tag:blogger.com,1999:blog-14892529005048177122024-02-08T12:05:01.102+08:00醫界同盟 + 乾隆花瓶默示錄成立於2011-11-12
目標: 結合醫界各團體,包括醫、護、藥、檢等,凝聚共識,終結禍延子孫的健保亂象。
民國三十七年三月,全國醫師公會聯合大會在南京舉行,會中決議請政府明定以十一月十二日 國父誕辰紀念日為醫師節,藉此紀念 國父革命建國的偉大精神。
在民國一百年的醫師節成立醫界同盟專頁,有感於醫界同仁身處水深火熱之痛,廣邀各界共聚一堂,共同成就醫道正軌。
誠如”搶救急診室”專頁所言,在歷經了眾多的事件,五大科的出走,執業環境的惡劣,健保的剝削……這都是我們必須共同面對的,期待我們繼續以各種方法來爭取改善,讓所有拯救人命的醫護人員有一天真的能夠快樂起來。
Change! Yes we can!!李紹榕http://www.blogger.com/profile/16837787046526872193noreply@blogger.comBlogger272125tag:blogger.com,1999:blog-1489252900504817712.post-10531970309179153542020-11-25T15:48:00.002+08:002020-11-25T15:48:57.836+08:00未列入需鑑別診斷之疾病並非主病因,二審卻改判應賠2000萬元?<p></p><p class="MsoNormal" style="line-height: 20.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14pt;">未列入需鑑別診斷之疾病並非主病因,二審卻改判應賠</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14pt;">2000</span><span style="font-family: 標楷體; font-size: 14pt;">萬元?</span></p>
<p class="MsoNormal" style="line-height: 20.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">https://news.ltn.com.tw/news/life/breakingnews/3340970<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 28.0pt; mso-char-indent-count: -2.0; mso-line-height-rule: exactly; text-align: justify; text-indent: -28.0pt; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">一、此案為一名女博士生<span lang="EN-US">102</span>年<span lang="EN-US">5</span>月間生產完後因右下腹部劇痛,至新竹馬偕醫院急診。嗣經醫師診斷為「右卵巢輸卵管膿腫」,晚間持續腹痛,值班之婦科醫師加入「左側卵巢畸胎瘤併扭轉」之診治,並於晚間施行腹腔鏡手術。惟於術中發生空氣栓塞,嗣後在加護病房昏迷,而成植物人。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 28.0pt; mso-char-indent-count: -2.0; mso-line-height-rule: exactly; text-align: justify; text-indent: -28.0pt; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">二、本案家屬對<span lang="EN-US">2</span>名醫師及麻醉科醫師提告,<span lang="EN-US">103</span>年刑事不起訴,<span lang="EN-US">105</span>年請求賠償:病人喪失勞動能力損失<span lang="EN-US">1300</span>萬,醫藥費及看護費<span lang="EN-US">398</span>萬,精神賠償<span lang="EN-US">200</span>萬。病人先生,母親,女兒精神賠償各<span lang="EN-US">100</span>萬,才會有<span lang="EN-US">2000</span>萬元此金額。一審新竹地院採醫審會鑑定結果,認為<span lang="EN-US">3</span>名醫師之診斷,安排之檢查,及術中處置皆無疏失,而駁回原告請求。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 28.0pt; mso-char-indent-count: -2.0; mso-line-height-rule: exactly; text-align: justify; text-indent: -28.0pt; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">三、然而二審高院不僅無視上揭鑑定總結論,更罕見判決全額<span lang="EN-US">500</span>萬元之精神賠償<span lang="EN-US">(</span>即未考量醫師並非故意,且努力救治病人而酌減<span lang="EN-US">)</span>外,竟以:醫師未將與主病灶卵巢輸卵管膿瘍無關,僅為繼發性之闌尾感染,列入鑑別診斷為由,認為有疏失,應成立過失侵權行為!實有重大違誤:<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 41.85pt; mso-char-indent-count: -1.0; mso-line-height-rule: exactly; mso-para-margin-left: 2.32gd; text-align: justify; text-indent: -14.0pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">蓋醫師已診斷出主因卵巢輸卵管膿瘍及腫瘤併扭轉而動手術,則有無將闌尾感染在急診時列入鑑別診斷,與病人術後之狀況並無因果關係!<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 41.85pt; mso-char-indent-count: -1.0; mso-line-height-rule: exactly; mso-para-margin-left: 2.32gd; text-align: justify; text-indent: -14.0pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">縱使林口長庚醫師於鑑定報告中之意見有提及,未列入鑑別難謂無違反醫療常規,但是該醫師的重點在於:既然稱「疑似感染」,則應將闌尾炎列入較妥,僅係訓示,提醒的意見爾!並非指本件醫師之診療,手術有疏失!<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="line-height: 20.0pt; margin-left: 28.0pt; mso-char-indent-count: -2.0; mso-line-height-rule: exactly; text-align: justify; text-indent: -28.0pt; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">四、祈上訴三審後,最高法院能再回歸因果關係和專業鑑定之審理判斷,而非將「情,理」置於「法」前。<span lang="EN-US"><o:p></o:p></span></span></p><br /><p></p>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-36534639656323868932020-11-02T15:02:00.001+08:002020-11-02T15:02:08.232+08:00病人第一次看診主訴之記載常是勝敗關鍵的小細節!<p> </p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">病人第一次看診主訴之記載常是勝敗關鍵的小細節!<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">一、此為<span lang="EN-US">104</span>年發生之案件,病人先是因咳嗽,喘到診所看病,之後轉診到台南醫院新化分院,當天於輸血後<span lang="EN-US">5</span>小時死亡。家屬主張醫師對病人可能之心肌炎症狀未進行任何處置,護理師未注意病人輸血後有無異狀,故病人之母及其<span lang="EN-US">2</span>名子女連帶要求醫院及醫護人員<span lang="EN-US">3</span>人賠償逾<span lang="EN-US">1</span>千萬元。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">歷經刑事不起訴,再議後<span lang="EN-US">106</span>年被駁回確定。民事求償部分從<span lang="EN-US">105</span>年纏訟至<span lang="EN-US">109</span>年<span lang="EN-US">(</span>案號:<span lang="EN-US">109</span>年度台上字第<span lang="EN-US">1801</span>號<span lang="EN-US">)</span>,然醫院及<span lang="EN-US">2</span>位醫師,<span lang="EN-US">1</span>名護理人員一審即獲勝訴判決,最後病家還提出再審之訴。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">二、本件醫師能全身而退原因在於病人從診所轉診而來時,主訴是:咳嗽,貧血,喘,然其最後死亡原因係「右下肢靜脈血栓造成的肺栓塞」。因此法院認為:<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">被告之急診醫師在呼吸胸膛科轉診後不到<span lang="EN-US">60</span>分鐘之時間內,即取得血液檢驗報告,嗣後開始輸血並無違反醫療常規。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">再者,醫審會報告亦指出,肺栓塞之症狀,易猝死,其血栓之來源,幾近全部來自下肢或骨盆之深部靜脈血栓,而病人到院及在急診時均無四肢腫脹或疼痛之情況,因此法官認為病家主張病人因急診醫師輸血排斥造成不良反應而發生下肢深部血栓等,「尚屬無據」。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">由上可見,病人初診或從診所轉診時的門診主訴,或者在急診的第一時間病人的生命徵象記載,往往是斷絕因果關係的有力證據。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;"><span style="font-family: 標楷體; font-size: 14.0pt;">三、附帶一提,此病家列為被告之護理人員並非當日實際照顧病人之人,僅係負責護理紀錄之人,若刑案獲不起訴時即提告誣告,以戰止戰,或許就不會有後面長達數年,歷經<span lang="EN-US">3</span>審,再審的纏訟。<span lang="EN-US"><o:p></o:p></span></span></p>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-35457697146760550162020-08-24T10:55:00.007+08:002020-08-24T10:55:37.162+08:00問題四:近年來復健科,骨科診所越來越多。其實當中有許多優秀的疼痛科醫師!<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">問題四:近年來復健科,骨科診所越來越多。其實當中有許多優秀的疼痛科醫師!</span></p><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">他們依規定,都必須已是某科醫師後,才能再進修為疼痛科醫師,形同有2個專業的醫師。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">但是,大部分診所,都還是不大敢直接登記或掛”疼痛科”市招,因為某些縣市衛生機關會以:</div><div dir="auto" style="font-family: inherit;">「疼痛科並非衛福部部定科別」為由,進而認定診所違反醫療法第85條第1項第4款規定而裁罰!</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">此處問題又是衛生主管機關自行擴大解釋,其相關函釋僅屬行政規則,命令位階,竟做出逾越醫療法85條第1項第4款規範內容之解釋!因如前所述,疼痛科醫師通常已具備2個以上的專業,在全台各大醫院更早已設有疼痛專科,則舉重以明輕,為何不能開設「疼痛科診所」?更何況,醫療法85條第1項第4款亦無規定,限縮可廣告之診療科別,限於衛福部部定科別!尤見衛生主管機關此種裁罰,顯有違誤。</div></div>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-29702617368765967692020-08-24T10:55:00.003+08:002020-08-24T10:55:10.358+08:00問題三:衛生局常用醫療法施行細則第59條規定,裁罰診所。<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">問題三:衛生局常用醫療法施行細則第59條規定,裁罰診所。</span></p><div class="kvgmc6g5 cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">實則已屬子法逾越母法,不當自行限縮醫療法第85條第1項第4款:可廣告診療科別規定之內容。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">以下即用處理過之案例說明:</div><div dir="auto" style="font-family: inherit;">1.因為依醫療法85條第1項第4款之規定,只有提及診所有在診療的科別,即可用做市招或廣告,故即使診所登記之負責醫師本身是家醫科,小兒科,只要在該診所有看診的皮膚科醫師,有報備支援,且實際看診,則就算該診所標明為「x x 皮膚科診所」,也無違反85條第1項第4款之規定。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">2.然衛生局原本依醫療法施行細則第59條規定,即診所市招,名稱限於使用登記為負責醫師的科別,即只准註明,廣告係家醫科診所,而欲裁罰5萬元,由上述可知,施行細則59條之規定顯已逾母法醫療法85條規定之範圍,自不足採。</div></div>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-54432644429238806602020-08-24T10:54:00.003+08:002020-08-24T10:54:42.480+08:00問題二:收到衛生局針對診所廣告要求於期限內說明之函文,該如何處理?<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">問題二:收到衛生局針對診所廣告要求於期限內說明之函文,該如何處理?</span></p><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">回答:</div><div dir="auto" style="font-family: inherit;">盡量不要覺得就罰5萬了事。而且現在依醫療法103條規定罰金提高,而且衛生主管機關不是法院,有時它來函,是要先了解始末,且許多客戶在回函好好說明後,有些縣市之衛生局也會基於勸導立場,裁示先不罰。就說明一下吧!</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1.衛生局通常來函會先詢問該則被檢舉的廣告是由何人製作?內容為何會載明被檢舉的部分?並指定一日期請診所負責醫師到場說明。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">建議:最好先寫好回函,且要表示日後會多加留意,更謹慎。寄出回函後,再打電話給衛生局承辦人員報備。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">2.到衛生局指定日期,診所方還是要有人員到場親自溝通說明即可,不一定要負責醫師或醫生到場。</div></div>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-42809256474202782052020-08-24T10:53:00.003+08:002020-08-24T10:53:44.095+08:00醫療廣告行不行?<p> <span style="background-color: white; color: #050505; font-family: inherit; font-size: 15px; white-space: pre-wrap;">醫療廣告行不行?</span></p><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">10幾年來協助處理之經驗,在此跟大家分享。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">問題一:各科診所醫師常會擔心,是否只能列出診所科別,門診時間等醫療法第85條第1項規定的基本項目?</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">1.其實同法條第3項早有規定,若是透過網路,比如診所粉專,臉書或其他網路平台廣告時,不受上述限制,簡言之,例如術式(雷射,拉提,隆鼻,內視鏡,隆乳等等),皆可列出,即便加上儀器或新式手術名稱,例如:魔滴隆乳,電波,音波拉提,無痛大腸鏡等,其實只要沒有誇大,吹捧”全國”,”唯一”等,是可以宣傳,廣告的。</div></div><div class="o9v6fnle cxmmr5t8 oygrvhab hcukyx3x c1et5uql ii04i59q" style="background-color: white; color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif; font-size: 15px; margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto" style="font-family: inherit;">2.但是為求瀏覽廣告者能較快,輕鬆了解手術或儀器,往往都會用自行創造或較通俗的字眼宣傳。避免有些縣市衛生局較嚴格,或承辦人員對”不實”廣告擴大解釋,建議在文末註明枋單上正式名稱,還有儀器的衛生主管機關核可字號。