裴易菲, 袁文文, 杨丽莉, 剧华剑, 韩路. 13例职业性布鲁氏菌病工伤劳动能力鉴定工作比较分析[J]. 环境与职业医学, 2024, 41(4): 437-441. DOI: 10.11836/JEOM23294
引用本文: 裴易菲, 袁文文, 杨丽莉, 剧华剑, 韩路. 13例职业性布鲁氏菌病工伤劳动能力鉴定工作比较分析[J]. 环境与职业医学, 2024, 41(4): 437-441. DOI: 10.11836/JEOM23294
PEI Yifei, YUAN Wenwen, YANG Lili, JU Huajian, HAN Lu. Comparative analysis of work-related injury appraisal of 13 cases of occupational brucellosis[J]. Journal of Environmental and Occupational Medicine, 2024, 41(4): 437-441. DOI: 10.11836/JEOM23294
Citation: PEI Yifei, YUAN Wenwen, YANG Lili, JU Huajian, HAN Lu. Comparative analysis of work-related injury appraisal of 13 cases of occupational brucellosis[J]. Journal of Environmental and Occupational Medicine, 2024, 41(4): 437-441. DOI: 10.11836/JEOM23294

13例职业性布鲁氏菌病工伤劳动能力鉴定工作比较分析

Comparative analysis of work-related injury appraisal of 13 cases of occupational brucellosis

  • 摘要: 背景

    根据《职业病分类和目录》,布鲁氏菌病是法定职业性传染病之一,在职业人群中时有发生。

    目的

    比较13例布鲁氏菌病患者省、市两级工伤劳动能力鉴定的过程和鉴定结果,分析总结劳动能力鉴定管理部门和劳动能力鉴定专家在布鲁氏菌病等职业病门科劳动能力鉴定实际工作中存在的偏差,研究并提出改进完善建议。

    方法

    对13例布鲁氏菌病患者职业接触史、临床诊断、职业病诊断分期、劳动能力鉴定依据的客观检查结果及劳动能力鉴定结论进行梳理分析,对比研究市级初次鉴定结论和省级最终鉴定结论不一致的原因。

    结果

    13例布鲁氏菌病患者认定工伤后全部申请了市级劳动能力鉴定,11例没有获得伤残等级,2例评为10级伤残。4例没有评上伤残等级的患者申请了省级劳动能力鉴定,2例维持了原鉴定结论,2例更改了鉴定结论,分别评为九级伤残和十级伤残。在回顾过往鉴定结果时发现,职业性布鲁氏菌病工伤劳动能力结果评定为九级伤残或十级伤残的案例,在石家庄市初级劳动能力鉴定和河北省再次劳动能力鉴定工作中尚属首次。由此总结的主要经验是职业病所致的靶器官损伤和(或)功能障碍的严重程度是工伤劳动能力鉴定的直接依据,职业性布鲁氏菌病工伤劳动能力鉴定时应该根据每一例评残对象,逐个确定相关的靶器官损伤和功能障碍程度,进行综合判定后做出客观、科学的伤残等级评定结论。

    结论

    该鉴定对河北省乃至全国的职业性布鲁氏菌病的工伤劳动能力鉴定应该会有指导和引领作用。GB/T16180—2014《劳动能力鉴定职工 工伤与职业病致残等级》(简称GB/T16180—2014)标准中职业病门科的相关条款存在滞后性。当前情况下劳动能力鉴定时专家除了在标准认真查找和职业病伤情能够直接对应的条款,还应该针对条款中没有涵盖的病患,结合职业病的特点,科学、准确、灵活应用该标准的单项条款和附录中的补充条款,这样才能做出公平、公正、专业的鉴定结论。

     

    Abstract: Background

    According to the Classification and Catalogue of Occupational Diseases, brucellosis is one of the notifiable occupational infectious diseases, which occurs from time to time in the occupational population.

    Objective

    To compare the work-related injury appraisal process and results of 13 cases of brucellosis at both provincial and municipal levels, analyze and summarize the bias in the practical work of labor capacity identification for occupational diseases such as brucellosis by appraisal management departments and experts, and propose suggestions for optimizing appraisal work.

    Methods

    A comparative study was conducted on the objective examination results and labor capacity appraisal conclusions based on the occupational contact history, clinical diagnosis, occupational disease diagnosis staging, and labor capacity appraisal of 13 patients with brucellosis. The reasons for the inconsistency between the initial appraisal conclusion by institutions at the municipal level and the final appraisal conclusion by institutions at the provincial level were compared and analyzed.

    Results

    All of the 13 patients with brucellosis applied for municipal-level labor capacity identification after being identified as work-related injuries, 11 of which did not receive a disability level, and 2 were rated as level 10 disability. Four of those who did not receive the disability rate applied for provincial-level labor capacity identification. As a result, 2 cases were maintained original appraisal conclusions, while the other 2 changed the conclusions to level 9 disability and level 10 disability respectively. It was the first time in Shijiangzhuang municipal-level primary labor capacity appraisal and Hebei provincial-level labor capacity re-appraisal that the work-related injury caused by occupational brucellosis was rated as level 9 disability or level 10 disability. Hence, the lessons learned from this comparative analysis are that the degree of target organ damage and (or) organ dysfunction are the direct basis for work-related injury appraisal; an objective and scientific labor capacity identification for occupational brucellosis should base on the each case of disability evaluation, identify the relevant target organ damage and the degree of dysfunction, and rate the disability level after a comprehensive appraisal.

    Conclusion

    This analysis would be a guidance to the identification of labor capacity for occupational brucellosis in Hebei Province and the whole country. There is a hysteresis issue in the occupational disease provisions in the national standard GB/T 16180—2014 Standard for identify work ability—Gradation of disability caused by work-related injuries and occupatiaonal diseases. In current situation, appraisal experts should not only search for clauses that directly correspond to the occupational diseases and injuries, but also target conditions not covered in the clauses and conduct assessment based on the characteristics of occupational diseases, with scientific, accurate, and flexible application of the clauses in the standard and appendix, so as to make fair, just, and professional appraisal conclusions.

     

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