台灣醫療糾紛訴訟案件策略之分析

Analysis of the Litigation Strategies of Medical Dispute Lawsuits in Taiwan

社會推演進步下，人權主義興起，民眾消費意識抬頭，對醫療的服務、品質、技術、管控要求也越來越高。雖然醫療也不斷的在進步當中，但醫療糾紛事件卻日益嚴重，醫病關係漸趨緊張，醫療人員的職業成就感與滿足感也受到衝擊。再加上台灣刑事訴訟的高便利性與低成本，漸成「以刑逼民」文化，高比例的醫療糾紛案件傾向採刑事訴訟來解決。在本研究中針對2011至2013年間在台灣在各級法院所結案的所有民、刑事醫療糾紛訴訟案件，共有252件，進行分析。本研究將醫療訴訟案件歸為民事訴訟、刑事訴訟與民刑事訴訟案件三種，研究結果以卡方檢定分析發現此三類案件與判決結果的關係在勝算率上結果無顯著差異（X^2＝ 4.70, p＝ 0.319）。其中以刑逼民案件共116件中，純民事訴訟案件107件，卡方檢定分析比較此兩種類型之民事訴訟案件對於訴訟結果的影響，得到以刑逼民與否與判決沒有顯著關係（X^2＝ 0.57, p＝ 0.754），再進一步分析發現以刑逼民案件平均訴訟時間為5.6年（SD＝2.67），純民事訴訟案件平均訴訟時間為4.6年（SD＝3.22），以獨立t檢定分析發現以刑逼民的訴訟時間顯著高於純民事訴訟（t＝2.52, p＝.012）。本研究結果證實以刑逼民並非有效的策略且會延長訴訟時間，建議強化醫院內（in－hospital）階段的醫病溝通，減少最後以醫療糾紛手段造成醫護人員、醫院、病家三輸的遺憾。

The high access and low cost of criminal litigation in Taiwan leads to the high prevalence of medical dispute cases tend to be resolved by criminal and civil combined litigation. Malpractices litigations further cause increased medical staff stress and decreased career satisfaction. We conducted an empirical analysis of effects of criminal and civil combined litigation in Taiwan. Based on closed medical malpractice claims at all levels of courts in Taiwan between 2011 and 2013, we examine the effects of strategies of criminal and civil combined litigation. A total of 252 civil and criminal courts cases were analyzed. We classified 252 medical malpractice claims cases into three types: civil, criminal, and civil with criminal cases. We found that there were no significant difference in the chance to win a case among three types of claims (χ^2=4.70, p=0.319). We analyzed the relationship between types of claims and final adjudication of litigation outcomes by the Chi-Square test. A total of 116 cases involved criminal and civil combined litigation and 107 cases did not involve this strategy. The chance to win a civil case was not associated with adopting criminal and civil combined litigation(χ^2=0.57, p=0.754). We further examined the average time to reach final adjudication of adopting criminal and civil combined litigation (5.6 years SD=2.67) and found that it was significantly higher than that of pure civil litigation (4.6 years SD=3.22) (t=2.52, p=0.012). In conclusion, we provide evidence that ''criminal and civil combined litigation'' is not an effective strategy for patients to win and will prolong the litigation time. Increased public education to prevent unrealistic expectations among patients and to strengthen the physician-patient communication in hospital is recommended to decrease frivolous lawsuits.