醫療機構法人組織之民事責任

Abstract

摘要 隨著時代變遷，現代醫療機構所提供的醫療服務多元，和傳統的單一醫師服務不同，醫院組織與醫療分工日漸精細，使得機構組織管理的重要性大增。然依我國現行學說，欲論證醫療機構民事責任之成立與否，必須先行判斷個別醫事人員之醫療相關行為有無過失為前提，意即醫療機構是為個別醫事人員的過失行為負責，並非為機構本身的組織管理缺失負責，實務上亦少見判決直接訴諸醫療機構負其自身之組織管理責任。但許多情況中，問題的癥結在於醫療機構本身，因此實有對醫療機構法人組織之民事責任加以探討之必要。面對現代醫療服務的組織化，我國現行學說與實務顯不足以支應其中可能潛在的風險與損害，如何於既有的醫療機構責任模式之外，建構醫療機構本身的組織管理責任，便成為值得進一步探究的議題。 本文觀察我國民事體系下醫療機構責任架構，分別就醫療機構民事契約責任、民事侵權責任、醫療機構僱用人責任、法人侵權責任以及醫療法第82條第5項規定進行探討。發現醫療機構乃係基於履行輔助人的過失負起債務不履行責任，或基於受僱人過失責任始負賠償責任，亦或因醫療機構的董事、代表人所造成的損害負責。法院多以自然人之故意過失為前提始要求醫療機構負責，然而部分醫療傷害事件實係出於系統性錯誤而非個別醫療人員之責任。更甚為，當個別醫療人員之過失責任歸屬難以判定，無法找到故意過失之自然人時，醫療機構於此狀況下，無須為自身負責，將導致被害人求償之漏洞。綜觀現今司法體制，如何處理這個議題，是相當大的挑戰。因此本文針對法人組織經營之醫療機構，嘗試提出以民法第184條第1項請求醫療機構獨立負侵權責任之可能性。當法院向醫療機構追償時，如果醫療糾紛原因指向系統性錯誤時，醫療機構不得向醫事人員求償，藉以增加醫療機構改善其制度並提升病人安全之動機。 同時本文以醫療法第82條第5項之規定，嘗試在我國既有法體系下，進行系統性之實證研究。對於醫療機構組織責任之明文化保持著正面且肯定的態度，認為醫療機構對於醫療環境之完善與安全應課予更高的義務標準，並在義務違反時要求醫院負擔損害賠償責任。但由於此條文內涵與意義不夠明確，配套措施亦不盡完整，在落實上與原立法所盼達成之醫療責任明確化、合理性的初衷背道而馳，同時觀諸我國法院判決，其形式上仍難脫傳統學說理論之窠臼。因此本文大膽地力倡法院實務應改變傳統見解並肯認醫療機構法人組織之獨立組織義務，以民法第184條作為醫療機構負獨立賠償責任之依據，醫療法第82條第5項規定解釋為民法第184條規定之特別規定，作為醫療機構組織責任之明文規定，藉以充實醫療機構組織義務之內涵、改善醫療機構組織制度和保障醫療品質。 最後參酌學說理論與實務判決，整理相關案例歸納出醫療機構組織義務之概念及具體內容包括：適當型態組織義務、周延人事（包括醫師與非醫師人事）組織義務、備有足夠人力配置、適當選任並監督義務、水平或垂直分工的醫療合作協調、安全管理義務、院內衛生及感染控制、醫療儀器與設備安全性、藥物使用安全性、病人照護組織義務、防範病患於醫院內自傷、確保病人受完整之告知、醫療資訊記載及管理等層面。本篇論文或許可提供另一種思考方向以解決醫療糾紛所遇到的困境，無論在醫療契約責任上、法人組織責任之重新論述、侵權責任上填補損害與預防損害以及醫療組織責任全面再建構，希冀經由本文的觀點能提供實務界更為具體的組織義務內容，適度緩解過度緊繃的醫病關係，並確保醫療機構法人組織所提供醫療品質及安全性，提升整體醫療專業水準。

