- 學位論文
2018年臺灣護理人員醫療刑事訴訟態樣分析
Criminal Charge Laid Against Nurses in Taiwan: A Review of Cases in 2018
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摘要
研究背景與目的： 過去涉及護理人員醫療刑事訴訟的研究，多以個案探討或單一條文解析的研究為主，整體案例彙整之態樣描述型研究則相對缺乏。本研究目的為回顧2018年間以護理人員為被告之刑事醫療訴訟案件，採用條文解析方式來分析比較起訴與定罪之態樣。 研究方法： 本研究採文獻分析法，從司法院裁判書查詢系統，收錄自2018年1月1日至2018年12月31日間，與護理人員及其護理業務相關之所有地方法院刑事裁判。所有納入之裁判書依裁判日期依序編號，並將裁判書內的護理人員涉案人數、執業別、執業場所層級、科別與裁判結果等進行分類統計，而涉及的法律條文，則將每一案件所涉及之單一或多項罪名，採累加計算。再進一步針對裁判書之涉及條文，以”醫療傷害事故相關”或”非醫療傷害事故相關”的角度進行分析討論。 研究結果： 研究共收錄2018年間的18件刑事裁判書。案發場域以區域醫院最高，佔33.3％，科別則以兒科27.8％為最高。裁判結果以不起訴佔61.1％為主要，38.9％的裁判案件受到起訴，而起訴後的定罪率為71.4％。在18件刑事裁判書中，涵蓋5項法律條文。若以條文出現次數做加總，共29次，而其中「非」醫療傷害事故相關之條文共出現17次（業務登載不實罪13次、密醫罪3次及詐欺取財罪1次）。又在13次的業務登載不實罪中，有5次受到起訴，起訴後的定罪率為100％。而業務登載不實罪被論予有罪判決之關鍵在於護理人員對於爭議的文書內容，是否具有「主觀明知為不實」的情形。另一方面，與醫療傷害事故相關之條文共出現12次（業務過失致死罪4次、業務過失傷害罪8次），此涉及的兩項罪名各有3次受到起訴，業務過失致死罪之判決結果皆為無罪；業務過失傷害罪則有2次被判有罪，定罪率為66.7％，而論予有罪判決之關鍵在於護理人員之過失行為與病患之傷害具有「因果關係」。 結論： 2018年以護理人員為被告的18件醫療刑事訴訟以不起訴居多，僅七件遭到起訴，但起訴後的定罪率則高達71.4％(五件判定有罪)。綜觀護理人員刑事訴訟涉及的法條類型，以「非」醫療傷害事故相關的法律條文，如業務登載不實罪，相較於與醫療傷害事故相關之法條，不僅出現率最高，其定罪率也高達100％。故未來護理人員於登載業務相關文書時，應謹慎注意內容的「人時地物的正確性」，且應避免為自身或他人利益，而在明知的情況下登載不實內容。而涉及醫療傷害事故相關的有罪案例中，多為涉及自身護理業務時未能安全執行，故護理人員除了應確實執行法律或執業場所訂定的工作職責外，更應謹慎、安全地執行，以避免訴訟的發生。本研究結果將做為未來規劃護理人員相關法律培訓之參考。
並列摘要
Background & Objectives: Few studies are available on the criminal charge laid against nurses in Taiwan. This study aimed to review the court judgment on all criminal charge laid against nurse in 2018 to describe the defendants’ statistics analyzing the judicial statement to summarize the common legal issues, holding, and rationales for nurses who has been found guilty. Method: This study used “document analysis” to review all court judgement on critical charge laid against nurses in 2018. The court judgements were collected from the Judicial Yuan Court's Judgment Retrieving System, from January 1, 2018 to December 31, 2018. All cases were coded by the date of judgment chronologically. The number of nurses being charged, their practiced licensure levels, department, and institution, and the final rule were coded and summarized. The article of law involved was coded and calculated cumulatively. We further analyzed the legal issues, holding, and rationales of guilty or not-guilty verdicts stratified by non-medical related charge versus medical related charges. Results: A total of 18 criminal court judgements on critical charge laid against nurses was included and reviewed. District hospital (6/18; 33%) and pediatric units (5/18; 27.8%), respectively, were the most common hospital’s level and work location where the events take placed. “Not-to-prosecute” was accounted for 61.1% (n=11) of 18 cases. For those prosecuted, 71.4% (n=5/7) were deemed guilty. Among the charges laid against nurses, 5 articles of law were involved with a total of 29 charges. Over half (n=17/29; 58.6%) were non-medical related charges (i.e., offences of false practice relevant documents x13; offences of fake doctor x3; offences of obtaining money by fraud x1). Notably, 100% (n=4/4) of the cases regarding offences of false practice relevant documents were found quality if the cases were prosecuted. Key reason for a guilty decision was the defendants knew the document content is indeed false. The rest of 12 charges were related to medical event or accident (i.e., offences of negligent homicide x 4; offences of reckless homicide x8). With both offences being prosecuted for 3 times each; none were found guilty in reckless homicide; but negligent homicide was found guilty in 2 cases resulting a conviction rate of 66.7%. The key reason for these guilty cases were the patient’s injury was directly caused by nurses’ reckless behavior (i.e., burn after using the hair dryer in newborn). Conclusion: We found in this study that 61.1% (11/18) of criminal charge laid against nurses in 2018 were not-to-prosecute. However, once prosecuted, 71.4% (5/7) were found quality. Among non-medical related charges, offences of false practice relevant documents, not only is the most common charges laid against nurses but also links with a 100% conviction rate. Nurses should pay attention in every medical documentation to ensure it is accurate (who when where, and what). Making fraudulent documents intentionally is deed quality in all cases. In the cases related to medical events or accident, nurse should fulfill their legal obligation based on the role and job descriptions and did it carefully to avoid causing patient’s injury. The results of this study would serve as a reference when planning future legal and law in-services for nurse.
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