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HOSŤ MESIACA JÚL 2012: JUDr. Petr Vojtek


 | 2.7.2012 | komentárov: 322

V mesiaci júl na naše potešenie pozvanie byť hosťom mesiaca prijal JUDr. Petr Vojtek, sudca Najvyššieho súdu Českej republiky, ktorý sa špecializuje na otázky náhrady škody. Spôsobenie škody a rozhodovanie o jej náhrade nesporne súvisí aj s poskytovaním zdravotnej starostlivosti. Bližšie sa tejto téme- predpokladom vzniku právnej zodpovednosti za škodu, typom zodpovednosti za škodu, ktoré sa uplatňujú v súvislosti s poskytovaním zdravotnej starostlivosti či zmenám, ktoré prinesie nový český Občanský zákonník venujeme v rozhovore.

Obrazok MEDIUS:  Pôsobíte na Najvyššom súde Českej republiky. Vyskytujú sa spory súvisiace s odškodnením pacientov často? Dá sa odhadnúť, ktorý odbor medicíny je, povedzme, z tohto hľadiska najrizikovejší?

Není pochyb o tom, že počet sporů o náhradu škody proti poskytovatelům zdravotnické péče obecně narůstá a projevuje se to i v agendě Nejvyššího soudu jako soudu dovolacího. Vzhledem k vývoji zdravotnické techniky a přechodu k jednorázovým injekčním jehlám i dalším nástrojům se snižuje počet dříve poměrně častých sporů o náhradu škody na zdraví, která byla vyvolána infekční nákazou pacienta. Statistiku oborů, jichž se spory týkají, asi nikdo nevede, nicméně z povahy věci půjde jednak o obory, kde dochází k invazivním zákrokům, většinou při použití vysoce sofistikované techniky, umožňující dříve nepředstavitelné zákroky. Před pochybením při zdravotnickém výkonu ani před nepatřičným fungováním techniky není ochráněn žádný obor, takže odpovědnost může vzniknout v jakémkoliv oblasti. Připadá mi, že se poměrně často objevují i nároky vůči porodnickým pracovištím. Stále se vyvíjející právní úprava informovanosti pacienta jistě povede ke sporům odvozeným od porušení právní povinnosti poučit pacienta o povaze a rizicích zákroku.

MEDIUS:  Aké sú predpoklady vzniku právnej zodpovednosti za škodu? 

Občanskoprávní odpovědnost je založena na tom, že v první řadě musí vzniknout škoda, tj. odškodnitelná újma, která má být právě systémem odpovědnosti reparována. Ta je vždy něčím vyvolána, takže základním předpokladem je buď porušení právní povinnosti (odpovědnost obecná), anebo zákonem kvalifikovaná zvláštní okolnost (odpovědnost zvláštní, zpravidla objektivního chraktreu). Mezi těmito dvěma podmínkami musí být naplněn vztah příčinné souvislosti (tzv. kauzální nexus), tedy odpovědnost nastupuje jen tam, kde je škodlivý následek vyvolán právě porušením právní povinnosti či okolností, s níž zákon odpovědnost spojuje.

MEDIUS:  Aké typy zodpovednosti za škodu je možné uplatňovať v súvislosti s poskytovaním zdravotnej starostlivosti?

Ve zdravotnictví se uplatní dva typy občanskoprávní odpovědnosti – obecná podle § 420 občanského zákoníku a zvláštní objektivní odpovědnost podle § 421a občanského zákoníku. Obecná odpovědnost vzniká při současném splnění tří podmínek, jimiž jsou porušení právní povinnosti, vznik škody a vztah příčinné souvislosti mezi nimi. Zavinění je presumováno, ovšem odpovědná osoba se může odpovědnosti zprostit, prokáže-li, že škodu nezavinila ani z nevědomé nedbalosti. Odpovědnost podle § 421a občanského zákoníku porušení právní povinnosti nevyžaduje a nepočítá ani se zaviněním. Podstatné je, zda škoda byla způsobena (je v příčinné souvislosti) s okolnostmi, které mají původ v povaze věci, přístroje či látky použité při zdravotnickém výkonu; jde o velmi přísně koncipovanou odpovědnost, která nemá žádné liberační důvody, což znamená, že při splnění uvedených podmínek (a jejich prokázání ve sporu) nemá zdravotnické zařízení možnost se takové odpovědnosti zprostit.  

MEDIUS: Aké predpisy sa v týchto prípadoch aplikujú?

Právním rámcem občanskoprávní odpovědnosti je samozřejmě občanský zákoník. Protože u obecné odpovědnosti se pracuje s pojmem „postup lege artis“ při posouzení porušení právní povinnosti, uplatní se předpisy, v nichž jsou alespoň rámcově požadavky na řádné (náležité) poskytování zdravotní péče upraveny, tj. § 11 zákona č. 20/1966 Sb., o péči o zdraví lidu, který byl s účinností od 1. 4. 2012 zrušen zákonem č. 372/2011 Sb., o zdravotních službách a podmínkách jejich poskytování (v něm zejména § 28 odst. 2 ve spojení s § 4 odst. 5 zákona), jakož i Čl. 4 Úmluvy o lidských právech a biomedicíně, č. 96/2001 Sb. m. s.)

