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Smrť pacientky pri pôrode - Rozsudok Krajského súdu v Trnave 10Co/909/2015


 | 5.8.2016 | komentárov: 300

Dňa 20.4.2016 Krajský súd v Trnave vydal konečné rozhodnutie vo veci náhrady nemajetkovej ujmy, spôsobenej poskytovateľom zdravotnej starostlivosti (ďalej len poskytovateľ). Ide o významné rozhodnutie z dôvodu neobvykle vysokej náhrady, ktorá bola príslušným súdom poškodeným osobám priznaná.

Obrazok

Pacientka bola prijatá na gynekologicko-pôrodnícku kliniku Fakultnej nemocnici v Trnave 14. júla 2011 o 16:12 hod. s diagnózou parturiens - rodička. Išlo o bežný pôrod druhorodičky bez komplikovaného priebehu no s následkom smrti pacientky. Bezprostrednou príčinou smrti
bol šokový stav a prasknutie steny maternice čo spôsobilo vykrvácanie do brušnej dutiny pacientky.

V prípadoch kedy dochádza k nečakanej smrti pacienta sa blízke osoby často snažia presvedčiť či zdravotná starostlivosť bola poskytnutá správne tzn. „lege artis“. Ak sa osoba domnieva, že zdravotná starostlivosť nebola neposkytnutá správne, je bežnou praxou
obrátiť sa na Úrad pre dohľad nad zdravotnou starostlivosťou (ďalej len Úrad) aby vykonal dohľad a potvrdil alebo vylúčil správnosť postupu lekára, či poskytovateľa zdravotnej starostlivosti. V tejto veci Úrad po vykonaní šetrenia uviedol, že „dôvodom krvácania
(prvotnou príčinou smrti) bola nerozpoznaná prasklina jazvy maternice po predchádzajúcom cisárskom reze“. Následne poukazuje na to, že ak pacientka rodí pomocou cisárskeho rezu je nevyhnutné aby pri každom následnom spontánnom pôrode bolo vykonané vyšetrenie prednej steny maternice za účelom vylúčenia jej roztrhnutia. Okrem toho, na možné krvácanie do brušnej dutiny pacientky v tomto prípade poukazovalo množstvo faktorov, ako nízky krvný tlak, zvýšený tep a pokles hemoglobínu v krvi, čo v spojitosti s cisárskym pôrodom, ktorý bol pacientke pri poslednom pôrode vykonaný zvyšovalo pravdepodobnosť krvácania. Navyše, podľa Úradu sa dalo krvácaniu jednoducho predísť ak by poskytovateľ vyšetrením overil, či sa v brušnej dutine nenachádza tekutina, a teda či je dutina maternice prázdna, a či je predná stena maternice celistvá. Preto na základe uvedených skutočností Úrad konštatoval, že „adekvátne liečebné postupy nemohli byť aplikované v plnom rozsahu“. Preto samotný postup lekára nebol v súlade s najnovšími lekárskymi postupmi tzn. „lege artis“, čo viedlo k rozvoju komplikácií, majúcich za následok úmrtie rodičky.

Na to, aby vznikla občianskoprávna zodpovednosť pri poskytovaní zdravotnej starostlivosti je potrebné aby boli splnené štyri základné predpoklady. Prvým predpokladom je protiprávnosť konania, tzn. že poskytovateľ postupoval „non lege artis“ a teda v rozpore s objektívnym právom. Druhou podmienkou je vznik škody (ujmy) ako následok protiprávneho konania poskytovateľa. Treťou podmienkou je príčinná súvislosť (kauzálny nexus), tzn. že protiprávne konanie má priamu spojitosť so vzniknutou ujmou. Posledným predpokladom pre vznik občianskoprávnej zodpovednosti je zavinenie, ktoré možno charakterizovať ako vnútorný psychický vzťah zodpovedného subjektu k vlastnému protiprávnemu úkonu a k ujme ako k výsledku tohto protiprávneho úkonu. Zavinenie sa však vyžaduje  len v prípadoch tzv.
subjektívnej zodpovednosti, ktorej nositeľom môžu byť len fyzické osoby, a v prípade tzv. objektívnej zodpovednosti sa neskúma.

To znamená, že ak má občianskoprávna zodpovednosť vzniknúť, ujmu pacienta musí spôsobiť zavinené protiprávne konanie poskytovateľa. V tomto konkrétnom prípade tým, že lekár zanedbal vyšetrovací postup, porušil zákonnú povinnosť poskytovateľa, čo malo za
následok smrť pacientky. Toto konanie veľkou mierou zasiahlo do práva na ochranu osobnosti a závažným spôsobom narušilo súkromný a rodinný život blízkych osôb pacientky. Závažnosť tohto zásahu do práv osôb spočíva v následku smrti, ktorá spôsobila, že manžel
navždy stratil možnosť viesť rodinný a súkromný život, vrátane výchovy detí, spolu s manželkou ako so ženou, s ktorou si založil rodinu a pacientkine deti stratili matku vo veku, kedy je matka pre dieťa nenahraditeľná.

