Zodpovednosť pri poskytovaní zdravotnej starostlivosti vo Francúzsku | Medicínske právo
              

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Zodpovednosť pri poskytovaní zdravotnej starostlivosti vo Francúzsku


 | 26.7.2010 | komentárov: 301

Ponúkame Vám exkluzívny preklad článku, ktorý rozoberá problematiku poskytovania zdravotnej starostlivosti vo Francúzsku. Dozviete sa napríklad o potrebných úkonoch, pochybeniach a o rôznych druhoch zodpovednosti.

Obrazok
redigované Me DURRIEU-DIEBOLT, Avocat à la Cour

Zodpovednosť zdravotníckych pracovníkov je charakterizovaná svojou komplexnosťou, pretože je situovaná na hraniciach dvoch oblastí, práva a medicíny. Pojem zodpovednosti je primárne v práve : je upravená vo všetkých systémoch práva, občianskom, administratívnom, trestnom. Čo sa týka poskytovania zdravotnej starostlivosti, nie je prípustné, aby lekár bol považovaný za zodpovedného za všetky dôsledky svojich zdravotníckych úkonov okrem tých, ktoré zavinil, nie je akceptovateľné aby chyba pri poskytovaní zdravotnej starostlivosti viedla k nepovšimnutiu bez akéhokoľvek uznania a náhrady.
Táto zodpovednosť vzniká na základe kumulatívneho splnenia nevyhnutných podmienok a to pochybenia, ujmy na strane pacienta a kauzálnej súvislosti medzi pochybením a ujmou.
Pacient alebo jeho právny nástupcovia teda môžu vymôcť náhradu škody a odsúdenie zdravotníckeho pracovníka.

Povinnosť potrebných úkonov :
Lekársky výsledok je neistý, lekár nemusí vyliečiť pacienta. Neexistuje tu teda povinnosť, nevyhnutnosť výsledku.
Avšak, zdravotnícky pracovník musí poskytnúť všetky nevyhnutné úkony, so zreteľom na dosiahnutý vedecký pokrok, aby vyliečil alebo zmiernil bolesť pacienta, toto zahŕňa povinnosť poskytnutia potrebných úkonov.
Z toho vyplýva, že tak ako povinnosť potrebných úkonov aj zodpovednosť pri poskytovaní zdravotnej starostlivosti je zodpovednosťou za zavinenie, to znamená, že lekár je odsúdený iba ak obeť prinesie dôkaz o jeho pochybení.
Princíp zodpovednosti za zavinenie bol založený zákonom zo 4. marca 2002.

Aké pochybenia (protiprávne úkony) zakladajú zodpovednosť pri poskytovaní zdravotnej starostlivosti ?

Tieto pochybenia môžeme rozdeliť na pochybenia pri poskytovaní zdravotnej starostlivosti a na pochybenia v organizácií poskytovania služieb.
Pochybenia pri poskytovaní zdravotnej starostlivosti môžeme konkretizovať napríklad ako chyba v diagnóze, nedostatok poučenia, pochybenie pri výbere prevedenia liečby, ako tiež nedodržanie dosiahnutého vedeckého pokroku alebo pravidiel lekárskeho umenia :
- Neskorá alebo nedostatočná diagnóza spočívajúca v absencii nevyhnutných lekárskych vyšetrení (CE, 16/11/1998, REYNIER).
- Nedostatok informácií o známom lekárskom riziku.
- Injekcia kortikoidov pacientovi trpiacemu pretrvávajúcimi bolesťami dolných končatín v rozpore s pracovnými podmienkami (CAA, Bordeaux, druhá komora, 15/2/99, CHRU Toulouse c/Cauhape).
Pochybenie v organizácií poskytovania služieb môže spočívať v nedostatku starostlivosti, neprítomnosti zdravotníckeho pracovníka, nedostatku lekárskych schopností alebo v nedostatočnosti poskytnutých prostriedkov klinikou alebo nemocnicou.
Ako pochybenie v organizácií bol usúdený aj oneskorený zákrok internistu alebo anestéziológa spôsobený štandardnou poruchou telefónu (CAA, Nancy, 13/3/1997, CHR de Brest).

