海南省第二中级人民法院
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（2017）琼97民终1369号
海南省第二中级人民法院
民事判决书
（2017）琼97民终1369号
上诉人（原审原告）：李焕香，女，1970年6月3日出生，汉族，住海南省儋州市。
法定代理人：王定文，男，1973年11月6日出生，汉族，住海南省儋州市。系李焕香丈夫。
委托诉讼代理人：朱达人，国信信扬律师事务所律师。
上诉人（原审被告）：儋州市第一人民医院，住所地海南省儋州市那大镇人民中路***号。
法定代表人：欧波，该院院长。
委托诉讼代理人：喻鹏飞，海南天皓律师事务所律师。
上诉人李焕香因与上诉人儋州市第一人民医院医疗损害责任纠纷一案，不服海南省儋州市人民法院（2017）琼9003民初2121号民事判决，向本院提起上诉。本院于2017年11月1日立案后，依法组成合议庭进行了审理。本案现已审理终结。
李焕香上诉请求：1.撤销一审判决，改判支持李焕香的一审全部诉讼请求。2.本案一、二审诉讼费用由儋州市第一人民医院承担。事实和理由：一、一审判决将李焕香医疗费用117035.07元所包含的11389.7元护理费予以扣除是错误的。医疗费用中所包含的护理费是医院在治疗患者过程中费用清单所列明的项目，属于医院内部科目的分类，其属于医疗费的范围。而当事人主张的护理费是人身损害规定的赔偿项目，二者不具有同一性。二、李焕香主张的11986.92元护理费，有事实根据及法律依据。李焕香被鉴定为一级伤残即植物人，一天需二十四小时的护理，原定一个人护理难以胜任，不符合客观事实。李焕香根据伤残的需要，增加一个护理人是合情合法的。三、李焕香主张的营养费10800元和交通费2000元，有事实根据及法律依据。综上，请求二审法院支持李焕香的上诉请求。
儋州市第一人民医院的答辩意见与其上诉意见一致。儋州市第一人民医院上诉请求：1.撤销一审判决，改判驳回李焕香的诉讼请求。2.本案一、二审诉讼费用由李焕香承担。事实和理由：一、李焕香主张的后续治疗费117035.07元，缺乏依据。李焕香主张的后续治疗费117035.07元，大部分社保已扣除，李焕香个人实际支付的为27153.33元（其中包含护理费11389.7元，一审判决已扣除）。所以李焕香实际发生的医疗费仅为15763.63元，该费用没有超过本院（2016）琼97民终946号民事判决中所认定的后续治疗费35200元，故李焕香该项后续治疗费不应支持。二、李焕香主张的住院伙食补助费属于重复请求。本院（2016）琼97民终946号民事判决仅认定李焕香实际发生的后续治疗费超出35200元可另行主张，并未认定住院伙食补助费李焕香可以另行主张。即使要支持，一审判决对该项目的计算标准较高，请求予以调整。综上，请求二审法院支持儋州市第一人民医院的上诉请求，驳回李焕香的诉讼请求。
李焕香针对儋州市第一人民医院的上诉答辩称，一、儋州市第一人民医院的上诉超过了上诉期限。二、李焕香主张的各项费用符合规定。
李焕香向一审法院起诉请求：1.判令儋州市第一人民医院承担医疗损害赔偿后续治疗费24550.52元[（117035.07元－35200元）×30%]、住院伙食补助5400元（360天×50元/天×30%）、护理费11986.92元（360天×110.99元/天×30%）、营养费10800元（360天×100元/天×30%）、交通费2000元；2.诉讼费、律师费由儋州市第一人民医院负担。
一审法院认定事实：2014年8月12日，李焕香因医疗损害责任纠纷将儋州市第一人民医院诉至一审法院。2016年5月4日，一审法院作出（2014）儋民初字第1353号民事判决，认定由儋州市第一人民医院对李焕香的各项损失承担30%的赔偿责任，包含后续治疗费35200元、护理费277480元（自2011年10月1日起护理期限为10年），判决：儋州市第一人民医院应赔偿李焕香276805.18元，限于判决生效之日起二十日内支付；驳回李焕香的其他诉讼请求。2016年9月28日，本院作出（2016）琼97民终946号民事判决，认定除一审确认的医疗费用外，李焕香后续治疗发生的费用如超出35200元，可根据实际发生的费用另行主张，判决驳回上诉，维持原判。二审判决后，李焕香自2016年1月22日至2016年2月5日、2016年6月6日至2016年7月8日、2016年7月8日至2016年10月13日、2016年10月13日至2016年11月5日、2016年11月5日至2016年11月12日、2016年11月16日至2016年12月15日、2016年12月16日至2017年1月5日共七次住院，累计住院232天，共发生医疗费用117035.07元（含护理费共计11389.7元）。