</div></div>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-86716089072004927892020-08-06T16:54:00.002+08:002020-08-06T16:57:46.809+08:00發新聞不附當事雙方<div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;">發新聞不附當事雙方</div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;">此風不可長</div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;">誰是乾隆花瓶一眼看出</div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><br /></div><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrgGI_c8N2NaddOcQh6OMzSvhToNj4ifb0xJOIDsl5aO0Q-DefOJYl_Lnn428Fsq-If-myNnMfto-S6fsbF-87_E7UoLmnICbyTOHT9dwPr4b4OOtZKXOSOMd6aQCWeLTZkTE38-dPXoGt/s2048/116583831_3211807708885386_6087010696441843240_o.jpg" imageanchor="1" style="display: block; padding: 1em 0px;"><img border="0" data-original-height="2048" data-original-width="2048" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrgGI_c8N2NaddOcQh6OMzSvhToNj4ifb0xJOIDsl5aO0Q-DefOJYl_Lnn428Fsq-If-myNnMfto-S6fsbF-87_E7UoLmnICbyTOHT9dwPr4b4OOtZKXOSOMd6aQCWeLTZkTE38-dPXoGt/s640/116583831_3211807708885386_6087010696441843240_o.jpg" /></a></div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><br /></div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><br /></div><div dir="auto" style="background-color: white; color: #050505; font-family: "segoe ui historic", "segoe ui", helvetica, arial, sans-serif; font-size: 15px; white-space: pre-wrap;"><a class="oajrlxb2 g5ia77u1 qu0x051f esr5mh6w e9989ue4 r7d6kgcz rq0escxv nhd2j8a9 nc684nl6 p7hjln8o kvgmc6g5 cxmmr5t8 oygrvhab hcukyx3x jb3vyjys rz4wbd8a qt6c0cv9 a8nywdso i1ao9s8h esuyzwwr f1sip0of lzcic4wl py34i1dx gpro0wi8" href="https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.google.com.tw%2Famp%2Fs%2Fwww.storm.mg%2Famparticle%2F2906577%3Ffbclid%3DIwAR3_D6WaT_GeJrZOQozCVYmID3-N5KKQgTStvFrUPCQzH-z1s8u-LDOmwic&h=AT0ZEUdRXgjwC3OMFYAiwxdKqeMl_SD3AWksaqjKHLsU_Mx-KrOTU7cEyyHuEl_xYr-PuxDY5YglfZijn1aVQdbfxPw-1kH9DNQ6OuJMADn8NzgiDTC1WOseflCQLCiF07k&__tn__=R]-R&c[0]=AT1nb_lDN36AU_Z6SGFIyW5iaxzap1f_Oht-ReVcw5ZbeK1RnWVTXdDjeDDsCJj9agAyiYYXH0Fqa4kN96HiaZHodXdPnnhKoizlqesk6G3TXgo6M_-6RE4zim4X_mEttm-qmJOZjp3G4xoEITw_3T9_df3FDEuPOIcnujLJRDOJgUJfUWlQ73yRELqNng8" rel="nofollow noopener" role="link" style="-webkit-tap-highlight-color: transparent; background-color: #f0f2f5; border-color: initial; border-style: initial; border-width: 0px; box-sizing: border-box; cursor: pointer; display: inline; list-style: none; margin: 0px; outline: none; padding: 0px; touch-action: manipulation; white-space: normal;" tabindex="0" target="_blank">https://www.google.com.tw/amp/s/www.storm.mg/amparticle/2906577</a></div>芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-82875019982524795142020-05-18T09:11:00.004+08:002020-05-18T09:14:24.971+08:00女病患自主同意與男病患在院內愛愛,醫院竟需負連帶賠償40萬元責任?<br />
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<span style="font-family: 標楷體; font-size: 18.6667px;">女病患自主同意與男病患在院內愛愛,醫院竟需負連帶賠償</span><span lang="EN-US" style="font-family: 標楷體; font-size: 18.6667px;">40</span><span style="font-family: 標楷體; font-size: 18.6667px;">萬元責任?</span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">—<span lang="EN-US">></span>請台大聲請再審以公正視聽及維護醫界適當義務範圍<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此為高等法院<span lang="EN-US">107</span>年度上易字等<span lang="EN-US">1262</span>號判決,近日宣判,引起不小的關注,爭議。觀其內容,確有諸多值得商榷甚者無限上綱,自行解釋之失<span lang="EN-US">(</span>雖然已二審定讞<span lang="EN-US">)</span>:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一<span lang="EN-US">.</span>此案自<span lang="EN-US">106</span>年開始,病人先提刑事妨害性自主的告訴,皆獲不起訴處分,女病患在<span lang="EN-US">107</span>,<span lang="EN-US">4</span>,<span lang="EN-US">16</span>時效完成後不久提出妨害貞操,健康等民事損害賠償。二審法院認為,女病患欠缺性自主決斷能力,故不知道也不清楚,和男病患的親密是侵權行為,所以<span lang="EN-US">2</span>年時效無從進行!此部分的認定,不僅無視,未斟酌刑事案件的相關事證,更有就<span lang="EN-US">108</span>年醫審會鑑定報告和<span lang="EN-US">107</span>年埔里基督教醫院精神鑑定報告,還有不當擴大解釋之誤:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">蓋前者只有表示,病患「性自主決定能力降低」,後者精神鑑定也只是認為,病患在管理金錢,投資行為,或需要進行高層次認知思考的社會情境,才較難以判斷。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">豈料二審法院雖爰引上述報告內容,竟做出:病患認知功能並未康復,對於日常生活中行為(包括性行為)之社會意義和法律效果均無法為判斷,所以她在<span lang="EN-US">105</span>年<span lang="EN-US">4</span>月<span lang="EN-US">1</span>號告知醫護人員她與男病患發生性行為時,自無法判斷是否遭趁機性交,所以<span lang="EN-US">2</span>年時效無法進行!由上益見,二審法院的判斷,顯有重大疏失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二,再者,二審斷然否定刑事偵查結果,主要係爰引臺大竹東分院自己的護理紀錄,表示女病患”對現實判斷欠佳”。此節更有謬誤,因為:該次護理紀錄是描述,病患想和男患友結婚這部分,對現實判斷欠佳。詎高院卻斷章取義,以此認定女病患在偵查中所為:有同意性行為的陳述,並無可採,男病患仍有侵害性自主的行為。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">三,尤令人瞠目結舌者,在於二審法院認定臺大竹東分院就女病患的防護,治療雖已盡責<span lang="EN-US">(</span>可參判決第<span lang="EN-US">17</span>,<span lang="EN-US">18</span>頁<span lang="EN-US">)</span>,但未告知男病患不可進女病患病房,及對男病患為約束處置,所以醫院屬未盡保護,照顧女病患身體,健康及貞操權之附隨義務因而遭判賠,由上看見,更有無限上綱,擴大解釋”附隨義務”的違誤。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="https://www.google.com.tw/amp/s/news.ltn.com.tw/amp/news/society/paper/1373055">https://www.google.com.tw/amp/s/news.ltn.com.tw/amp/news/society/paper/1373055</a><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Harold<span style="mso-spacerun: yes;"> </span>X<o:p></o:p></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">男病患本身也是思覺失調症的患者嗎?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: red; font-size: 14.0pt;">醫界同盟<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">Harold<span style="mso-spacerun: yes;"> </span>X </span><span style="font-family: 標楷體; font-size: 14.0pt;">他是中度精神病患,但不一定是思覺失調<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">羅<span lang="EN-US">X</span>薰<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">我也覺得不合理。女病患在收容治療期間不允許有性需求?正常人就算單身,還能壓抑,也還有隱私的空間去處理自己的需求。但別說她生病了,在醫院這麼沒有隱私的地方生活你是要她怎麼辦?
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<span style="color: red; font-size: 14.0pt;">醫界同盟<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">羅<span lang="EN-US">X</span>薰</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 謝謝妳的留言。其實重點還是在法院對鑑定報告的解讀適用有不當之處。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">劉<span lang="EN-US">X</span>鴻<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">這個時候法官又不參考專業醫師的鑑定了<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #c00000; font-size: 14.0pt;">醫界同盟<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">劉<span lang="EN-US">X</span>鴻</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 沒錯!這就是重點<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">孔<span lang="EN-US">X</span>珣<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">犯人在監獄教化被性侵,國家要賠償嗎?<span lang="EN-US"><o:p></o:p></span></span></div>
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-14962494069887418782019-08-22T10:22:00.000+08:002019-08-22T10:39:11.271+08:00實習醫師也被告?被告醫師投書引起關注的案件<br />
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<span style="color: #1c1e21; font-size: 14.0pt;">實習醫師也被告?被告醫師投書引起關注的案件<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1c1e21; font-size: 14.0pt;">一、此為高雄長庚醫院風濕免疫科被告之案件,經二審判決無罪確定,自<span lang="EN-US">99</span>年<span lang="EN-US">(99</span>年自字第<span lang="EN-US">12</span>號<span lang="EN-US">)</span>打到<span lang="EN-US">102</span>年<span lang="EN-US">11</span>月<span lang="EN-US">(100</span>年醫上訴字第<span lang="EN-US">6</span>號<span lang="EN-US">)</span>。病人家屬是醫師,在一審時從護士,實習醫師到主治醫師皆提告,被告共<span lang="EN-US">7</span>人。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1c1e21; font-size: 14.0pt;">二、家屬主要提告原因在於,他們認為在<span lang="EN-US">97</span>年<span lang="EN-US">1</span>月<span lang="EN-US">12</span>日,<span lang="EN-US">13</span>日病人即有高度感染可能性與全身性發炎反應症候群,所以當時病人應已罹敗血症,實習醫師及護理師未<span lang="EN-US">“</span>主動通知<span lang="EN-US">”</span>住院及主治醫師到場,延誤治療<span lang="EN-US">;</span>而主治醫師至<span lang="EN-US">14</span>日方使用抗生素藥物,故有疏失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1c1e21; font-size: 14.0pt;">三、然經法院審理及醫審會鑑定結果,本案未解剖,已無法確認死亡真正原因<span lang="EN-US">;</span>且病人罹患皮肌炎,故細菌,黴菌,病毒感染之可能性皆存在,病人就醫期間未能確定病原,故縱使提早投以抗生素治療,亦無法避免死亡結果之發生。因而認定<span lang="EN-US">7</span>名被告之醫療行為,合乎醫療常規。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1c1e21; font-size: 14.0pt;">四、本案例因病人本身有免疫系統的問題,在醫師有無違反醫療常規的認定,攻防上,其實沒有太大的困難。本件的特色及可分享給大家的意見列出:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1c1e21; font-size: 14.0pt;">1.</span><span style="color: #1c1e21; font-size: 14.0pt;">本件病患家屬不從檢察署提告,跳過偵查階段,直接用自訴的方式。其實遇到不用害怕,因為在刑庭法官來說,會覺得是額外的案件,且依刑事訴訟法的規定,自訴人的舉證責任更重。但病患方的律師為什麼還用此法?一來可能是因為自訴案件雙方可影印,看到對方的書狀,證物,但另一方面,它是一定要委任律師開庭的。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1c1e21; font-size: 14.0pt;">2.</span><span style="color: #1c1e21; font-size: 14.0pt;">當病家把所有經手的醫護人員都告進去時,別害怕,因為刑事犯罪案件審查的重點,只有最後與病患死亡有相當因果關係的行為,所以不須跟著病家起舞。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1c1e21; font-size: 14.0pt;">3.</span><span style="color: #1c1e21; font-size: 14.0pt;">實習醫師在實習執行醫療業務過程,在醫師指導下執行即可,此指導不以現場指導為要件,其所為之診療,診斷,經指導醫師確認也可。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 重點還有,總醫師因前<span lang="EN-US">2</span>天病歷用打字,第<span lang="EN-US">3</span>天接著記載病況用手寫,竟也被告偽造文書!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一審法官判決認為是不同天的,且並無故意為不實記載之情判決無罪。二審病家撤回此部分上訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">WeiFeng Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">我是高雄長庚,陳瑋豐醫師本人。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">其實現任高雄榮總,眼科主治陳世洲醫師,當年有去地檢署提告,但眼看檢察官就要做不起訴處分了,陳世洲醫師去向檢察官要求撤告,然後改提刑事自訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> WeiFeng Chen </span><span style="font-family: 標楷體; font-size: 14.0pt;">謝謝你本人的補充。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">但透過這個案子,想讓大家知道,以後病家方就算直接提自訴跳過檢方,也別太擔心。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">因為有時病家是用此方式讓醫護朋友害怕,而在訴訟開始不久就和解。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> WeiFeng Chen </span><span style="font-family: 標楷體; font-size: 14.0pt;">其實若是這樣,你們更辛苦,等於<span lang="EN-US">2</span>種程序都跑過…難怪您在報紙投書會寫<span lang="EN-US">6</span>年,因為自訴程序<span lang="EN-US">2</span>個審級是<span lang="EN-US">4</span>年<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> WeiFeng Chen </span><span style="font-family: 標楷體; font-size: 14.0pt;">且因為業務過失致死是非告訴乃論之罪,才能如此。否則若是業務過失致傷是告訴乃論罪,撤回就不能再自訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">WeiFeng Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">涉案女醫師 兩年後自殺<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">〔記者孫友廉╱台北報導〕造成四死慘劇的台北榮總院內瘧疾感染事件中,其中一名同樣被控業務過失致死的台北榮總住院醫師賴仁怡,於事發兩年半、在她即將滿三十歲大關的前夕,疑因承受不了本案帶來的心理壓力,竟在家中注射藥物自殺,令人不勝欷歔。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">https://forum.doctorvoice.org/viewtopic.php?f=172......<o:p></o:p></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">WeiFeng Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">我希望,救一個,算一個。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">陳怡怡</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> WeiFeng Chen </span><span style="font-family: 標楷體; font-size: 14.0pt;">撐過被告那幾年的煎熬,無論有什麼快樂的事發生,只要想到還有案在身,就快樂不起來,真的辛苦你了,我想瞭解一下,當初醫院對被告醫護的態度是放你們自生自滅?還是替你們尋求法律支援?甚至預告賠償金醫院會概括承擔?另外陳世洲醫師求償<span lang="EN-US">4000</span>萬會不會太扯,有什麼所本嗎?還是純粹想威嚇被告和解?<span lang="EN-US"><o:p></o:p></span></span></div>
