指導(dǎo)教授周天

1、1指導(dǎo)教授：周天 所長(zhǎng) 報(bào) 告 人：碩專班二年級(jí) 9520705周綸音國(guó)立高雄第一科技大學(xué)國(guó)立高雄第一科技大學(xué)科技法律研究所科技法律研究所案例討論案例討論課程：醫(yī)療與法律課程：醫(yī)療與法律案號(hào)：案號(hào)：Brook v. St. Johns Hickey Memorial Hospital (269 Ind. 270) 2 病人病人（P）RadiologistSupreme court（被告勝訴，確認(rèn)初審原判）（被告勝訴，確認(rèn)初審原判）Court of appeal（撤銷對(duì)撤銷對(duì)被告被告Radiologist的判決的判決)Trial court（原告敗訴）（原告敗訴）pediatrician, ur

2、ologist, radiologist hospital (A)ON PETITION TO TRANSFERplaintiffs appealed 3事實(shí)nDr. Fischer, a radiologist, injected the contrast medium into the calves of both of Tracys legs, because he was unable to find a vein which he could use.n The package insert, which contained the manufacturers directions

3、for injecting the contrast medium, recommended that the contrast medium be injected into the gluteal muscles (buttocks).n Dr. Fischer had read articles in medical journals which warned against making intramuscular injections into the buttocks or thighs especially in tiny children, because possible n

4、erve and muscle damage could result. nThat is why Dr. Fischer chose to inject the contrast medium into the calves of Tracys legs, because, after the buttocks and the thighs, they were the next largest muscle mass away from the trunk of the body.n“A short while (four months later) after being dischar

5、ged from the hospital Tracy began to have trouble with her right leg. Her leg was stiff and her heel began to lift off the ground. nTracys problem was later diagnosed as a shortening of the achilles tendon, which May have been precipitated by some kind of trauma to her ankle or calf muscle. nAfter t

6、wo operations and other expensive treatment, including the wearing of a leg brace, Tracys problem was substantially corrected. 4事實(shí)nThe jury returned a favorable verdict to all the defendantsnthe Brooks appealed on eight issues:n1. Whether the verdict of the jury in favor of Dr. Guy E. Ross and Dr. L

7、awrence Allen was contrary to law;n2. Whether the trial court erred in refusing to give plaintiffs tendered instruction No. 5 to the jury;n3. Whether the trial court erred in refusing to give plaintiffs tendered instruction No. 1 to the jury. n4. Whether the trial court erred in giving Dr. Rosss ins

8、tructions Nos. 2, 3, and 4 to the jury;n5. Whether the trial court erred in giving Dr. Fischers instructions Nos. 4 and 5;n6. Whether the trial court erred in granting St. Johns *273 Hickey Memorial Hospitals motion for judgment on the evidence;n7. Whether the trial court erred in refusing to give p

9、laintiffs tendered instruction No. 4 to the jury; andn8. Whether the verdict in favor of Dr. Warren E. Fischer was contrary to law.5事實(shí)nThe Court of Appeals upheld the verdict as to all the defendants except Dr. Fischer.nDr. Fischer filed petition to transfer.n Court of Appeals judgment reversed, tri

10、al courts judgment affirmed.6爭(zhēng)點(diǎn)n此案爭(zhēng)點(diǎn)此案爭(zhēng)點(diǎn)nWere the technologists qualified by any training to know the propriety of injection sites chosen by the licensed radiologist? nDid Dr. Fischer makejudgmental decisions orexperimentation ?nWas the verdict of the jury in favor of Dr. Fischer contrary to law? 7判

11、決nThe judgment of the trial court is in all respects affirmed.8判決理由（1）n In light of the evidence which was presented at trial the verdict in favor of Doctors Ross and Allen is not contrary to law. nThere was ample evidence presented at trial which revealed that any intramuscular injection could caus

12、e nerve or muscle damage at the site of the injection. Therefore, the fact that Tracys calf muscle may have been traumatized by an injection of contrast medium does not necessarily give rise to a presumption that such trauma was precipitated by an act of negligence. 9判決理由（2）nthe judgmental decisions

13、 were to be made by the licensed radiologists and not the technologists.nThere was therefore no proof of liability on the part of St. Johns Hickey Memorial Hospital and there was no error in granting the Hospitals motion for judgment on the evidence.n The trial court refused to give this instruction

