病人為何要告醫師？以糾紛發動者為中心之法實證研究

Why do People Sue Doctors? An Empirical Legal Study from the Perspectives of Patients and Their Families

臺灣一直未有以病人為中心的實證調查，關於病人何以偏好刑事程序均為臆測性的推論。本研究是國內首度對臺灣曾經有過醫療糾紛的病人及家屬進行實證調查，參考國際文獻以及臺灣醫療糾紛特徵設計一份結構性問卷，透過滾雪球及人際網絡的方式收集，自2012年5月23日起至2012年12月30日止總共回收有效問卷174份。問卷內容分析有四大發現：一、在面對醫療爭議的行動策略上，病方最常見的行動策略為「直接和醫方主張」（54.0%），因此訴訟外解決機制，應以院內調解機制做為最重要的第一線。二、對於以刑事程序來處理醫療糾紛，有一半以上的填答者（51.7%）同意「讓檢察官來調查，比較能知道真相」；而只有21.3%填答者同意「提出刑事訴訟，是為了節省訴訟費用」。是以，若能有一套檢察官外的真相發現機制，應能有效引導病人從刑事程序轉向。三、關於國際間大力推動的認錯與道歉運動，一半以上的填答者（53.5%）表示「會告醫師是因為醫師發生事情後，態度不好」，且同意「醫師只要誠實認錯，就不會告醫師」（50.5%）。四、只有不到2成的填答者（17.8%）認同「即使醫師有疏失，也不應該去坐牢」，由此可見若要推動成文法上的醫療糾紛去刑化，還需要更多的論證與說理。

Quite a few Taiwanese patients, or their families, have filed a malpractice lawsuit against medical providers in cases of disputes. A close examination of the total 223 district court criminal verdicts in the last decade, however, highlights a “3-low” phenomenon: low prosecution rate, low conviction rate, and low sentence serving rate, which demonstrates that criminal court alone is not a viable recourse to settling malpractice disputes. Before any policy to decriminalize medical malpractice liability is made, it is important to understand the underlying reasons why patients file criminal charges against their doctors.
This research, a pioneer empirical study on patients’ experience with and attitudes towards criminal liability system, aims to discover the true needs of patients and their families in medical malpractice disputes. Based on literature reviews and analyses of the characteristics of medical disputes in Taiwan, a questionnaire was created and distributed, through personal networks, to patients and families who had been involved in such disputes. Overall, from 23 May 2012 to 30 December 2012, 184 respondents were enrolled, 174 of them having met the inclusion criteria. The findings provide four in-depth suggestions. First, among all respondents, 54% directly and personally made a claim against medical providers, which indicates that in-hospital mediation should be introduced as the first and foremost measure of alternative dispute resolutions (ADR). Second, more than half of the respondents (90, 51.7%) considered it more likely to discover the truth by appealing to prosecutors, and only 37 (21.3%) admitted that their purpose to file a criminal charge was to save money. It implies that patients or families are motivated to file criminal complaints by the desire to find out the truth instead of saving money on legal fees. Thus, a truth finding mechanism would effectively channel patients and families to civil remedy. Third, 93 of the respondents (53.5%) ascribed their legal actions to the doctors’ bad attitude, and slightly more than half (88, 50.5%) chose not to sue if physicians are honest with them about medical errors. Whether doctors have apologized for injury or medical malpractice, as the data show, would influence the decision of patients and families to file a lawsuit. Fourth, only 31 (17.8%) respondents agreed that medical professionals, in the case of malpractice, should not be held responsible for criminal liability, which suggests that advocates of decriminalization in the substantive law need to proffer more persuasive argument to support their cause.
To conclude, a well-designed ADR that takes patients’ needs into account would encourage patients or their families to settle malpractice disputes without resorting to criminal law procedures in court.