Môže zodpovednosť pri poskytovaní zdravotnej starostlivosti vzniknúť aj bez zavinenia?
Podľa zákona zo 4. marca 2002, je to len výnimka, zodpovednosť bez zavinenia je možná v dvoch prípadoch :
1. V prípade zdravotníckych pomôcok :
Zodpovednosť za zavinenie sa neaplikuje v prípade vady zdravotníckej pomôcky pripísateľnej farmaceutickým laboratóriám a praktickému lekárovi (napríklad dodanie protézy).
2. V prípade nemocničnej nákazy, infekcie vznikajúcej pri liečbe v zdravotníckych zariadeniach, táto zodpovednosť sa týka zdravotníckych zariadení( v súkromnej praxi je potrebné priniesť dôkaz o pochybení v aseptickej technike).

Zodpovednosť občianskoprávna, administratívna alebo trestná:

Občianske právo a správne právo sú založené na odškodnení jednotlivca
Pojem občianskoprávnej zodpovednosti vyvoláva myšlienku škody a jej náhrady alebo ešte odškodnenia obetí.
Presnejšie povedané, je zvyčajne definovaná ako záväzok daný na ťarchu zodpovednému nahradiť škodu, ktorá bola spôsobená inému.
Občianskoprávna zodpovednosť sa výlučne aplikuje v súkromnom sektore. Teda chybný lekársky zákrok vykonaný vo verejnom zariadení zakladá administratívnu zodpovednosť.

Trestné právo smeruje k odškodneniu spoločnosti

V trestnom konaní sa koná o jednotlivcovi a spôsobenej škode, ale nie len o individuálnej osobe, ale aj o spoločnosti ako celku.
Tieto sociálne škody sú definované v zákone ako trestné činy pretože predstavujú zásah do všeobecných záujmov celej skupiny.
Trestné sankcie sa skladajú z trestov, ktoré majú hlavne sankčnú a represívnu funkciu : väzenie, pokuta, zákaz činnosti.

Tiež existuje rozdiel medzi zavinením podľa občianského, správneho a trestného práva.

Podľa trestného práva, zákon z 10. júla 2000 uložil povinnosť preukázať kvalifikované zavinenie (môžeme prirovnať k vedomej nedbanlivosti, ale tento pojem je širší )1 v prípade nepriamej kauzality medzi pochybením a škodou. Jednoduché zavinenie (nevedomá nedbanlivosť) môže samo osebe postačovať len, ak zdravotnícky pracovník spôsobil priamo ujmu ( napríklad, ak omylom porezal životne dôležitý orgán), toto však predstavuje výnimku.
V trestnom práve, sa neprezumuje zavinenie alebo kauzálna súvislosť tak ako v občianskoprávnej alebo správnej zodpovednosti : nedbanlivosť, domienka viny, predpoklad príčinnej súvislosti, povinnosť zabezpečenia výsledku alebo straty možnosti umožňuje dosiahnúť nápravu.

Na zapamätanie :
Tieto spory zvyknú byť medializované, psychicky náročné, niekedy ponižujúce, ale zriedkavo dochádza k odsúdeniu, štyri z piatich procesov končia prepustením obžalovaného na slobodu.
Navyše, od účinnosti zákona z 10. júla 2000, je potrebné kvalifikované zavinenie, ktoré je veľmi zriedkavé v trestných veciach. Taktiež je potrebné rozlišovať rozhodnutia súdov vynesených pred a po účinnosti tohto zákona, ktorý je viac zhovievavejší k zdravotníckym pracovníkom.

1. poznámka prekladateľa

© Carine DIEBOLT - "Droit pour Tous" - 2009

zdroj : http://sos-net.eu.org/medical/index.htm
foto: bedekerzdravia.sk

Článok preložila: Bc. Marta Nováková




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