Na základe uvedených skutočností nemožno spochybniť vznik občianskoprávnej zodpovednosti u poskytovateľa a  nemajetkovej ujmy u poškodeného. V tejto súvislosti treba povedať, že v prípadoch kedy je konaním poskytovateľa, osobe spôsobená ujma má
dotyčný poškodený vždy právo na primeranú satisfakciu. Náhradu si poškodený môže v prvom rade uplatniť priamo u poskytovateľa, a to na základe mimosúdnej dohody medzi subjektmi. No v prípade, ak ku konsenzu medzi stranami nedôjde, poškodený má právo
obrátiť sa na príslušný súd, ktorý o náhrade rozhodne. Nárok je možné si uplatniť voči lekárovi alebo lekárskemu zariadeniu, podľa toho, kto je za vzniknuté pochybenie zodpovedný. Ak poškodený nevie, voči ktorému subjektu je potrebné si nárok uplatniť, je
možné ho uplatniť voči obom subjektom a  súd bude v takom prípade povinný poškodeného ako navrhovateľa poučiť o tom, voči komu je možné si náhradu škody nárokovať. Najdôležitejšie však je, aby bol nárok vždy uplatnený pred uplynutím premlčacej doby.

Otázku výšky náhrady, respektíve rozsah peňažného zadosťučinenia, platná právna úprava v súčasnosti neupravuje. Určenie náhrady prináleží príslušnému súdu, a je predmetom voľnej úvahy súdu, a to s prihliadnutím na petit žaloby a povahu jednotlivých okolnosti prípadu (spôsob neoprávneného zásahu, charakteru a rozsahu zasiahnutej hodnoty osobnosti). Pri stanovení výšky náhrady nemajetkovej ujmy treba tiež pamätať na cieľ náhrady. Pričom podľa názoru súdu: „cieľom náhrady nemajetkovej ujmy v peniazoch je aspoň čiastočné zmiernenie ujmy v prípadoch, kedy navrátenie do pôvodného stavu neprichádza do úvahy“.Preto súd musí určiť výšku náhrady, ktorá nie je prinízka v pomere k spôsobenej ujme, avšak nesmie ísť ani o náhradu, v dôsledku ktorej by sa poškodený voči poskytovateľovi bezdôvodne obohatil. Významnú úlohu pri stanovení výšky náhrady zohráva aj posúdenie zavinenia, kde hrubú nedbanlivosť alebo sériu takýchto hrubých nedbanlivostí pôvodcu neoprávneného zásahu súd bude hodnotiť podstatne prísnejšie a takýto zásah by sa mal prejaviť i vo výške stanovenej relutárnej satisfakcie. Súd zároveň musí pri stanovení náhrady prihliadať na to aby uhradenie danej peňažnej čiastky nepôsobilo pre poskytovateľa likvidačne, a to aj vzhľadom na verejný záujem. Základnými kritériami pre určenie výšky nemajetkovej ujmy v peniazoch v dôsledku neoprávneného zásadu do práva na ochranu osobnosti, sú teda závažnosť vzniknutej ujmy, ako i okolnosti, za ktorých k porušeniu práva došlo. Pretrhnutím rodinných a citových väzieb, vyplývajúcich predovšetkým z intenzity vzťahu so zomrelou a skutočnosť, že išlo o mladý manželský pár, budujúci si rodinu, s dieťaťom v útlom veku a pripravujúci sa na príchod ďalšieho dieťaťa, poukazuje na mimoriadne závažný zásah do osobnostných práv, ktorému by malo zodpovedať aj primerané a spravodlivé zadosťučinenie. Na základe uvedených skutočností sme preto toho názoru, že mimoriadna závažnosť vzniknutej ujmy u poškodeného v danom prípade, ako i mimoriadnosť okolností, za ktorých k porušeniu práv došlo, plne opodstatňujú priznanú a poškodenými žiadanú výšku náhrady nemajetkovej ujmy, čo v súhrne predstavuje peňažnú čiastku vo výške 150.000 eur.

Náhrada, ktorá bola súdom v predmetnej veci priznaná má spĺňať dve základné funkcie. Sú to funkcie reparačná, ktorá spočíva v povinnosti poskytovateľa odčiniť škodlivý následok, v tomto prípade formou odškodnenia a funkcia satisfakčná, ktorá sa zameriava na odstránenie následkov zásahov do práv, a takisto počíta s primeraným zadosťučinením. Zároveň sa domnievame, že takto vysoká náhrada má v tomto prípade predovšetkým spĺňať ešte jednu dôležitú funkciu, a to funkciu preventívno-sankčnú. Preventívno-sankčná funkcia má zabezpečiť aby poskytovateľ v budúcnosti predchádzal podobným situáciám a minimalizoval ohrozenie porušenia právom chránených záujmov, pri ktorých dochádza  k vzniku ujmy na zdraví, na živote alebo na majetku pacienta, či už postupmi „non lege artis“ alebo iným
konaním resp. nekonaním zdravotníckeho pracovníka alebo zdravotníckeho zariadenia.




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