心導管手術醫療事故之刑事責任【寰宇醫事裁判】 試閱
The Criminal Liability for the medical Malpractice in Cardiac Catheterization
被告為患者A施行心導管手術，卻於插入導管後忘記拔除導引線，使其遺留於患者A體內長達兩個月；期間被告為患者A進行X光影像檢查，均能可見導引線在心臟中形成環狀結構，惟被告卻無任何作為；直至患者A轉院後，因導引線已刺入右心室壁並癒合，導致他院醫師拔除導引線時，刺穿右心室壁而致心包填塞，最終患者A死亡。法院認為，由於難以排除轉院方醫師在拔除導引線時導致心肌損傷，故不難斷定被告行為即是傷害主因；法院仍須考量無論心肌損傷是被告或轉院方醫師所致，被告均須負起責任。經查，被告人未盡早確認X光影像是否為導引線遺留並予以拔除，其帶來的風險促成了後續轉院方醫師的介入行為，進而導致死亡結果的現實化，故而該過失與A死亡之間具有因果關係。儘管後續接手醫師在拔除操作中缺乏謹慎，但倘若被告人能夠儘早拔除，便能夠避免後續接手醫師的拔除操作，因此即便後續接手醫師之操作可能對A死亡結果帶來影響，其程度仍然有限。
The defendant performed a cardiac catheterization procedure on the Patient A but forgot to remove the guidewire after insertion, leaving it inside A’s body for two months. It is clear from the X-ray imaging examinations conducted by the defendant that the guidewire formed a ring-like structure within the heart. The defendant didn’t take any action. The issue only became critical after A was transferred to another hospital. The guidewire had penetrated and adhered to the right ventricular wall. When the physicians at the new hospital tried to remove it, the guidewire perforated the right ventricular wall, causing cardiac tamponade. A died eventually. The court ruled that it was not unreasonable to conclude that the defendant’s actions were the primary cause of the harm, given that it was difficult to rule out myocardial damage caused by the transferring hospital’s physicians during guidewire removal. The court ruled that the defendant was responsible for the myocardial injury, regardless of its origin. The investigation revealed that the defendant failed to promptly confirm whether the X-ray image depicted a retained guidewire and remove it. This failure created a risk that necessitated intervention by the receiving hospital physician, thereby causing the fatal outcome. This negligence undoubtedly caused A’s death. The subsequent physician’s failure to exercise due care during the removal procedure as a key factor in the incident. Had the defendant removed the guidewire promptly, the subsequent physician’s removal procedure would have been unnecessary. It is clear that even if the subsequent physician’s actions contributed to A’s death, this contribution was limited.
105-113
