点滴作り置き事件、院長に罰金

え？
業務上過失致死傷罪で略式起訴されるということは罰金ということなのですか？
そんな程度のことなんですか？

　業務上過失致死傷の法定刑は「五年以下の懲役若しくは禁錮又は百万円以下の罰金」ですが、検察官が罰金でいいと思った場合に、被疑者の同意があれば、略式起訴します。
　簡単な説明は「略式手続（ウィキペディア）」

当事者はどうなのでしょう。普通、略式起訴なら争わないでしょうね。事実認定に問題があったわけでないし、過失は明白なので。

個人的には、こういう過失が明らかな事案でも、民事賠償と行政処分のみを行うべきで刑事罰には反対です。罰金ならいいと言っても過失の程度によればもっと重い刑も十分に可能性が出てきますから。

法と秩序を維持するためであっても、十分な賠償と適切な行政処分で事足りると考えます。

お金に困らない人も注意義務を
果たそうと努力してくれますかね？

高級車を見たら轢かれると思え！
という世の中はどうなんでしょう？

現在は､一般的に医師や病院を信頼していますが、
過失責任が問われなくなるとしたら
同じ信頼を寄せる自信がありません。

過失責任を問われる現在ですら、点滴を
作り置きしてしまう病院もあるくらいですから。

当事者はどうなのでしょう。

「当事者」とは？院長？患者？
（刑事事件では「当事者」という言い方はしないので・・・）

普通、略式起訴なら争わないでしょうね。

といいますか、上にモトケン先生も書いているとおり、略式起訴を受けるためには、「略式起訴でけっこうです」という書面にサインする必要があります。
争う場合にはそもそも略式に乗らないです。
（正式裁判で、法廷で審理されることになります）

ちなみに私見は、仮に医療行為について実体法レベルで処罰範囲が縮減されたとしても、本件は刑事罰OKという見立てです。
（罰すべき！罰したい！ということではなく、処罰してもいんでない？くらい）

法と秩序を維持するためであっても、十分な賠償と適切な行政処分で事足りると考えます。

行政処分を下すためには、刑事訴訟の結果が必要なのが、現在の医療の問題点の一つかと思います。

行政処分が先で、刑事訴訟が後なら、警察や検察が医療過誤に介入することも減少すると思いますが、現状は警察や検察が介入する他はないんですよね。

　現状はその通りです。ですから、この事例での略式起訴がどうこう言うわけではありません。医道審議会で今後処分が来るのでしょうが。

　以前から述べていますが、医療の質を担保するのには現状の刑事罰はなじまないのだと言いたかったわけです。
　第３者による、医療上適切な評価(出来れば強制力のある組織によって)が必要であり、それに基づいて行政処分(免許停止や教育研修など)がなされる仕組みが必要なのではないかと考えます。安全調も政治のゴタゴタでどういう方向になるか見当が付きません。

　以前から述べていますが、医療の質を担保するのには現状の刑事罰はなじまないのだと言いたかったわけです。

それには同意するのです。ただ、ニワトリが先か、タマゴが先かという問題が発生するようにも思います。

第３者による、医療上適切な評価(出来れば強制力のある組織によって)が必要であり、それに基づいて行政処分(免許停止や教育研修など)がなされる仕組みが必要なのではないかと考えます。

整形外科学会がどう反応するのかなと、実は期待していたのです。学会が主導的に事故調査・再発防止対策を実施するのであれば、警察・検察の介入は減少するのかなと。

私がウォッチしていた限りでは、整形外科学会は沈黙を保っていたようで、その辺りが残念でした。

この事件で整形外科学会は動かないでしょう。反応すべきは医師会ですよ。医師会は何らかの行動をとっているのでは。

はて？学会や医師会なぞ除名されたところで痛くも痒くもない代物ですよ。そもそも当該院長が学会員や医師会員であったかどうかも定かではありませんよね。現実に医師会や学会に所属してない医師はたくさんいます。

そう言えば、某○○眼科の医師（院長）は、学会員でもなく、医師会にも所属されていませんでした。　

　一般の方が学界や医師会に期待するものが、実際より大きいのでしょう。刑事罰や医道審議会や事故調の代替調査＆処分になるくらいを期待しているのかも知れません。

都会ならいざ知らず、伊賀市のような地方で長年開業しているのなら、まず医師会会員であると思って間違いないでしょう。本人が医師会を除名されたとしても、そんなことは屁でもないこと、はよく分かりますが、医師会側から見れば会員が起こした事件に対し知らんぷりしていることはまず考えられません。医師側に非がなければ彼を庇うでしょうし、非があれば何らかの対応があるはずです。

