我國地方法院刑事醫療糾紛判決之實證研究

An Empirical Study of Medical Malpractice Judgments from District Criminal Courts in Taiwan

系所名稱：公共衛生研究所法律與政策組 學位別：碩士 畢業學年：98年 指導教授：楊秀儀、黃心苑 研究背景與目的：醫療糾紛之刑事責任以及醫療糾紛除罪化一直是我國醫療糾紛中最受關切的議題。晚近相關研究數量倍增，但仍多屬個人主觀見解或者小規模實證研究，無法真實且完整地反應台灣醫療糾紛及處理的實際狀況。本文以為，若欲完整的討論我國的醫療糾紛除罪化問題，必須優先完成一個可供所有研究者參考的刑事判決實證資料庫與實證數據，以提供客觀及足夠的資料做進一步的論辯與檢討。研究方法：全面性地蒐集我國自89 年1 月1 日起至97 年6 月30 日止，所有地方法院對醫師之醫療糾紛所做成之刑事判決書，運用內容分析法（Content Analysis）擷取判決書中之客觀可辨的司法資訊、案件事實、判決結果等要件進行建檔。利用統計軟體SPSS 15.0 版進行描述性統計與相關性統計分析，來真實呈現地方法院之刑事醫療糾紛案件訴訟實況。並利用統計學上之相關性檢定（p-value < 0.05）對於法學理論與司法政策之立法目的進行假說檢定，進一步釐清相關法學爭論在醫療糾紛議題之真偽。研究結果：本研究共蒐集到223 個刑事判決，計312 名醫師被告。案件以公訴程序進行為多，有128 件（57.4%），但也有相當之案件以自訴程序進行，有95 件（42.6%）。全部的判決中共有204 件經過專業鑑定（91.5%）。每個案件從醫療傷害發生時起到一審判決作成日止，平均需要經過3.12 年。從被告醫師的服務單位來看，以醫學中心為最多，有110 人（35.3%），其次為區域醫院70 人（22.4%），地區醫院58 人（18.6%）、診所55 人（17.6%）。被告科別則以外科最多，共計82 人（26.3%），其次為內科64 人（20.5%）、婦產科50 人（16%）、急診醫學科40 人（12.8%）、骨科23 人（7.4%）、兒科10 人（3.2%）。在312 名醫師被告中，有232 名被告（74.4%）是無罪判決；80 名被告（25.6%）被判有罪，刑期最高者為3 年，最低者為拘役10 天，所有有罪被告之平均刑期為6.7 個月。有罪被告中有64 人（80%）被宣告緩刑或可易科罰金，實際有入監服刑風險者僅有16 人（20%）。經過相關性分析並且控制可能的干擾因子（Confounding）之後發現，醫事專業法庭或獨任法官審理之案件較容易作成有罪判決，且案件以公訴程序進行或當鑑定意見認為有疏失時，被告也較容易得到有罪判決（p < 0.05）。此外，案由為業務過失重傷害或傷害的案件較傾向於提起自訴，自訴案件也較容易同時起訴1 名以上的被告（p < 0.05）。討論與結論：1. 我國地方法院所審理的刑事醫療糾紛案件定罪率低，僅有25.6%的被告會獲判有罪，相較於同一法條其他類型的業務過失犯罪動輒九成以上的定罪率，差距甚大。此外，懲罰性效果微弱，獲得有罪判決的被告中高達八成可因為緩刑宣告或者易科罰金代替自由刑之執行而不必入監服刑。另外，訴訟耗時冗長，平均每個案件都要耗費3 年以上的時間才能夠換得一紙地方法院的判決，若歷經三級三審與更審之程序，耗費的人力、物力與司法成本更難以計數。因此，從刑事程序處理醫療糾紛之效率來看，除罪化似有其正當性。2. 高達42.6%的醫療糾紛刑事案件是以自訴程序提起，遠高於全國所有案件中自訴之比例，顯見醫療糾紛中家屬一定要告的強烈的情緒性。但審理的結果卻是：自訴案件中的159 名醫師被告僅有13 人獲判有罪，定罪率8.2%，遠低於同一時期公訴案件的定罪率43.79％。足見因為沒有檢察官之把關，醫療糾紛之刑事自訴制度往往流於濫訴，應有改革之必要。綜合前述狀況，本研究發現我國以刑事程序處理醫療糾紛案件的成效確實不甚理想，因此，在討論醫療過失行為是否應當除罪化時，應併從目前的執行成效進行評估，而非僅侷限於法釋義學的論辯與純粹價值上的取捨而已。

Background: Recently, the debate on decriminalization of medical malpractice has received mounting attentions in both medical and law communities. An increasing number of studies try to analyze different aspects of the issue for future criminal law revision. However, the existing literature focuses mainly on theoretical discussion. Of the limited legal empirical studies, they are mostly limited in study scope and number of cases analyzed. Due to the limitations in study scope and size, previous findings may not reflect the true picture of medical malpractice lawsuits in Taiwan over time. Therefore, we aimed to conduct a population-based study to analyze characteristics, process, and court decisions of medical malpractice lawsuits in Taiwan.Method: The “Law Bank” database was used to search all the district criminal court’s medical malpractice judgments from 21 district courts in Taiwan during the period of January 1st, 2000 to June 30th, 2008. Exclusion criteria were applied. A total of 223 eligible cases and 312 physician-defendants were included. Contents of each court judgment were analyzed and description statistical methods were applied. Factors affecting judgment and private prosecution were investigated by chi-square test and logistic regression analysis.Result: Of all 223 cases, 128 cases (57.4%) were prosecuted by district attorneys, and 95 cases were made by private parties. During the court process, medical expert opinions were sought in 204 cases (91.5%). On average, a malpractice lawsuit took 3.12 year from the time when medical injury occurred to the time court decision was made.Of the 312 defendants, 110 defendants (35.3%) worked in medical center, 70 defendants (22.4%) in regional hospital, 58 defendants (18.6%) in local hospital, 55 defendants (17.6%) in clinics. 82 defendants (26.3%) were surgeons, 64 defendants (20.5%) were internists, 50 defendants (16%) were obstetricians/gynecologists, 40 defendants (12.8%) were emergency specialists, 23 defendants (7.4%) served as orthopedic surgeons, and 10 defendants served as pediatricians. In terms of court decisions, 232 defendants (74.4%) were found not guilty, and 80 defendants (25.6%) were found guilty. Of those defendants found guilty, 64 (80%) had a probation or amerce. Only 16 defendants (20%) were at risk of confinement. Among the 312 physician defendants, who were judged by professional court, whose practices were considered malpractices by medical experts, who were judged by only one judge, who were prosecuted by district attorneys, were more likely to be guilty. Patients who were injured from medical malpractice accidents, they were more likely to use private prosecution procedure, and to suit more than one defendant.Conclusion: In general, medical malpractice lawsuits had a low conviction rate, the punishment tended to be trivial, and the process lasted a long period of time. Based on the findings, decriminalization of medical malpractice may seem to be an option.