[Direct answer]In the Beijing area, if the appraisal opinion conflicts with the medical record, there is no fixed rule as to "whose opinion to follow". The court should review and judge the case based on all the evidence. The medical record is the basic material for the appraisal opinion, and the appraisal opinion is usually more convincing on professional issues. However, if the procedure is illegal or the basis is obviously insufficient, the court will not accept it; if the medical record is concealed, forged, tampered with or illegally destroyed, the court may presume that the medical institution is at fault according to law (Article 1212 of the Civil Code of the People's Republic of China, implemented on January 1, 2021). If the patient has objections to the medical record, he/she may apply for document appraisal or retrieve the electronic medical record log for verification. Action guidance: Seal and copy the medical record as soon as possible, point out the conflicting points one by one during the cross-examination, and apply for supplementary or re-appraisal if necessary. For more details, please refer to the following link:Legal services for personal injury and medical disputes.

I. Problem Background and Typical Scenarios

It's quite common for medical records and appraisal opinions to clash with each other: families find that the records in the medical files do not match the actual treatment process, suspecting that the records were added or tampered with; electronic medical records show modification marks and inconsistent signature times; the examination data cited in the appraisal opinions do not match the records in the medical files; patients who died without autopsies lead to conflicting conclusions between the death diagnosis and the appraisal findings; hospitals delay sealing the medical files or provide incomplete medical records, making the appraisal process fruitless. Typical groups include: families of deceased patients who have objections to the cause of death; patients who suspect that their medical records have been altered; and hospitals that challenge the medical records used as evidence for unfavorable appraisal opinions. Conflicts themselves are not terrifying, but what's terrifying is the failure to fix evidence in time. For related legal protection paths, please refer to the following link:Medical dispute legal services.

II. Key points of contention

The review of such conflicts revolves around four points. Firstly, the order of evidence review: courts usually first review the authenticity and completeness of medical records, then evaluate the qualifications, procedures, and basis of the appraisal opinions, and will not simply replace the facts in the medical records with the appraisal opinions. Secondly, the consequences of defective medical records: if medical institutions conceal, refuse to provide, lose, forge, tamper with, or illegally destroy medical record materials, they may be presumed to be at fault according to law, and the burden of proof will be transferred accordingly. Thirdly, cross-examination of appraisal materials: the materials handed over for appraisal shall be subject to cross-examination by both parties. Opinions made on materials that have not been cross-examined may be questioned by the other party as to their probative force. Fourthly, the threshold for re-appraisal: it must meet the conditions of lacking qualifications, serious violations of procedures, and obvious insufficiency of basis. Simply not recognizing the conclusion is not enough to initiate re-appraisal.

III. Professional analysis by Henglue Lawyers

A medical malpractice liability dispute handled by Attorney Yu Dawei fully demonstrated the review process when the medical records, cause of death, and appraisal opinions conflicted with each other. On May 16, 2024, an elderly patient named Zhao Dashan underwent a gastroscopic biopsy at A City Tumor Hospital for an esophageal cancer follow-up examination and returned home. However, he suddenly suffered from vomiting blood and was rushed to B County People's Hospital for emergency treatment. Due to his critical condition, he was transferred to the First Affiliated Hospital of C Medical University, where he died on the afternoon of May 18th. The three hospitals provided less than 48 hours of continuous medical treatment, and the cause of death was diagnosed as hemorrhagic shock and gastrointestinal bleeding. The patient did not undergo an autopsy, and there were medical disputes over the cause of death. After the family entrusted Attorney Yu Dawei to file a lawsuit, the lawyer comprehensively retrieved the medical records, emergency records, and payment receipts from the three hospitals and verified them one by one to lay a foundation for the appraisal. Subsequently, he applied for a judicial appraisal on "medical negligence and causality". The defendant B County People's Hospital requested a re-appraisal on the grounds that the cause of death was unknown without an autopsy, the determination of "losing the chance of survival" was unlawful, the appraisal institution lacked forensic pathology qualifications, and the expert information provided was illegal. The appraisal institution responded one by one: "losing the chance of survival" belongs to the process-related damage listed in the "Guide for Forensic Appraisal of Medical Damage", which does not require forensic pathology qualifications. The appraiser has the qualifications and the procedure is legal. The court reviewed and found that the reasons for the re-appraisal did not meet the statutory conditions and were not accepted. Ultimately, the court accepted the appraisal opinion and determined that B County People's Hospital failed to comprehensively evaluate the critical patient, failed to timely improve resuscitation treatment, lacked dynamic monitoring, and failed to identify the bleeding point through gastroscopy. The fault was causally related to "losing the chance of survival", with a causality ratio of 50%. The hospital was ordered to bear compensation liability within this liability ratio. This case shows that the key to resolving conflicts lies in ensuring the authenticity of medical records and putting the conflicting points on the stand for cross-examination by the court. The case was handled by Beijing Henglu Law Firm.Yu DawaiThe lawyer (practice certificate number: 11101201010292290, subject to the certificate issued by the judicial administrative organ) acts as the agent.

