探討台灣醫療糾紛訴訟風險與結果—以地方法院判決分析

研究背景：1994年通過消費者保護法帶動了一波民眾消費權利的意識，緊接在1995年開辦全民健康保險，大幅提升民眾自由就醫的選擇，就醫的消費權益更受到強化，致使傳統醫病和諧關係逐漸淡化，醫療糾紛及其衍生之訴訟快速成長。據福利部統計資料顯示，醫事鑑定案件自1987年起即不斷攀升至2012年達到高峰。因應醫病對立不斷升高之社會氛圍，衛福部為減少醫療糾紛及醫療糾紛訴訟，推出一連串相關政策及法令，國內醫事鑑定案件似有較為下降，然每年仍維持在三百至四百餘件。但對於實際涉及醫療糾紛之司法案件的趨勢，近十年來並未有研究予以探討。又對不同專科醫師而言，在高醫療糾紛下產生的「五大皆空」現象，隨時間推移且與政府試圖緩和醫病關係似也有了不同變化，而對於醫療糾紛發生後，選擇以訴訟為解決之道是否對病方是一有效良方？在時間與勝訴率上，過去的訴訟案件的經驗值如何？不同科別是否有所差異？這些數據應可提供病方在提出訴訟前事先評估的參考，有助於當事人是否要採取訴訟作為。前述問題，均值得予以仔細探討。研究目的：探討醫療糾紛判決整體趨勢、瞭解醫療訴訟各科別相關風險、分析醫療糾紛訴訟相關結果。研究方法：本研究為回溯性研究，以次級資料作為資料蒐集標的並進行分析，利用「司法院法學資料檢索系統」，蒐集我國22家地方法院2009年起2020年間關於民、刑事醫療糾紛案件判決，經過兩階段人工逐案篩選出符合本研究要件之判決書共1,871案後，使用內容分析法，找出判決書中客觀之相關資訊後，再使用統計分析法，運用Microsoft Excel 2016軟體進行相關的統計與分析，以描述性統計的方式，描繪出2009年至2020年醫療糾紛訴訟概況外，再找出醫療糾紛訴訟相關醫事科別之數量及風險，並對超過訴訟耗時超長之醫療糾紛判決共22件作綜合比較分析。研究結果：耗時天數：民事及刑事醫療糾紛訴訟耗時天數，所有訴訟案件起訴至第一審終結耗時中位數527天，民事訴訟中位數為537天，刑事訴訟案件中位數為418天；而自案件發生日至第一審終結，所有訴訟案件平均耗費中位數1,365天，民事訴訟平均耗時天數中位數為1,363天、刑事訴訟案件中位數1,429天。病方勝訴比例：民、刑事訴訟案件中勝訴比例為11.60％、民事訴案件勝訴比例為10.87%、刑事訴訟案件勝訴比例為21.86%、簡易訴訟案件勝訴比例為8.30%。賠償金額及刑期：民事訴訟判賠金額中位數為86萬1,805元、簡易訴訟判賠金額中位數為3萬5,200元；刑事訴訟案中，醫師敗訴判決刑期中位數為150天。而以各科別判賠金額中位數最高前5名依序為：麻醉科、病理科、放射科、耳鼻喉科、家醫科。刑事訴訟醫師敗訴判決刑期中位數最高前5名依序為：神經外科、外科、一般科、兒科、中醫。被訴科別風險：醫療糾紛訴訟各科別訴訟數量前5名依序為：內科、外科、骨科、婦產科、急診；醫方敗訴高比例科別前5名依序為：病理科、一般科、牙科、整型外科、皮膚科；每千名醫師發生醫療糾紛訴訟件數之科別前5名依序為：神經外科、整型外科、一般科、骨科、急診。訴訟超長之歸因：22件訴訟耗時超長之案件，同時提起刑事追訴及重複鑑定為訴訟耗時最重要因素。結論：醫療糾紛發後，對病方而言，訴訟並非最好的選擇。減少醫療糾紛訴訟及縮短醫療糾紛訴訟耗時需從法制面著手，制訂醫療專法刻不容緩。而減少醫療糾紛訴訟時程如醫療鑑定時程縮短、避免重複鑑定及設立醫療專庭有其必要性。