一审法院认为，本院（2016）琼97民终946号民事判决已认定儋州市第一人民医院对李焕香的诊断、治疗存在过错，且与李焕香的不良后果之间存在一定的因果关系，儋州市第一人民医院对李焕香的损失依法承担30%的赔偿责任，除一审确认的医疗费用外，李焕香后续治疗发生的费用如超出35200元，可根据实际发生的费用另行主张。李焕香请求由儋州市第一人民医院负担其律师费用缺乏法律依据，不予支持。李焕香自2016年1月22日至2017年1月5日共七次住院，累计住院232天，共发生医疗费用117035.07元，其中包含护理费共计11389.7元。因本院（2016）琼97民终946号民事判决已对护理费、营养费、交通费作出处理，李焕香再行主张属重复请求，故对医疗费用117035.07元中包含的护理费11389.7元及李焕香主张的护理费11986.92元、营养费10800元、交通费2000元，不予支持。李焕香所受损失：1.医疗费105645.37元（117035.07元－11389.7元），予以支持。2.住院伙食补助费23200元（100元/天×232天），李焕香主张5400元，未超出上述限额，超出部分视为李焕香对其实体权利的放弃，予以照准。综上，李焕香因本次事故进行的后续治疗期间损失总额为75845.37元（105645.37元+5400元－35200元）。儋州市第一人民医院对李焕香的损失依法承担30%的赔偿责任，即22753.61元。
一审法院根据《中华人民共和国侵权责任法》第十六条、第五十四条，《最高人民法院关于适用<中华人民共和国民事诉讼法>的解释》第九十条之规定，判决：一、儋州市第一人民医院应赔偿李焕香22753.61元，限于判决生效之日起二十日内支付。二、驳回李焕香的其他诉讼请求。如未按判决指定的期间履行给付金钱义务，应按照《中华人民共和国民事诉讼法》第二百五十三条之规定，加倍支付迟延履行期间的债务利息。案件受理费347元，由儋州市第一人民医院负担。
二审中，双方当事人均未提交新证据。
二审对一审判决查明的事实，予以确认。另查明，李焕香自2016年1月22日至2017年1月5日在西部中心医院、儋州市人民医院、儋州市中医院、儋州市那大镇卫生院住院治疗，共发生医疗费用117035.07元，其中李焕香个人实际支付27165.33元，其他费用新农合已直接扣减。一审判决查明的医疗费中”含护理费共计11389.7元”，该护理费为医疗费发票上载明的护理费项目之和。在生效的本院（2016）琼97民终946号民事判决认定了李焕香的营养期为24个月。
以上事实有李焕香的医疗费票据、本院（2016）琼97民终946号《民事判决书》等证据在案证实，足资认定。
本院认为，本案的争议焦点是：李焕香主张儋州市第一人民医院赔偿后续治疗费24550.52元、住院伙食补助5400元、护理费11986.92元、营养费10800元、交通费2000元，合计54737.44元是否有相应的事实根据及法律依据。生效的本院（2016）琼97民终946号民事判决认定儋州市第一人民医院对李焕香的诊断、治疗存在过错，且与李焕香的不良后果之间存在一定的因果关系，儋州市第一人民医院对李焕香的损失依法承担30%的赔偿责任。李焕香在本院（2016）琼97民终946号案件主张的各项损失处理终结后，又七次住院治疗共232天，产生了新的损失，儋州市第一人民医院亦应根据生效判决确定的承担责任比例进行赔偿。
李焕香在本案中主张的各项损失：1.医疗费。李焕香七次住院治疗共产生医疗费用117035.07元，其中李焕香个人实际支付27165.33元，其他费用新农合已直接扣减。因李焕香个人实际支付的医疗费仅为27165.33元，未超出本院（2016）琼97民终946号民事判决已支持的后续治疗费35200元，故对李焕香主张的后续治疗费，本院不予支持。李焕香主张应按117035.07元计算其医疗费，依据不足，不予支持。一审判决对李焕香主张的后续治疗费处理不当，本院予以纠正。2.护理费。李焕香一级伤残终身全部护理依赖，但本院（2016）琼97民终946号民事判决已支持其从2011年10月1日起10年的护理费，现未超出该护理期，故李焕香本案主张的护理费属重复主张，本院不予支持。此外，医疗票据中载明的护理费属于患者在治疗过程中医院直接收取的费用，属于医疗费的范畴，与人身损害赔偿规定中当事人主张的护理费，不属同一概念，一审判决将二者混同，并在医疗费中扣除，处理不当。3.住院伙食补助费。李焕香住院治疗232天，住院伙食补助费应为23200元（100元/天×232天）。儋州市第一人民医院应承担6960元（23200元×30%）。李焕香主张5400元，未超出规定，本院予以支持。4.营养费。本院（2016）琼97民终946号民事判决虽已支持李焕香24个月的营养费，但李焕香从2011年10月1日开始终身全部护理依赖，鉴于李焕香本案住院治疗的时间、伤残等级及身体状况，李焕香住院治疗232天期间应适当加强营养，营养费酌情支持11600元（232天×50元/天）。儋州市第一人民医院应承担3480元（11600元×30%），超出部分不予支持。5.交通费。李焕香自2016年1月22日至2017年1月5日在西部中心医院、儋州市人民医院、儋州市中医院、儋州市那大镇卫生院七次住院治疗232天。李焕香虽未提供正规的交通费票据，但确已实际发生，本院根据实际酌情支持1500元。儋州市第一人民医院应承担450元（1500元×30%），超出部分不予支持。李焕香本案主张的营养费及交通费系本院（2016）琼97民终946号案件主张的各项损失处理终结后，再次住院治疗新产生的损失，一审判决认定该费用本院（2016）琼97民终946号案件已作处理，属重复主张，与事实不符，本院予以纠正。综上，本案儋州市第一人民医院应赔偿李焕香的各项经济损失为9330元（住院伙食补助费5400元＋营养费3480元＋交通费450元）。
