28/05/2015

國賠表示國家有錯,基層消防沒有錯,政府和體制有改善的空間

國賠表示國家有錯,基層消防沒有錯,政府和體制有改善的空間

這個過世的年輕人一開始就犯了致命的錯,但是救難人員並不會因為他有錯而疏於搜救,也沒有因此受到懲罰。如果是「消防隊員被判賠」,或「救難隊員要承擔百分之三十賠償」,那才真的要鳴不平。「國賠」表示國家有錯,基層消防沒有錯,政府和體制有改善的空間。失去兒子的父母親付出時間,捐出全數國賠款項,投入改善山難救助體制、投入推動面山教育和建立安全的登山機制…,是父母親能給過世孩子最大的懷念。問題是,受處罰國家,不知道能否因此思考救難系統改善的空間?還是民眾繼續自力救援?

大學生張博崴四年前發生山難,台北地方法院判決國賠兩百六十七萬元,南投縣仁愛消防分隊隊員得知法院判決後情緒低落,表示已盡心盡力,「判賠是難以承受之重」。
基層消防很辛苦,救難隊員也很了不起。但山難救助機制如果真有問題,是政府和相關官員監督不週、管理不善,導致專責救難機制散漫。今天如果是「消防隊員被判賠」,或「救難隊員要承擔百分之三十賠償」,那才真的要鳴不平。所以,判國賠是對的,表示國家有錯,基層消防沒有錯。問題是:國賠後,救難系統有沒有改善?還是民眾繼續自力救援?

山難搜救不力 判國賠267萬:http://udn.com/news/story/7321/930094
消防隊鳴不平 救難判賠很失望:http://udn.com/news/story/7321/930100
博崴山難 父母奔走推救助體制:http://udn.com/news/story/7321/930096


最近醫糾法的問題,也牽涉到類似不同立場者的邏輯和理念。處理醫糾問題的邏輯如果走到美國、加拿大、義大利方向,最後一定「愈補愈大洞」,意即:愈朝向對醫師或醫院救償,去解決醫糾問題,就愈容易忽略了「醫療不確定性」或「健保體制有問題」。就如同災難受害人對救難人員求償,最後國家就再也沒有人要救人了。

在英國,政府認為醫療是「國家有責任提供的福利」,英國醫師大多是為政府工作,幫忙政府提供「助人救人服務」,相對於其他工作,醫師是高付出但並非高收入,人民了解六十年前沒有健保的痛苦、政府讓民眾了解醫療資源很有限、了解醫療風險原本存在、了解醫師沒有傷害或不願助人的意圖。所以,萬一有嚴重疏失,民眾只能告國家National Health Service (NHS) 監督不週、管理不善(而不是告醫師),也就是國賠。英國醫療訴訟成立的機會很低,目的也是不容許民眾無理醫鬧,影響救人者之士氣。英國醫療不要說訴訟,連抱怨都很少 (http://cobolsu.blogspot.tw/2013/02/blog-post.html)


紐西蘭是全世界最早建立並實施醫療傷害事故處理制度的國家(1974),瑞典比紐西蘭晚一年,從侵權法體制轉變為「不論過失補償」(no-fault compensation),把醫療傷害的處理從訴訟體制改為採用不論過失補償、非訴訟的模式。若認定某件醫療傷害是可以避免的,病人就可以獲得理賠,無須去判斷是否肇因於醫療人員的過失。這種制度的最大好處,是將焦點放在可以努力彌補和預防的醫療傷害事件上。因為不必去追究醫療提供者是否有過失責任,因此醫師和醫院願意坦誠告知病人到底發生什麼事,並且能夠主動協助病家提出補償申請,醫病雙方可以維持互相信任,也在後續的傷害復原過程中攜手努力(https://www.storm.mg/lifestyle/490708)。

我們很慶幸,這一次的法律沒有處罰救人的人,而是罰體制。醫界最期待的,也就是能夠把因為某些錯誤的健保制度或惡劣的醫療政策所間接引發的相關糾紛,可以去刑化醫療人員,然後罰體制(健保制度和醫療政策),進而改善醫療品質。


這個過世的年輕人一開始就犯了致命的錯,但是救難人員並不會因為他有錯而疏於搜救,也沒有因此受到懲罰。失去兒子的父母親付出時間,捐出全數國賠款項,投入改善山難救助體制、投入推動面山教育和建立安全的登山機制…,是父母親能給過世孩子最大的懷念。問題是,受處罰國家,不知道能否因此思考救難系統改善的空間?還是民眾繼續自力救援?


