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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 郭彥彬(Yen-Ping Kuo) | |
dc.contributor.advisor | 郭彥彬(Yen-Ping Kuo | oddie@ntu.edu.tw | ), | |
dc.contributor.author | King-Jean Wu | en |
dc.contributor.author | 吳金俊 | zh_TW |
dc.date.accessioned | 2023-03-20T00:12:16Z | - |
dc.date.copyright | 2022-10-05 | |
dc.date.issued | 2022 | |
dc.date.submitted | 2022-08-01 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/86702 | - |
dc.description.abstract | 背景 關於牙科根管治療醫療糾紛訴訟的結果和特性,目前所知有限。本研究依據法院裁判的結果,探討原告、被告之背景特性及發生訴訟的可能原因,以期減少根管治療醫療訴訟的發生。 材料和方法 本研究以法學實證研究方式進行,以根管治療醫療訴訟的法院判決書為研究標的。第一部分自台灣司法院法學資料檢索系統 (https://law.judicial.gov.tw),以關鍵字 (根管治療–交通事故–車輛–碰撞–給付保險金–違反醫師法–詐欺–妨害自由) 搜尋地方法院2001/01/01 – 2021/12/31 一審判決、簡易判決案件。第二部分自美國 LexisNexis法學資料檢索系統 ( https://plus.lexis.com )以關鍵字「medical malpractice」AND (I) 「endodontist」, (II) 「endodontics」, (III) 「root canal」, (IV) 「dental pulp」,搜尋2000/01/01 – 2020/12/31根管治療醫療糾紛訴訟的判決案件。 除資料庫檢索方式外,另以人工方式搜尋可能的疏漏案件。逐筆檢視原告的背景資訊、被告的服務院所、專科資歷、訴訟的理由、判決的結果,以卡方檢定統計分析。 結果 22個台灣地方法院搜尋得案件數共計188件,扣除非牙科、無照執業、非根管治療等案件,共得到36件根管治療醫療糾紛判決,平均每年1.71 ± 1.20件,案發地以台中發生10件最多。 36件中有3件和解, 告訴撤回,法院諭知公訴不受理之判決 , 餘33件案件判決進行分析。 33件案件之被告, 2件為根管專科醫師 (6.1%),26件非專科醫師 (78.8%),5件無法識別 (15.1%)。訴訟理由包括術前欠缺告知後同意、術中操作不當、術後感染、術後齒裂等。法院裁判的結果,三個案件 (9.1%) 原告病患勝訴、30個案件 (90.9%) 被告勝訴, 牙醫師有罪率9.1% 。三件牙醫師敗訴案件,新北、新竹、台中各一件, 病患勝訴的原因為術前未告知次氯酸鈉灼傷的風險、根管銼斷裂於根管內未適當處理、根管充填不足引發感染等。 美國資料庫搜尋得案件數共計581件,有87件根管治療醫療訴訟判決,平均每年4.14 ± 2.23件。扣除一件和解、二件部分勝敗案件,取得84件判決進行分析,其中73個案件 (86.9%) 被告非專科醫師, 36個案件 (42.9%) 原告病患勝訴、48個案件 (57.1%) 被告勝訴。 病患勝訴的原因為術後麻木、牙根穿孔、未使用橡皮障、治療錯牙、術後感染等。病患基於「術後」理由提告的勝訴率顯著高過「術前」、「術中」 理由 (P < 0.05)。本研究台灣牙醫師的有罪率為9.1%, 美國牙醫師的有罪率為42.9%,亦具顯著差異。 結論 根管治療發生的法律訴訟,雖然時有所聞,但台灣、美國發生的案件平均每年皆不超過五件,且絕大多數被告非根管專科醫師。台灣牙醫師勝訴率達90.9%、美國牙醫師則僅57.1%。本研究建議牙醫師務必於術前正確診斷,詳細告知說明、取得患者同意後,再使用橡皮障小心以器械清創、擴大、完整充填神經管。至於困難病例,則建議轉診根管專科醫師治療; 根管治療術後若出現非預期性結果,應即刻告知、設法補救、減輕後續傷害,方能減少訴訟的發生。 | zh_TW |
dc.description.abstract | Background and Purpose Little is known regarding the outcomes and distinguishing characteristics of lawsuits related to endodontic procedures. This study aimed to analyze the factors associated with endodontic malpractice lawsuits and mitigate the risk of litigation. Materials and Methods This study presents a unique comprehensive analysis of endodontic malpractice lawsuits in Taiwan and the United States (US). The analysis interprets decisions from jurisdiction court collected between 2001 and 2021 in Taiwan and between 2000 and 2020 in the US. In Taiwan, the Judicial Law and Regulations Retrieving System (https://law.judicial.gov.tw) was used to collect endodontic malpractice litigation cases. “Endodontic therapy” – “traffic accident” – “car” – “collision” – “insurance pay” – “against physician law” – “fraud” – “offenses against personal liberty” were used as keywords for searching the “First-instance Court” and “Summery Court” endodontic malpractice judgments from January 1, 2001 to December 31, 2021. In the US, the LexisNexis legal database ( https://plus.lexis.com ) was used to search for endodontic malpractice cases from January 1, 2000 to December 31, 2020, using the terms “medical malpractice” and (I) “endodontist” (II) “endodontics” (III) “root canal” (IV) “dental pulp.” Each case was reviewed for medical characteristics and litigation outcomes. Data were analyzed using chi-squared test for categorical variables based on the plaintiff’s demographics, defendant’s qualifications, allegations, and outcomes. The significance of all tests was set at a two-tailed P value < 0.05. Results In Taiwan, a total of 188 cases were collected using the Boolean search, of which 36 cases met the inclusion criteria. Annually, the mean number of cases was 1.71 ± 1.20 (mean ± SD). Thirty-three cases were enrolled in the final analysis after exclusion