14、 on the basis that since no substantial evidence of a medical experiment had been introduced, it would be erroneous to give an instruction covering medical experiments. 10判決理由（3）n The record clearly shows that Dr. Fischer had several compelling, professional reasons for choosing the calf muscles as

15、an injection site for the contrast medium in this case.nthe choice of the calf muscles as the site for the injection of a contrast medium in a two-year old child, based upon prior successful uses of this same injection site, is not a medical experiment.nThis was sufficient evidence of probative valu

16、e for the jury to find that he was not negligent in exercising his professional judgment in Tracys case and choosing the calf muscles as an injection site. The verdict of the jury in favor of Dr. Fischer was not contrary to law.11醫(yī)療法n第六十四條第六十四條 醫(yī)療機(jī)構(gòu)實(shí)施中央主管機(jī)醫(yī)療機(jī)構(gòu)實(shí)施中央主管機(jī)關(guān)規(guī)定之侵入性檢查或治療，應(yīng)向病人關(guān)規(guī)定之侵入性檢查或治療，應(yīng)向病

17、人或其法定代理人、配偶、親屬或關(guān)係人或其法定代理人、配偶、親屬或關(guān)係人說明，並經(jīng)其同意，簽具同意書後，始說明，並經(jīng)其同意，簽具同意書後，始得為之。但情況緊急者，不在此限。得為之。但情況緊急者，不在此限。n前項(xiàng)同意書之簽具，病人為未成年人或前項(xiàng)同意書之簽具，病人為未成年人或無法親自簽具者，得由其法定代理人、無法親自簽具者，得由其法定代理人、配偶、親屬或關(guān)係人簽具。配偶、親屬或關(guān)係人簽具。12醫(yī)療法n第一百零三條第一百零三條 有下列情形之一者，處新臺(tái)幣五萬元有下列情形之一者，處新臺(tái)幣五萬元以上二十五萬元以下罰鍰：以上二十五萬元以下罰鍰：一、違反第十五條第一項(xiàng)、第十七條第二項(xiàng)、第二十二條第二項(xiàng)一、違

18、反第十五條第一項(xiàng)、第十七條第二項(xiàng)、第二十二條第二項(xiàng)、第二十三條第二項(xiàng)、第三項(xiàng)、第五十七條、第六十一條、第二十三條第二項(xiàng)、第三項(xiàng)、第五十七條、第六十一條、第六十三條第一項(xiàng)、第六十四條、第七十二條、第八十五條第六十三條第一項(xiàng)、第六十四條、第七十二條、第八十五條、第八十六條規(guī)定或擅自變更核準(zhǔn)之廣告內(nèi)容。、第八十六條規(guī)定或擅自變更核準(zhǔn)之廣告內(nèi)容。二、違反中央主管機(jī)關(guān)依第六十二條第二項(xiàng)、第九十三條第二項(xiàng)二、違反中央主管機(jī)關(guān)依第六十二條第二項(xiàng)、第九十三條第二項(xiàng)規(guī)定所定之辦法。規(guī)定所定之辦法。醫(yī)療廣告違反第八十五條、第八十六條規(guī)定或擅自變更核準(zhǔn)內(nèi)容醫(yī)療廣告違反第八十五條、第八十六條規(guī)定或擅自變更核準(zhǔn)內(nèi)容者，

19、除依前項(xiàng)規(guī)定處罰外，其有下列情形之一者，得處一個(gè)者，除依前項(xiàng)規(guī)定處罰外，其有下列情形之一者，得處一個(gè)月以上一年以下停業(yè)處分或廢止其開業(yè)執(zhí)照，並由中央主管月以上一年以下停業(yè)處分或廢止其開業(yè)執(zhí)照，並由中央主管機(jī)關(guān)吊銷其負(fù)責(zé)醫(yī)師之醫(yī)師證書一年：機(jī)關(guān)吊銷其負(fù)責(zé)醫(yī)師之醫(yī)師證書一年：一、內(nèi)容虛偽、誇張、歪曲事實(shí)或有傷風(fēng)化。一、內(nèi)容虛偽、誇張、歪曲事實(shí)或有傷風(fēng)化。二、以非法墮胎為宣傳。二、以非法墮胎為宣傳。三、一年內(nèi)已受處罰三次。三、一年內(nèi)已受處罰三次。13醫(yī)醫(yī) 事事 放放 射射 師師 法法 第十二條第十二條 （醫(yī)事放射師業(yè)務(wù)範(fàn)圍）（醫(yī)事放射師業(yè)務(wù)範(fàn)圍） 【相關(guān)罰則相關(guān)罰則】第二項(xiàng)第二項(xiàng) 35 醫(yī)事放射師業(yè)

