醫療訴訟之實證研究——民事案件之上訴率及其維持率

An Empirical Study on Medical Litigation: Appeal Rate and Consistency of Civil Case

醫療糾紛訴訟涉及實體與程序之交錯，本文研究旨在就此實務運作之現況進行調查，跟隨審級救濟的程序開展，予以拆解為「上訴率」及「上訴維持率」兩項指標進行考察。依統計，類屬病方勝訴判決之案件上訴率，約略算來在一、二審各為50.5%、36.9%，反觀醫方勝訴案件之上訴率則分別達於34.4%、25.3%。從此延伸，病方勝訴案件經上訴續審後，第二審、乃至三審以後之判決維持率依序為67.7%及93.8%，相對而言，醫方勝訴案件的判決維持率則分別高達92.7%、97.4%。由此以觀，不管在上訴率或者上訴過後之判決維持率，病方勝訴案件本身標示之統計數據，比較起來都與醫方勝訴者相去懸殊？依本文所見，前者上訴率之所以有此落差，除源自醫病雙方之興訟動機有所不同外，更重要的原因是在於民事訴訟必須繳納裁判費用，一般需要委任專業律師代勞，無從藉由檢察官發動偵查以保全證據，操作上較諸刑事訴訟有更為嚴格的程序門檻，當事人多數考量成本效益而予作出相應抉擇。至於後者上訴維持率為何呈現高低不一，對照既往之實證研究結果，不難察覺此與鑑定維持率之分布情形多所雷同，凡此不僅印證醫療爭訟發展至今，過失歸責判斷仰賴囑託鑑定予以協助釐清，已然成為實務上所不可或缺的操作模式，更直指醫療傷害之原因事實及其間的因果關係甚為複雜，在事案解明上向來有其窒礙難行之處，至若反映在訴訟實務上，毋寧強調醫療糾紛鑑定所面臨之施作難題，法庭審理活動也是亦步亦趨受此影響，由來已久。

Litigation on medical malpractice involves alternation of entity and procedures. The study aims to have an investigation on the status quo of practice with an attempt to research “appeal rate” and “consistency” respectively based on the development of appeal procedures. According to statistics, appeal rate for winning lawsuit by patient is approximately 50.5% in the first instance and 36.9% in the second sentence, while that by practitioners owns appeal rates of 34.4% and 23.5% respectively. Extended from such, if the winning lawsuit is appealed for revivor, the consistency of the second instance and the judgment at third instance or beyond are 67.7% and 93.8%, in comparison, that of practitioner winning lawsuit are a staggering 92.7% and 97.4%. As this article concerns, reasons for the gap existing in former’s appeal rate, other than the difference of motives for filing lawsuits by practitioner and patient parties, the major reason is that the court cost will be charged in civil procedures. Generally, the entire process is completed by attorneys instead of investigations raised by prosecutors which can secure evidences. Such situation represents a higher procedure threshold than appeal to criminal procedure and the party involved often considers costbenefit and therefore making corresponding decisions. As for the uneven consistency by the latter, in comparison with the past empirical results, it’s not difficult to notice that the uneven consistency shares a high level of similarity with distribution of assessment consistency. The fact cannot only serve as a proof that, as the medical litigation has been developed from the past to present, negligence attribution judgment with assistance of request assessment for clarification has become a indispensable operation, and, furthermore, that transactions of medical harm or occurrences and its cause and effects is rather intricate, difficulties will often take place at case solution. If reflected to practice of litigation, the court sentence is influenced even without the emphasis of implement adversities in medical dispute assessments, and it’s long-standing.