復健前評估義務與醫療過失、組織過失之認定【醫事法學教室】 試閱
Obligation of Assessment before Rehabilitation and Determination of Medical Negligence and Organizational Negligence
實務上在判斷有無醫療過失時,經常係以醫師有無違反醫療常規作為標準,然而訴訟當事人可能提出許多不同見解之醫療文獻,使非醫療專業之法院經常難以尋求與個案相符之醫療常規;且縱使醫療文獻未有常規之記載,亦不代表在個案中無相應之注意義務存在,則判斷醫師有無醫療過失時,仍應回歸理性醫師標準,以判斷有無注意義務之違反。又醫療行為在醫院內多涉及跨科別分工,如手術醫師不負責在病人復健前評估其骨密度,而實施復建之物理治療師因不具備醫師資格,亦無權對病人為骨質疏鬆之診斷,造成對病人之保護漏洞,卻不可歸責於個別醫師或物理治療師,惟醫院既然得透過建立系統性評估制度防免此風險,仍應認為醫院應有建立此制度之組織性義務,倘違反此組織義務,病人得單獨請求醫院負契約或侵權責任。
In practice, when judging whether a physician has medical negligence, it is often determined by the violation of medical custom. However, the litigant may put forward many different medical literatures, often making it more difficult for non-medical professional courts to find out the medical custom that are consistent with the case. Besides, even there is no medical custom record in the medical literature, it cannot be taken for granted that there is no corresponding duty of care in the case. When judging whether a physician has medical negligence, it should still return to the rational physician standard to judge whether there is a violation of duty of care. In addition, medical behavior involves multiple divisions of labor in hospitals. For example, the surgeon is not responsible for assessing the bone density before the rehabilitation of patient, on the other side, have the physiotherapists who performs the rehabilitation no right to diagnose osteoporosis, because they are unqualified as physician. This divisions of labor between different branches in hospitals causes a gap in the protection of patients, but it should not be attributed to individual physicians or physiotherapists. Instead, since the hospital is able to prevent this risk by establishing a systematic assessment system, it should be considered that the hospital should have an organizational obligation to establish this system. If this organizational obligations are violated, the patient may separately request the hospital to assume the liability in contract or in tort.
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