20、務(wù)如下：醫(yī)事放射師業(yè)務(wù)如下： 一、放射線診斷之一般攝影。一、放射線診斷之一般攝影。 二、核子醫(yī)學(xué)體外檢查。二、核子醫(yī)學(xué)體外檢查。 三、放射線診斷之特殊攝影及造影。三、放射線診斷之特殊攝影及造影。 四、放射線治療。四、放射線治療。 五、核子醫(yī)學(xué)診斷之造影及體內(nèi)分析檢查。五、核子醫(yī)學(xué)診斷之造影及體內(nèi)分析檢查。 六、核子醫(yī)學(xué)治療。六、核子醫(yī)學(xué)治療。 七、磁振及非游離輻射診斷之造影。七、磁振及非游離輻射診斷之造影。 八、其他經(jīng)中央衛(wèi)生主管機(jī)關(guān)認(rèn)定之項(xiàng)目。八、其他經(jīng)中央衛(wèi)生主管機(jī)關(guān)認(rèn)定之項(xiàng)目。 醫(yī)事放射師執(zhí)行前項(xiàng)第一款、第二款業(yè)務(wù)，應(yīng)依醫(yī)師開具之會(huì)檢單為之。醫(yī)事放射師執(zhí)行前項(xiàng)第一款、第二款業(yè)務(wù)，應(yīng)依醫(yī)師

21、開具之會(huì)檢單為之。但自費(fèi)至醫(yī)事放射所檢查者，不在此限；執(zhí)行前項(xiàng)第三款至第八款業(yè)務(wù)但自費(fèi)至醫(yī)事放射所檢查者，不在此限；執(zhí)行前項(xiàng)第三款至第八款業(yè)務(wù)，應(yīng)配合醫(yī)師行之。，應(yīng)配合醫(yī)師行之。 第一項(xiàng)各款所稱之?dāng)z影及造影，包括其影像之獲取、處理及品質(zhì)管理。第一項(xiàng)各款所稱之?dāng)z影及造影，包括其影像之獲取、處理及品質(zhì)管理。 第二項(xiàng)但書規(guī)定於本法公布施行之日起，試行五年，屆期重新檢討。第二項(xiàng)但書規(guī)定於本法公布施行之日起，試行五年，屆期重新檢討。 第十三條第十三條 （受理醫(yī)師開具之會(huì)檢單檢查）（受理醫(yī)師開具之會(huì)檢單檢查） 【相關(guān)罰則相關(guān)罰則】第三項(xiàng)第三項(xiàng) 38 醫(yī)事放射師受理醫(yī)師開具之會(huì)檢單，如有疑點(diǎn)，應(yīng)詢明原開具會(huì)

22、檢單之醫(yī)醫(yī)事放射師受理醫(yī)師開具之會(huì)檢單，如有疑點(diǎn)，應(yīng)詢明原開具會(huì)檢單之醫(yī)師確認(rèn)後，始得執(zhí)行，並應(yīng)按會(huì)檢單上之檢查項(xiàng)目執(zhí)行，不得擅自更改師確認(rèn)後，始得執(zhí)行，並應(yīng)按會(huì)檢單上之檢查項(xiàng)目執(zhí)行，不得擅自更改檢查項(xiàng)目。檢查項(xiàng)目。 前項(xiàng)會(huì)檢單，以執(zhí)行一次為限；執(zhí)行後，醫(yī)事放射師應(yīng)於會(huì)檢單上簽名或前項(xiàng)會(huì)檢單，以執(zhí)行一次為限；執(zhí)行後，醫(yī)事放射師應(yīng)於會(huì)檢單上簽名或蓋章，並填註執(zhí)行時(shí)間。蓋章，並填註執(zhí)行時(shí)間。 14醫(yī)醫(yī) 事事 放放 射射 師師 法法n第三十八條第三十八條 違反執(zhí)業(yè)相關(guān)規(guī)定、加入公會(huì)等之處罰）違反執(zhí)業(yè)相關(guān)規(guī)定、加入公會(huì)等之處罰） 違反第七條第一項(xiàng)、第二項(xiàng)、第九條、第十條第一違反第七條第一項(xiàng)、第二項(xiàng)、第九條、第十條第一