abstract:
Judicial appraisal of medical disputes and technical appraisal of medical acc
abstract:
Judicial appraisal of medical disputes and technical appraisal of medical accidents are both evidence-based procedures to deal with medical disputes. However, due to their different backgrounds, their legislative basis, research direction and identification standards are also obviously different. One is to judge the causal relationship between medical results and patients' life and health damage, and the other is to study whether medical behavior constitutes a medical accident. The fundamental difference between them is that one is to study and analyze medical results with legal theory, and the other is to study and analyze medical behavior with medical theory. The difference between judicial expertise and medical malpractice expertise not only causes widespread controversy in academic circles and judicial practice, but also has many adverse effects on maintaining normal medical order and the interests of both doctors and patients. In the era of "dualism", it is of profound practical and historical significance to study and discuss the differences and solutions between them for correctly applying the law and safeguarding the legitimate rights and interests of both doctors and patients.
Keywords: judicial expertise; Identification of medical accidents; Judicial expertise and medical malpractice expertise; Documentary examination opinions.
Text:
First, the background and coexisting confusion of technical appraisal of medical accidents and judicial appraisal of medical disputes
The predecessor of the Regulations on Handling Medical Accidents is the Measures for Handling Medical Accidents promulgated by the State Council 1987. This method is the legal basis for administrative handling and civil adjudication of medical disputes from 1980s to early 20th century. Article 18 of this method stipulates that if it is identified as a medical accident, it can be given a one-time economic compensation according to the level of the accident, the circumstances and the patient's situation, and the medical staff who have a medical accident will be given administrative sanctions. During this period, the economic relief measures for the victims of medical accidents are the principle of compensation.
Due to the reform of economic system and the improvement of citizens' legal consciousness, people realize that the contradiction between doctors and patients has gradually become prominent and become one of the social focus contradictions. In 2002, the State Council promulgated the Regulations on Handling Medical Accidents, and then the Ministry of Health promulgated seven supporting documents. The Regulations on Handling Medical Accidents upgrades the principle of economic compensation in the Measures for Handling Medical Accidents to the liability for compensation for medical accidents. However, the compensation provisions in the Regulations do not completely correspond to the compensation items, contents and standards in the General Principles of Civil Law, and the compensation stipulated in the Regulations on Handling Medical Accidents is only a low-limit compensation.
In 2005, the National People's Congress Standing Committee (NPCSC) adopted the Decision on the Administration of Judicial Appraisal, which confirmed and standardized the legal status and appraisal categories of social judicial appraisal institutions. Incorporate judicial expertise into the daily work scope of judicial expertise institutions. Since then, some appraisals involving medical disputes have been transferred from medical associations to judicial appraisal institutions.
The Tort Liability Law, implemented in July 1 1, 2065438, puts the medical tort liability in a separate chapter, which mainly stipulates that medical institutions and their medical personnel shall bear the liability for compensation if they infringe on patients in medical treatment activities. This law breaks the concept that medical damage is beyond the scope of medical malpractice. No matter whether it constitutes a medical accident or not, all medical behaviors that are at fault and cause damage to patients should be compensated. Because whether it constitutes an accident or not, as long as there is a medical fault, the concept of compensation for damage caused to patients has formed the understanding of legal persons. This * * * understanding further promotes the trend that medical dispute appraisal deviates from judicial appraisal procedure. Medical malpractice identification has been met with a certain degree of cold reception and criticism, and the medical malpractice identification has gradually decreased, and even the work of some medical malpractice identification institutions has stagnated. When patients are in dispute, try to find a reason not to participate in medical malpractice appraisal. The choice of medical malpractice appraisal and judicial appraisal has become a difficult problem for the parties and even the judicial organs.
After the implementation of the Tort Liability Law, the Regulations on Handling Medical Accidents, which should have been declared invalid, are still in force. Due to the parallel of medical accident appraisal and medical dispute judicial appraisal, the evidence collection of medical dispute cases has encountered difficulties. Some people call this phenomenon "duality". When dealing with medical disputes, some courts use judicial expertise and some use medical malpractice expertise. Some use medical malpractice identification first, then judicial expertise, and some use judicial expertise first, then medical malpractice identification. Some assess disability according to the "corresponding standard" of medical accidents, and some directly use the disability assessment standard of employees' work-related injuries. Different appraisals are associated with different compensation standards and contents, which indirectly complicates the contradiction between doctors and patients.
