醫療糾紛涉及醫療疏失及因果關係等專業判斷，因此實務操作上相當仰賴囑託鑑定，然而，醫療糾紛鑑定在法庭運作上，有多少機會被法官引用？如何影響判決結果？又哪些案例特性會影響到醫療糾紛鑑定在法庭上的角色？過去的文獻從未探討過這些議題。本研究希望藉由司法院的法學資料檢索系統，進行醫療訴訟案件之實證分析，好回答上述重要問題。本研究分析了民國 91 年到 99 年之間，總計 1,917 件醫療糾紛判決案例。其中，法官引用鑑定意見據以形成法院心證者，總數達 1,295 件，所占比例達到 83.0%。在多變數分析中，我們發現刑事訴訟案件（勝算比 1.98倍），以及重傷或死亡的案件（勝算比 2.89 倍），法官在其裁判過程中，顯有較高的機會引用鑑定意見據以形成心證。至於醫療糾紛判決結果部分，我們發現在多變數分析中，經控制了相關因素之後，鑑定結果對於醫師有利時（勝算比 37.72 倍），以及在刑事訴訟中（勝算比 2.64 倍），尤見醫方有顯著較高的勝訴機會。進一步帶入分層多變數分析，我們發現鑑定意見不利於醫方時，被告醫師在刑事追訴的定罪機會為四成多，偏巧與醫療糾紛的疏失鑑定維持率相仿。反之，當鑑定意見有利於醫方時，醫方卻仍有 6%的敗訴或者定罪的機會，其原因還有待將來的研究予以解答。本研究證實了法官的心證過程中，相當高的程度引用了鑑定意見，特別是在刑事訴訟案件，以及重傷或者死亡案件。而鑑定意見有利於醫方，以及病方採取刑事訴訟，則是醫方勝訴的兩個顯著獨立因素。

Medical malpractice litigation involves very professional judgment about negligence and causality. Therefore, professional medical assessments are essential for judges to make their sentences. However, how often the judges use the assessment reports in their cases and how the assessment reports influence the trials remain unclear in Taiwan. Therefore, we conducted an empirical study based on a nationwide trial database. We analyzed 1,917 medical malpractice litigation cases between 2002 and 2010. Among these cases, judges used assessment reports in their cases in 1,295 trials (83.0%). In multivariate analyses, criminal cases (odds ratio, OR=1.98) and cases with severe injury or death (OR=2.89) were associated with higher chance to use assessment reports in trials. For outcomes of trials, we found physicians had higher chance to win the suits if the assessment reports favoring physician (OR=37.72) or in criminal courts (OR=2.64). In stratified multivariate analyses, we found that if assessment reports did not favor physicians, physicians had about 40% chance to win their trials, which was approximately the same chance as the consistent rate of negligence in the assessment reports. On the other hand, physicians still had 6% chance to lose their trials even though the assessment reports did not find any negligence. In the present study, we used empirical evidence to prove that medical assessment reports were highly cited in the medical malpractice litigations, especially in criminal cases and cases with severe injury or death. Assessment reports favoring physicians and criminal cases were the two independent factors associated with higher chance for physicians to win their cases after adjusting other factors.

醫療糾紛訴訟;醫療鑑定;實證研究;身體傷害

Medical Malpractice Litigation; Medical Assessment; Empirical Study; Medical Injury