關鍵字

醫療糾紛；醫療糾紛訴訟；訴訟耗時；醫事科別訴訟風險；勝訴率

並列摘要

Background: After the enactment of the Consumer Protection Act in 1994 and the launch of national health insurance in 1995, the awareness of consumer rights in general public had significantly increased. As a result, the traditional cordial relationship between patients and physicians gradually waned, and medical malpractice claims and litigation had significantly increased. As a result, the traditional cordial relationship between patients and physicians gradually waned, and medical malpractice claims and litigation had rapidly increased. As shown in the statistics published by the Ministry of Health and Welfare (MoHW), the number of cases involving medical expert testimony had been on the rise since 1987 and reached a peak in 2012. In light of the escalating confrontation between patients and physicians, the MoHW launched a series of relevant policies and regulatory bills in an attempt to decrease medical malpractice claims and litigation arising therefrom. Subsequently, the number of cases involving medical expert testimony had decreased, yet the number of such cases still ranges between 300 and 400 each year. On the other hand, few research has been on the trend of judicial cases involving actual medical malpractice claims over the past decade. In addition, for physicians of various specialties, the phenomenon of ‘five vacant specialties’ – partly attributable to frequent medical malpractice claims – appeared to be changing with time and the government’s efforts easing the patient-physician relationship. A number of relevant questions also merit further examination. For instance: post the occurrence of medical malpractice, is it the most effective solution for patients to file legal actions? What’s the past experience in relevant judicial cases in terms of time consumption and the plaintiff’s win rate? Can any difference be observed between different specialties? Such data can provide useful reference for patients to consider before filing litigation and assess whether legal actions are worth pursuing. Purpose: This study aims to explore the overall trend of judgments in medical malpractice claims and, the relevant risks of medical malpractice claims by specialty, and analyze the relevant outcomes of medical malpractice claims. Method: This study is a retroactive study and compiles secondary data for analysis. The Judicial Yuan’s ‘Law and Regulations Retrieving System’ is used to collect the civil and criminal judgments that the 22 district courts in Taiwan involve with medical malpractice claims from 2009 to 2020. Of the 1,871 cases meet the inclusion criteria after a manual filtering. These cases, employ the content analysis to analyze the relevant or objective information in these judgments, and use the Microsoft Excel 2016 software to conduct the data analysis. Results:Number of days consumed: Civil and criminal cases of medical malpractice claims are time-consuming. The median number of days between filing of legal action and conclusion of the proceedings in the first instance is 527 days for all such cases, 537 days for civil cases, and 418 days for criminal cases; the median number of days between the occurrence of the underlying circumstances and conclusion of the proceedings in the first instance is 1,365 days for all cases, 1,363 days for civil cases, and 1,429 days for criminal cases. Win rate for patients as plaintiffs: 11.60% for civil and criminal cases combined; 10.87% for civil cases; 21.86% for criminal cases; 8.30% for summary judgment cases. Amount of compensation / length of imprisonment: The median number of the amount of compensation awarded in civil cases is NT$861,805 and NT$35,200 in summary judgment cases; the median number of the length of imprisonment for physicians found guilty in criminal cases is 150 days. Among all specialties, the top 5 specialties with the highest amount of compensation awarded are: anesthesiology, pathology, radiology, otorhinolaryngology, and family medicine. The top 5 specialties with the longest imprisonment terms for physicians found guilty in criminal cases are: neurosurgery, surgical, general, pediatrics, and Chinese medicine. Litigation risk by specialty: The top 5 specialties with the highest number of medical malpractice claims litigation are: internal medicine, surgical, orthopedics, obstetrics and gynecology, and emergency; the top 5 specialties with the highest percentage of cases where judgment is rendered against physicians are: pathology, general, dentistry, plastic surgery, and dermatology; the top 5 specialties with the highest number of medical malpractice claims per thousand physicians are: neurosurgery, plastic surgery, general, orthopedics, and emergency. Key factors for litigation to last more than 1,800 days: Among the 22 cases lasting more than 1,800 days, the length of time is mainly attributable to two key factors: filing criminal complaints concurrent to civil action, and repeated recourses to medical expert witnesses. Conclusion: Post the occurrence of the underlying circumstances for medical malpractice claims, litigation is not the best choice for patients. In order to reduce medical malpractice claims litigation and shorten the length of time consumed in such proceedings, the solution requires legal reform and there is a high level of urgency for enacting a special law governing medical affairs. In addition, in the interest of shortening the length of time consumed in medical malpractice claims litigation, it is critical to reduce the timeframe for medical expert witness procedures, minimize duplicate recourses to medical expert witness procedures, and establish a specialized medical court system.