台灣地區非自然死亡未轉介司法相驗之研究

Abstract

研究背景：隨著一個生命的終結，揭開了死亡管理的序幕。在台灣，對於非自然或疑似非自然死亡者，應該轉介至檢察官，由檢驗員或法醫師進行司法相驗，以釐清死亡背後的真相。但是實際上究竟有多少應轉介司法相驗卻遺漏通報的情況，並不得而知，而這些遺漏案件勢必造成台灣死亡管理的重大缺口。 研究目的：估計台灣地區司法相驗之遺漏，進一步分析遺漏案件的特徵。 研究材料與方法：利用台灣地區2006年健保急診入院主診斷為損傷、中毒碼(ICD-9 code 800-999)或外因碼者(ICD-9 code E800-E999)以及暴斃，死因不明者(ICD-9 code 798.x)，連結死因統計檔，針對非自然或疑似非自然之自宅死亡者，估計司法相驗率，並進一步分析遺漏轉介個案的特徵和死亡證明書內容。 研究結果： (1)在1098名非自然或疑似非自然死亡案件中(ICD-9 800-999 或E800-E999)，司法相驗率達到61%(669/1098)，而死診提及傷害的情況約63.6%(698/1098)。其中以外科及內科醫療上之併發症或異物窒息兩種傷害類型的司法相驗率最低。此外死者為女性、年長者，司法相驗率有偏低的趨勢。 (2)在4309名急診入院唯一診斷為暴斃、死因不明者，司法相驗率只有9.8%(421/4309)。分析未轉介司法相驗的死診發現最常開立的原死因為糖尿病、急性心肌梗塞、呼吸衰竭、未提及精神病之老衰以及腦血管病變後期影響。其中也發現原死因為傷害但由非司法途徑開立的情況，主要的原死因為窒息以及意外傷害後期影響最多。 結論： 由健保資料庫連結死因統計檔，相對於單用死因統計檔監測非自然或疑似非自然死亡者的敏感度要來的好。隨著不同傷害型態、司法相驗率差異甚大。因此未來可針對常見遺漏的案件，進行教育宣導以增進死亡管理的品質。

Background： Mortality data has often been used to monitor the cause of death in public health or legal justice. In Taiwan, if a person died or was suspected of dying from an unnatural cause, the public prosecutor is empowered to examine the death under the Criminal Procedure Code. However, it has no data about how many unnatural deaths are under-referring actually. It becomes a problem for mortality surveillance data. Objective： To investigate the under-referring about unnatural deaths at home to legal justice in mortality data. Method： All patients with main admission diagnosis of injury (ICD-9 800-999) or external code (ICD-9 E800-999) and sudden, unknown death (ICD-9 798.x) who died in 2006 are identified by data linkage between emergency admission claim data and cause of death data in Taiwan. Percentage of non-referring deaths at home is estimated and the characteristics of those who haven’t been reported are also analyzed. Results： (1)Of 1098 known or suspected unnatural deaths (800-999 or E800-E999), only 61% (669/1098) were referred to legal justice, and in 63.6% (698/1098) injury-related information was reported on the death certificate. The percentage of referral was low for deaths related to complications in medical and surgical care or effects of foreign body ingestion. The majority of under-referral cases were elder and female. (2)Of 4309 deaths with sudden, unexpected death as only one diagnosis, only 9.8% (421/4309) were referred to prosecutors. The majority of cause of death in death certificate about non-referring deaths are diabetes mellitus, acute myocardial infarction, respiratory arrest, senility without mention of psychosis and late effects of cerebrovascular disease. In these cases, some death certificate was made by non-forensic medical doctor, although the initial injury has been recorded, which are mainly asphyxia or late effects of injury. Conclusions： The sensitivity of using linkage between mortality data and emergency admission data base in health insurance to detect known or suspected unnatural deaths is better than mortality data alone. Different types of injury varies the referral rate, so in the future we should make efforts in those under-referring cases to provide more correct mortality data.