Investigation of Tracheostomy-related Medical Practices and Criminal Negligence

• Main Authors: Wen-Hung Wang, 王文弘
• Other Authors: Ying-Chieh Lu
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/24312747238409478713

碩士 === 國立中正大學 === 法律學研究所 === 103 === In the variety of acute disease, the problem of breathing is most urgent. When breathing stop because of obstruction, the patient will lose the brain stem function within a minute, and will have serious brain cell damage after five minutes. Therefore the patient usually became the vegetative state or the result of death because of hypoxic encephalopathy even CPR can save a life, the consequently urgent airway management must complete within short of 2-3 minutes. If the first line of physicians can not immediately establish airway patency, it usually has already caused irreversible consequences while support physician arrives, family members usually don't easily accept because of unexpected results of its coming, and the medical malpractice will occur. However, in such emergency situation and time to grab life, only "at the time" and "live" physicians know the critical scenes, when the outcome of the medical act could not entirely satisfied with the families expect, bring civil or criminal told to court. After the court received and send medical identification, medical evaluation committee made the appraisal report as the time to visit the scene, and the opinion was filled with so-called "medical routine", once the medical act failing to "medical routine" in the current practice is likely to be considered a violation of the duty of care, judges and prosecutors often decided according to only medical appraisal report, physicians may bring criminal law penalties. However, the human physique different, they may change greatly even if the same disease, "medical routine" can not fit all the "possibility", if medical act practice only according to "medical routine", physicians will be a "law doctor", the law become a medical criteria, above the medicine. The medical practices of physicians had to be conservative in this atmosphere of ambient pressure, less to see the high-risk patients, to enter the low-risk divisions, to treat minor ailments without medical illness, to explain the disease both analog, which we called as defensive medicine. At present, there is no related criminal negligence of critical airway emergency in the literature review. In the current study, we analyzed the criminal proceedings concerning emergency treatment of critical airway judgment and found that physicians losing rate of 30%, especially at the local court physician losing as much as 50 percent rate. This rate were far higher than previous reports of all physician, high-risk emergency doctors, and cardiac surgery specialist with the results of losing rate of the criminal proceedings between 3.4% and 28%. In addition, we also found the identification results of medical committee strongly dominated the final verdict, objective imputation (the behavior of non-price) and causality (the results of the non-price) are all adopted or all not by medical review will result in not guilty or certainly guilty for the defendant physician; when objective causal attribution and identification results were vague, the district court judge's evaluation of evidence tend to consider the defendant doctor is guilty (80%). When physicians face the high-risk patients with critical airway, the disease often quick change, life-moment decision to rescue patients must be made in minutes and seconds. How to protect themselves? A physician could become defendants at this type of medical malpractice will not be limited to high-risk divisions (such as the emergency department, cardiac surgeons, neurosurgeons), other specialist divisions (such as anesthesia, thoracic surgery, chest medicine, otolaryngology, rehabilitation department) are likely to be defendants if magagement of the critical airway is not ideal. So we want to know if practice are not in accordance with the "medical routine" (non-price behavior), it is destined to be sentenced in violation of the duty of care fate? What will be the medical routine of trial court in different stages of airway disposal of current medical practice? Whether does causality (the result of non-price) in an emergency situation become the magic hoop which a physician can not escape? This is the purposes of this thesis lies. In addition, the judge causality of critical airway cases need to analyze what stage of the natural progression of diseases such as hypoxic encephalopathy has been reached, and whether the diseases can be effectively avoided or blocked by medical practices. Therefore, we propose the authentication method to determine the causal relationship between airway disposal and patients casualties as "whether natural processes of hypoxic encephalopathy can be effectively avoided or intercept by medical practices" and construct a flow chart to determine the causal relationship between critical airway cases, we hope this examine ways to determine the causal relationship of critical airway cases can reduce the judiciary to finds a causal relationship by the conditions at the time of causal thinking, but it was formally known as quite a causal form name.