The coexistence of judicial expertise and medical malpractice expertise not only wastes social expertise resources, but also puzzles the choice of parties and the use of judicial personnel. From the analysis of legal rank, Tort Liability Law is the superior law, and Regulations on Handling Medical Accidents is the subordinate law, so the judicial expertise based on Tort Liability Law should be more effective than medical malpractice appraisal. However, the identification of medical malpractice is vividly in front of people. When medical institutions encounter medical disputes, they are good at choosing medical accident identification procedures. From the analysis of legal practice, the conclusions of medical malpractice appraisal are mostly beneficial to medical institutions, and judicial appraisal is more beneficial to patients; From the analysis of the law of scientific development, judicial expertise belongs to the category of social science, and its development law is "anti-folding" A law came into being and a new mechanism began to operate. However, due to the application of medical professional knowledge, the nature of medical malpractice identification is biased towards the field of natural science, and its development law presents a "spiral" development law, from one to two, and it continues to progress until it is endless. The development law of the two can not be the same; Most directly, medical resources and the enthusiasm of medical staff should be protected, and the rights and interests of patients should also be protected. Both should not be neglected. The application of forensic expertise may be too critical of medical aspects, and it may also have a certain impact on some medical theories, such as surgical side injuries, complications, complications, medical accidents and so on. These are covered by the causal relationship in judicial expertise. Regardless of medical characteristics, only talking about medical effect, judicial expertise is bound to draw the conclusion that infection is related to surgery, and may further describe the situation of improper operation selection and unfavorable measures to prevent and control infection. Such a conclusion is powerful for patients to get compensation, but unfavorable for doctors. Choosing the technical appraisal of medical malpractice, the problem of surgical infection will generally be classified as a surgical complication, which does not constitute an accident, and the doctor will not bear the responsibility. Unless the patient finds that the doctor is at fault in preventing and controlling infection. In medical malpractice identification, it is not easy for patients to win the case because the identification resources and medical materials are in the medical side. Surgical infection is a complication of surgery, and it is a conclusion that no compensation will be paid if it does not constitute an accident. Without discussing whether the medical accident constitutes, judicial expertise is likely to take the causal relationship between surgery and infection as the appraisal conclusion, attribute natural factors to the responsibility of medical behavior, and regard doctors as "omnipotent". It is bound to harm the interests and work enthusiasm of medical staff, and the negative effect of medical staff's work enthusiasm will be counterproductive to the majority of medical staff.
The confusion of the coexistence of judicial expertise and medical malpractice expertise lies not only in the theory of the previous case, but also in the unfairness of legal practice. The compensation items, standards and years obtained by judicial expertise are the compensation contents stipulated in the General Principles of Civil Law. Medical malpractice identification leads to "low limit" compensation for medical protection measures, which are quite different from each other in terms of disability level, compensation standard and compensation period. Especially in the compensation for death or disability caused by patients, the general principles of civil law stipulate the per capita disposable income, while the compensation for medical accidents is the average living expenses, and the difference between them is nearly double. The existence of these differences has turned the doctor-patient relationship that should be "grateful" into one of the more complicated and prominent social contradictions.
In addition to theoretical and practical confusion, there is another question: who should go and who should stay in judicial expertise and medical malpractice expertise, or continue to coexist. Lawmakers believe that since the Tort Liability Law is a superior law, there is no need to discuss the effectiveness of the Regulations on Handling Medical Accidents as a subordinate law. Health professionals believe that forensic doctors don't understand clinical medicine, and there is no explicit invalid provision in the State Council, so the technical appraisal of medical malpractice is irreplaceable. Judicial expertise is easily accepted by patients because it eliminates the suspicion of industry protection of "doctor-to-doctor expertise". The disadvantage is that the appraiser lacks medical clinical professional knowledge and scientific appraisal equipment. The reason why doctors prefer medical malpractice identification is that it can reflect the particularity of medicine and does not constitute an accident without compensation. The disadvantage is that the accident is difficult to confirm, and both have their own advantages and disadvantages. In order to better safeguard the life and health interests of citizens, to better safeguard the normal medical order and national medical resources, and to promote the development of medical science, the legal status of judicial expertise should not be shaken, and the medical accident appraisal procedure should not be abandoned. The key lies in how to choose the appraisal accurately according to the nature of different cases. The compensation standard of medical malpractice should be consistent with the Tort Liability Law. The confusion caused by the coexistence of judicial expertise and medical malpractice expertise can be solved in practice, and some have yet to be solved by legislation. It is necessary to amend the Regulations on Handling Medical Accidents by legislation.
