【醫療民事法】雷射近視手術併發圓錐角膜案:病歷與舉證責任【學習式判解評析】 試閱
Laser Myopia Surgery Complicated with Keratoconus: Medical Records and Burden of Proof
裁判字號 臺灣高等法院103年度醫上更(一)字第1號民事判決
引用法條 民法第184條、第195條、第227條、第227條之1;民事訴訟法第277條;醫療法第70條、第82條
A(一審原告)因近視由醫師B(一審被告)診治,B醫師於診療當日上午旋即進行雷射近視手術。惟A術後雙眼視力逐漸模糊,約2年後經C醫院診斷為圓錐角膜,雖經C醫院配戴硬式隱形眼鏡方式矯正,仍於第一次術後約6年與8年分別接受右眼與左眼角膜移植手術,其後A雖曾向B醫師請求交付其就醫病歷,但經已銷毀為由拒絕。A認B醫師術前檢查未善盡注意義務,而術中將角膜基質厚度削減過薄,致其受損害起訴請求賠償。一審為原告部分勝訴判決;二審認A之請求權已罹於時效,且A未能舉證B醫師於術中將角膜基質厚度削減過薄,而判A敗訴。嗣經最高法院廢棄發回,更一審法院認為病歷係由B醫師於醫療法規定保存期限內銷毀,倘仍須由A負舉證責任,顯失公平,應適用民事訴訟法第277條但書之規定,由B醫師負舉證責任;再者,A之侵權行為請求權雖罹於時效,但債務不履行之請求權則尚未罹於時效。本文兩位作者即就前開案件所涉及之病歷保存與舉證責任之關係、消滅時效之起算等議題,進行評論。
Patient A (the plaintiff at district court) suffered from myopia and was treated by doctor B (the defendant). Doctor B performed the laser myopia surgery for bilateral eyes exactly at the same morning A came to clinic. Unfortunately blurred vision followed, and A was told 2 years post-operatively that keratoconus developed. A was then treated with rigid gas contact lens to correct corneal condition but in vain, and subsequently by corneal transplantation 6-8 years post-operatively. The patient A filed the civil action herein for damages caused by doctor B. The District Court found for the plaintiff A, however was reversed by the appealed court, which decision was reversed by the Supreme Court. A then prevailed in the subsequent remanded decision by High Court and Supreme Court, which held that the burden of proof should be reversed because doctor B disposed the medical records against the regulation stipulated in Medical Care Act, which caused the great difficulty hindering A to prove that doctor B is liable. Besides the Supreme Court held that A’s action was still within the Statute of Limitations. Two authors comment on this case with special emphasis on the application of the Statute of Limitations, and how the disposing medical records should reverse the burden of proof.
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