of 3 settled cases. Most of the defendants were non-endodontist (78.8%). Taichung had the most cases (n = 10), and 3 guilty verdicts were identified in New Taipei, Hsinchu, and Taichung. The major causes of action included insufficient information or lack of informed consent before therapy (n = 12), improper instrumentation (n = 14), post-treatment pain (n = 8), infections (n = 8), and cracks (n = 5). Only three dentists were found guilty (9.1%). The primary reasons for the guilty verdicts include sodium hypochlorite (NaOCl) irritation and lack of informed consent, broken instrument, and incomplete root canal obturation. In the US, a total of 581 cases were initially identified, 87 cases were included, and 84 cases were enrolled in the final analysis after exclusion of the settled and two-partial win/loss cases. Of the 84 defendants, 73 (86.9%) was non-endodontists; 36 (42.9%) cases favored the plaintiff, whereas 48 (57.1%) favored the defendants. The annual case mean was 4.14 ± 2.23 (mean ± SD). The major allegations favored for the plaintiffs involved paresthesia, root perforation, rubber dam use, wrong tooth therapy, and infections. Plaintiffs who claimed with postprocedural reasons had a significantly higher winning rate than those claiming non-post-procedural reasons (P < 0.05). In the present study, the conviction rate of endodontic litigation in Taiwan was 9.1%, whereas it was 42.9% in the US, and the difference was significant as well. Conclusions Endodontic therapy is still associated with malpractice disputes, despite the annual case mean being < 5 in both Taiwan and the US. In this study, 90.9% of the verdicts in Taiwan and 57.1% in the US favored the dentists. Clinicians should always diagnose correctly, share decision-making, obtain informed consent before a complicated surgery, use rubber dam routinely, use proper instrumentation, and employ timely management to prevent malpractice claims. Therefore, it is recommended that general dentists refer complicated cases to endodontists and treat patients carefully to avoid paresthesia, root perforation, wrong tooth therapy, and infections. | en |
dc.description.provenance | Made available in DSpace on 2023-03-20T00:12:16Z (GMT). No. of bitstreams: 1 U0001-1507202220294700.pdf: 6607221 bytes, checksum: f1ae9ba359d7df448c2dd42469a1956e (MD5) Previous issue date: 2022 | en |
dc.description.tableofcontents | 口試委員會審定書 I 謝辭 II 中文摘要 III ABSTRACT V 目錄 IX CHAPTER I. INTRODUCTION 1 1.1 MEDICAL MALPRACTICE CRISIS 1 1.2. LEGAL ELEMENTS OF MEDICAL MALPRACTICE 3 1.3 DENTAL MALPRACTICE 5 1.4 ENDODONTIC MALPRACTICE 6 1.4.1 Pre-procedural Claims 8 1.4.1.1 Reckless in diagnosis 8 1.4.1.2 Failure to obtain informed consent 9 1.4.2 Intra-procedural Claims 10 1.4.2.1 Adverse reaction to anesthetics 11 1.4.2.2 Failure to use a rubber dam 12 1.4.2.3 Incomplete cleaning of canals 13 1.4.2.4 Broken instruments 13 1.4.2.5 Swallowing or inhaling of foreign matter 15 1.4.2.6 Perforation of a tooth 16 1.4.2.7 Sodium hypochlorite (NaOCl) irrigation accident 18 1.4.2.8 Improper material used to fill canals 19 1.4.2.9 Over-filling, over-extension, and under-filling 20 1.4.3 Post-procedural claims 20 1.4.3.1 Presence of infections and dentist failure to administer proper treatment 21 1.4.3.2 Postoperative tooth fracture 22 1.4.3.3 Paresthesia 23 1.5 HYPOTHESIS AND SPECIFIC AIMS 23 CHAPTER II. MATERIALS AND METHODS 26 2.1 ENDODONTIC MALPRACTICE LITIGATION IN TAIWAN 26 2.1.1 Study samples and cases collection 26 2.1.2 First-instance Court judgments 26 2.1.3 Summary court judgments 27 2.1.4 Statistical analysis 27 2.2 ENDODONTIC MALPRACTICE LITIGATION IN THE US 28 2.2.1 Study samples and cases collection 28 2.2.2 Statistical analysis 29 CHAPTER III. RESULTS 30 3.1 ENDODONTIC MALPRACTICE LITIGATION IN TAIWAN 