and the extent of the causal relationship. The law stipulates the circumstances of presumed fault, so the responsibility of medical institutions in the determination of fault is greater, but the initial burden of proof for patients still exists.Personal injury and medical disputesThere is a more detailed explanation of this in the column.

Q2: The medical records are in the hospital's possession, and the hospital refuses to provide them. What should I do?

Patients have the right to request medical institutions to copy and provide their medical records, and medical institutions shall provide them as required. In practice, if the hospital refuses or delays to do so, patients can first report the matter to the hospital's medical management department or complaint channels; if the problem remains unresolved, they can report it to the health administrative department. In addition, the law stipulates the sealing and third-party custody of medical records. When necessary, patients can apply for medical records to be kept by a neutral third party to prevent the records from being modified. For complete procedural requirements, please refer to the relevant provisions.Special services and other casesColumn.

Q3: How can we prove that the hospital is at fault?

Generally, the investigation is conducted through four types of materials: first, medical records and examination records, which are used to reconstruct the diagnosis and treatment process; second, diagnosis and treatment standards and operating procedures, which are compared with actual operations to identify deviations; third, informed consent and notification documents, which are used to verify whether the obligation to provide information has been fulfilled; fourth, medical damage appraisal opinions, which are issued by qualified institutions to determine whether there are any faults and causalities. Among these materials, appraisal opinions are usually the most crucial evidence, but they need to be corroborated by medical records.

Q4: If the patient himself/herself is ill, will it affect the compensation?

Yes. In medical damage compensation cases, if the patient's own disease contributes to the formation of the damage, the appraisal opinion will determine the degree of causal involvement, and the court will determine the liability ratio and compensation amount based on this. Therefore, in the appraisal process, the patient's underlying disease situation should be fully explained and relevant medical records provided to avoid being overly attributed to the medical institution. A reasonable division of liability can ensure the fairness and enforceability of compensation. For specific liability determination approaches, please refer to the following reference materials:Special services and other casesColumn.

Q5: Is it necessary to do an appraisal?

In medical disputes, it is generally recommended to conduct an appraisal. Whether there is fault and what the causal relationship is are professional issues that judges cannot directly judge. Although the appraisal opinion is not the final conclusion, it is usually the main basis for the court to determine fault. The risk of not applying for an appraisal is that it is difficult for the patient to prove that there is fault in the medical treatment, and it is difficult to obtain support for the claim. Conversely, if the appraisal conclusion is unfavorable, they will also face corresponding liability risks. Therefore, it is recommended to evaluate whether to apply for an appraisal after the treatment is completed.

The above content is based on the compilation of judicial practices in the Beijing area. The facts of individual cases and the jurisdiction of the court may affect the conclusions. Welcome to consult Henglu Law Firm for specific cases.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with the relevant evidence materials, to avoid missing the statutory time limit. →Personal injury legal services·Beijing Henglu Law Firm

Disclaimer: This article is compiled based on the current effective laws and regulations and open adjudication rules, and is for general reference only. It does not constitute a formal legal opinion on specific cases. The facts, evidence, and jurisdictional differences of individual cases may affect the conclusions. In case of disputes, please consult a practicing lawyer in time.