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<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-913197734428530952019-05-02T09:09:00.001+08:002019-05-02T09:09:26.609+08:00醫療法納入臨床裁量權概念後出現的重要判決:<br />
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<span style="font-family: 標楷體; font-size: 14.0pt;">醫療法納入臨床裁量權概念後出現的重要判決:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">真正落實刑法上罪刑法定及罪疑唯輕原則,更將歷來較粗糙,跳躍式認定醫師觸犯刑責之實務審理習慣予以指正<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">明確表示<span lang="EN-US">107</span>年<span lang="EN-US">1</span>月修正後之醫療法第<span lang="EN-US">82</span>條第<span lang="EN-US">3</span>,<span lang="EN-US">4</span>項規定,在於降低醫師過失責任,並適用於修法前後之案件,最高法院日前的判決,令人讚嘆!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">本件係因抽脂手術,病人死亡之醫糾案件,自<span lang="EN-US">102</span>年開始偵查,到<span lang="EN-US">107</span>年醫師經高等法院二審判刑<span lang="EN-US">2</span>年,已纏訟<span lang="EN-US">5</span>年多。上訴第三審後,最高法院<span lang="EN-US">(</span>案號:<span lang="EN-US">107</span>年度台上字弟<span lang="EN-US">4587</span>號<span lang="EN-US">)</span>嚴謹,詳細的推論方式,不僅真正落實刑法上罪刑法定及罪疑唯輕原則,更將歷來較粗糙,跳躍式認定醫師觸犯刑責之實務審理習慣予以指正,在日後訴訟攻防答辯上甚具意義。茲略述如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">法官明確寫出:修正後醫療法<span lang="EN-US">82</span>條第<span lang="EN-US">3</span>項對於過失責任的認定標準既界定為「違反醫療法上必要之注意義務且逾越合理臨床專業裁量」,並有第<span lang="EN-US">4</span>項所列:醫療水準,醫療設施,工作條件及緊急迫切等多元判斷之標準,顯係為降低醫師過失責任,有利於醫療行為人,爾後無論修法前後關於醫療刑事過失責任的認定,自應以此作為判斷準據!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">三審法官明確點出:二審認定被告醫師有罪,似乎僅因該診所設備不足即推論醫師有過失致死犯行,然對於醫師對於被害人於手術期間,究因何項醫療步驟<span lang="EN-US">(</span>如麻醉,抽脂或其他手術,急救措施<span lang="EN-US">)</span>認有違反醫療常規等疏失,均未深究,說明,法官還舉例譬喻:如同不能僅因駕駛者無駕照,就認定他對於駕駛時所造成的死傷應負過失責任。此觀點實乃真正落實罪刑法定,也就是:必須行為人的某個醫療,手術行為,違反醫療常規,才能進一步認定有無犯罪,而非僅因:設備不足此間接事證,即認定有過失!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">最過癮的,是法官指出,不能僅因在無齊備的生命徵象監測儀器及急救設備下,認為死亡之風險有提高,也就是:違反注意義務之行為升高了法益侵害的風險,就認定此違反注意義務的行為即應對結果負責。如此除了違反罪疑惟輕原則,並有將危險犯視為實害犯處罰,有不當擴大過失犯成罪之虞!這段論述實在精彩。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">此外,醫審會鑑定結果或法醫的,解剖報告,縱使結論對醫師不利,但如本案中三審法官所列,其中只要鑑定報告理由中某部分仍有所存疑,例如:「手術室設置不符標準,或許可能提升手術風險或死亡率,然與病人於術中發生抽搐難認有因果關係」等情,仍應在開庭過程中具狀或當庭質疑答辯,別太早放棄。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">5.</span><span style="font-family: 標楷體; font-size: 14.0pt;">法官難得少見在判決中強調:過失行為與結果間須有相當因果關係,而在醫療紛爭事件,由於醫療行為介入前病人已罹患疾病,疾病的因果歷程已進行中,所以在認定因果關係時,需分<span lang="EN-US">2</span>個層次判斷:首先為醫療行為介入時,病人已存在疾病之種類,發展狀況,及使病人演變成死傷結果的可能性程度如何。第二,再因醫療行為介入病人病程之時期<span lang="EN-US">(</span>潛伏期,初期,高峰期等<span lang="EN-US">)</span>不同,可以治療或攔截的效果亦有差異。這部分特別指出,醫療糾紛中病人自身狀況也要加以深究,審酌,而非都在檢討醫療行為,非常難得。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="https://udn.com/news/story/7321/3733433">https://udn.com/news/story/7321/3733433</a><o:p></o:p></span></div>
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<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-31564078597071969862018-12-27T15:44:00.001+08:002018-12-27T15:44:11.508+08:00醫療廣告中有「優惠」,是否即違反醫療法86條第7款為不正當廣告,要罰5萬元?<div class="MsoNormal" style="line-height: 22.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: 標楷體; font-size: 14.0pt;">醫療廣告中有「優惠」,是否即違反醫療法<span lang="EN-US">86</span>條第<span lang="EN-US">7</span>款為不正當廣告,要罰<span lang="EN-US">5</span>萬元?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">此為最近高雄法院<span lang="EN-US">107</span>年度簡字第<span lang="EN-US">59</span>號行政判決。因為診所內張貼「優惠排毒點滴<span lang="EN-US">600</span>元」,有<span lang="EN-US">"</span>優惠<span lang="EN-US">"2</span>字,一般幾乎大部分縣市衛生局,只要看到:優惠,折扣,贈送等字眼,就來函爰引醫療法第<span lang="EN-US">86</span>條第<span lang="EN-US">7</span>款之規定,再引用衛福部<span lang="EN-US">1051667434</span>號函釋,直接開罰<span lang="EN-US">5</span>萬元,不看整體廣告狀況,內容,及排放版面,位置。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">診所這方頂多先回函說明,有些縣市衛生局承辦人員第一次會接受,請診所以後注意,改善。但有些主管機關就是要罰。大部分診所到第二階段,收到要罰<span lang="EN-US">5</span>萬元的通知時,雖明知也可訴願,若被駁回,還可打行政訴訟,但衡量委任撰寫訴願書和訴訟一審要花的錢,可能超過<span lang="EN-US">5</span>萬,大多直接給衛生局<span lang="EN-US">5</span>萬了事。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">但實則,衛生局常常只是僵硬,制式化在套用衛福部的函釋就開罰,在法律適用上不見得符合醫療法規定意旨,更與行政程序法中諸多規定,原則違背。像本案法官即明示:依衛福部<span lang="EN-US">1031660048</span>號及<span lang="EN-US">1051667434</span>號函釋,及醫療法第<span lang="EN-US">9</span>條,<span lang="EN-US">86</span>條規定之旨,用廣告招攬病人,是中央主管機關容許的行為,登載費用也是。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">重點在,是否不正當,而不是一出現”優惠”,“團購”等字眼,就構成醫療法<span lang="EN-US">86</span>條之違反。且認為被告機關只是僵化執著於法律上的用語,故判診所勝訴,撤銷原處分。由此案學到的重點:若要列出優惠的費用,就不要列出優惠前的費用。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">其實行政救濟,即寫訴願書和行政起訴狀,費用不會過高,況且事實單純,像本件原告也沒委任律師開庭,寫起訴狀即可。還有切記!救濟不停止強制執行,也就是說:還是需先繳納<span lang="EN-US">5</span>萬元罰金,等訴願,行政訴訟勝訴,衛生局會退還<span lang="EN-US">5</span>萬元。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="http://m.ltn.com.tw/news/society/breakingnews/2645694">http://m.ltn.com.tw/news/society/breakingnews/2645694</a></div>
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-27706020055509266452018-10-22T09:51:00.002+08:002018-10-22T09:51:51.839+08:00病患急診出院後2小時,檢查報告確認急性闌尾炎,醫院未通報,二審改判醫院賠償164萬元?<br />
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<span style="font-family: 標楷體; font-size: 18.6667px;">病患急診出院後</span><span lang="EN-US" style="font-family: 標楷體; font-size: 18.6667px;">2</span><span style="font-family: 標楷體; font-size: 18.6667px;">小時,檢查報告確認急性闌尾炎,醫院未通報,二審改判醫院賠償</span><span lang="EN-US" style="font-family: 標楷體; font-size: 18.6667px;">164</span><span style="font-family: 標楷體; font-size: 18.6667px;">萬元?</span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、此為衛福部桃園醫院發生於<span lang="EN-US">100</span>年的案例,刑事部分也發回續行偵查開了<span lang="EN-US">2</span>回合,後係不起訴處分。而民事部分<span lang="EN-US">101</span>年打到<span lang="EN-US">105</span>年<span lang="EN-US">8</span>月,一審判醫院和醫師勝訴,至高院二審<span lang="EN-US">(</span>案號:高院<span lang="EN-US">104</span>年度醫上字第<span lang="EN-US">18</span>號<span lang="EN-US">)</span>,醫師們仍被認定無疏失,勝訴,而醫院方面,二審則以債務不履行判決需賠償死者之子<span lang="EN-US">150</span>萬元精神賠償及<span lang="EN-US">14</span>萬<span lang="EN-US">8</span>千之喪葬費和醫療費用。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、此案例二審判決理由就醫師無過失和醫院未善盡醫療義務而判賠,有詳盡的說明:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">二名急診醫師於隔日<span lang="EN-US">9:40</span>檢查完畢,電腦斷層掃描病人無主動脈剝離,按壓病人腹部無反彈疼痛,腹部柔軟,均非急性闌尾炎之典型症狀,且出院前覺得膀胱還痛,急診醫師亦有會診泌尿科醫師,並開立藥物舒緩,法院因而認定,二名急診醫師就病人當時膀胱前方之下腹痛症狀已為必要相當之醫療處置,故其等依臨床判斷未診斷出急性闌尾炎並無疏失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">醫院部分,放射科醫師檢查報告在病人離開急診<span lang="EN-US">2</span>小時後,於<span lang="EN-US">11:29</span>確認<span lang="EN-US">c t</span>檢查結果符合急性闌尾炎,醫審會認倘有緊急通報,尚有機會召回病人及時治療。故桃園醫院未為通知的不作為,不論其他醫院是否將急性闌尾炎列為需緊急通報之情況,乃係未依債之本旨所為之給付,致病人因盲腸炎破裂引致腹膜炎造成敗血性休克而死亡,故需負賠償責任。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">三、本案二審判決理由中,有下列可供大家注意和日後訴訟攻防使用:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">因雙方爭執點有一項,在於病人自診所轉診到桃醫時,有無主訴腹痛。判決特別提到:在診所的護理評估紀錄中有胸痛及腹痛症狀,故即便主訴欄中未載明病人自己有主訴腹痛,但診所的護理評估紀錄裡,護理人員有寫到,所以不要輕忽:到院前,前手診所或醫院的護理評估紀錄。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人經檢查有哪科的症狀,急診醫師即需照會該科醫師。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://yns.page.link/wHk1v?soc_src=unv-sh&soc_trk=li">https://yns.page.link/wHk1v?soc_src=unv-sh&soc_trk=li</a></div>
<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-15943294043765333292018-10-11T09:21:00.002+08:002018-10-11T09:24:03.605+08:00切除痔瘡手術進行後2日內死亡,官司纏訟7年,最後醫院和醫師終皆全身而退!<br />
