根管治療醫療糾紛判決之實證研究

An Empirical Study of Endodontic Malpractice Litigation

吳金俊(King-Jean Wu)

指導教授 ： 郭彥彬

國立臺灣大學/醫學院/臨床牙醫學研究所/博士(2022年)

https://doi.org/10.6342/NTU202201485

摘要

背景
關於牙科根管治療醫療糾紛訴訟的結果和特性，目前所知有限。本研究依據法院裁判的結果，探討原告、被告之背景特性及發生訴訟的可能原因，以期減少根管治療醫療訴訟的發生。
材料和方法
本研究以法學實證研究方式進行，以根管治療醫療訴訟的法院判決書為研究標的。第一部分自台灣司法院法學資料檢索系統 (https://law.judicial.gov.tw)，以關鍵字 (根管治療–交通事故–車輛–碰撞–給付保險金–違反醫師法–詐欺–妨害自由) 搜尋地方法院2001/01/01 – 2021/12/31 一審判決、簡易判決案件。第二部分自美國 LexisNexis法學資料檢索系統 ( https://plus.lexis.com )以關鍵字「medical malpractice」AND (I) 「endodontist」， (II) 「endodontics」， (III) 「root canal」， (IV) 「dental pulp」，搜尋2000/01/01 – 2020/12/31根管治療醫療糾紛訴訟的判決案件。 除資料庫檢索方式外，另以人工方式搜尋可能的疏漏案件。逐筆檢視原告的背景資訊、被告的服務院所、專科資歷、訴訟的理由、判決的結果，以卡方檢定統計分析。
結果
22個台灣地方法院搜尋得案件數共計188件，扣除非牙科、無照執業、非根管治療等案件，共得到36件根管治療醫療糾紛判決，平均每年1.71 ± 1.20件，案發地以台中發生10件最多。 36件中有3件和解, 告訴撤回，法院諭知公訴不受理之判決 , 餘33件案件判決進行分析。 33件案件之被告， 2件為根管專科醫師 (6.1%)，26件非專科醫師 (78.8%)，5件無法識別 (15.1%)。訴訟理由包括術前欠缺告知後同意、術中操作不當、術後感染、術後齒裂等。法院裁判的結果，三個案件 (9.1%) 原告病患勝訴、30個案件 (90.9%) 被告勝訴, 牙醫師有罪率9.1% 。三件牙醫師敗訴案件，新北、新竹、台中各一件, 病患勝訴的原因為術前未告知次氯酸鈉灼傷的風險、根管銼斷裂於根管內未適當處理、根管充填不足引發感染等。
美國資料庫搜尋得案件數共計581件，有87件根管治療醫療訴訟判決，平均每年4.14 ± 2.23件。扣除一件和解、二件部分勝敗案件，取得84件判決進行分析，其中73個案件 (86.9%) 被告非專科醫師， 36個案件 (42.9%) 原告病患勝訴、48個案件 (57.1%) 被告勝訴。 病患勝訴的原因為術後麻木、牙根穿孔、未使用橡皮障、治療錯牙、術後感染等。病患基於「術後」理由提告的勝訴率顯著高過「術前」、「術中」 理由 (P < 0.05)。本研究台灣牙醫師的有罪率為9.1%, 美國牙醫師的有罪率為42.9%，亦具顯著差異。
結論
根管治療發生的法律訴訟，雖然時有所聞，但台灣、美國發生的案件平均每年皆不超過五件，且絕大多數被告非根管專科醫師。台灣牙醫師勝訴率達90.9%、美國牙醫師則僅57.1%。本研究建議牙醫師務必於術前正確診斷，詳細告知說明、取得患者同意後，再使用橡皮障小心以器械清創、擴大、完整充填神經管。至於困難病例，則建議轉診根管專科醫師治療; 根管治療術後若出現非預期性結果，應即刻告知、設法補救、減輕後續傷害，方能減少訴訟的發生。

