[Title] Dispute over Intentional Injury, Civil Tort, Tetanus, Death, and Medical Malpractice Liability

[Keywords] Medical Injury Liability Disputes

【Key Points of the Ruling】

After being beaten by Qi at the dock, Liu suffered a comminuted fracture of the patella. The injury was assessed as minor, and Liu was subsequently hospitalized for medical treatment. During hospitalization, Liu developed a tetanus infection and was transferred to Weihai Central Hospital for further treatment. Unfortunately, despite intensive medical efforts, Liu died due to ineffective treatment. A postmortem examination confirmed that the cause of death was respiratory and circulatory failure resulting from tetanus infection. Subsequently, Liu’s family entrusted lawyers Lu Zongxing and Zhang Yuefeng to pursue their legal rights. After undergoing forensic examinations, the first-instance court ruled that the three defendants should bear compensation liability according to their respective proportions of fault. The second-instance court upheld the original verdict, and the retrial dismissed Qi’s application for a retrial. Ultimately, Liu’s family fully achieved their goal of protecting their rights and interests.

[Basic Facts of the Case]

Liu Moutao and Qi were crew members aboard the same fishing vessel. On September 30, 2023, while aboard the vessel, a physical altercation broke out between Liu Moutao and Qi over a verbal dispute. During the scuffle, Liu Moutao was attacked by Qi and fell from the ship’s side onto the deck, sustaining a patellar fracture. As a result, Liu Moutao was hospitalized at the People’s Hospital of a certain island, where he was diagnosed with a patellar fracture. He remained hospitalized at the hospital for 19 days, starting on September 30, 2023. After his admission, the People’s Hospital of the island provided him with treatments including anti-inflammatory therapy, blood circulation promotion, and thrombosis prevention. On October 2, 2023, Liu Moutao underwent open reduction and internal fixation of his patellar fracture using Kirschner wires and tension band wiring under femoral nerve block anesthesia. Postoperatively, he received sodium aescin for anti-inflammatory treatment and low-molecular-weight heparin for promoting blood circulation and preventing thrombosis. On October 8, 2023, after taking pain-relieving tablets, Liu Moutao experienced abdominal distension and discomfort, accompanied by episodic chest tightness. Tests ruled out pulmonary embolism and mesenteric thrombosis. Subsequently, Liu Moutao developed tension in his masticatory muscles and neck muscles. The People’s Hospital of the island considered the possibility of tetanus and recommended that Liu Moutao be transferred to a higher-level hospital for further treatment. On October 9, 2023, Liu Moutao was transferred to the City Central Hospital, where he was diagnosed with tetanus infection. The City Central Hospital administered him anti-infective therapy and intravenous fluid replacement. On October 10, 2023, Liu Moutao’s condition became critical. With the consent of his family, he was transferred to the Intensive Care Unit, where he received mechanical ventilation, sedation and analgesia, antitetanus toxin treatment, muscle relaxants, anti-infective therapy, wound debridement, maintenance of water and electrolyte balance, and nutritional support—all aimed at addressing his critical condition. Due to the severity of Liu Moutao’s condition, the City Central Hospital informed his family about his prognosis. However, due to internal family reasons, his family requested that mechanical ventilation and other aggressive treatments no longer be continued. On October 20, 2023, Liu Moutao passed away. Zu Wixiu, Yang Yanyan, and Liu C were Liu Moutao’s relatives. The first-order heir believes that the People’s Hospital of a certain island and the Central City Hospital, during Liu Moutao’s medical treatment, … There was serious negligence in diagnosis and treatment, so we have filed a lawsuit against the previous tortfeasor, Qi, and the Second Hospital.

Zu Wixiu and others submitted medical records from the People’s Hospital of a certain island, medical records from the Central Hospital of a certain city, as well as radiographic images of Liu Motao’s patella taken at the People’s Hospital of the said island on September 29, 2023, September 30, 2023, and October 3, 2023, to prove that Liu Motao had undergone diagnosis and treatment at both the People’s Hospital of the said island and the Central Hospital of the said city. On November 13, 2023, a forensic appraisal institute issued a forensic appraisal report concluding that Liu Motao died from respiratory failure caused by infection with Clostridium tetani. The People’s Hospital of the said island objected during cross-examination, stating that it disputed the conclusion that Liu Motao’s death was due to tetanus. According to the hospital, all bacterial culture results did not indicate the presence of Clostridium tetani. Without definitive evidence of tetanus bacterial infection, the conclusion that the patient died from tetanus was clearly insufficiently supported by evidence.