だから,医師会員であっても会員をやめればいいだけのことですよ。

>非があれば何らかの対応があるはずです。
たとえば具体的にどんな対応お考えですか？

学会や医師会なぞ除名されたところで痛くも痒くもない代物ですよ。

除名したという事実だけで世間にはアピールできると思いますが。それに、原因究明・原因追及、再発防止対策を取らなければ「医療過誤に対して医療界は消極的」という印象を与えてしまうと思うんですよね。

医師会だろうが学会だろうが構わないのですが、医療界として主導的に動いて欲しい訳ですよ。

除名というのは属する組織の内規に違反した事実が確定しなければできませんよね。そういう意味で,除名するとすれば判決が確定した後にならざるを得ません。会費を取っている以上,単に過失があったようだから除名というわけにはいかないんでは。

原因究明・原因追及、再発防止対策を取らなければ「医療過誤に対して医療界は消極的」という印象を与えてしまうと思うんですよね。

> 感染ルートを確定するのは保健所がすると思います。

まさに実地疫学（field epidemiology）の世界の話ですので、地域における専門機関として、保健所が中心的な役割を担うのはいうまでもありません。これに加えて、核酸検査による菌株同定の関係で地方衛生研究所が協力したり、県内の医科大や国立感染研がアドバイザー的に関与したりといったところが通例かと。本事案のようにメディアの関心が高い事例では、本庁や厚労省も刺さりこんできて現場はさぞ大変でしょうね。

で、普通は、これらをメンバーとした、原因究明のための委員会が保健所内に設置されます。大抵は郡市医師会の会長もメンバーに加わりますし、医師会長が会長を務めるケースも結構あるように思います。

…一般の方々的には、こういうのはあくまで行政力の行使であって、“医療界が主導しての原因究明”とはみなされないんですかね。

一部訂正。

×行政力の行使
○公権力の行使

はて、何年も前に、医道審議会の処分には刑事罰は必要としないという方針に切り替えたという記事を見かけましたが、変わっていないのでしょうかね。

そうか。医療事故の原因究明は公衆衛生の一分野として確立していけばいいと思うんですが。

医師会としてとりうる具体的な対応ですか。
そうですね。ひとつは医師会として独自に事実関係を確認すること、同様の事例が他の医師会員の診療所等で行われていないかのチェック、会員に対し再発防止のための注意喚起でしょうか。しかもそれを見える形で行うことが大切なのでしょう。
　実際に伊賀市医師会はこの件に対しどのように対応したのでしょうか。どなたかご存知でしたら教えて頂きたい。

日医は、セラチア菌による院内感染　　病院内での集団感染防止のために
医療従事者向けに解説　
http://www.med.or.jp/kansen/serratia.html

県医師会長　中嶋寛さん（７０）
2008年07月16日
asahi.com
http://mytown.asahi.com/mie/news.php?k_id=25000410903210012

この辺で少し触れらては、おります。

教えて頂きありがとうござます。
読みますと医師会としてやるべきことはやっているのではないかという気がします。
1日300人の患者を診てたとは驚きました。

コメントno.16,17を参照してください。

>で、普通は、これらをメンバーとした、原因究明のための委員会が保健所内に設置されます。大抵は郡市医師会の会長もメンバーに加わりますし、医師会長が会長を務めるケースも結構あるように思います。

今回の原因究明体制は、

(1)　対策本部　（６月10日設置）
　名称　伊賀地域医療事案対策本部
　構成　本部長　：健康福祉部長
　　　　副本部長：副部長兼総括室長（経営企画分野）
　　　　キャップ：医療政策監兼総括室長（保健・医療分野）
　　　　メンバー：総括室長（健康・安全分野）
　　　　　　　　　健康福祉総務室長
　　　　　　　　　健康福祉企画室長
　　　　　　　　　健康危機管理室長
　　　　　　　　　薬務食品室長
　　　　　　　　　健康づくり室長
　　　　　　　　　医療政策室長
　　　　　　
(2)　地域対策本部
　　　本部長　：伊賀保健所長
　　　　患者の健康相談窓口　※土日も含む8:30～17:15