Second, the difference between judicial expertise and medical malpractice identification
The differences between judicial expertise and medical malpractice expertise mainly include social attributes, organizational methods, identification procedures, research direction and content, court cross-examination and so on.
(A) the difference between social attributes
The conclusion of judicial authentication is made by a social authentication institution approved by the judicial administrative department. The legal basis for the examination and approval by the judicial administrative department is the Decision on the Administration of Judicial Appraisal made by the National People's Congress Standing Committee (NPCSC). Therefore, judicial expertise belongs to the legal category of social science.
The conclusion of medical malpractice appraisal is made by the medical malpractice appraisal committees at all levels. The members of the medical malpractice appraisal committee are composed of medical experts. The legal basis for the establishment of the medical accident appraisal committee is the Regulations on Handling Medical Accidents promulgated by the State Council. Therefore, medical malpractice identification should belong to the category of national administrative regulations. During the period of "Measures for Handling Medical Accidents", some people called the appraisal of medical accidents "the appraisal given by Laozi to his son". At present, medical expertise has not been completely "born out" from the administrative organs, which can be called "brother expertise" In addition, medical knowledge is needed for medical malpractice identification, and medicine belongs to natural science, so does medical malpractice identification.
(b) organizational differences
Judicial authentication shall be conducted by social authentication institutions, and the appraiser shall be approved and registered by the judicial administrative organ. There should be more than two appraisers, who can ask for expert opinions on specialist and professional technical issues, and finally the appraisers will issue expert opinions.
Medical malpractice identification is organized by medical associations at all levels. The local medical associations at the municipal and county levels divided into districts in provinces, autonomous regions and municipalities directly under the Central Government are responsible for organizing the first appraisal, and the local medical associations in provinces, autonomous regions and municipalities directly under the Central Government are responsible for organizing the second appraisal. The medical association shall establish an expert database, and the expert database shall set up a discipline professional group according to the catalogue of discipline professional groups. The Chinese Medical Association is responsible for the identification of difficult, complicated and major medical disputes in China.
(C) the difference between identification procedures
1. The difference between startup programs.
Judicial appraisal can accept unilateral application, but medical malpractice appraisal does not accept unilateral application, which requires both doctors and patients to apply at the same time, either designated by the health bureau or entrusted by the judicial organs;
2. The difference between hearing procedures
Judicial expertise can be carried out by relying on the information provided by the client, without organizing a hearing, conducting a unilateral written examination, or inviting the other party to participate in the hearing. The appraisal of medical malpractice must be provided by both parties, and there must be a hearing attended by both parties.
3. Jurisdiction differences
Judicial expertise is not limited by region and level. However, the appraisal of medical accidents was conducted by the municipal medical association of the place where the accident occurred for the first time, and if it needs to be appraised again, it shall be conducted by the medical associations of provinces, autonomous regions and municipalities directly under the Central Government. The appraisal procedure of Chinese Medical Association is unnecessary.
4. Difference of appraisal time limit
Generally, the judicial expertise should be issued within 15 days. With the consent of the appraiser and the consent of the client, the extension can be up to 30 days and not more than 60 days. 7 days before the medical accident appraisal, both parties shall be informed in writing of the time, place and requirements of the appraisal, and the appraisal shall be organized and issued within 45 days from the date of receiving the materials.
5. Identify signature differences
The judicial appraiser must sign the appraisal book. The experts who participated in the medical malpractice appraisal did not sign the appraisal book.
6. Differences in professional consultation
Professional and technical issues of judicial expertise can be consulted by local or foreign experts. However, the identification of medical accidents is generally carried out by experts from the affiliated expert database. When the number of experts in this expert database is insufficient, another medical association may be entrusted.
7. Differences in distribution procedures
Judicial authentication documents shall be issued by appraisers and, if necessary, by authorized examiners. Medical malpractice appraisal is issued by the head of the expert group.