Abstract As time changes, medical institutions are providing more diversified medical services, which are different from the traditional single patient-single physician structure, and the organization of hospitals along with the division of medical work are becoming more and more sophisticated, which makes the management of institutions more important. According to the current doctrine in Taiwan, in order to prove the establishment of civil liability of a medical institution, it is necessary to first determine whether the individual medical personnel were negligent in their medical-related conduct, meaning that the medical institution is responsible for the negligent conduct of the individual medical personnel, and not for the institution's own management failures. However, in many cases, the core of the problem lies with the medical institution itself, and it is therefore necessary to delve in depth into the civil liability of the medical institution. With the modernization of medical services, the current practices and theories in Taiwan are insufficient to support the potential risks and damages. As to how to build risk management of a medical institution outside of the current approach, is an issue worth exploring. This paper observes the liability structure of medical institutions under the civil system in Taiwan, and discusses the civil contractual liability of medical institutions, tort liability, employer liability of medical institutions, tort liability of juridical persons, and Article 82 (V) of Medical Care Law in Taiwan. Medical institution usually has joint liability with its employees, and it is liable for the non-performing of debts due to the negligence of its employees, and for damages caused by the directors or representatives of the medical institution. However, some medical injury cases are due to systemic errors rather than the mistakes of individual medical personnel, and it is difficult to determine the attribution of responsibility for the negligence of the individual medical personnel, and it is impossible to identify the natural person who is at fault. In this case, medical institutions are not responsible for its legal liabilities, which may create a onundrum for victims seeking compensation. Therefore, this paper attempts to propose the possibility of claiming independent liability for tort from medical institutions under section 1 of Article 184 of the Civil Law. In order to raise the incentive for medical institutions to improve their system and patient safety, medical institutions are not allowed to seek compensation from its medical personnel if the cause of the medical dispute is due to a systemic error of the medical institution. In addition, this paper attempts to conduct a systematic empirical study under the existing judicial system in Taiwan based on Article 82 (V) of the Medical Care Act, and maintains a positive attitude towards the organizational responsibility of medical institutions, and believes that medical institutions should be held to a higher standard of liability for the improvement and safety of the medical environment, and that hospitals should be held liable for damages when their responsibilities are not followed through. The connotation and meaning of article 82 of the Medical Care Act being unclear, and its supporting measures are not complete enough, to the contrary of the original legislative intent of clarifying and rationalizing medical liability. Therefore, this paper boldly advocates that the court practice should change the traditional view and recognize the independent organizational responsibilities of medical institutions and take Article 184 of the Civil Law as the basis of the independent liability of medical institutions, with Article 82 (V) of the Medical Care Law as the special provision to Article 184 of the Civil Law specifying that medical institutions should bear independent liability for compensation. All the same time promoting medical institutions to improve their systems and maintain patient safety and quality assurance. Finally, referring to the theories and court decisions, the concepts of organizational obligation of medical institutions are outlined, including the following: appropriate type of organizational duty, suitable personnel (including physicians and non-physicians) organizational arrangement, appropriate human resources, appropriately selected and supervised accountability, horizontal or vertical division of labor for medical cooperation and coordination, safety management, hospital hygiene and infection control, safety of medical devices and equipment, drug safety, quality patient medical care, including proper informing of the patients and correct detail and organization of case files. This paper provides an alternative way of thinking about how to resolve medical disputes, whether in terms of contractual liability, the re-discussion of the responsibility of legal organizations, the responsibility of tort, the responsibility to fill damages and prevent damages, or the responsibility of medical organizations as a whole. It is hoped that this paper will provide the practical community with a more concrete definition of organizational obligation, in order to alleviate the overly stressful doctor-patient relationship, ensure that the responsibility of medical institutions are fully re-established and the improvement of the medical care system.