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Postup zdravotníckeho zariadenia non lege artis


 | 20.4.2014 | komentárov: 275

Sťažovateľka M.R. bola kvôli obojstrannému šedému zákalu nútená podstúpiť operačný zákrok. Pri operácii však došlo k omylu a sťažovateľke bola voperovaná nesprávna vnútroočná šošovka, čo spôsobilo sťažovateľke zhoršenie zraku, a to tak, že sa u nej prejavila refrakčná chyba oka (krátkozrakosť).Z tohto dôvodu sa rozhodla podať žalobu na zdravotnícke zariadenie, v ktorom zákrok podstúpila a žiadala náhradu vzniknutej škody. Vykonaným dokazovaním sa však preukázalo, že sťažovateľka trpela krátkozrakosťou už pred operáciou, ale kvôli svojej chorobe si ju neuvedomovala, a teda nebola spôsobená poskytnutou zdravotnou starostlivosťou. Aj na napriek tomu, že moderné technológie umožňujú korekciu refrakčnej vady priamo pri operácii šedého zákalu, neporušila žalovaná strana žiadne povinnosti, lebo „u stěžovatelky však byla operace doporučena právě z důvodu, že trpěla šedým zákalem a cílem operace bylo odstranění šedého zákalu, k čemuž došlo, nikoli korekce refrakční vady.“ Prvostupňový súd s prihliadnutím na uvedené argumenty zamietol žalobu. Krajský súd v odvolacom konaní ďalej konštatoval, že operačný zákrok šedého zákalu bol vykonaný lege artis a nedošlo k právom odškodniteľnej ujme, keďže samotná skutočnosť, že pri operácii nedošlo ku korekcii nezakladá právo na náhradu škody.

Sťažovateľka za týchto okolností podala dovolanie, ktoré však bolo najvyšším súdom zamietnuté, a preto sa rozhodla pre podanie ústavnej sťažnosti. Opierala sa o skutočnosť, že v predchádzajúcich konaniach nebola vzatá do úvahy dohoda medzi sťažovateľkou a zdravotníckym zariadením, podľa ktorej mala byť pri operácii odstránená aj refrakčná chyba oka. Z toho podľa nej teda vyplýva, že operácia nemohla prebehnúť lege artis.

Ústavný súd vo svojom rozhodnutí spochybnil závery prvostupňového súdu. Podľa neho došlo k protiprávnemu konaniu zo strany zdravotníckeho zariadenia, a teda bol naplnený jeden zo znakov zodpovednosti za škodu. Zdravotná dokumentácia sťažovateľky obsahovala chybný biometrický údaj, na základe ktorého jej bola neskôr voperovaná chybná šošovka. Prvostupňový súd považoval postup žalovanej strany  za  postup lege artis aj keď bol založený na nesprávnych údajoch o zdravotnom stave sťažovateľky. Ústavný súd s tým však  nesúhlasil, a priklonil sa k názoru, že sa nejednalo o postup lege artis. Ten je potrebné vždy posudzovať z hľadiska „účelu, toho kterého aspektu operace. Opačný přístup by nadto značil stěží udržitelnou a Listině hovící úvahu, podle níž může být operace v její části usilující naplnit sekundární účel libovolná, v rozporu se současnými dostupnými poznatky lékařské vědy, a to se všemi myslitelnými negativními dopady na lidský život a zdraví, když by zdravotnickému zařízení (lékaři) žádná sankce (občanskoprávní či trestněprávní) nehrozila, kvůli apriorní nemožnosti naplnit pojem protiprávní jednání [to jen s odkazem na méně významný (sekundární) původní účel operace].“ Znalecký posudok vyhotovený v konaní, uznal, že operačný zákrok zameraný na odstránenie šedého zákalu, síce prebehol v súlade s najnovšími lekárskymi poznatkami, ale celkový postup žalovaného zdravotníckeho zariadenia už tieto požiadavky nespĺňal. „Vložení příslušné nitrooční čočky pak bylo jen důsledkem tohoto předchozího pochybení, a proto z pohledu zpracovatele posudku snad bylo možné izolovaně tvrdit (takto izolovaně byl totiž naformulován i dotaz soudu), že při samotné operaci k pochybení nedošlo, protože do oka byla vložena čočka, jejíž hodnota odpovídala údajům o měření oka zanesených do zdravotnické dokumentace stěžovatelky, která byla podkladem proběhlé operace. V tomto směru je třeba pod pojem lex artis zahrnout i dodržení postupů, které mají lékařský výkon lege artis zajistit.“
    K protiprávnemu konaniu zo strany zdravotníckeho zariadenia môže podľa ústavného súdu dôjsť okrem zhoršenia zdravotného stavu aj tým, že „nedojde ke zlepšení zdraví, ač se to dalo očekávat s ohledem na předpokládaný právně souladný postup škůdce (tedy vzhledem k pravidelnému běhu věcí). Tudíž protiprávní postup zdravotnického zařízení může negativně zasáhnout tělesnou integritu (tedy způsobit újmu na zdraví zejména ve smyslu čl. 7 odst. 1 Listiny) nejen zhoršením zdraví poškozeného, ale i ztrátou očekávaného zlepšení zdraví.“
Vo svetle uvedených skutočností ústavný súd rozhodol o porušení práv sťažovateľky na ochranu zdravia a práva na spravodlivý proces.


Spracovala: Ľudmila Moľová

Rozhodnutie môžete nájsť v sekcii slovenská a česká judikatúra, náhrada škody a nemajetková ujma




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