8. Identify differences between samples.
Judicial expertise shall be conducted according to the materials provided by the client. When conditions permit and necessary, the appraiser can conduct autopsy to extract pathological materials and analyze pathological drugs; In the identification of medical malpractice, the medical association does not organize autopsy or make samples, and relies entirely on the samples and materials provided by the client for demonstration and analysis. Judicial expertise can be tested by documentary evidence. If there is no autopsy that affects the determination of the cause of death, the medical association will not accept the entrustment and will not write a documentary review opinion.
(D) identify the differences between research direction and research content
The direction of forensic research is generally medical results. In view of the patient's objection, the causal relationship participation in medical results is analyzed. The content of its research is whether the human body is infringed, the degree of infringement, the end time of medical treatment, the number and duration of nurses, nutritional needs and the participation of causality.
The research direction of medical malpractice identification is whether medical behavior violates laws, regulations and technical operation norms, and the research content is whether it constitutes an accident, accident level, accident responsibility degree, medical care suggestions, etc.
The essential difference between them is that one is to study people's life and health rights, and the other is to study whether medical behavior is legal and standardized.
(5) Differences in court cross-examination.
The judicial appraiser must appear in court for questioning when the court needs it, otherwise the appraisal conclusion will not be accepted. However, the experts involved in medical malpractice identification did not appear in court for questioning.
Three, the legal status of judicial expertise and medical malpractice identification
The legal status of judicial expertise and medical malpractice expertise is between the parties, and they do not represent patients or doctors. In civil trials, these two kinds of professional knowledge are evidence.
Although both expert conclusions are evidence in civil proceedings, their legal status is different due to their respective characteristics. First of all, judicial expertise comes from the legal system, and its conclusion is proof material, and its legal status only belongs to legal evidence. Secondly, the identification of medical malpractice comes from administrative regulations, and its conclusion is not only civil evidence, but also the administrative basis for health administrative organs to deal with it. Its legal status naturally combines the dual status of civil evidence and administrative basis. When the two are different, judicial expertise should be the main method.
Four, medical malpractice identification and judicial expertise.
(a) the technical ability and professional equipment of judicial expertise.
The General Principles of Judicial Appraisal stipulates that those who do not have the technical ability and equipment conditions cannot accept the entrustment of appraisal. Most social appraisal institutions lack specialized medical technicians and professional equipment for drug and pathological analysis, and often entrust other institutions to carry out auxiliary examination and drug and pathological analysis. The general court does not accept the appraisal conclusion of the drug pathology analysis report of the non-appraisal institution, and finds that the appraisal institution has no appraisal ability.
For the special problems that the appraisal institution does not have the professional equipment and technical ability to solve, it should not be entrusted by the appraisal institution, but should be carried out by the client and provide the conclusions of the special problems. The appraisal institution can conduct document review and appraisal.
The problem of unilaterally entrusting judicial expertise
Due to incomplete information, lack of subjective medical records and medical defenses, the court will not adopt the unilaterally entrusted appraisal conclusion. Due to the limitation of the statute of limitations, the necessity of striving for leading evidence and the fact that appraisal institutions are allowed to accept unilateral entrustment, the legitimacy and feasibility of unilateral entrustment appraisal cannot be denied. Although the client and the appraiser have no right to ask the other party to participate in the appraisal, the client and the appraiser can inform the other party by letter. Failure to participate is regarded as giving up, forcing the other party to participate, and the other party should also take the initiative to participate. In addition, the "flagpole effect" of unilateral entrustment can not be ignored. The appraisal entrusted unilaterally should be allowed to be re-appraised in the lawsuit to protect the other party's right to speak.
(c) Judicial experts did not analyze the lack of pathological reports.
In the identification of medical accidents, if there is no autopsy that affects the determination of the cause of death, it will not be entrusted. Pathological report is the gold standard of identification. Judicial expertise should not be entrusted without pathological report. However, if the cause of death and the causal relationship can be found from the written materials, the entrustment shall be accepted. This kind of appraisal belongs to the nature of written review, and the documents are issued to review opinions.
(four) the solution to the problem of judicial expertise.
It is impossible for judicial appraisers to fully master their professional expertise. A certain professional knowledge needs professional consultation, which is allowed by general judicial principles. Professional consulting materials should be attached to the appraisal book and should not be kept as internal files. However, consulting experts do not participate in court cross-examination as appraisers.