【Judgment Result】

1. Within ten days after this judgment becomes effective, the Defendant, the People’s Hospital of a certain island, shall pay to the Plaintiffs Zu Wixiu, Yang Yyan, and Liu C an amount equal to 15% of the reasonable expenses incurred by Liu Motao during his treatment at the People’s Hospital of the said island, totaling RMB 2,563.50; as well as 40% of the total amount comprising Liu Motao’s reasonable medical expenses incurred at the Municipal Central Hospital, death compensation, fees for copying medical records, funeral expenses (including living expenses for dependents), and transportation costs, which amounts to RMB 482,597.38. Additionally, the Defendant shall pay the appraisal fee (charged by a certain forensic appraisal institute) of RMB 10,800 and compensation for mental distress in the amount of RMB 40,000. The total sum payable by the Defendant is RMB 535,960.88.

2. Within ten days after this judgment becomes effective, the defendant Qi shall compensate the plaintiffs Zu Wixiu, Yang Yyan, and Liu C in the amount of 55% of the reasonable expenses incurred by Liu Taotao during his treatment at the People’s Hospital on a certain island, which totals RMB 17,090.05, i.e., RMB 9,399.53; as well as 15% of the total amount comprising Liu Taotao’s reasonable medical expenses incurred at the Central Hospital of a certain city, plus death compensation, fees for copying medical records, funeral expenses (including living expenses for dependents), and transportation costs, totaling RMB 1,206,493.46, i.e., RMB 180,974.02; additionally, the defendant shall pay the appraisal fee (charged by a certain forensic鉴定 institute) of RMB 4,050 and compensation for mental distress in the amount of RMB 2,000. The total amount to be paid is RMB 196,423.55.

3. Within ten days after this judgment becomes effective, the defendant, a certain city central hospital, shall pay to the plaintiffs Zu Wixiu, Yang Yyan, and Liu C an amount equal to 10% of the total sum of RMB 1,206,493.46—comprising the reasonable expenses incurred during Liu Motao’s treatment at the defendant hospital, death compensation, medical record copying fees, funeral expenses (including living expenses for dependents), and transportation costs—namely, RMB 120,649.35, plus the appraisal fee (charged by the Certain Judicial Appraisal Institute) of RMB 2,700 and compensation for mental distress in the amount of RMB 10,000, for a total of RMB 133,349.35.