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<span style="font-family: 標楷體; font-size: 14.0pt;">切除痔瘡手術進行後<span lang="EN-US">2</span>日內死亡,官司纏訟<span lang="EN-US">7</span>年,最後醫院和醫師終皆全身而退!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">這是在台北馬偕的案子<span lang="EN-US">(</span>案號:<span lang="EN-US">103</span>年度醫上字第<span lang="EN-US">33</span>號<span lang="EN-US">)</span>,家屬主張:醫師未於術前評估病人糖尿病史,誤判手術風險,以及於病人發炎感染時延誤處置,而護理師於手術隔日上午遲至<span lang="EN-US">10</span>時<span lang="EN-US">40</span>分後始通知醫師,顯有延遲啟動檢查會診機制之情事,而向院方,醫師連帶請求<span lang="EN-US">777</span>萬元之賠償。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一,醫師部分,民事一審從<span lang="EN-US">98</span>年提告,刑事也一起,到<span lang="EN-US">103</span>年始判決,在這漫長的<span lang="EN-US">5</span>年間,刑事因家屬一直再議,發回<span lang="EN-US">3</span>次,共歷經<span lang="EN-US">4</span>個檢察官,<span lang="EN-US">3</span>次醫審會鑑定,均認醫師無過失,民事部分亦採相同意見,判決醫師不用賠,勝訴。理由在於:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人不論是入院前護理評估,麻醉前評估單,均自訴無糖尿病病史,故醫師未進行其他檢測,乃合於醫療常規。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人在隔日<span lang="EN-US">12</span>點前,皆無得認定為系統性發炎反應之症狀,而後<span lang="EN-US">12:10</span>分緊急照會確認可能是壞死性筋膜炎後,<span lang="EN-US">12:13</span>作電腦斷層掃描,<span lang="EN-US">14:05</span>報告完成,<span lang="EN-US">14:22</span>醫師做術前解釋,<span lang="EN-US">14:45</span>送達手術室,故<span lang="EN-US">3</span>次醫審會鑑定皆認醫師已立即進行相關醫療處置,時效迅速,故無遲誤。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">故醫師在一審結束時,已過<span lang="EN-US">5</span>年。民刑事方均勝訴結束。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二,醫院部分,一審法官認為,護理師延誤通知,違反護理人員法<span lang="EN-US">24</span>條,<span lang="EN-US">26</span>條,故判決醫院需賠償<span lang="EN-US">777</span>萬元。上訴至二審,法官及院方律師皆認真仔細,高院於<span lang="EN-US">104</span>年再交由醫審會為第四次鑑定,這次有個重大突破,鑑定意見表示:壞死性筋膜炎不易診斷,病程發展迅速,故即便護理人員提前將病人傷口變化通知醫師,亦難完全避免死亡結果之發生,因而於<span lang="EN-US">105</span>年<span lang="EN-US">7</span>月判決醫院亦毋須賠償。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">三,此案件二審之判決,有<span lang="EN-US">2</span>點可供大家日後參考,謹記在心:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">許多病家方律師皆會辯稱,主訴只是病人自己的敘述,醫師不能據以推諉等等。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">但是本案法官爰引最高法院判決<span lang="EN-US">96</span>台上字<span lang="EN-US">2476</span>號判決,載明:依醫師法及醫療法施行細則之病歷規定,可認患者「主訴」病情,乃構成醫師為正確醫療行為之一環,因此醫師的術前或醫療評估,若基於病人主訴,與其後之客觀檢查結果,即可答辯無疏失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">醫審會之鑑定報告,如果不利,不要太早放棄,積極列載鑑定項目,再聲請補充鑑定。有時,亦可善加利用函詢其他醫院之方式為之。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://tw.appledaily.com/headline/daily/20141018/36153386/?utm_source=Line&utm_medium=MWeb_Share&utm_campaign=https%3A%2F%2Ftw.appledaily.com%2Fheadline%2Fdaily%2F20141018%2F36153386%2F">https://tw.appledaily.com/headline/daily/20141018/36153386/?utm_source=Line&utm_medium=MWeb_Share&utm_campaign=https%3A%2F%2Ftw.appledaily.com%2Fheadline%2Fdaily%2F20141018%2F36153386%2F</a></div>
<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-233822908808669442018-06-06T17:15:00.001+08:002018-06-06T17:19:43.960+08:00車禍受傷送急診,竟以「X 光傷害症」訴請醫院和醫生賠償775萬元?<br />
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<span style="font-family: 標楷體; font-size: 14.0pt;">車禍受傷送急診,竟以「<span lang="EN-US">X </span>光傷害症」訴請醫院和醫生賠償<span lang="EN-US">775</span>萬元?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、此案病人開始先告車禍肇事者,打了<span lang="EN-US">2</span>審,之後就其被法院駁回的部分再提告台南市立醫院和醫師,一審定讞,接著才告成大醫院,從<span lang="EN-US">105</span>年告到<span lang="EN-US">107</span>年。其實過程不久,也將狀況略敘如後,以供參酌:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人開始訴請肇事者賠償<span lang="EN-US">91</span>萬元<span lang="EN-US">(</span>案號:<span lang="EN-US">105</span>訴<span lang="EN-US">967)</span>,其中包括醫藥費,修車費共<span lang="EN-US">5500</span>元,因照<span lang="EN-US">X </span>而有症狀所花費之保健食品和中藥費共<span lang="EN-US">11</span>萬,精神賠償<span lang="EN-US">80</span>萬。而因該肇事者僅係大學生,有因果關係的部分,只有醫藥費修車費,故一審判<span lang="EN-US">3</span>萬<span lang="EN-US">(</span>精神賠償<span lang="EN-US">)5500</span>。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">上訴二審<span lang="EN-US">(</span>案號:<span lang="EN-US">105</span>上易<span lang="EN-US">256)</span>後,只有精神賠償多<span lang="EN-US">7</span>萬,其他仍駁回,且高院法官有去函成大醫院詢問,照<span lang="EN-US">4</span>次<span lang="EN-US">X </span>是否會有病人所述的傷害症?成大表示,醫用<span lang="EN-US">X </span>光檢查輻射量極低,應不會造成傷害。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">因照<span lang="EN-US">X </span>受傷部分,法院<span lang="EN-US">1</span>、<span lang="EN-US">2</span>審皆未採納,病人即於<span lang="EN-US">106</span>年起訴台南市立醫院和急診幫其檢查之醫師,但到了醫師這兒,請求金額陡然暴增<span lang="EN-US">9</span>倍!精神賠償<span lang="EN-US">500</span>萬,保健食品和中藥費<span lang="EN-US">175</span>萬<span lang="EN-US">9</span>,無法再工作損害<span lang="EN-US">100</span>萬共<span lang="EN-US">775</span>萬<span lang="EN-US">9</span>。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一審法院<span lang="EN-US">(</span>案號:<span lang="EN-US">106</span>醫<span lang="EN-US">18)</span>只用半年多的時間,且再次引用之前案子成大醫院的回函,認定病人應無<span lang="EN-US">X </span>光傷害症,而判其敗訴。病人未再上訴,因一審敗訴他已需給法院<span lang="EN-US">7</span>萬<span lang="EN-US">7824</span>元,再上訴裁判費更會高達約<span lang="EN-US">12</span>萬。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">因為照<span lang="EN-US">X </span>光傷害部分一直敗訴,不管告肇事者或台南市立醫院、醫師,所以病人竟於<span lang="EN-US">106</span>年<span lang="EN-US">12</span>月台南市立醫院案判決後,接著告函覆的成大醫院。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">因此新聞重點應在台南市立醫院而非成大。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、由上述該病人的民事訴訟歷程可知:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">以後若收到天價的民事起訴狀,大家別太擔心,因為就算是醫糾案,精神賠償部分通常原告都漫天喊價,但法院最後判決都不會太多。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">其次,民事案件原告就其請求的金額要盡舉證責任,又要繳裁判費,這也是為什麼大多數病人先提告刑事的原因。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="https://tw.appledaily.com/new/realtime/20180510/1350451">https://tw.appledaily.com/new/realtime/20180510/1350451</a></div>
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<span style="color: #0070c0; font-size: 14.0pt;">黃<span lang="EN-US">x</span>勵</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 各位醫師不用太緊張(如果不幸遇到的話),刑附民的求償通常是「開價嚇死人、成交笑死人」<span lang="EN-US">XD<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">蕭<span lang="EN-US">x</span>龍</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 通常不會成啦<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Po Sen Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">插嘴一句——如文中說的,因為刑附民一審不用繳裁判費,所以漫天喊價常見。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">但這個案子有跑刑事訴訟嗎?沒有吧?就算有應該也是不起訴,所以他佔不到便宜,才會直接告民事。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Po Sen Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">刑附民的另一個重點是,刑事部分有檢察官會負責偵查、搜證,而且能拿到許多一般人不容易拿到的證據,這些證據會大幅增加民事部分的勝率。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">但也要真有案情才能辦,畢竟檢察官負有客觀義務,像這麼誇張的案子不會任對方與取予求。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 刑案他只有告肇事者。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">沒告醫師刑事,是因早過了<span lang="EN-US">6</span>個月告訴期間,而且本來就只是車禍,醫院在她送急診後做檢查這部分,本就無過失問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">林<span lang="EN-US">x</span>韜</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 可以反告誣告嗎?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 回樓上朋友的話,本件病人只有提起民事訴訟訴請醫院醫師賠償,而未提告刑事,誣告罪只能針對對方有提出刑事告訴,有誣指你犯罪者才可。所以本件不能對對方提誣告告訴<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">王<span lang="EN-US">x</span>清</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 檢察官起訴個屁<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 回樓上朋友,是那個原告,提起民事訴訟訴請醫院和醫師連帶賠償<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">林<span lang="EN-US">x</span>安</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 幫檢察官<span lang="EN-US">QQ</span>補個血<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">檢察官只管刑事<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">檢察官只管刑事<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">檢察官只管刑事<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">所有<span lang="EN-US">"</span>民事<span lang="EN-US">"</span>訴訟,檢察官一概不管的<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">起訴是個動作。把狀子丟進法院,說我要告某某某,就是起訴了,基本上不是只有檢察官可以完成這個動作。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Zoey Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">這個案子是告放射師,不是告醫師,當然最後是敗訴拉<span lang="EN-US">..</span>他還要自己負擔裁判費<span lang="EN-US">XD<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Ob Xiom </span><span style="font-family: 標楷體; font-size: 14.0pt;">告錯人了吧。醫師處方,放射師才執行<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Banksy Hsu</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">這種濫訴的惡人無法可治真是司法之之恥<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">鄧<span lang="EN-US">x</span>瑋</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 沒立法的東西,<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">司法要怎麼治?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">究竟是司法之恥?還是立法之恥?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">韓<span lang="EN-US">x</span>軒</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 這樣特殊的案例應當讓所有醫師知道 這樣的人 一輩子都別幫他照<span lang="EN-US"> X </span>光<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Yuan-Fu Lin</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">若判例確定,被告的醫師或放射師能否具名公佈對方姓名及判決書?有無侵犯隱私?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 會有爭議。最好的方式,就是<span lang="EN-US">p o </span>判決全文,什麼<span lang="EN-US">comment </span>,評論都不要有。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">謝<span lang="EN-US">x</span>翰</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 如果<span lang="EN-US">X</span>光傷害這個論調可以求償成功<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">那獸醫師以後幫動物拍一張<span lang="EN-US">X</span>光應該要收個兩三千<span lang="EN-US"> XD<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">洪<span lang="EN-US">x</span>興</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 没減寿,是夭寿<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-size: 14.0pt;">Alandia Zhang </span><span style="font-family: 標楷體; font-size: 14.0pt;">沒有腦袋怎麼會有腦傷害呢<span lang="EN-US">?<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">陳<span lang="EN-US">x</span>光</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 可以反訴嗎?要求它賠償<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 若是反訴,台南市立醫院訴請賠償較適合<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">董<span lang="EN-US">x</span>銘</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 應該還好 法院對醫師有相當大的寬容度<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">王<span lang="EN-US">x</span>專</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 這如果能成立,以後任何治療在有人簽切結書前,都不敢執行了吧。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">黃<span lang="EN-US">x</span>中</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 真的有病<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-size: 14.0pt;">黃<span lang="EN-US">x</span>瑋</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 世上一定會有腦子有問題又無恥的人,這是意料內。但是假如司法單位也是非不明,那才是真正的可悲。<span lang="EN-US"><o:p></o:p></span></span></div>