综上所述，李焕香与儋州市第一人民医院的上诉请求有理部分予以支持，其余部分缺乏根据应予驳回；一审判决认定事实清楚，但各项费用处理不当，本院予以纠正。依照《中华人民共和国民事诉讼法》第一百七十条第一款第（二）项规定，判决如下：
一、撤销海南省儋州市人民法院（2017）琼9003民初2121号民事判决第二项；
二、变更海南省儋州市人民法院（2017）琼9003民初2121号民事判决第一项为：儋州市第一人民医院应赔偿李焕香9330元，限于本判决生效之日起十日内付清；
三、驳回李焕香的其他诉讼请求。
如果未按本判决指定的期间履行给付金钱的义务，应当依照《中华人民共和国民事诉讼法》第二百五十三条之规定，加倍支付迟延履行期间的债务利息。
一审案件受理费347元，由儋州市第一人民医院负担。二审案件受理费647元，由儋州市第一人民医院负担347元，由李焕香负担300元。李焕香应承担部分，经李焕香申请，本院同意予以免交。
本判决为终审判决。
审判长张模金
审判员何亮
审判员雷琼艳
二○一七年十二月十三日
书记员胡燕君
附：本案适用的相关法律条文
《中华人民共和国民事诉讼法》
第一百七十条第二审人民法院对上诉案件，经过审理，按照下列情形，分别处理：
（一）原判决、裁定认定事实清楚，适用法律正确的，以判决、裁定方式驳回上诉，维持原判决、裁定；
（二）原判决、裁定认定事实错误或者适用法律错误的，以判决、裁定方式依法改判、撤销或者变更；
（三）原判决认定基本事实不清的，裁定撤销原判决，发回原审人民法院重审，或者查清事实后改判；
（四）原判决遗漏当事人或者违法缺席判决等严重违反法定程序的，裁定撤销原判决，发回原审人民法院重审。
原审人民法院对发回重审的案件作出判决后，当事人提起上诉的，第二审人民法院不得再次发回重审。
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[{法规名称:\'《最高人民法院关于审理人身损害赔偿案件适用法律若干问题的解释》\',Items:[{法条名称:\'第十一条第一款\',法条内容:\'
第十一条
雇员在从事雇佣活动中遭受人身损害，雇主应当承担赔偿责任。雇佣关系以外的第三人造成雇员人身损害的，赔偿权利人可以请求第三人承担赔偿责任，也可以请求雇主承担赔偿责任。雇主承担赔偿责任后，可以向第三人追偿。
雇员在从事雇佣活动中因安全生产事故遭受人身损害，发包人、分包人知道或者应当知道接受发包或者分包业务的雇主没有相应资质或者安全生产条件的，应当与雇主承担连带赔偿责任。
属于《工伤保险条例》调整的劳动关系和工伤保险范围的，不适用本条规定。
\'},{法条名称:\'第二十三条第一款\',法条内容:\' 第二十三条
住院伙食补助费可以参照当地国家机关一般工作人员的出差伙食补助标准予以确定。
受害人确有必要到外地治疗，因客观原因不能住院，受害人本人及其陪护人员实际发生的住宿费和伙食费，其合理部分应予赔偿。
\'},{法条名称:\'第二十五条第一款\',法条内容:\'
第二十五条
残疾赔偿金根据受害人丧失劳动能力程度或者伤残等级，按照受诉法院所在地上一年度城镇居民人均可支配收入或者农村居民人均纯收入标准，自定残之日起按二十年计算。但六十周岁以上的，年龄每增加一岁减少一年；七十五周岁以上的，按五年计算。
受害人因伤致残但实际收入没有减少，或者伤残等级较轻但造成职业妨害严重影响其劳动就业的，可以对残疾赔偿金作相应调整。
\'},{法条名称:\'第二十八条第一款\',法条内容:\'
第二十八条
被扶养人生活费根据扶养人丧失劳动能力程度，按照受诉法院所在地上一年度城镇居民人均消费性支出和农村居民人均年生活消费支出标准计算。被扶养人为未成年人的，计算至十八周岁；被扶养人无劳动能力又无其他生活来源的，计算二十年。但六十周岁以上的，年龄每增加一岁减少一年；七十五周岁以上的，按五年计算。
被扶养人是指受害人依法应当承担扶养义务的未成年人或者丧失劳动能力又无其他生活来源的成年近亲属。被扶养人还有其他扶养人的，赔偿义务人只赔偿受害人依法应当负担的部分。被扶养人有数人的，年赔偿总额累计不超过上一年度城镇居民人均消费性支出额或者农村居民人均年生活消费支出额。
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