2 comments:

  1. 自由時報2015/5/31修改後刊登,我再轉貼後續的一些討論:
    http://talk.ltn.com.tw/article/paper/884897

    …這個案例批評者說「消防隊過勞與制度問題」我非常認同,他們一直罵死者我也沒有意見(反正往生者聽不到了),但他們還批評「胡鬧的家屬」和「亂判的法官」…

    來自醫界的批評「不能認同家屬去告救人者」,是把家屬等同於我們醫界最痛恨的「醫鬧」。這個家屬有沒有「鬧」,見仁見智。然而,這一次的法律沒有因家屬「鬧」而處罰救人的人,而是罰體制,這不正是醫界最期待的?司法若是能夠把因為某些錯誤的健保政策或惡劣的醫療制度所間接引發的相關糾紛,可以去刑化醫療人員,然後罰體制(健保和醫療制度),改善醫療環境,不正是醫界應肯定的?

    另一群批評來自登山者,擔心因國賠產生後遺症:政府封山。果真如此,該批判的是無能政府做出低能的決策。試想:登山者或其家屬是否可以百分之百保証不用和救難人員打交道?救難體制如果因為被檢討而改善,這個「胡鬧」的家屬、「愚蠢」的死者、和「恐龍」的法官,沒有功勞嗎?(問題是:救難體制會不會因檢討而改善?)

    有些人批評「憑什麼國賠,賠的是納稅人」,沒錯,政府國家出錯的時候,確實是全民買單。這是台灣國賠一覽表:http://p.udn.com.tw/upf/newmedia/2015_data/20150527_udncompensate/udncompensate/

    這個過世的年輕人一開始就犯了致命的錯,但是救難人員並不會因為他有錯而疏於搜救,這次還好司法沒有懲罰救人者。失去兒子的父母親付出時間,捐出全數國賠款項,投入改善山難救助體制、投入推動面山教育和建立安全的登山機制…,是父母親能給過世孩子最大的懷念。

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  2. Taipei Times Editorial (翻譯)
    Mountain fatality highlights inadequacy
    http://www.taipeitimes.com/News/editorials/archives/2015/06/04/2003619863

    Mountain fatality highlights inadequacy

    By Su Kuan-pin 蘇冠賓
    Translated by Edward Jones

    Chang Po-wei (張博崴), a medical student who died in 2011 after getting lost while climbing Baigu Mountain (白姑大山) in Nantou County, committed a fatal mistake by venturing into the area alone. The mountain rescue team from the Nantou County Fire Department did what they could in the search, necessitated by Chang’s mistake, and it is for this reason they have not been punished.

    The compensation award ordered by the Taipei District Court reflects errors on the part of government. The rescue team are not to blame. Instead, the fault lies with the government and its systems, and there is much room for improvement. Chang’s family have spent a great deal of time pursuing their claim through the courts. They plan to invest all of the compensation — NT$2.67 million (US$86,685) — in promoting education related to mountain climbing and funding mountaineering safety apparatus. The key question is: Will the court’s ruling spur the government to improve the nation’s search and rescue system, or will the public have to continue organizing rescue efforts themselves?

    Firefighters have an extremely tough job and their rescue teams deserve to be highly commended. However, if rescue systems and procedures are inadequate, and the authorities have not provided adequate supervision and management, operations are likely to be disorganized.

    If the court had ruled that the firefighters themselves should pay damages, or that the rescue team should pay 30 percent of the damages, this would have been grossly unfair. The court made the right decision in awarding state compensation as the government was at fault and the firefighters are blameless.

    The issue of the medical care redress bill similarly involves people in different camps holding conflicting ideas and approaches. If Taiwan goes down the same road as the US, Canada and Italy, it would result in a financial black hole for the medical system. The further a nation moves toward building a compensatory system focused on individual doctors or hospitals, the more likely it is that important concepts, such as the inherent uncertainty of medical treatment or problems with medical insurance systems, are overlooked.

    If people affected by of natural disasters start to claim damages from rescue workers, nobody would be willing take on such tasks.

    In the UK the state provides medical treatment as a form of social welfare. Most doctors in the UK are employees of the state and compared with other professions, doctors receive relatively low pay considering what they do.The public is keenly aware how tough it was 60 years ago, when the public health system did not exist. The government, in turn, works to make the public aware that resources are limited, treatments contain an element of risk and that doctors will never intentionally harm their patients nor refuse to treat them. Therefore, in the event of a case of gross negligence, the public must directly sue the National Health Service (NHS) for inadequate supervision or management. A member of the public cannot directly sue a doctor. Thus, it can be viewed as a form of state compensation. The bar for initiating a prosecution of the NHS is intentionally kept high, to ensure members of the public do not cause trouble needlessly, which would negatively impact upon the morale of medical workers.

    In the case of Chang, the court punished the system, rather than individual rescue workers. Many in the medical profession hope that, instead of criminalizing individual doctors or nurses, the government takes the opportunity to correct mistakes with the National Health Insurance system and reforms its health policy to improve the standard of medical healthcare.

    Su Kuan-pin is a professor and director of China Medical University’s Institute of Neural and Cognitive Sciences.

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