Wu Kuan-Han, Cheng Shih-Yu, Yen Yung-Lin, Wu Chien-Hung, Tsai Ming-Ta, Cheng Fu-Jen
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Township, Kaohsiung County 833, Taiwan.
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Township, Kaohsiung County 833, Taiwan.
Leg Med (Tokyo). 2016 Nov;23:71-76. doi: 10.1016/j.legalmed.2016.10.001. Epub 2016 Oct 5.
Most medical malpractice in Taiwan leads to criminal prosecution. This study examined the epidemiologic factors and clinical errors that led to medical malpractice convictions in Taiwanese criminal prosecutions. A retrospective, 15-year population-based review of criminal Supreme Court judgments pertaining to medical malpractice against physicians and nurses was conducted. Eighty-four cases were reviewed, yielding data that included the number and specialty involved, accused hospitals, the diagnosis, the time interval between incidents to closure, result of adjudication, the origin of cases (private vs. public prosecution), the result of medical appraisal, and the primary error. Overall, the cases averaged 7.6years to achieve final adjudication. Seventy-five percent were settled in favor of the clinician; twenty-three physicians and three nurses were found guilty, but all of these avoided imprisonment via probation or replacement with forfeit. The single most risky specialty was emergency medicine (22.6% of the cases), with 36.8% of those resulting in guilty verdicts. The most common diagnosis groups were infectious diseases (23.8%), intracranial hemorrhages (10.7%), and acute coronary syndrome (9.5%). Public prosecutions had a 41.2% conviction rate; no guilty verdicts resulted from private prosecution. Nineteen (22.6%) cases were commuted, and 73.7% of those had a controversial appraisal result. The characteristics of criminal malpractice prosecution in Taiwan that could be improved to relieve the stress of frivolous lawsuits on the judicial process include lengthy jurisdiction process; low public-prosecution conviction rate; frequent commuted jurisdiction related to a controversial appraisal; and zero imprisonment rate for clinicians.
台湾地区的大多数医疗事故都会引发刑事诉讼。本研究调查了导致台湾地区刑事诉讼中医疗事故定罪的流行病学因素和临床失误情况。我们对刑事最高法院关于针对医生和护士的医疗事故判决进行了一项基于人群的回顾性研究，时间跨度为15年。共审查了84起案件，获取的数据包括涉及的数量和专业、被指控的医院、诊断结果、事件发生至结案的时间间隔、判决结果、案件来源（自诉与公诉）、医学鉴定结果以及主要失误。总体而言，这些案件平均耗时7.6年才达成最终判决。75%的案件判决结果对临床医生有利；23名医生和3名护士被判有罪，但他们均通过缓刑或缴纳罚金替代监禁的方式避免了入狱。风险最高的单一专业是急诊医学（占案件的22.6%），其中36.8%的案件最终判定有罪。最常见的诊断类别为传染病（23.8%）、颅内出血（10.7%）和急性冠状动脉综合征（9.5%）。公诉案件的定罪率为41.2%；自诉案件无一有罪判决。19起案件（22.6%）被减刑，其中73.7%的案件医学鉴定结果存在争议。台湾地区刑事医疗事故诉讼中可加以改进以减轻司法程序中 frivolous诉讼压力的特点包括：管辖程序冗长；公诉定罪率低；因鉴定结果有争议而频繁减刑；临床医生监禁率为零。
