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[手术患者体位摆放的责任分配及因体位摆放不当导致损害的责任认定]

[Allocation of responsibility for positioning patients for surgery and liability for damages consequent on faulty positioning].

作者信息

Weissauer W

出版信息

Anaesthesist. 2002 Mar;51(3):166-74. doi: 10.1007/s00101-002-0283-z.

Abstract

The cooperation of surgeon and anaesthetist in positioning of the patient is subject to the principles of horizontal division of labour recognized in the interdisciplinary agreement and confirmed by the legislature: anaesthetist and surgeon carry out their respective tasks independently of each other, each bearing full responsibility for their own work (principle of strict separation of functions), they tailor their procedures to fit in with each other (duty of coordination), and each is entitled to expect and rely on due care in the other (principle of trust). In the case of conflict--when the best position for the specific intervention leads to a higher anaesthesiological risk--the principle of predominance of the actual requirements applies. If no agreement is reached it is incumbent on the surgeon to make the decision; this means that the surgeon bears the medical and legal responsibility for appropriate deliberation. Faults in organization are regarded under the law as faulty treatment. Anaesthetist and surgeon are each responsible for their own errors. According to the interdisciplinary agreements, positioning and checks on position are the task of the surgeon, while the anaesthetist is responsible for the "infusion arm". This does not exclude the possibility that anaesthetist and surgeon may agree on a different division of labour in the operating room. The patient bears the burden of proof that errors were committed in a case for damages. The doctor does, however, have to prove that the patient was correctly positioned. The demands of jurisdiction in terms of documentation of the positioning and of presentation of evidence are practically oriented and can basically be met. The same is true of the information supplied to the patient on the risk that positioning can cause harm. The doctor is obliged to supply evidence of the patient's substantive consent and the provision of information that this implies.

摘要

外科医生与麻醉师在患者体位摆放方面的合作应遵循跨学科协议中认可并经立法确认的水平分工原则

麻醉师和外科医生各自独立开展工作,对自身工作承担全部责任(职能严格分离原则),他们调整各自的操作以相互配合(协调职责),并且双方都有权期望并依赖对方的应有关注(信任原则)。在出现冲突的情况下——当特定手术的最佳体位会导致更高的麻醉风险时——实际需求优先原则适用。若无法达成一致,外科医生有责任做出决定;这意味着外科医生要对进行适当审议承担医疗和法律责任。组织方面的失误在法律上被视为治疗失误。麻醉师和外科医生各自对自己的错误负责。根据跨学科协议,体位摆放及体位检查是外科医生的任务,而麻醉师负责“输液手臂”。但这并不排除麻醉师和外科医生在手术室就不同分工达成一致的可能性。在损害赔偿案件中,患者负有证明存在失误的举证责任。然而,医生必须证明患者体位摆放正确。司法部门对体位摆放记录和证据出示的要求注重实际,基本能够得到满足。向患者提供关于体位摆放可能造成伤害风险的信息也是如此。医生有义务提供患者实质性同意及由此隐含的信息提供的证据。

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