論到院前緊急醫療之法律問題：從國家賠償案件之角度切入

Law and Emergency Medical Services：An Exploration of National Compensation Cases

洪誠佑(Cheng-Yu Hung)

指導教授 ： 梁志鳴

臺北醫學大學/人文暨社會科學院/醫療暨生物科技法律研究所/碩士(2017年)

摘要

本文從國家賠償的面向切入，探討到院前緊急醫療救護國家賠償訴訟可能涉及之法律問題。第貳章首先簡介緊急醫療救護的概念及現行實務運作方式。第參章則對緊急醫療救護體系，進行相關法學研究的文獻回顧，以點出從國賠案件角度研究到院前緊急醫療之必要性。在文獻回顧的基礎上，本文試圖透過描述性統計、判決文本分析、以及訪談，研究到院前緊急醫療救護國家賠償之司法實務運作。本文首先在第肆章藉由描述性統計的方式，呈現到院前緊急醫療救護國家賠償判決之態樣與特色，並將相關結果與一般醫療糾紛之訴訟型態進行比較。本文第伍章進一步對國家賠償法學說見解進行回顧，並分析其與到院前緊急醫療救護國家賠償訴訟司法實務上之差異。同時，第伍章也比較到院前緊急醫療救護國賠訴訟與一般醫療糾紛訴訟，在鑑定上實務運作的情形。

最後，本文透過第伍章的判決文本分析，發現三項值得進一步討論的議題，具體包括：一、國家賠償訴訟是否應該回歸行政法院審理的討論？；二、法院判斷怠於執行職務時是否應依釋字第469號解釋意旨進行判斷？；三、法院在判斷公務員行為過失時，是否亦應如一般醫療糾紛訴訟，考量公務員本身對於執行緊急醫療救護之專業能力？在第陸章中，本文對這三項議題進行討論與分析，並主張：一、應思考國家賠償訴訟審判權之適當歸屬及相關配套措施，以改善普通法院民事庭在判斷公務員是否有過失時，較少考量行政法規背後規範目的之問題；二、法院在判斷怠於執行職務時，應遵循釋字第469號解釋之意旨，考量行政法規範之保護目的；三、法院應實質考量法規背後的規範目的，以釐清法律規範上要求公務員所應盡之注意義務標準，及其與公務員現實上之專業能力是否存在落差。

上述強調應考量行政法背後規範目的、不拘泥法律文字限制的解釋方式，可能會造成擴大國家賠償責任之構成。此時，由於賠償義務機關依法可再進一步向公務員行使求償權，可能會造成在某些狀況，對系爭風險並無掌控能力之公務員，卻受到賠償義務機關行使求償權，而承受過度的賠償責任問題。因此，本文第陸章第四部分進一步建議，未來國家賠償法的修正內容，可以思考如何將國家的系統責任予以法制化，將國家在其應負系統責任之情境下，不得對個別公務員行使求償權的要件明確化，亦即加強國家建置系統除錯的責任，而非一昧追究公務員個人之責任，以減少第一線公務員不必要的負擔。第陸章另外透過訪談消防機關與矯正機關中，負責緊急醫療業務並有國賠經驗之人員，試圖了解牽涉到院前緊急醫療之行政機關，在實務運作上是如何面對國家賠償訴訟？尤其是國家賠償制度是否確實能發揮改善到院前緊急醫療救護行政制度(流程)之功能。

關鍵字

到院前緊急醫療 ； 國家賠償 ； 系統責任 ； 釋字第469號 ； 保護規範理論

並列摘要

This paper starts from the perspective of state compensation to explore the legal issues that may be involved in the litigation of state compensation for emergency medical care. Chapter two begins with an introduction to the concept of emergency medical care and its current mode of operation. Chapter three is a review of legal research literature concerning the emergency medical care system to point out from the perspective of state compensation the need for pre-hospital emergency medical care. On the basis of literature review, this paper tries to study the judicial practice of state compensation for emergency medical care by means of descriptive statistics, judgment text analysis and interviews. In chapter four of this paper, the patterns and characteristics of state compensation judgment of pre-hospital emergency medical care are first presented by means of descriptive statistics, and a comparison is made with the litigation patterns of general medical disputes. In chapter five a further review is made on the theory and interpretation of the State Compensation Law, and an analysis is made on the difference between the State Compensation Law and the judicial practice of state compensation on pre-hospital emergency medical care. Also in chapter five a comparison is made on the actual operation of identification between the litigation of state compensation for pre-hospital emergency medical care and the litigation of general medical disputes.

Lastly, through the judgment text analysis in chapter five, three issues worthy of further discussion are identified, which are: 1. whether the state compensation related litigation should fall back to the administrative court for judgment; 2. whether the interpretation in J.Y. Interpretation No. 469 should be followed by the court to determine whether there is a negligence in the performance of duties; 3. whether the court should, as in the ordinary course of medical disputes, consider the civil servant's own professional ability to perform emergency medical care when judging the civil servant's misconduct. In chapter six, the paper discusses and analyzes these three issues, and advocates that: 1. the appropriate attribution of the jurisdiction of state compensation litigation and related supporting measures should be considered so that in determining whether a civil servant is at fault by an ordinary court’s civil court, less consideration will be given to the purpose behind administrative norms; 2. In determining whether there is negligence in the performance of duties, the interpretation in J.Y. Interpretation No. 469 should be followed by the court and the purpose of protection stipulated in the administrative law should be taken into account; 3. the court should practically consider the purpose behind laws and regulations, so as to clarify the legal norms required of the civil servant on the duty of care standards, and whether there is a gap between such standards and the civil servant’s actual professional competence.

The emphasis above is on the consideration of the purpose behind administrative norms, and an interpretation without being subject to rigid restrictions of the legal text may result in an expansion of state compensation. At this point, as the organization with the compensation liability may further exercise its right of recourse against the civil servant in accordance with the law, it may result in a situation where the civil servant involved who does not have the ability to control the risk will bear excessive compensation responsibility. Therefore, the first part of chapter four of this paper further suggests that future amendments to the State Compensation Law may take into account how to legalize the system responsibility of the state, and clarify the elements in a situation where the state should bear the system responsibility and should not exercise its right of recourse against the civil servant involved. That is, to strengthen the responsibility of the state to construct a system debugging function, rather than ignorantly holding the individual civil servant accountable, in order to reduce the unnecessary burden of front-line civil servants. In chapter six, through interviews with those responsible for emergency medical services with experience of state compensation of fire control and correctional authorities, the paper tries to understand how the administrative organizations that are involved in pre-hospital emergency medical treatment face state compensation lawsuits in practice; in particular, whether the state compensation system can indeed play a role of improving the administrative system (process) of pre-hospital emergency medical care.

並列關鍵字

pre-hospital emergency medical treatment ； state compensation ； system liability ； J.Y. Interpretation No. 469 ； protection norm theory

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