【Reasoning of the Ruling】

Article 1179 of the Civil Code of the People's Republic of China stipulates that if someone inflicts bodily harm on another, they shall compensate for reasonable expenses incurred for treatment and rehabilitation, including medical expenses, nursing fees, transportation expenses, nutrition expenses, and inpatient meal allowances, as well as lost income due to missed work. Article 1173 of the Civil Code of the People's Republic of China further provides that if the injured party bears any fault for the occurrence or aggravation of the same damage, the liability of the tortfeasor may be reduced accordingly. If a patient suffers harm during medical treatment and the medical institution or its medical personnel are at fault, the medical institution shall bear the compensation liability. If someone inflicts bodily harm on another, they shall compensate for reasonable expenses incurred for treatment and rehabilitation, including medical expenses, nursing fees, transportation expenses, nutrition expenses, and inpatient meal allowances, as well as lost income due to missed work. In cases resulting in disability, compensation shall also cover the cost of assistive devices and disability compensation; in cases resulting in death, compensation shall further include funeral expenses and death compensation. If the infringement upon the personal rights of a natural person causes severe mental distress, the injured party has the right to claim compensation for mental damages. In this case, the three defendants failed to submit any grounds or evidence sufficient to refute the expert opinions issued by a certain forensic appraisal institute and the Beijing Forensic Science Evidence Appraisal Center. Regarding Qi’s objection, the written response provided by the Beijing Forensic Science Evidence Appraisal Center confirmed that although the examinations conducted by the hospital on Liu Motao after October 8, 2023, were not directly causally related to the knee injury, they were nonetheless reasonable examinations conducted to rule out common complications of fractures. Qi did not submit any evidence to challenge this response. Therefore, this court accepts the expert opinions issued by the forensic appraisal institute and the Beijing Forensic Science Evidence Appraisal Center, as well as their corresponding responses. Considering the expert opinions and the specific circumstances of this case, Liu Motao suffered a fracture of the right hip bone when he fell from the starboard side of the vessel during a scuffle with Qi. As the direct tortfeasor, Qi should bear primary responsibility for this damage. Although Liu Motao himself was partially at fault for his injuries sustained during the scuffle with Qi, he should bear secondary responsibility for the resulting harm. The Island People’s Hospital committed medical negligence during the course of treatment (such negligence led to increased medical expenses at the hospital). Therefore, this court determines that, with regard to all expenses incurred by Liu Motao during his treatment for the fracture at the Island People’s Hospital, Qi shall bear 55% of the compensation liability, the Island People’s Hospital shall bear 15%, and Liu Motao himself shall bear 30%. As for Liu Motao’s death from tetanus while receiving treatment at the City Central Hospital, according to the expert opinion, Qi, the Island People’s Hospital, and the City Central Hospital jointly caused Liu Motao’s death. Therefore, this court determines that, with regard to all expenses incurred by Liu Motao during his treatment for tetanus at the City Central Hospital and the ultimate outcome of his death, the Island People’s Hospital shall bear 40% of the compensation liability, the City Central Hospital shall bear 10%, and Qi shall bear 15%.

Regarding medical expenses, Zu Wxiu and others claim that Liu Motao’s medical expenses during treatment at the Island People’s Hospital totaled 14,918.35 yuan, while his expenses at the City Central Hospital amounted to 65,623.56 yuan, for a total of 80,541.91 yuan. The receipts and expense lists submitted by Zu Wxiu and others are authentic and valid; therefore, this court recognizes this amount. As for death compensation, Zu Wxiu and others assert that Liu Motao’s death compensation should be 1,031,420 yuan. Neither the Island People’s Hospital, the City Central Hospital, nor Qi Mou has raised any objection to this amount; thus, this court also recognizes it. Concerning the inpatient meal allowance, Zu Wxiu and others contend that Liu Motao was hospitalized for a total of 20 days (9 days at the Island People’s Hospital and 11 days at the City Central Hospital), at 100 yuan per day. Accordingly, the inpatient meal allowance for Liu Motao’s stay at the Island People’s Hospital is 900 yuan, and the allowance for his stay at the City Central Hospital is 1,100 yuan, totaling 2,000 yuan. The Island People’s Hospital, the City Central Hospital, and Qi Mou have all agreed with this amount; hence, this court recognizes it as well. With regard to nursing fees, Zu Wxiu and others maintain that Liu Motao was cared for by one of his relatives, and the total nursing fee amounts to 2,825.8 yuan. Specifically, the nursing fee for Liu Motao’s stay at the Island People’s Hospital was 1,271.7 yuan, and the nursing fee for his stay at the City Central Hospital was 1,554.1 yuan. The calculation method—dividing the 2023 per capita disposable income of urban residents in Shandong Province, which is 51,575 yuan, by 365 days and then multiplying by the number of hospitalization days—is consistent with legal provisions; therefore, this court recognizes this amount. As for the living expenses of dependents, Zu Wxiu and others claim that these expenses amount to 50,418.3 yuan. Neither the Island People’s Hospital, the City Central Hospital, nor Qi Mou has objected to this amount; thus, this court also recognizes it. Regarding the cost of copying medical records, Zu Wxiu and others submitted an invoice confirming that the copying fee was 475 yuan. The Island People’s Hospital, the City Central Hospital, and Qi Mou have all agreed with this amount; hence, this court recognizes it as well. Finally, concerning funeral expenses, Zu Wxiu and others claim that these expenses amount to 54,902.5 yuan. Neither the Island People’s Hospital, the City Central Hospital, nor Qi Mou has raised any objection to this amount; thus, this court recognizes it as well.

