醫療機構組織責任之理論建構與案例類型之具體化－以德國與臺灣案例為中心

Abstract

現代醫療服務高度分工下，醫療糾紛往往非個別醫師醫療過錯所致，而係醫療機構經營過程風險實現之結果，醫療機構應妥適規劃經營流程、形成整體營運組織，以確保病人之生命身體安全，醫療機構若違反此組織義務造成他人損害，即應負損害賠償責任，此與僱用人責任係以所屬醫師有醫療過錯為前提，尚屬不同。蓋依法人實在說及過失客觀化之觀點，法人團體得獨立履行義務、並為其義務違反獨立負責，故非自然人之醫療機構仍得就其本身組織義務之違反獨立負侵權責任。醫療機構組織責任之建構，使病患無庸再探究個別醫師有無醫療過錯、究竟醫療過錯係存在於何醫療環節，有助於無醫療專業知識之病患求償，而醫療訴訟不再僅聚焦於個別醫師是否有醫療疏失，亦有助於緩和醫病間緊張關係。

The traditional research of civil liability in medical malpractice mainly focuses on the doctor`s personal liability-either contractual or tort liability. Excessive amount of emphasis on individual responsibility, however, may cause defensive medicine. Oftentimes medical errors are not caused solely by an individual doctor but the medical system or organization as a whole. The judgments of German Federal Court (BGH) had constructed a general duty of organizations based on ＂Verkehrspflicht.＂ The said duty is independent from the individual fault of a specific doctor. Rather, it establishes an institutional responsibility for an organization. The medical institutions are obligated to insure that medical equipment is in order, the departments are not understaffed, and the staffs are well-trained without cases of working overtime. Whether or not the representatives or employees are individually held liable, medical institutions shall be held liable for violation of the organizational duties under the provisions equivalent to article 184 of the Civil Code.