關鍵字

根管治療 ； 醫療糾紛 ； 法律訴訟 ； 告知後同意 ； 專科醫師

並列摘要

Background and Purpose
Little is known regarding the outcomes and distinguishing characteristics of lawsuits related to endodontic procedures. This study aimed to analyze the factors associated with endodontic malpractice lawsuits and mitigate the risk of litigation.
Materials and Methods
This study presents a unique comprehensive analysis of endodontic malpractice lawsuits in Taiwan and the United States (US). The analysis interprets decisions from jurisdiction court collected between 2001 and 2021 in Taiwan and between 2000 and 2020 in the US. In Taiwan, the Judicial Law and Regulations Retrieving System (https://law.judicial.gov.tw) was used to collect endodontic malpractice litigation cases. “Endodontic therapy” – “traffic accident” – “car” – “collision” – “insurance pay” – “against physician law” – “fraud” – “offenses against personal liberty” were used as keywords for searching the “First-instance Court” and “Summery Court” endodontic malpractice judgments from January 1, 2001 to December 31, 2021. In the US, the LexisNexis legal database ( https://plus.lexis.com ) was used to search for endodontic malpractice cases from January 1, 2000 to December 31, 2020, using the terms “medical malpractice” and (I) “endodontist” (II) “endodontics” (III) “root canal” (IV) “dental pulp.” Each case was reviewed for medical characteristics and litigation outcomes. Data were analyzed using chi-squared test for categorical variables based on the plaintiff’s demographics, defendant’s qualifications, allegations, and outcomes. The significance of all tests was set at a two-tailed P value < 0.05.
Results
In Taiwan, a total of 188 cases were collected using the Boolean search, of which 36 cases met the inclusion criteria. Annually, the mean number of cases was 1.71 ± 1.20 (mean ± SD). Thirty-three cases were enrolled in the final analysis after exclusion of 3 settled cases. Most of the defendants were non-endodontist (78.8%). Taichung had the most cases (n = 10), and 3 guilty verdicts were identified in New Taipei, Hsinchu, and Taichung. The major causes of action included insufficient information or lack of informed consent before therapy (n = 12), improper instrumentation (n = 14), post-treatment pain (n = 8), infections (n = 8), and cracks (n = 5). Only three dentists were found guilty (9.1%). The primary reasons for the guilty verdicts include sodium hypochlorite (NaOCl) irritation and lack of informed consent, broken instrument, and incomplete root canal obturation. In the US, a total of 581 cases were initially identified, 87 cases were included, and 84 cases were enrolled in the final analysis after exclusion of the settled and two-partial win/loss cases. Of the 84 defendants, 73 (86.9%) was non-endodontists; 36 (42.9%) cases favored the plaintiff, whereas 48 (57.1%) favored the defendants. The annual case mean was 4.14 ± 2.23 (mean ± SD). The major allegations favored for the plaintiffs involved paresthesia, root perforation, rubber dam use, wrong tooth therapy, and infections. Plaintiffs who claimed with postprocedural reasons had a significantly higher winning rate than those claiming non-post-procedural reasons (P < 0.05). In the present study, the conviction rate of endodontic litigation in Taiwan was 9.1%, whereas it was 42.9% in the US, and the difference was significant as well.
Conclusions
Endodontic therapy is still associated with malpractice disputes, despite the annual case mean being < 5 in both Taiwan and the US. In this study, 90.9% of the verdicts in Taiwan and 57.1% in the US favored the dentists. Clinicians should always diagnose correctly, share decision-making, obtain informed consent before a complicated surgery, use rubber dam routinely, use proper instrumentation, and employ timely management to prevent malpractice claims. Therefore, it is recommended that general dentists refer complicated cases to endodontists and treat patients carefully to avoid paresthesia, root perforation, wrong tooth therapy, and infections.

並列關鍵字

endodontics ； malpractice ； litigation ； informed consent ； endodontist

參考文獻

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