Zníženie šance na prežitie | Medicínske právo
              

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Zníženie šance na prežitie


 | 20.1.2014 | komentárov: 577

V sekcii Česká a slovenská judikatúra Vám tento týždeň prinášame rozhodnutie Najvyššieho súdu Českej republiky, ktoré sa týka teórie zníženia šance na prežitie a náhrady ujmy z titulu ochrany osobnosti (30 Cdo 3377/2011).

Žalobcovia T.M., J.M., M.S. a K.S. sa podaním žaloby voči zdravotníckemu zariadeniu M – VIA NOVA domáhali ochrany osobnosti a náhrady nemajetkovej ujmy za zásah do súkromia a práva na rodinný život. K porušeniu uvedeného práva podľa nich došlo nesprávnym lekárskym postupom a starostlivosťou po pôrode, v dôsledku ktorých došlo k úmrtiu M.M. – manželky, matky a dcéry žalobcov.

Prvostupňový krajský súd žalobu zamietol, keďže „v řízení bylo prokázáno, že žalovaná jednala non lege artis, ale nebylo prokázáno, že by toto jednání bylo v příčinné souvislosti s úmrtím M. M.“ Odvolací súd vrátil uznesením vec na rozhodnutie späť prvostupňovému súdu s odkazom na ustálenú judikatúru Ústavného súdu ČR týkajúcu sa príčinnej súvislosti (sp. zn. I ÚS 1919/08).

Prvostupňový súd následne žalobu zamietol, keďže „zjistil, že bezprostřední příčinou smrti byla masivní vzduchová embolizace pravého srdce, což je stav neslučitelný se životem. Tomuto stavu předcházela těžká porucha krevní srážlivosti na základě embolizace plodovou vodou, vzniklé během zcela fyziologického porodu. Při vzniku této komplikace dochází až v 80% případů k úmrtí pacienta. Šance M. M. na přežití byla minimální, při těchto komplikacích je v mnoha případech smrt neodvratná i při poskytnutí nejvyšší možné péče.“  Súd zároveň poukázal na závažné nedostatky liečebného postupu (ukončenie rizikového tehotenstva v pôrodnici bez laboratórneho zázemia, absencia krvnej banky, nepreloženie pacientky na zdravotnícke pracovisko vyššieho stupňa, nedostatočne poskytnutá zdravotná starostlivosť, nedostupnosť laboratórnych výsledkov pacientky).  Súd však v rozhodnutí uviedol, že ani tieto preukázané nedostatky nespôsobili smrť M.M. priamo. „Pochybením v léčbě M. M. ztratila pacientka určitou šanci na přežití, a v tom je příčinná souvislost mezi protiprávním zásahem a následkem.“ Súd sa preto zameral na riešenie otázky , „zda zjištěná míra ztráty šancí na přežití zakládá předpokládaný odpovědnostní vztah a vznik práva na požadovanou satisfakci.“  Výsledkom jeho úvah bolo konštatovanie, že dvadsať percentná šanca pacientky na prežitie „byla natolik nízká, že její ztráta nezakládá odpovědnost žalované, a proto není dána příčinná souvislost mezi protiprávním zásahem a následkem,“ a preto vo svojom rozhodnutí žalobu zamietol.

Odvolací súd potvrdil prvostupňové rozhodnutie: „pokud není mezi vadným postupem při léčení a smrtí pacienta dána příčinná souvislost (příčina hlavní, důležitá, podstatná a značná), ale zdravotní péče vykazuje chyby a nedostatky, v důsledku kterých byla šance na přežití pacientovi snížena, je takový stav protiprávním, pokud postupem non lege artis byla šance na přežití odňata v míře převažující nad vývojem zdravotního stavu, který nebylo možné řádným využitím poznatků lékařské vědy ovlivnit.“ Keďže žalované zdravotnícke zariadenie znížilo šancu pacientky na prežitie „len“ o 20% namiesto požadovaných 50%, neexistoval kauzálny nexus medzi konaním žalovanej strany a smrťou pacientky.

Voči uvedenému rozhodnutiu bolo podané dovolanie, o ktorom rozhodoval najvyšší súd. Ten poukázal na ustálenú judikatúru, podľa ktorej „neposuzuje teorii ztráty šancí jinak než jako otázku příčinné souvislosti. I doktrinálně je převažující názor, že v oblasti ochrany osobnosti nepředstavuje ztráta šancí jako taková újmu odškodnitelnou z titulu ochrany osobnosti. Preto vo výroku rozhodnutia zamietol najvyšší súd dovolanie ako neprípustné.

Spracovala: Ľudmila Moľová

Celé znenie rozhodnutia  tu




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