(5) Causality is involved in the assessment of the degree of responsibility of judicial expertise and medical malpractice identification.
At present, there is no unified national standard for the division of the degree of responsibility in judicial expertise. Generally, A, B, C, D and E are used for classification, some are classified by "six-point method", some are classified by "five-point method" and some are classified by "four-point method", and each method has a corresponding "responsibility coefficient". Others are directly evaluated by percentage method. These sub-methods still remain at the level of academic criticism. It is in a position of reference value in legal judgment. Causality participation in judicial expertise requires a unified industry standard.
The degree of responsibility of medical malpractice appraisal is divided into four grades: all, major, minor and minor, regardless of percentage. Percentage of judge's discretion when judging the degree of responsibility. A reasonable percentage should be 25 percentage points per file.
In judicial expertise, there is no need to study the legal norms of medical behavior. Because the problem of illegal and standardized medical behavior belongs to the category of medical accident identification.
(vi) Disability standards
In the identification of medical accidents, the disability standard is applicable to the classification standard of medical accidents, which corresponds to ten levels of disability. Judicial expertise mostly adopts the Classification Standard for Workers' Work Injury, and Beijing adopts the standard formulated by the local forensic medicine society. There are differences among the three standards, such as complete loss of single hip function, which belongs to level 6 disability in the classification standard of medical accidents, level 5 disability in the identification standard of workers' work-related injuries, and level 7 disability in the Beijing urban court. In view of the fact that medical damage is a kind of negligent tort damage and compensation has punitive factors, high standards should be adopted in appraisal.
There is symmetry in the application of disability standards. Whether the judicial expertise can refer to the "corresponding standard" of medical malpractice; Whether the judicial appraisal can refer to the "Disability Assessment Standard for Workers" applicable to the no-fault labor security; Whether to use medical dispute cases in the evaluation standard of employees' non-work-related injuries and disabilities needs to be unified and clear.
(7) Solving the problem of different conclusions.
If the conclusion of medical malpractice appraisal is different from that of judicial appraisal, the judicial appraisal institution may accept the application of the dissident and re-appraise. However, when re-appraising, only the original judicial appraisal items are re-examined and appraised, and the appraisal conclusion of medical accident is not taken as the evaluation basis, that is, the law of judicial appraisal is followed, and only the causal relationship of medical results is studied, and the fault of medical behavior is not studied.
(eight) to deal with the problems that are difficult to identify in judicial expertise.
"Unknown" and "variable" in clinical medicine are recognized by doctors as scientific knowledge. Everyone has the idea that the client hopes to get a favorable conclusion through appraisal. However, due to the limitation of scientific degree and objective conditions, as well as the development law of medicine itself, some medical dispute cases can not draw exact conclusions in appraisal. At this time, it is not convenient to simply make a positive or negative conclusion. We should scientifically use the method of "exclusion" or "cannot be excluded" to make a conclusion. For example, if the parturient excessively uses oxytocin before delivery, 25 units (usually 5 units, the maximum dosage shall not exceed 10 units) will be injected intravenously at one time, and "amniotic fluid embolism" will occur during delivery, and the rescue will be ineffective, and amniotic fluid tangible substances will be found in the heart and blood. The patient thinks that maternal death is related to the overdose of oxytocin, but the doctor thinks it has nothing to do with it, saying that there has been no problem in using this dose frequently before. Amniotic fluid embolism may be related to oxytocin overdose or caused by other reasons. However, in view of the fact that the overuse of oxytocin can't rule out the correlation, Beijing Fayuan Judicial Appraisal Center made an appraisal conclusion after accepting the entrustment: the overuse of oxytocin in pregnant women can't rule out the excessive contraction of uterine smooth muscle, which promotes the amniotic fluid remaining on the uterine wall to enter the maternal circulation, which has a causal relationship with maternal death. This conclusion was adopted by the judge and became a classic case.
(nine) the name of the death diagnosis confirmed by judicial expertise.
Respiratory and circulatory failure is the pathological evolution of patients' death, not the name of clinical diagnosis. But clinicians often use this pathological change as the name of death diagnosis.