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<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-57767255308545246052018-01-02T09:04:00.003+08:002018-01-02T09:04:56.372+08:00吃中藥減肥死亡,中醫遭判刑6個月??<div class="MsoNormal" style="line-height: 25.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: 標楷體; font-size: 14.0pt;">吃中藥減肥死亡,中醫遭判刑<span lang="EN-US">6</span>個月??<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此為新北地院<span lang="EN-US">104</span>年度醫訴字第<span lang="EN-US">5</span>號,在中和中醫診所之案例。此案自<span lang="EN-US">102</span>年檢察官偵查,<span lang="EN-US">104</span>年起訴後,至<span lang="EN-US">106</span>年<span lang="EN-US">12</span>月始判決,辯方律師和告訴人方都盡力攻防,不僅有一般刑案法醫,醫審會的鑑定和報告,還有毒物化學組人員之做證,長庚,中國醫藥學院中醫的函覆及做證,更大量參酌雙方提供的中醫藥典與書籍,判決長達<span lang="EN-US">4</span>、<span lang="EN-US">50</span>頁。茲將重點及大家可參考處臚列如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">法官認定被告醫師有過失至病人死亡之理由,亦為醫審會鑑定結果,在於:病人每日服用麻黃<span lang="EN-US">30</span>公克,不僅過量,依中醫書籍和長庚大學函覆,已達中毒劑量之標準,況且中醫藥典及長庚中醫副主任均表示,麻黃不可與咖啡因配合應用,會加強麻黃之功效,被告身為中醫師當知之甚詳,竟於開立減腫三麻黃藥時同時開立含咖啡因之減重茶,而麻黃成分會使血管發生痙攣,減重茶又加強病人原已存在之冠狀動脈狹窄程度,造成其急性心肌梗塞致死。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">醫師方雖提供不少文獻和教科書,但大家以後要注意!自己提出的資料中,不可有不利於己,或反而證明對方主張之內容:如本案,被告醫師答辯稱麻黃具有使冠狀動脈血管擴張之功能,增加冠脈流量,故病人死亡與其服用減腫藥無關。但法官於判決理由中,即引述被告提出的文章中「若大量食用含麻黃鹼之藥物,可能引發…心血管疾病等」之內容打臉。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">此外,更不可忽略病歷,門診紀錄已記載之事而答辯,易讓法官覺得是狡辯<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">如本案中,辯護人另以病人於初診時告知無任何特殊病史,血壓屬正常範圍,是被告對於病人有冠狀動脈粥狀硬化之情形無預見可能性。但是,法官即指出,病人於<span lang="EN-US">6</span>月<span lang="EN-US">26</span>日到<span lang="EN-US">7</span>月<span lang="EN-US">19</span>日歷次均主訴胸悶,噁心,且反應之狀況均屬中藥典籍記載之服用麻黃不良反應,被告醫師實有預見之可能。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">最後也很重要的是,日後不管是中醫或是其他學會,若大家想請本科學會鑑定,較專業且公平,則要確切聲請或請他們先答應鑑定,而不是只有函覆。像本件雖然中醫師公會全聯會函覆被告無違反醫療常規,但法院表示「本院僅函送被害人病歷…與全聯會,請其評估可否進行鑑定,該會未經本院委託,…該函文自屬被告以外之人於審判外書面陳述」,因此「並無證據能力」。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">103</span><span style="font-family: 標楷體; font-size: 14.0pt;">公斤男吃中藥、減重茶致死 中醫師判<span lang="EN-US">6</span>月徒刑:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="https://udn.com/news/story/7321/2888346">https://udn.com/news/story/7321/2888346</a><o:p></o:p></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 補充一下,附民賠償請求部分,法官已移到民事庭。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">Peter
Smith</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">建議小編大人</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt; mso-bidi-font-family: 標楷體;">😅👍</span><span style="font-family: 標楷體; font-size: 14.0pt;">可以在寫白話文一點<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 謝謝你哦。其實已經盡量了。而有些是法官的判決內容。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">曹<span lang="EN-US">X</span>榮</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 看不出那一段是文言文啊!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 謝謝樓上朋友<span lang="EN-US">^^<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">Vivian
Liu</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">好輕<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">陳<span lang="EN-US">X</span>武</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 此案最重要關鍵<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">應該是使用過量藥物,超過醫療裁量,便需要更強注意義務<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此醫師沒辦法提出足以說服法官的理由<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 陳兄補充的好。謝謝<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">陳<span lang="EN-US">X</span>武</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 先說明,我對於這樣的醫療行為非常不贊成<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">甚至達到和神外賣水一樣厭惡<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">以下是自己的臆測<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">有強烈主觀意識<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">不喜勿讀<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一般刑案法醫,醫審會的鑑定和報告,還有毒物化學組人員之做證,長庚,中國醫藥學院中醫的函覆及做證,更大量參酌雙方提供的中醫藥典與書籍,判決長達<span lang="EN-US">4</span>,<span lang="EN-US">50</span>頁。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">這法官很認真<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">值得給他鼓勵<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">我常看醫糾判決書<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">常常都是兩三份鑑定<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">法官就心證形成<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">單單這一點<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">依中醫書籍、中國醫藥學院和長庚大學鑑定,患者用量,不僅過量,已達中毒劑量之標準,不可與咖啡因配合應用,會加強麻黃之功效<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">就足以定罪<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">法官願意讓被告盡情發揮<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">感覺起來是有點要讓被告自己良心發現自己的錯誤<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">對於這樣的行為<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">18</span><span style="font-family: 標楷體; font-size: 14.0pt;">萬易科罰金換一條人命,太輕了<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 法官真的很認真。在實務上也有可能是告訴人的律師,寫很多補充告訴理由狀給檢察官請他轉呈,法官也一併寄。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 陳兄的確看的很仔細。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">陳<span lang="EN-US">X</span>武</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 三家醫學中心及醫審會及法醫都否定他的醫療決策或解釋<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">也沒冤枉他了<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">陳<span lang="EN-US">X</span>武</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 辯護人固以長庚大學回函稱麻黃用量過大或誤用,易引起心悸、氣促等症狀,認心悸時大腦感測到心臟缺氧之訊號,即會設法增加血液之供應量,進而使冠狀動脈擴張,以增加流經心臟之血液量云云。然辯護人所指上開情節並未提出相關醫學文獻供本院參酌,自難逕信為真,並無從遽為有利被告之認定。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">這是甚麼理由<span lang="EN-US">??</span>,心臟科專家可以解說一下嗎<span lang="EN-US">?<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">Ob
Garmawangdo</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">搞死人判六個月?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">David
Ting</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">非故意<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">陳<span lang="EN-US">X</span>武</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 至中華民國中醫師公會全國聯合會雖函覆本院稱被告本案醫療行為尚未發現有何違反醫療常規情形,難以僅憑該減肥中藥含有偽麻黃素及甲基麻黃素等成分,即認定被告之醫療行為具有過失云云(詳本院卷一第<span lang="EN-US">338 </span>頁、第<span lang="EN-US">339 </span>頁)。然查,本院僅函送被害人病歷、法醫解剖報告書及鑑定報告書與中華民國中醫師公會全國聯合會,請其評估可否進行鑑定(詳本院卷一第<span lang="EN-US">269 </span>頁、第<span lang="EN-US">302 </span>頁),該會未 經本院委託,逕就本院檢送之書面資料進行審視,該函文自屬被告以外之人於審判外之書面陳述,並無證據能力,復經檢察官否認該證據方法之證據能力(詳本院卷一卷第<span lang="EN-US"> 345 </span>頁),是該函文自不得為本院認定事實之依據。況查,該會僅憑本院檢送之被害人病歷資料、解剖報告書及鑑定書等影本進行審視,逕謂被告之診斷並無不當,尚未發現有何違反醫療常規,尚難發現被害人死亡之結果與其服用減肥中藥有相當因果關係,並未說明其審核之依據。且其謂被告就該減肥中藥所開具之劑量與服用次數,若符合該藥仿單所標示之範疇,被害人死因即與該減肥中藥無涉云云,更係完全未探究晉安龍沙濃縮膠囊之仿單內容,另其謂「難以僅憑該減肥中藥含有偽麻黃素及甲基麻黃素等成分」云云,亦與事實不符,從而,該中華民國中醫師公會全國聯合會函文自無從為有利被告之認定。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此篇是法官解釋為何不採納唯一對被告有利的鑑定<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">被告律師如果像醫界同盟一樣有能力<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">應該會再次主張送中醫師公會全國聯合會鑑定<span lang="EN-US">(</span>因為之前是函問<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">同一機構被請求再次鑑定也不是沒發生過的<span lang="EN-US">(</span>此次中國和長庚都鑑定兩三次,當然真對的項目或是細節有所不同<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">我猜全聯會的回覆被認為偏袒<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">所以法官和檢察官不同意再送全聯會<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">後續就沒有正式送全聯會的鑑定<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 陳兄說的是。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">Ching-Ming
Liu</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">非故意?難道是“無知”嗎?我不懂?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">Leonard
Lin</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">中醫師就是醫師,在量刑方面都不會重,大都在醫療疏失的民事賠償金額上爭議!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #1f497d; font-family: 標楷體; font-size: 14.0pt; mso-themecolor: text2;">林<span lang="EN-US">X</span>峰</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 六個月還能易科罰金<span lang="EN-US"><o:p></o:p></span></span></div>
芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-18101729550002279472017-12-20T14:07:00.001+08:002017-12-20T14:07:51.588+08:00機長於健檢3周後因急性心臟衰竭在美不幸過世,家屬主張航空局,航醫中心與醫師需連帶賠償200萬?<div class="MsoNormal" style="line-height: 25.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: 標楷體; font-size: 14.0pt;">機長於健檢<span lang="EN-US">3</span>周後因急性心臟衰竭在美不幸過世,家屬主張航空局,航醫中心與醫師需連帶賠償<span lang="EN-US">200</span>萬?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此為剛宣判之台北地院<span lang="EN-US">105</span>年度醫字第<span lang="EN-US">42</span>號案件。家屬主張,檢查報告結果一切正常,已有判讀疏失,且未將心壓測試及冠狀動脈血管攝影納入檢測,民航局亦怠忽職守。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">本案判決中有幾個值得學習或肯定處,特說明如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、法官不僅遵守侵權行為法則:由請求者舉證證明因果關係,即侵權行為成立要件舉證,更在判決理由中適用「醫師於臨床治療上有自由裁量之餘地」之觀念,而因經成大鑑定,函覆被告醫師在<span lang="EN-US">105</span>年<span lang="EN-US">1</span>月<span lang="EN-US">4</span>號之檢查判讀並無疏失,故判決原告敗訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、本案被告方的攻防策略很厲害,日後大家可參考,就是從大前提答辯,就打倒對方的攻擊:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> 1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">本件被告方律師先從:系爭體檢契約係成立於航醫中心與長榮航空間,所以死亡的機長和民航局都非當事人,故向被告之一民航局請求無理由!也就是直接從當事人就不適格此程序上理由攻擊。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> 2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">再來最重要的,是被告方主張,他們所做的體檢,只是民航法<span lang="EN-US">26</span>條所規定的體格檢查,並非健康檢查,也就是說,目的只在判定航空人員是否符合有關我國飛航人員體格之標準而已,而非如對方所稱是「預防人體疾病,傷害,殘缺為目的所為之診察診斷行為」,此處辯方再度用上位階的理由攻克,十分厲害。法官也採此主張,而認定:「系爭體檢之結果判定機長之體格適於飛行,至於執行飛行任務後在國外因急性心臟衰竭死亡,尚難認與被告為其檢查體格之行為有何因果關係」,而駁回原告<span lang="EN-US">200</span>萬元之精神賠償。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">三、在醫療糾紛的案件中,除了醫審會外,法院也常用醫院鑑定或函詢醫院的方式,依處理過的經驗,台大,榮總常因業務繁忙而拒絕,成大雖在南部,但配合度頗高,大家可參酌。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">四、最後,本案成大分別在<span lang="EN-US">106</span>年<span lang="EN-US">3</span>月,<span lang="EN-US">7</span>月及<span lang="EN-US">9</span>月回覆共<span lang="EN-US">3</span>次,在這兒再次提醒大家:倘若日後案件之鑑定,函覆結果不利或不夠詳細,可如本案的模式,再具狀寫明理由,聲請鑑定單位再回覆。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">http://www.setn.com/News.aspx?NewsID=326838<o:p></o:p></span></div>