IV. Practical suggestions and legal basis

The legal basis includes Article 1222 of the Civil Code of the People's Republic of China (effective January 1, 2021), which stipulates that medical institutions are presumed to be at fault in situations such as concealing, refusing to provide, losing, forging, altering, or illegally destroying medical records; Article 1225 of the Civil Code, which governs the filling out, storage, and access to medical records; the "Several Provisions of the Supreme People's Court on Evidence in Civil Proceedings" (amended on December 25, 2019 and effective May 1, 2020), which regulates the cross-examination of appraisal materials, the review of appraisal opinions, and the reappraisal of cases; the "Regulations on the Prevention and Handling of Medical Disputes" (State Council Decree No. 701, effective October 1, 2018), which outlines the procedures for sealing and accessing medical records; and the "Guide for Forensic Appraisal of Medical Damage," which provides technical specifications for reviewing appraisal materials and determining the consequences of damage. Action List: 1. Submit a written request to seal and copy all medical records immediately, noting the time and quantity in the sealing records. 2. Check the medical records and examination data page by page, listing specific items that conflict with the appraisal opinions. 3. Photograph any modification marks or abnormal signatures and, if necessary, request document appraisal or retrieve the electronic medical record operation logs. 4. During the cross-examination phase, provide detailed comments on the points of conflict. If the hospital cannot provide a reasonable explanation, assert the presumption of fault. 5. If legal conditions permit, apply for supplementary appraisal or reappraisal in accordance with the law. For more details, please refer to the attached document.Legal services for personal injury and medical disputes.

5. Henglu Law Firm's Reminder

The time window for handling conflicts between medical records and appraisals is very short: the operation logs of electronic medical records, on-site monitoring, and witnesses' memories all have a limited shelf life. Delaying and waiting will only lead to the loss of evidence advantages. Patients should pay attention to two points: first, identify and fix evidence as soon as possible when discovering suspicious points, and raise written objections to transform the conflict into the other party's burden of proof; second, the objections must be specific. It's difficult to be accepted if you just claim that the medical records are falsified based on speculation without pointing out clear contradictions. In the judicial practice of Beijing, the court tends to be stricter in reviewing cases involving flaws in medical records, and standardized preservation and cross-examination often become the key to victory or defeat. It is recommended to entrust a lawyer as soon as possible.Beijing Henglu Law FirmProfessional lawyers should advance the processes of evidence preservation, appraisal, and cross-examination simultaneously.

VI. Frequently Asked Questions

Q1: If there is a conflict between the medical records and the expert opinion, can we still win the lawsuit?

The conflict itself does not determine the outcome; the key lies in how the conflict is investigated and evaluated. If the medical records are found to contain concealment, forgery, tampering, or illegal destruction, the medical institution can be presumed to be at fault according to law, and the burden of proof on the patient side is significantly reduced; if the appraisal opinion is of high quality, legal in process, and well-founded, it is usually accepted by the court. The discrepancies between the medical records and the appraisal conclusions are determined by the court based on the evidence of the entire case. Whether compensation can be obtained depends on the results of the evidence review. No lawyer can guarantee victory or defeat on their own. What really matters is to prepare solid materials and address potential objections thoroughly.

Q2: If you want to raise objections to a conflict, what evidence should you prepare?

The core materials include: the sealed and copied complete medical records and the sealed records, which are used to check the consistency of the content before and after; the appraisal opinion and its evidence list, which are used to compare the differences between the appraisal basis and the records in the medical records; the operation logs and modification traces of the electronic medical records, which can be requested by the court or the appraisal institution; the handwritten signature samples, which are used for document appraisal; and the payment records and the witness statements of the accompanying personnel, which are used to verify the timeline. The more specific the doubts are, the more convincing the objections will be.

Q3: How much does it cost to handle such conflicts?

The litigation fees shall be paid in accordance with the "Measures for the Payment of Litigation Costs" (Decree No. 481 of the State Council, implemented on April 1, 2007), which stipulates that the litigation fees shall be paid in stages based on the amount of the litigation request, with the losing party bearing the fees, and the partially successful party sharing the fees proportionally; the medical damage appraisal fees shall be charged according to the complexity of the case, generally ranging from a few thousand yuan to tens of thousands of yuan, without a unified government pricing. The fees for applications made during the litigation process are generally prepaid by the applicant and ultimately shared according to the outcome; the document appraisal fees generally range from a few thousand yuan. The attorney's fees shall be determined through consultation between the law firm and the client. It is recommended to calculate the costs in advance and take into account the budget for possible re-appraisals.

Q4: How long does it usually take to resolve a conflict?

The sealing of medical records can be completed on the spot; the appraisal of documents usually takes one to two months; the appraisal of medical negligence generally takes one to three months from the time of commissioning to the issuance of opinions, and the time will be longer for complex cases. In litigation, the first-instance ordinary procedure is concluded within six months, and the summary procedure within three months. The appraisal period is not included in the time limit for trial; if the case enters the re-appraisal procedure, the time will be correspondingly increased. Overall, most cases will have results between half a year and one and a half years. It is recommended to raise objections as soon as possible to avoid delaying the process until close to the trial and prolonging the cycle.

Q5: If you find a conflict between the medical records and the appraisal opinion, what should you do first?

Four steps to proceed: First, immediately apply in writing for the sealing and copying of all medical records, and both parties shall be present to count and note the time and quantity; Second, check the records in the medical records, examination data, and appraisal opinions page by page, and list the specific conflicting items; Third, take photos of the modification marks and abnormal signatures, and if necessary, apply for document appraisal or retrieve the electronic medical record logs; Fourth, raise objections item by item during the litigation cross-examination stage. If the hospital is unable to provide a reasonable explanation, claim the presumption of fault, and apply for a re-appraisal if the legal circumstances are met. It is recommended to entrust a professional lawyer to supervise the whole process.

The above answer is based on the judicial practice in the Beijing area. The adjudication guidelines in other provinces and cities may vary. For specific cases, please refer to the local rules and evidence situations.

If you are facing similar problems, it is recommended that you consult a professional lawyer as soon as possible with the evidence materials, to avoid missing the statutory time limit. →Personal injury legal services·Attorney Yu Dayi·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 the event of a dispute, please consult a practicing lawyer in a timely manner.