When a patient dies of a sudden illness or an incurable disease, doctors often make a death diagnosis according to the symptoms of the patient before death. Such as circulatory and respiratory failure. This diagnosis is easy to cause disputes between patients. For this kind of dispute, the identification should be analyzed from two parts, one is whether the diagnosis of the primary disease is established, and the other is whether the emergency measures are appropriate. If the diagnosis of the primary disease is correct and the rescue measures are appropriate, there is no need to dispute the pathological diagnosis. If the diagnosis of primary disease is unfounded and the treatment measures are improper, the diagnosis of respiratory and circulatory failure should not be recognized in the identification. A patient was admitted to hospital because of acute appendicitis, and suddenly had difficulty breathing, sweating and vomiting during infusion. He told the medical staff that no special treatment was taken. Three hours later, the symptoms worsened and he died after being rescued. Death diagnosis: acute respiratory failure, circulatory failure, diffuse peritonitis, cerebral hemorrhage? Acute pulmonary embolism? The corpse was not autopsied and cremated, and the bottle and night were not preserved. After the body was cremated, some relatives suggested that the name of the hospital's death diagnosis was wrong, and it should be the death caused by infusion. After the patient's wife heard about it, she entrusted a lawyer to apply for judicial expertise. The application item is: 1. Is the diagnosis of death valid? 2. Whether the rescue measures are appropriate. Through judicial expertise, it is determined that respiratory and circulatory failure is not an independent disease that leads to death; The diagnosis of cerebral hemorrhage lacks evidence; Improper treatment of pulmonary embolism without using tracheal dilator has a causal relationship with the patient's death, and the participation rate is 30%. The patient filed a civil compensation lawsuit on the grounds of misdiagnosis and mistreatment.
(ten) identification of complications, complications, medical accidents and surgical side injuries.
In the identification of medical accidents, complications, complications, medical accidents and surgical side injuries are not medical accidents. However, in judicial expertise, we should pay attention to whether the above diseases can be avoided, and the avoidance is inevitable. Judicial expertise should still determine the causal relationship.
(eleven) the important taboo of judicial expertise
Most judicial appraisers lack clinical medical experience, and social judicial appraisal has economic benefits. Judicial expertise is often "eager for success" and "quick success", and it is easy to ignore clinical medical theory. Judicial expertise must respect medical science! If we don't take medicine as the basic point, we can't get the correct opinion of medical dispute appraisal. A consumer with liposuction of lower eyelid developed eye pain and headache three days after operation, and was diagnosed as bilateral uveitis, which stimulated retinal detachment. In judicial expertise, doctors have repeatedly stressed that consumers' eyelids are not infected, and the formation of uveitis has nothing to do with liposuction. However, in the absence of consultation with an ophthalmologist, the appraiser concluded that uveitis was directly related to liposuction, and the judge awarded the beautician compensation according to the appraisal conclusion. This case representatively shows that the judicial appraiser's indifference to medical science, and the conclusion made will not only affect the economic interests of the parties, but also undermine the scientific nature of the basic medical theory.
Conclusion:
The role of judicial expertise in handling medical disputes is gradually being reflected in civil trials. Because the system and mechanism of judicial expertise are still not perfect, and the technical strength of appraisal institutions is still insufficient, the procedure of medical malpractice appraisal should not be abandoned. The identification of medical malpractice is facing legal challenges, and there are indeed many defects, which should be revised through legislation. At present, the judicial expertise of medical damage and medical accident is parallel, which is an important means to judge the responsibility of medical fault in both jurisprudence and legal application. However, the identification of medical malpractice cases also shoulders the important social responsibility of improving the relationship between doctors and patients and promoting the harmony between doctors and patients when the Regulations on Handling Medical Accidents has not been clearly stipulated as invalid. The phenomenon that "saving the wounded and saving the dying" may also be investigated for compensation responsibility reflects the civilization of legal progress; But it is undeniable that this also reflects the decline of social morality and ethics. Therefore, the appraisers in charge of judicial appraisal of medical disputes and medical experts in charge of medical accident appraisal should respect medicine and law and conduct scientific appraisal fairly.
[1] Cui Gaoming, born in September, 1952, male, Han nationality, director of Heilongjiang Qianjin Law Firm, second-class lawyer, surgeon, research direction: prevention and treatment of medical disputes.
[2] Cui Xiuyu, born in July, 1980, male, Han nationality, Jiamusi, Heilongjiang, assistant to the director of Heilongjiang Qianjin Law Firm, bachelor of law, research direction: health law.