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<a href="http://www.setn.com/News.aspx?NewsID=326838">體檢正常!機長21天後飛美國猝死 家屬向民航局求償敗訴</a></div>
芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-50296689651581015042017-12-03T09:13:00.000+08:002017-12-03T09:16:55.671+08:00X 光片判讀錯誤,診所醫師和診所需連帶賠償198萬元??<div class="MsoNormal" style="line-height: 25.0pt; margin-left: 28.0pt; mso-char-indent-count: -2.0; mso-line-height-rule: exactly; text-align: justify; text-indent: -28.0pt; text-justify: inter-ideograph;">
<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">X </span><span style="font-family: 標楷體; font-size: 14.0pt;">光片判讀錯誤,診所醫師和診所需連帶賠償<span lang="EN-US">198</span>萬元??<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、此為高院<span lang="EN-US">105</span>年度醫上更一字第<span lang="EN-US">5</span>號判決,日前剛宣判,又引起醫界關注。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此案件其實自<span lang="EN-US">99</span>年纏訟至今已<span lang="EN-US">7</span>年,歷經三審,再發回高院二審更為審理,先將法院見解之重點和轉變過程略述如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">北院一審<span lang="EN-US">(99</span>年醫字<span lang="EN-US">6</span>號<span lang="EN-US">)</span>判決診所和醫師需賠償<span lang="EN-US">500</span>多萬元,因其認定:<span lang="EN-US">X </span>光片誤判病人為正常,不符當時之臨床醫療水準而有過失,至病人存活機率降低<span lang="EN-US">46%</span>,故需賠償病人<span lang="EN-US">43</span>歲到<span lang="EN-US">60</span>歲<span lang="EN-US">17</span>年間勞動能力減少的損害<span lang="EN-US">321</span>萬,和精神痛苦賠償<span lang="EN-US">200</span>萬元。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">嗣上訴至高院<span lang="EN-US">(101</span>醫上字<span lang="EN-US">6</span>號<span lang="EN-US">)</span>,也就是第一次二審判決,相對而言,判決理由論理較正確,法官認為病人<span lang="EN-US">98</span>年發現的惡性胸腺瘤,距離<span lang="EN-US">96</span>年診所的健檢已<span lang="EN-US">2</span>年,期間病人身體變數極大,故難認:誤讀<span lang="EN-US">X </span>光片檢查,與胸腺瘤病程演化有因果關係,所以只保留精神賠償的部分,判賠<span lang="EN-US">180</span>萬元。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">之後到最高法院第三審<span lang="EN-US">(105</span>台上<span lang="EN-US">1602)</span>,接受病人部分上訴理由,在於他們認為,二審一方面認為醫師誤讀<span lang="EN-US">X </span>光片和病人的胸腺瘤不一定有關,另方面卻又認該誤讀,讓病人喪失及早接受治療的機會,至病人精神上承受憾恨痛苦,故判賠<span lang="EN-US">180</span>萬,顯有判決理由矛盾的違法,所以發回高院更審。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">最後就是數日前判決賠<span lang="EN-US">198</span>萬,第二次的高院判決。簡言之,他們又再採用北院一審的認定,而認誤讀和病人的胸腺瘤有因果關係,但喪失勞動能力的賠償再降剩<span lang="EN-US">118</span>萬元,精神賠償也降為<span lang="EN-US">80</span>萬元。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、由此案例,要告訴大家:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">倘若鑑定醫院函覆或醫審會鑑定結果較不利時,可聲請補充鑑定或函詢,或函詢其他醫院。就有利不利的點,均用書狀詳為論證。勿掉以輕心。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">在<span lang="EN-US">X </span>光片判讀或其他檢驗報告上,盡量不要使用太確定的字眼<span lang="EN-US">;</span>例如可用:疑似,無異常等等。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">就處理過的案件經驗,在此提醒:該檢查與病症間無因果關係?還有時間經過?病人體質,賠償金額之計算等等,都要「錙銖必較」,才較能得到勝利。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">版主就此案第一次的二審判決在<span lang="EN-US">2016</span>年<span lang="EN-US">4</span>月<span lang="EN-US">10</span>日有詳細論述討論,大家也可參考。<span lang="EN-US"><o:p></o:p></span></span></div>
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-60401886767150240372017-11-29T16:01:00.001+08:002017-11-29T16:03:10.234+08:00由實證研究看台灣醫療過失的刑事責任<h2 id="new-title" style="background-color: white; box-sizing: border-box; color: #333333; font-family: 微軟正黑體, "PT Sans", Arial, serif; font-size: 40px; line-height: 1.1; margin: 20px 0px 30px;">
由實證研究看台灣醫療過失的刑事責任</h2>
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本文期待透過實證研究呼籲國內法學界對醫師承受醫療過失刑事責任之嚴厲做法予以修正。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">消費者意識高漲 醫病關係面臨挑戰</span></span><br />
當今社會是消費者意識高漲的時代,而且病人也可大量獲得醫療照護資訊。在醫療照護資訊的快速傳播與輕易獲得的情況下,加上媒體的宣傳,傳統的醫病關係已經大大地改變。近幾年來,病人自主權急速提升,醫師在醫療處置的決策地位已被病人人權提倡者所褫奪。因此,醫病關係正急遽改變。當病人或其家屬不滿意醫療結果時,醫病關係就面臨挑戰。法界學者歸納在我國醫療糾紛案件遽增之原因,大概如下:(1)醫療需求的不斷擴充;(2)醫療期待的大幅提升;(3)新興醫療儀器、藥品或治療方法的大膽嘗試運用(陳忠五,2004)。一方面反映出病人自我保護意識及消費者意識增強。在另一方面也是社會大眾對醫院的醫療服務品質提出了更高的要求。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">台灣醫師所承受的壓力 世界第一</span></span><br />
西方各國對醫療過失的處理,均採取比交通事故等其他業務過失更為寬宥的態度。德、日等國刑法學界認為基於合理信賴原則及可容許風險原則,醫療過失應減輕或免除業務過失責任。至於英美等海洋法系國家,則完全以民事訴訟來解決醫療糾紛。目前,在各國的司法實踐上,極少以刑事責任追究醫療過失,僅有少數國家以刑法規範醫療行為。我國醫療過失的刑事案件確佔所有醫療糾紛案件的大多數,成為「世界第一名」。從而,台灣醫師承受著全世界絕大多數醫師所不須承受的壓力,這是醫界難以接受的。台灣這種錯誤的制度只會造成病、法、醫三輸,並非台灣人民之福。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">美國醫療事故做法</span></span><br />
美國傳統上,醫療事故係在民事法庭解決受害患者或其家屬之損害,極少提起刑事訴訟。在美國,當被告醫師的醫療照顧品質或治療水準未能達到當時當地的水準,因而發生診斷錯誤、判斷錯誤或治療失當時,通常被認定為醫療疏忽或不良執業,而以民法的不盡責處理。麻薩諸塞州最高法院認為醫師之良好誠實的錯誤判斷或無心過錯,不應以刑法處理。美國司法官審理醫療糾紛時,若被認定為「一般過失」,通常以民法處理,只有在下列情況,才可能被認定是「重大過失」,以刑法起訴:(1)承辦醫療保險有詐欺行為;(2)對病人有性侵犯行為;(3)非法處方或使用管制藥品;(4)醫療行為嚴重地或故意地、且極端偏離執業標準。也就是說,在美國必須因重大忽視醫學學理,或於治療的實施或選擇有重大過失,缺乏使用器械的技術,或對病人未有適當的注意,致對病人的人身安全有重大的缺乏專業能力、重大的不注意、或魯莽的漠不關心,方可構成刑事過失(陳怡安,2000)。<br />
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客觀上,注意義務的偏離應達到明顯重大的程度,才有成立刑事過失啟動刑事處罰之必要;醫師主觀上對於注意義務之違反,亦必須達到不道德與輕率之程度,否則其主觀心態並無以刑事責任加以非難之必要(張明偉,2008)。在美國法制史上,以刑事司法系統處理醫療糾紛之案件,可追溯至西元1809年之麻州訴湯普森案。1809年至1981年為止,上訴法院大約審判了15個類似的案件。在其後的20年裡,僅有24案件進入了下級法院的審判程序(0.004位醫師/百萬人口),其中有5名醫師被判刑。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">日本醫療事故做法</span></span><br />
日本在1974年和2003年之間,總共有100位醫師被起訴,88位醫師被判有罪。但是,在2000年和2006年之間,確有106位醫師被刑事起訴。也就是說,近年來,日本平均每年15位醫師被刑事起訴(0.12位醫師/百萬人口)。日本法界學者認為醫師被起訴數字的增加可能是由於社會大眾擔心醫療錯誤的增加。在1999年,兩起醫療意外事件經大眾傳播媒體的渲染而造成醫師被起訴的向上趨勢。事件一:一位心臟病病人和另外一位肺腫瘤病人被誤認而給錯手術。事件二:在一所大都市的醫院的一位護士因給錯藥而造成病人的死亡。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">台灣醫療事故做法</span></span><br />
我國學說與實務有關刑事過失之判斷,均以一般輕過失為標準,因此只要行為人之行為違反了相關的注意義務,不論注意義務違反的情節輕重,一概認為其行為該當刑事過失之評價。我國刑法並未探討輕過失與重大過失之問題。縱使是行為人所犯的僅是輕微過失,也僅在量刑上考慮而已,並不影響過失犯之成立(張明偉,2008)。<br />
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台灣地區醫療過失刑事案例的實證研究並不多。依1993年陳榮基醫師等學者之「台灣醫療糾紛之現況與處理」調查發現台灣醫療糾紛訴訟案件的類型以刑事附帶民事起訴者最多(82.3%),判決結果病人勝訴佔3.4%。根據筆者年於東吳大學法研所的實證研究,在21世紀的最初4年內,台灣共有15件刑事訴訟醫師敗訴「確定」的案件。也就是說,平均每3個月有一位醫師被判刑定讞。「有罪的」醫師全來自「內外婦兒」四大科與重症科(麻醉科、急診科)。根據筆者最近之研究,2000年至2007年,全台灣僅有的74名心臟外科(重症科中的重症科)專科醫師中,竟有6名醫師被刑事起訴,多為極資深優秀醫師,被起訴者三分之二為主任級以上(含院長級)醫師。其中一名主任級醫師被判刑定讞,敗訴率高達16.7%。台灣每年地方法院醫療訴訟刑事判決數,平均每年43案件(1.95位醫師/百萬人口),與心臟外科醫師比較,其p值小於0.0001,統計學上非常有意義。醫師敗訴率約為7%,與心臟外科醫師比較,其p值等於0.024,統計學上相當有意義。若以統計方式分析,醫療糾紛刑事訴訟新案件發生率:台灣遠大於美國、台灣遠大於日本、日本遠大於美國。台灣刑事訴訟新案件發生率是顯著地高於其它兩國(p值小於0.0001,統計學上非常有意義。)。從而,在台灣,風險越大的科別之醫師,越易敗訴。目前,醫學系的優秀畢業生多不選擇「勞心勞力」、又「容易被告」的科別。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">訂定機制汰除不適任醫師以確保醫療品質</span></span><br />
為何醫療過失案件要啟動刑事訴訟程序?美國法界學者認為,刑事制裁手段或可成為填補民事制裁手段不足之工具。然而,在美國執業的醫師絕大部分都有加入醫療過失保險體系,保險公司握有拒絕承保或增加保費的權力。若醫師反覆出現醫療過失行為,勢將被保險公司拒絕承保或增加保費。美國賠償金額極大,若未加入醫療過失保險體系,醫師根本不敢執業。從而,醫療過失保險體系與民事訴訟仍有淘汰不合格醫師之效。此外,日本平均每年15位醫師被刑事起訴,佔所有醫療訴訟案件百分之1.6。美國平均每年1.2位醫師被刑事起訴,佔所有醫療訴訟案件不到萬分之1。如此低的刑事起訴率是否足以產生堅強的外控機制以汰除不適任醫師,以確保醫療品質,實在另人懷疑!<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">經常性醫療糾紛之刑事訴訟需耗費極高的「防衛性醫療」</span></span><br />
台灣法界人士絕大部分都主張基於平等原則、保護生命和身體法益,醫療過失應負刑事責任。他們雖然認可醫療行為有不確定性和高危險性,但仍主張不能因為有民事賠償,就可以不論刑責,否則將衍生弊端(蔡振修,2004)。然而,從實證研究可知:外國的司法實務極少對於醫療過失追訴刑事責任。因醫療糾紛而經常性的提起刑事訴訟乃台灣所特有,會造成耗費極高的「防衛性醫療」,對醫病關係極為不利。從而,醫療刑事訴訟會造成醫病雙輸,應為智者所不採。<br />
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<span style="box-sizing: border-box; color: blue;"><span style="box-sizing: border-box; font-weight: 700;">未來展望</span></span><br />
未來修法時,一、醫療過失罪之構成要件,宜修正為:「在客觀上注意義務的偏離達到明顯重大的程度」,亦即將醫療法第八十二條第二項修正為「醫療機構及其醫師因執行業務致生損害於病人,以故意或過失為限,負損害賠償責任。除嚴重不負責任外,不受刑事上之訴究。」;二、免除過失輕傷害的刑事責任,減輕過失致死及過失致重傷害之刑罰;三、善用「緩起訴制度」和「罪刑協商制度」,以達成「準去刑化」之目的。但為使台灣人民安心,「去刑化」仍須在立法上有配套措施:一、比照交通事故的第三責任險,建立有強制性的「醫療責任險」,使病人家屬獲得快速賠償,歐美日本各國多有此制度;二、醫療糾紛案件進入訴訟程序前,應強制「調解」,因為此時醫病雙方較能心平氣和地坐下來談;三、縮短醫療糾紛民事訴訟案件之處理流程,訴訟費用在判決前由醫療責任險成立的基金暫墊。 <br />
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附註:本文部分內容發表於「過失醫療行為應否負刑事責任之探討」學術研討會,台灣刑事法學會主辦,2008年12月7日。<br />
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本文作者【林口長庚心臟外科教授 林萍章醫師】</div>
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資料來源:<a href="https://www.kingnet.com.tw/knNew/news/single-article.html?newId=18762">國家網路醫藥</a><br />