30 3.1.1 Claim period and jurisdictional court 30 3.1.2 Institutional level of the defendant 31 3.1.3 Causes of action and judgment 32 3.1.4 Liabilities 32 3.1.5 Availability of expert testimony and correlation between judgment and expert testimony 33 3.2 ENDODONTIC MALPRACTICE LITIGATION IN THE US 34 3.2.1 Characteristics of endodontic malpractice cases 34 3.2.2 Rationales for lawsuits and court decisions 35 CHAPTER IV. DISCUSSIONS 36 4.1 ELEMENTS OF ENDODONTIC MALPRACTICE LAWSUITS 37 4.1.1 Doctor–patient relationship 37 4.1.2 Breach the duty of care 38 4.1.3 Medical procedure resulting in damages 39 4.1.4 Proximate cause 40 4.2 COMPARISONS OF ENDODONTIC MALPRACTICE LITIGATION BETWEEN TAIWAN AND THE US 41 4.2.1 Endodontic malpractice litigation in Taiwan 41 4.2.1.1 Conviction rate and characteristics 42 4.2.1.2 Dental clinics encounter most of the litigations 42 4.2.1.3 Causes of action and the critical factors 43 4.2.1.4 Civil or criminal proceedings 44 4.2.1.5 Expert testimony and judgment 45 4.2.2 Endodontic malpractice litigation in the US 46 4.2.2.1 Pre-procedural allegations 46 4.2.2.2 Intra-procedural allegations 47 4.2.2.3 Post-procedural allegations 52 4.2.3 Comparisons between Taiwan and the US 53 4.2.3.1 The similarities 53 4.2.3.2 The differences 54 CHAPTER V. CONCLUSIONS 56 REFERENCES 58 FIGURES 72 Figure 1. Cases collection for endodontic malpractice litigation in Taiwan ..............................72 Figure 2. Year of decision for endodontic malpractice litigation in Taiwan ...............................73 Figure 3. Lawsuits appraised by the expert witness ...................................................................73 Figure 4. Cases collection for endodontic malpractice litigation in US .......................................74 Figure 5. Year of decision for endodontic malpractice litigation in US .......................................75 TABLES 76 Table 1. Characteristics of cases with endodontic malpractice litigation in Taiwan ..................76 Table 2. Geographical distribution of endodontic malpractice litigation in Taiwan ...................76 Table 3. Rationales for lawsuits and court decisions in Taiwan ..................................................77 Table 4. Institution level of the defendant in Taiwan .................................................................78 Table 5. Characteristics of cases with endodontic malpractice litigation in US ..........................78 Table 6. Characteristics of representing cases with court decisions in US................................. 79 Table 7. Rationales for lawsuits and court decisions in US .........................................................80 APPENDIX I Endodontic malpractice litigation in Taiwan- Summary of included cas-es…………...81 APPENDIX II Endodontic malpractice litigation in US- Summary of included cas-es……………………87 CURRICULUM VITAE……….……………………………………………………….……………………………………………100 | |
dc.language.iso | en | |
dc.title | 根管治療醫療糾紛判決之實證研究 | zh_TW |
dc.title | An Empirical Study of Endodontic Malpractice Litigation | en |
dc.type | Thesis | |
dc.date.schoolyear | 110-2 | |
dc.description.degree | 博士 | |
dc.contributor.author-orcid | 0000-0002-6149-525X | |
dc.contributor.oralexamcommittee | 呂炫堃(Hsein-Kun Lu),林思洸(Sze-Kwan Lin),謝松志(Sung-Chih Hsieh),張瑞青(Zwei-Chieng Chang) | |
dc.subject.keyword | 根管治療,醫療糾紛,法律訴訟,告知後同意,專科醫師, | zh_TW |
dc.subject.keyword | endodontics,malpractice,litigation,informed consent,endodontist, | en |
dc.relation.page | 101 | |
dc.identifier.doi | 10.6342/NTU202201485 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2022-08-01 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床牙醫學研究所 | zh_TW |
dc.date.embargo-lift | 2023-12-31 | - |
顯示於系所單位: | 臨床牙醫學研究所 |
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