指导教授周天

1、1指導教授：周天 所長 報 告 人：碩專班二年級 9520705周綸音國立高雄第一科技大學國立高雄第一科技大學科技法律研究所科技法律研究所案例討論案例討論課程：醫療與法律課程：醫療與法律案號：案號：Brook v. St. Johns Hickey Memorial Hospital (269 Ind. 270) 2 病人病人（P）RadiologistSupreme court（被告勝訴，確認初審原判）（被告勝訴，確認初審原判）Court of appeal（撤銷對撤銷對被告被告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爭點n此案爭點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判決nTh

11、e 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 cause ne

12、rve 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 wer

13、e 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 on

14、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 an i

15、njection 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 value fo

16、r 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醫療法n第六十四條 醫療機構實施中央主管機關規定之侵入性檢查或治療，應向病人或其法定代理人、配偶、親屬或關係人說明，並經其同意，簽具同意書後，始得為

17、之。但情況緊急者，不在此限。n前項同意書之簽具，病人為未成年人或無法親自簽具者，得由其法定代理人、配偶、親屬或關係人簽具。12醫療法n第一百零三條 有下列情形之一者，處新臺幣五萬元以上二十五萬元以下罰鍰：一、違反第十五條第一項、第十七條第二項、第二十二條第二項、第二十三條第二項、第三項、第五十七條、第六十一條、第六十三條第一項、第六十四條、第七十二條、第八十五條、第八十六條規定或擅自變更核准之廣告內容。二、違反中央主管機關依第六十二條第二項、第九十三條第二項規定所定之辦法。醫療廣告違反第八十五條、第八十六條規定或擅自變更核准內容者，除依前項規定處罰外，其有下列情形之一者，得處一個月以上一年以下

18、停業處分或廢止其開業執照，並由中央主管機關吊銷其負責醫師之醫師證書一年：一、內容虛偽、誇張、歪曲事實或有傷風化。二、以非法墮胎為宣傳。三、一年內已受處罰三次。13醫醫 事事 放放 射射 師師 法法 第十二條 （醫事放射師業務範圍） 【相關罰則】第二項35 醫事放射師業務如下： 一、放射線診斷之一般攝影。 二、核子醫學體外檢查。 三、放射線診斷之特殊攝影及造影。 四、放射線治療。 五、核子醫學診斷之造影及體內分析檢查。 六、核子醫學治療。 七、磁振及非游離輻射診斷之造影。 八、其他經中央衛生主管機關認定之項目。 醫事放射師執行前項第一款、第二款業務，應依醫師開具之會檢單為之。但自費至醫事放射所檢查者，不在此限；執行前項第三款至第八款業務，應配合醫師行之。 第一項各款所稱之攝影及造影，包括其影像之獲取、處理及品質管理。 第二項但書規定於本法公布施行之日起，