Regarding transportation and accommodation expenses, Zu Wixiu and others claimed that the total transportation costs amounted to 5,365 yuan and the total accommodation costs amounted to 2,208 yuan. Article 9 of the “Interpretation by the Supreme People’s Court on Several Issues Concerning the Application of Law in the Trial of Personal Injury Compensation Cases” stipulates that transportation expenses shall be calculated based on the actual expenses incurred by the victim and any necessary accompanying caregivers for medical treatment or transfer to another hospital. The transportation expenses of 5,365 yuan claimed by Zu Wixiu and others were incurred after Liu Motao’s death, rather than during his medical treatment. Since Liu Motao was transferred to a certain city central hospital on October 9, 2023, this court has determined that such expenses should be set at 1,000 yuan. As for the accommodation expenses of 2,208 yuan claimed by Zu Wixiu and others, there is no legal basis for this claim, and therefore this court does not support it.

Regarding the fee for corpse preservation, Zu Wxiu and others claimed that this fee amounted to 1,460 yuan. The invoices submitted by Zu Wxiu and others confirm that this fee covers expenses such as body disinfection, cryopreservation, body handling, cremation, and funeral supplies, and should therefore be included in the funeral expenses. Consequently, this court does not support their claim.

Regarding compensation for mental distress, Zu Wxiu and others claim that the People’s Hospital of a certain island should compensate them 40,000 yuan for mental distress, while Qi Mou and the Central Hospital of a certain city should each compensate 20,000 yuan for mental distress. The actions of the People’s Hospital of a certain island, the Central Hospital of a certain city, and Qi Mou were causally linked to the death of Liu Motao. As Liu Motao’s direct relatives, Zu Wxiu and others have suffered mental harm as a result. Therefore, this court finds that the People’s Hospital of a certain island, the Central Hospital of a certain city, and Qi Mou should pay compensation for mental distress to Zu Wxiu and others; however, the amounts are adjusted as follows: the People’s Hospital of a certain island shall pay 40,000 yuan for mental distress, the Central Hospital of a certain city shall pay 10,000 yuan for mental distress, and Qi Mou shall pay 2,000 yuan for mental distress.

Zu W Xiu and others paid an appraisal fee of 27,000 yuan (appraised by a certain forensic appraisal institute). The People’s Hospital of a certain island is responsible for 10,800 yuan (27,000 yuan × 40%), the Central Hospital of a certain city is responsible for 2,700 yuan (27,000 yuan × 10%), and Qi Mou is responsible for 4,050 yuan (27,000 yuan × 15%). The remaining portion will be borne by Zu W Xiu and others.

【Relevant Statutes】

Supreme People's Court’s “Interpretation on Several Issues Concerning the Application of Law in the Trial of Personal Injury Compensation Cases” and “Supreme People's Court’s Interpretation on Several Issues Concerning the Determination of Liability for Compensation for Non-Material Damage in Civil Tort Cases”

[Lawyer’s Perspective]

This case involves a fatal outcome resulting from the combined effects of personal injury and medical malpractice, constituting a scenario where multiple factors jointly contributed to the single causal event. The case was initially handled through criminal proceedings, followed by civil litigation. Combining the claims for personal injury and medical malpractice into a single lawsuit better aligned with the client’s needs in pursuing their rights. After numerous communications with both prosecutors and judges, the representing attorney successfully secured the consolidation of the two claims into one proceeding and ensured that the responsibilities of each party were clearly defined during the forensic appraisal. Moreover, the attorney managed to obtain a relatively high compensation ratio within the prescribed limits, thereby effectively safeguarding the client’s maximum interests. The case went through several stages—criminal investigation, public prosecution, first-instance civil trial, second-instance civil trial, and retrial—making it a highly complex legal process. In particular, the Shandong Provincial High People’s Court, in its civil ruling, confirmed that Liu’s injuries were jointly caused by Qi’s actions and the medical institution’s treatment practices. By hearing the case in a single proceeding, the court facilitated the clarification of the facts, enabled an accurate determination of the fault of the tortfeasor, and resolved the dispute in one case without violating any legal provisions. Thus, this decision has provided valuable legal guidance for resolving similar complex cases in the future.