<br />芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-26421472657594445342017-11-23T09:07:00.002+08:002017-11-23T09:08:06.635+08:00隆乳後出現良性鈣化,盡力幫病人處理仍被訴請賠償500萬,纏訟2年?<div class="MsoNormal" style="line-height: 25.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: 標楷體; font-size: 14.0pt;">隆乳後出現良性鈣化,盡力幫病人處理仍被訴請賠償<span lang="EN-US">500</span>萬,纏訟<span lang="EN-US">2</span>年?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、此為高等法院<span lang="EN-US">106</span>年醫上字第<span lang="EN-US">20</span>號判決,全案因病人僅就<span lang="EN-US">100</span>萬範圍內上訴而確定。病人於<span lang="EN-US">100</span>年<span lang="EN-US">11</span>月,因產後胸部萎縮而至診所進行自體脂肪隆乳。其主張醫師僅抽血檢驗,術前未妥善評估後遺症,且注射過量有疏失,又未善盡說明義務,致其未能正確認知可能的風險,訴請醫師及診所連帶賠償精神慰撫金<span lang="EN-US">500</span>萬元!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、台北地院<span lang="EN-US">(104</span>年度醫字第<span lang="EN-US">33</span>號<span lang="EN-US">)</span>及高院均為醫師勝訴之判決,高院更是<span lang="EN-US">4</span>個月內就駁回病人之上訴,法院以下列理由,認為醫師無疏失且已盡說明義務:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">依據台北榮總鑑定回函表示:目前臨床上仍缺乏有效的工具檢測何為「易引起乳房鈣化及其他併發症之高風險體質」,亦即目前醫療上無檢測方法可事先預知<span lang="EN-US">;</span>且醫師注射<span lang="EN-US">180cc </span>的脂肪,又在相關文獻所載:<span lang="EN-US">150</span>至<span lang="EN-US">200</span>間之範圍,故醫師並無何醫療疏失可言。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">→此部分之攻防,即係大家常聽到:有無疏失之判定,係依當時醫療水準及現況為標準。還有,找出其他相關期刊,雜誌或論文來佐證。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人又以<span lang="EN-US">1</span>年半後的乳房切片檢查之病理報告,主張其反應性淋巴增生狀況係手術所造成。然因反應性淋巴性增生的原因者眾,且又是手術後<span lang="EN-US">1</span>年半多的狀況,故北榮鑑定認定:無法據以判斷兩者有無因果關係。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">說明義務部分,因為在<span lang="EN-US">103</span>年<span lang="EN-US">2</span>月,醫師還有替病人進行鈣化清除手術,豈料病人竟以<span lang="EN-US">103</span>年<span lang="EN-US">2</span>月的手術同意書中未記載手術風險有鈣化這點,反過來指控:醫師於<span lang="EN-US">100</span>年<span lang="EN-US">11</span>月的本件隆乳手術同意書上,會「發生鈣化」此手術風險之記載係事後所填而主張醫師未盡說明義務,然為法官所不採。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">→在此建議,手術同意書固可用衛服部制式的,但各種不同手術之風險及併發症,則建議另行列出印出,併成附件一起給病人。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="http://www.chinatimes.com/realtimenews/20171121003636-260402">女隆乳B變D怒告醫師 法院判敗訴定讞</a></div>
芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-91538673657550397952017-11-20T09:08:00.003+08:002017-11-20T09:08:50.090+08:00攸關眾診所權益之全民健保特管辦法,涉及違反一行為不二罰之部分,從釋字753號解釋後,可再努力!<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: 標楷體; font-size: 14.0pt;">攸關眾診所權益之全民健保特管辦法,涉及違反一行為不二罰之部分,從釋字<span lang="EN-US">753</span>號解釋後,可再努力!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">753</span><span style="font-family: 標楷體; font-size: 14.0pt;">號解釋於今年<span lang="EN-US">10</span>月<span lang="EN-US">6</span>號公佈,已有不少評論剖析。爭議亦不小,多位大法官持不同意見。茲將日後行政訴訟之重點和心得說明如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">因全民健保為強制性之社會保險,屬公共利益之重大事項,故全民健保法第<span lang="EN-US">66</span>條第<span lang="EN-US">1</span>項授權主管機關得制定法規命令,規定申請特約之資格,程序及違約處理等事項,故,特管辦法此規定之本身,並無違憲。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">但是,重點在:特約診所有虛報,詐領健保費或未依處方箋記載調劑之情形時,健保法第<span lang="EN-US">81</span>條第<span lang="EN-US">1</span>項前段,即有處罰之規定:「以不正當行為或以虛偽之證明,報告,陳述而領取保險給付者…處以申報醫療費用<span lang="EN-US">2</span>至<span lang="EN-US">20</span>倍之罰鍰」,豈料現行特管辦法第<span lang="EN-US">39</span>條第<span lang="EN-US">4</span>款,<span lang="EN-US">47</span>條第<span lang="EN-US">1</span>項及<span lang="EN-US">37</span>條第<span lang="EN-US">1</span>項第<span lang="EN-US">1</span>款竟再為停止特約,不予支付,停約扣抵等處罰,不僅有子法(特管辦法)逾越母法(全民健保法)之嫌,單一行為卻重複處以金錢上之不利益,更應認這些規定,違反一行為不二罰之原則,而有違憲法第<span lang="EN-US">23</span>條之比例原則。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">上述意見,本次有大法官於不同意見書中有精闢的論述,在此特別提出:日後若再遇健保署以虛報健保費,在用健保法第<span lang="EN-US">81</span>條處罰後又再適用特管辦法規定,為停止特約,不給付等雙重處罰時,在提出訴願及行政訴訟時,最好具體指謫如此有子法逾越母法,違反一行為不二罰之原則,而不要再只抽象,廣泛地表示健保署違反法律保留和授權明確性原則。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="http://www.lawtw.com/article.php?template=article_content&area=free_browse&parent_path=%2C1%2C2169%2C1481%2C&job_id=147167&article_category_id=2388&article_id=147167"><span lang="EN-US"><span lang="EN-US">司法院釋字第753</span></span><span lang="EN-US"><span lang="EN-US">號解釋摘要</span></span></a><o:p></o:p></span></div>
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-27057889978895292682017-09-15T17:50:00.003+08:002017-09-15T17:51:24.112+08:00以後有遭負面報導及被刊登照片者,可參照本案例訴請賠償!<div class="MsoNormal" style="line-height: 25.0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: 標楷體; font-size: 14.0pt;">以後有遭負面報導及被刊登照片者,可參照本案例訴請賠償!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一、此為經最高法院發回更審之二審判決<span lang="EN-US">(105</span>年度上更一字第<span lang="EN-US">108</span>號<span lang="EN-US">)</span>,特別處在於:原告是新北地院的法官,他在審理一性侵案被告是否應羈押時,判斷嫌犯應無逃亡串供之餘,所以裁定交保。而蘋果日報卻報導:「因法官輕信嫌犯你情我願的說詞,而以<span lang="EN-US">5</span>萬元縱放惡狼」,本件法院認為如此會使讀者對原告產生認事荒謬,審判不公之負面觀感,且非本於合理查證而為,乃屬不法侵害原告之名譽權,故判決該記者,蘋果日報需連帶賠償該名法官<span lang="EN-US">40</span>萬元。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二、蘋果日報又在之後<span lang="EN-US">2</span>次的報導中刊登原告的照片,並於下方用較大字體註記「恐龍法院」,「腦殘法官下台」字樣,本件法官以下列<span lang="EN-US">4</span>理由,認定蘋果侵害原告的肖像權,判決需賠償<span lang="EN-US">20</span>萬元:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">司法人員並非公眾人物,他承辦的案件固屬可受公評之事項,然其外貌如何,與交保裁定之作成是否妥適並無關聯性。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">這點也很重要:縱然蘋果主張原告的照片是自公開網際網路轉載,然也不表示原告同意第三人得任意以原使用目的以外之其他目的不當使用其個人肖像。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">刊登照片的目的,在於使社會大眾將原告與「恐龍法官,腦殘法官」之形象產生不當連結,無助於民眾對報導內容事實之瞭解。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">兼以蘋果日報之市占率高,照片又可透過連結蘋果日報網頁供不特定人瀏覽,則原告肖像權遭受侵害之情節,實屬重大。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">三、結論:自本件高院更審判決可知:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">上述判決媒體應賠償該名被報導法官的理由,在各位醫護朋友因醫糾案件被報導,照片被刊登時,皆可爰引適用,請求肖像權之損害賠償。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">提告的對象,除了記者和報社以外,本件法官認為總編輯對於照片與內容之連結是否妥適,如何放置,理應有審核督導之權,故判決總編輯也應負連帶賠償之責!<span lang="EN-US"><o:p></o:p></span></span><br />
<span style="font-family: 標楷體; font-size: 14.0pt;"><span style="background-color: #f6f7f9; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 13px; text-align: start; text-indent: 0px;">最高法院發回的判決案號:105年度台上字第1895號</span></span></div>
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<a href="https://udn.com/news/story/7321/2670683">https://udn.com/news/story/7321/2670683</a></div>
芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-81433671742142661572017-09-01T16:21:00.004+08:002017-09-01T16:21:50.446+08:00病人死亡被認定係抽脂手術所致,遭判刑2年,再次證明:病歷,手術紀錄的重要,是不分診所醫院和醫美的!<div class="MsoNormal" style="line-height: 30.0pt; mso-line-height-rule: exactly;">
<span style="font-family: 標楷體; font-size: 14.0pt;">病人死亡被認定係抽脂手術所致,遭判刑<span lang="EN-US">2</span>年,再次證明:病歷,手術紀錄的重要,是不分診所醫院和醫美的!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">本案為高雄地院<span lang="EN-US">104</span>年度醫訴字第<span lang="EN-US">1</span>號判決,想必醫護朋友應十分震驚。然而此判決不僅連在法界都難得一見,理由亦論述詳盡,特將重點及特殊處說明如下,供大家參酌:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">本件檢察署原已為不起訴處分,經病家向高檢署提出再議也被駁回,所以在<span lang="EN-US">10</span>日內他們又向法院提出交付審判的聲請。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">特別的來了:上述案件經地檢,高檢都不起訴,告訴人可再額外向法院聲請交付審判的狀況,從<span lang="EN-US">91</span>年修改刑事訴訟法後,成功地讓法院再開庭審理的機率,連萬分之一都不到,很難成功。這件是版主看過第二件,但共通點是,都是被害人死亡的情形。先告訴大家這點,所以法官才會在判決一開始載明:經本院裁定准予交審確定後,視為提起公訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">再者,本案分別由法醫研究所和中山大學鑑定死因,前者認係溶脂手術後出現心血管疾病發作死亡,後者認係肺栓塞,由此小地方可見雙方攻防之精彩!因為:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">雖然二個都是抽脂手術常見的併發症,但是關鍵在於,若是肺栓塞,因它術後較難發現,且也沒有一定的時間進程,所以就算醫師有做到術後監測病人狀況,也難避免!如此就較無:應注意,未注意的狀況。且醫審會表示:此二者他們無法確定為何。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">大家注意!此時在實務上法官大多會採法醫的見解,因為法官認為法醫是直接接觸,觀察鑑驗標的<span lang="EN-US">(</span>即大體<span lang="EN-US">)</span>作為其鑑定判斷的依據。所以本案法官認定死因是溶脂術後併發心血管疾病。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">而因術後<span lang="EN-US">25</span>分鐘,醫師僅和他打招呼,詢問,見無異狀,即讓病人出院。然於出院後<span lang="EN-US">3</span>個小時其生命徵象之變化進程即已惡化嚴重,且在此時間內病人均在休息睡覺,並無其他事故或從事劇烈運動,又非瘁死,因此法官認定病人因抽脂手術產生的出血,引發血氧濃度過低之缺血程度,進而誘發心肌梗塞,在本件手術完成時即已開始,而因病歷中,病人術前術中術後之生命徵象數據毫無記載,醫師又只有以和病人交談,目視之方式觀察,法官實無法認定醫師沒有過失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">自本案再提醒大家:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">A .</span><span style="font-family: 標楷體; font-size: 14.0pt;">千萬不要說,上次他抽脂也是這樣啊!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">因如此只會更令法官感覺你在迴避本次事件的陳述,還認為你都沒手術紀錄,對抽脂手術之執行均未持謹慎的態度。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">B .</span><span style="font-family: 標楷體; font-size: 14.0pt;">一般牙醫,醫美診所手術都較簡略。在此建議大家,起碼術前術後檢測病人的生命徵象紀錄,或手術施打麻藥的計量等要記載。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="http://news.ltn.com.tw/news/society/breakingnews/2180156"><span lang="EN-US"><span lang="EN-US">自由時報</span></span></a><o:p></o:p></span></div>
芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-11788000780361386382017-08-25T11:21:00.003+08:002017-08-25T11:24:12.450+08:00於診所進行內視鏡手術,後已在大醫院另進行其他手術,不幸死亡仍要求診所賠償?<div class="MsoNormal" style="line-height: 30.0pt; mso-line-height-rule: exactly;">
<span style="font-family: 標楷體; font-size: 14.0pt;">於診所進行內視鏡手術,後已在大醫院另進行其他手術,不幸死亡仍要求診所賠償?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">一,此為士林地院<span lang="EN-US">105</span>年度醫字第<span lang="EN-US">1</span>號之案件,判決結果係診所方勝訴,法官之論理分明,就醫審會的鑑定報告亦未任意擴張解釋或斷章取義,說明如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">雖然醫審會鑑定結果係認:因病人發生延後性穿孔,進而接受後續手術等相關治療,其死因與醫師的手術有關<span lang="EN-US">;</span>但是,此屬內視鏡手術不可避免的風險,所以不得逕認醫師有疏失<span lang="EN-US">;<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">承上,接著即應判斷,醫師執行手術過程有無疏失?因為術中並無出現出血及穿孔此內視鏡黏膜剝離術過程之併發症,且依麻醉紀錄,病人生命徵象穩定,晚上<span lang="EN-US">7</span>時尚可自行出院,於晚上凌晨因不適送至長庚急診,脈搏血壓亦正常,因此合理推知,手術未直接造成穿孔,故醫審會認定執行手術時無疏失。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">關於術後照護亦無疏失:因內視鏡黏膜剝離手術後,病人生命徵象穩定後即可出院,並無必須住院之<span lang="EN-US">guideline</span>。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">況且,在<span lang="EN-US">6:30</span>病人表示腹部疼痛時,醫師有替其施打止痛針,而在晚上<span lang="EN-US">10</span>點病人去電告知醫師覺得腹部疼痛不適,醫師即時建議病人至醫院急診室,由上可知,醫師在手術完成後的照護追蹤過程,亦無違反醫療常規。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">此外,病人於當晚不適送至長庚後,還進行了數個手術,期間一度好轉,益證其最後的死亡結果與醫師最初的內視鏡手術無因果關係!綜上理由,法院駁回病家的請求。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">二,自本案例之判決理由,在此提醒:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">術前併發症,風險的說明,告知,不管是錄音或病歷,都要有紀錄存證。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">麻醉,術後的脈搏,血壓,呼吸紀錄也要有<span lang="EN-US">;<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人術後狀況穩定,離開出院時的狀況,最好記載或請其簽名。有護士在旁亦可。<span lang="EN-US"><o:p></o:p></span></span></div>