MEDIUS: Aké zmeny by mali nastaviť v úprave zodpovednosti za škodu v súvislosti s pripravovanou rekodifikáciou Občianskeho zákonníka?

U obecné odpovědnosti není změna nikterak zásadní, významně se však mění úprava rozsahu odškodnění. Nová koncepce pak byla zvolena u odpovědnosti za škodu způsobenou povahou použitých věcí či přístrojů, kde nový zákoník již počítá jen s odpovědností za vadu věci. V podrobnostech bych odkázal na články, v nichž rozbor stávající úpravy konfrontuji i s pohledem do budoucna, tj. za datum 1. 1. 2014, kdy nový občanský zákoník (zákon č. 89/2012 Sb.) nabývá účinnosti.

MEDIUS: Od čoho závisí úspešnosť pacientov uplatňujúcich si nároky na odškodnenie?
 

Tak jako v jiných sporech o náhradu škody musí poškozený tvrdit a prokázat splnění podmínek odpovědnosti. V oblasti zdravotnictví je však poškozený nepochybně znevýhodněn několika faktory. Za prvé je zpravidla od počátku hendikepován zdravotními potížemi, s nimiž se na zdravotníka obrací; je povětšinou laikem, jemuž činí potíže proniknout do složité problematiky soudobých léčebných procedur. Proto se začasté hůře orientuje jak při pochopení, co ho při zákroku čeká, tak v případě nezdaru při rozlišení důvodů, proč k nepříznivému následku došlo. Konečně pak je pacient odkázán na kvalitu zdravotnické dokumentace, která je dílem zdravotnického zařízení a jejíž kvalitu nemůže ovlivnit. Nedostatek průkazných materiálů mu však poněkud paradoxně může přinést neúspěch ve sporu. Snad by se dalo říci, že na druhé straně jsou tyto nevýhody kompenzovány velmi široce pojatou objektivné odpoědností za škodu způsobenou okolnostmi, které mají původ v povaze věci (§ 421a občanského zákoníku).

MEDIUS:  Čo v prípadoch, ak sa zodpovednosť zdravotníckeho zariadenia nepreukáže? Myslíte si, že by systém mal reflektovať aj takéto prípady a ponúkať možnosť kompenzácie tam, kde sa nedá preukázať príčinný následok medzi pochybením a následkom, avšak k poškodeniu pacienta prípadne k úmrtiu došlo?

To je dosti složitý problém, protože důvody neúspěchu ve sporu mohou být různé. Nepochybně je na jedné straně nepříznivé, nedostane-li se přiměřené náhrady poškozenému, na straně druhé není přípustné, aby povinnost k náhradě škody byla ukládána někomu, jehož odpovědnost není skutečně prokázána. Rozsah nároků může být široký a finančně objemný, proto asi není na místě, aby takové povinnosti zatížily někoho jen na základě domněnky či pravděpodobnosti. Pokud pro takové případy existuje možnost poskytnutí příspěvku, která vyeliminuje alespoň některé výjimečné případy, kdy náhrada z titulu odpovědnosti za škodu nenáleží, nelze mít nic proti. V českém právním řádu šlo o příspěvek poskytovaný státem podle § 78 odst. 2 části věty za středníkem dřívějšího zákona č. 20/1966 Sb., o péči o zdraví lidu, který se však v praxi prakticky neuplatňoval a v nové úpravě již nefiguruje. Stejně může jít jen o jakýsi doplněk odpovědnostního sytému a ne o nějaké základní pravidlo. Mnohem prospěšnější jsou jasná pravidla odpovědnosti a záruka vynutitelnosti nároků, které podle nich vzniknou.

MEDIUS:  Začiatkom tohto roka Francúzsko odhalilo problém s prsnými implantátmi výrobcov PIP a M-Implants. Tento typ implantátov bol použitý aj v Českej republike. Aký je Váš názor na postup pri odškodňovaní nárokov takto postihnutých pacientok? Mali by poisťovne preplácať odstránenie vadných prsných implantátov?

K tomu se neodvažuji vyjadřovat, neboť jednak nemám dostatek informací, jednak může i u nás dojít ke sporům, jejichž výsledek nemohu tímto způsobem předjímat. Nicméně je asi třeba si uvědomit odlišnost mezi tím, co představuje vadně provedený implantát pro zdraví pacientky (újma na zdraví s tím spojenými nároky) a co pro vztahy smluvní a platební (odpovědnost za vady či dopady do systému zdravotního pojištění).

MEDIUS: Akým témam hodláte venovať svoje príspevky?

Rád bych vysvětlil některé otázky stávající právní úpravy týkající se odpovědnosti za škodu ve zdravotnictví, zejména problémy s mimořádným zvyšováním náhrady za ztížení společenského uplatnění a otázku objektivní odpovědnosti podle § 421a občanského zákoníku, a to i v nových souvislostech, které vyvstaly přijetím nového občanského zákoníku. V každém případě bych čtenářům těchto řádků chtěl popřát hodně zdraví, tedy aby jejich zájem o problematiku mohl zůstat jen v teoretické rovině a aby nebyli nuceni získané poznatky aplikovat ve vlastních záležitostech.

Ďakujem za rozhovor.

Spracovala: Zuzana Zoláková





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