(3)　特別調査班　（６月12日設置）
　　目的
　　　１．原因の早期究明　２．安全衛生管理体制の確立
　　構成　班長　　：伊賀保健所長
　　　　　キャップ：総括室長（健康・安全分野）
　　　　　メンバー：伊賀保健所
　　　　　　　　　　津保健所
　　　　　　　　　　健康危機管理室
　　　　　　　　　　薬務食品室
　　　　　　　　　　医療政策室　　　　　　　　　　　
　　　　　　　　　　　　計11名程度

http://www.pref.mie.jp/TOPICS/2008060308.htm

と三重県庁関係者だけで医師会は入っていないようです。

No.20 うらぶれ内科さま

公衆衛生における原因究明の目的は、まさに被害拡大阻止と再発防止。本事案は感染症法よりもむしろ医療法マターと思われますが、医療法に基づく行政処分も、本来は処罰を目的としたものではないとされます。しばしば誤解されますが(^^;

ですので、個人的見解としては大いに同意。組織体制が付いてこれるか否かという実務上の懸念はありますが…。

No.21 ころちゃん さま

本事案については承知していませんが、医師会独自で動くことも一案と思います。

ただ、マンパワーの乏しい郡市医師会だけでは手に余る可能性が高いのと、いわば“内部評価”の結果をどれだけ信頼してもらえるか、とりわけ行政と医師会で異なる結論に至った場合にどうするかといった観点もあろうかと（医事訴訟においても、原告側と被告側が対立する内容の鑑定書を提出することは珍しくないですよね）。

「複数のチャンネルから、それぞれに異なる情報が発せられてはならない」は、危機管理における鉄則のひとつです。その意味で、私としては行政と医師会が相互協力しつつ対応するのがベターと思うのですが…。

No.25 じじいさま

情報ありがとうございます。
…現場の苦労が偲ばれる体制ではありますね…。

http://sankei.jp.msn.com/region/kinki/mie/080620/mie0806200228001-n1.htm

三重県医師会　点滴事件で谷本院長から事情聴取
2008.6.20 02:28

この件に、県医師会と三重県庁との調査関係は、分かりませんが、独自での事情聴取でしょうか。　谷本医師は、伊賀市医師会の会員のようです。　　　

御教示ありがとうございます。
医師会関係者は一人も入っていないようですね。

通りすがりの公衆衛生医先生

通常の院内感染事案と異なり、感染原因が点滴というピンポイントな話なので、保健所で何とかなるという判断だったのかもしれませんが、県側も最終的には警察沙汰が避けられなさそうな話なので、医師会に気を遣ったのかなとも思います。

No.29 じじいさま

諸般の事情(^^;にて、これにて落ちますが…。

あくまで妄想の域を出ませんが…

>医師会に気を遣った

…というよりも…

>医師会関係者は一人も入っていないようですね。

…県サイドがこういった反応を想定していなかっただけという気が、少しだけですが、しています。

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The new Zune browser is surprisingly good, but not as good as the iPod's. It works well, but isn't as fast as Safari, and has a clunkier interface. If you occasionally plan on using the web browser that's not an issue, but if you're planning to browse the web alot from your PMP then the iPod's larger screen and better browser may be important.

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Hands down, Apple's app store wins by a mile. It's a huge selection of all sorts of apps vs a rather sad selection of a handful for Zune. Microsoft has plans, especially in the realm of games, but I'm not sure I'd want to bet on the future if this aspect is important to you. The iPod is a much better choice in that case.

If you're still on the fence: grab your favorite earphones, head down to a Best Buy and ask to plug them into a Zune then an iPod and see which one sounds better to you, and which interface makes you smile more. Then you'll know which is right for you.

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This is getting a bit more subjective, but I much prefer the Zune Marketplace. The interface is colorful, has more flair, and some cool features like 'Mixview' that let you quickly see related albums, songs, or other users related to what you're listening to. Clicking on one of those will center on that item, and another set of "neighbors" will come into view, allowing you to navigate around exploring by similar artists, songs, or users. Speaking of users, the Zune "Social" is also great fun, letting you find others with shared tastes and becoming friends with them. You then can listen to a playlist created based on an amalgamation of what all your friends are listening to, which is also enjoyable. Those concerned with privacy will be relieved to know you can prevent the public from seeing your personal listening habits if you so choose.

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