<a href="http://m.appledaily.com.tw/realtimenews/article/local/20170814/1182110/%E7%97%85%E6%82%A3%E5%85%A7%E8%A6%96%E9%8F%A1%E8%A1%93%E5%BE%8C%E8%85%B8%E7%A0%B4%E8%A3%82%E4%BA%A1%E3%80%80%E5%90%8D%E9%86%AB%E5%88%A4%E5%85%8D%E8%B3%A0">蘋果日報</a><br />
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-3787674023882665562017-08-21T09:42:00.001+08:002017-08-21T09:42:16.463+08:0010年後才提告眼科醫師雷射手術有疏失,卻仍勝訴可向醫師請求71萬2719元,竟只因為……<div class="MsoNormal" style="line-height: 30.0pt; mso-line-height-rule: exactly;">
<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">10</span><span style="font-family: 標楷體; font-size: 14.0pt;">年後才提告眼科醫師雷射手術有疏失,卻仍勝訴可向醫師請求<span lang="EN-US">71</span>萬<span lang="EN-US">2719</span>元,竟只因為……<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此案件自<span lang="EN-US">98</span>年病人起訴求償後,歷經三審,又發回高等法院,而因判賠金額未達<span lang="EN-US">150</span>萬元,醫師已不能再上訴第三審,故此部分已定讞<span lang="EN-US">(103</span>年度醫上更<span lang="EN-US">(</span>一<span lang="EN-US">)</span>字第<span lang="EN-US">1</span>號判決<span lang="EN-US">)</span>。特別提出本案例,是因:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">病人在<span lang="EN-US">88</span>年<span lang="EN-US">12</span>月做雷射手術,<span lang="EN-US">90</span>年<span lang="EN-US">10</span>月在馬偕醫院檢查發現有圓錐角膜症狀,<span lang="EN-US">97</span>年做完角膜移植手術,<span lang="EN-US">98</span>年<span lang="EN-US">12</span>月才提告,因果關係本即難成立,證明<span lang="EN-US">;<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">又因:馬偕眼科醫師,醫審會都認為,圓錐角膜成因至今不明,且北榮亦認為,最後病人起訴時即馬偕醫院病歷記載的角膜厚度,並非被告醫師雷射手術後所測量,故也有可能是因病變膨脹變薄所致,<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">綜合以上狀況,本案原本醫師獲勝訴判決之機率頗高。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">3.</span><span style="font-family: 標楷體; font-size: 14.0pt;">但是,醫師在手術時是否有預留足夠的角膜基皮厚度,不論係醫審會或做證醫師皆表示,需要有術前病歷做判斷,被告醫師卻在未滿<span lang="EN-US">7</span>年即將病歷銷毀!法官才會認為要病人提出病歷證明醫師無過失,顯失公平,轉而要醫師證明其醫療行為無過失。所以,在此提醒大家:病人可能或已提告,就好好攻防,不要節外生枝。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">4.</span><span style="font-family: 標楷體; font-size: 14.0pt;">承上,就算要證明自己無過失,在本案因前面<span lang="EN-US">1.</span>所述理由,原也不難<span lang="EN-US">;</span>但是!<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">醫師於當天檢查完,即接著手術,然醫審會及證人醫師均表示通常不會在同日執行檢查與雷射手術,故被告醫師還要證明:病人的角膜經術前檢查,適宜當日即手術此事實,然而病歷已被銷毀,當然無法證明。所以再次提醒,不論哪科,術前解釋和施行手術,盡量不要在同一天,要證明有讓病人考慮。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">5.</span><span style="font-family: 標楷體; font-size: 14.0pt;">本案大家最大疑問,該是時效問題:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">法官以病人與醫師間類似有償之委任關係,故民法<span lang="EN-US">227</span>條不完全給付為依據,而不是侵權行為,所以時效是<span lang="EN-US">15</span>年。併此敘明。<span lang="EN-US"><o:p></o:p></span></span></div>
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<a href="http://m.ltn.com.tw/news/society/breakingnews/2121937" style="font-family: 標楷體; font-size: 18.6667px;">http://m.ltn.com.tw/news/society/breakingnews/2121937</a></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">陳<span lang="EN-US">X</span>玉</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 病歷要保存七年,為何十年後不能主張病歷己消銷毀,整個時間已超過法定保存期限啦<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 在七年満期前銷毀</span><span style="font-family: "MS Mincho"; font-size: 14.0pt; mso-bidi-font-family: "MS Mincho";">⋯⋯</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><o:p></o:p></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此地無銀三百兩<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">Jenny Kam</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">不過我絕對不動近視雷射手術<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">Wing Chau</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">請問,本案不是應該適用<span lang="EN-US">227-1</span>嗎?如果適用<span lang="EN-US">227-1</span>準用<span lang="EN-US">197</span>之規定,消滅時效應該只有兩年。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 這位朋友很厲害哦!這案子因為發生在<span lang="EN-US">88</span>年<span lang="EN-US">12</span>月,而<span lang="EN-US">227</span>之<span lang="EN-US">1</span>條是<span lang="EN-US">89</span>年<span lang="EN-US">5</span>月<span lang="EN-US">5</span>號才施行,所以無法用這條請求精神賠償,這部分對方的請求才敗訴。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">而且因法官認醫師有疏失,給付不完全,所以直接適用<span lang="EN-US">227</span>條。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">因為很冗長,才未在主文提。<span lang="EN-US"><o:p></o:p></span></span></div>
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芳小月http://www.blogger.com/profile/02888003731555341164noreply@blogger.com0tag:blogger.com,1999:blog-1489252900504817712.post-17040290264820106792017-07-25T16:42:00.002+08:002017-07-25T16:42:29.387+08:00名醫對醫院提起確認僱傭關係存在之訴<div class="MsoNormal" style="line-height: 30.0pt; mso-line-height-rule: exactly;">
<span style="font-family: 標楷體; font-size: 14.0pt;">名醫對醫院提起確認僱傭關係存在之訴<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">此為江醫師對新光醫院提起之訴訟<span lang="EN-US">(</span>案號:士林地院<span lang="EN-US">105</span>年度重勞訴字第<span lang="EN-US">4</span>號判決<span lang="EN-US">)</span>,法院判決原告與醫院間成立的是委任關係,故於今年<span lang="EN-US">6</span>月<span lang="EN-US">30</span>日判決原告醫師敗訴。自該判決理由,整理提出幾點意見:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">1.</span><span style="font-family: 標楷體; font-size: 14.0pt;">訴訟法中關於訴訟程序規定之運用,也是種策略,但是前提是,必須先遵守法律,法院限定的時間,像於本案,法官已於<span lang="EN-US">4</span>月<span lang="EN-US">27</span>日進行言詞辯論程序,並請雙方在<span lang="EN-US">3</span>周內提出書狀,在<span lang="EN-US">6</span>月<span lang="EN-US">1</span>日續行言詞辯論程序,就是案件要終結了。然醫師在<span lang="EN-US">5</span>月<span lang="EN-US">24</span>日聲請法官迴避,並解除律師的委任,亦未於<span lang="EN-US">4</span>月<span lang="EN-US">27</span>日後<span lang="EN-US">3</span>周內提出辯論書狀,因為訴訟程序已要結束才聲請迴避又未提出辯論書狀,令法官認為有延滯訴訟的情形,<span lang="EN-US">6</span>月<span lang="EN-US">1</span>日原告方又均無人出庭,於此狀況下結案,其實對己較不利。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">2.</span><span style="font-family: 標楷體; font-size: 14.0pt;">法官駁回原告之主張,而認雙方的關係是委任,主要理由如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">a .</span><span style="font-family: 標楷體; font-size: 14.0pt;">醫院開立的扣繳憑單所得類別雖為「薪資所得」,然而主治醫師對於醫療業務之執行有自行裁量處理權限,並非單純提供勞務,故委任關係不因支領報酬之名目為薪資而異。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">b .</span><span style="font-family: 標楷體; font-size: 14.0pt;">住院醫師與主治醫師和醫院的關係不同,縱使曾有台南高分院曾判認住院醫師和醫院間係僱傭關係,於本案不適用。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;">c .</span><span style="font-family: 標楷體; font-size: 14.0pt;">原告醫師於本案訴訟中,有聲請假處分,法院固有裁定,在訴訟終結前,暫定醫師和醫院的僱傭關係存在。但這只是保全程序,並無確認醫師與醫院間實質法律關係之效力。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"><a href="http://m.appledaily.com.tw/realtime%E2%80%A6/%E2%80%A6/new/20170622/1145790/"><span lang="EN-US"><span lang="EN-US">蘋果日報</span></span></a><o:p></o:p></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">謝<span lang="EN-US">X</span>智</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 記得多年前有一案件,國稅局認定醫院與主治醫師間是僱傭關係而不是委任關係,某大醫院與主治醫師間簽有委任契約,因此,主治醫師以執行業務所得申報所得稅,少繳很多稅金,事後,國稅局認定委任契約不合法,這是僱傭關係,必須以薪資所得申報。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 9:10<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 謝謝您的補充!稅務單位是行政機關,法院審理認定的重點,和他們不同。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 9:50<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">陳<span lang="EN-US">X</span>光</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 以稅務常規<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">行之久遠<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">早已成為社會通念<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">為說項理由?<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 11:40<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">黃<span lang="EN-US">X</span>扣</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 我搞不懂主治醫師究竟是僱傭還是委任了<span lang="EN-US">@@<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 12:19<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">醫界同盟</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 其實法院的判決審理的都是一件件的個案,主治醫師自主權高,並非皆聽醫院指示治療看診,故在民事這兒大多認為是委任關係。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14.0pt;">至於是薪資所得?或執行業務所得,在法院而言,那只是酬勞名稱的差別而已,不等於醫師與醫院間的實質法律關係。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 14:20<o:p></o:p></span></span></div>
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<span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">黃<span lang="EN-US">X</span>扣</span><span style="font-family: 標楷體; font-size: 14.0pt;"> 所以看起來實務上見解還是以委任關係為主囉<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 14:47<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">Mark Fan</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">請把稅金還回來吧<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">19</span>日<span lang="EN-US"> 15:16<o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">Vincent Chen</span><span lang="EN-US" style="font-family: 標楷體; font-size: 14.0pt;"> </span><span style="font-family: 標楷體; font-size: 14.0pt;">其實,不論兩者間成立的是僱傭(勞基法)或委任(民法)關係,新光醫院若是以江醫師涉嫌<span lang="EN-US">A</span>健保或其他重大職務疏失為由,來解僱或解任,都不會有太大問題的。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: 標楷體; font-size: 14pt;">而江醫師解除律師委任又聲請法官迴避的種種動作,只是有遲滯訴訟之嫌而已,並不會影響訴訟的結果。</span></div>
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<span lang="EN-US" style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">7</span><span style="color: #0070c0; font-family: 標楷體; font-size: 14.0pt;">月<span lang="EN-US">21</span>日<span lang="EN-US"> 23:19<o:p></o:p></span></span></div>
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