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 奈良県警橿原署の駐車場から救急搬送されずに意識不明に陥った同県大淀町内の男性(44)とその両親が、重篤になったのは中和広域消防組合が搬送義務を怠ったのが理由として、治療費や慰謝料など計約2億5000万円の損害賠償を求めた訴訟の判決が27日、奈良地裁であった。

 坂倉充信裁判長(一谷好文裁判長代読)は「すぐに救急搬送していれば、重篤にならなかった可能性が高い」と、同組合に計約1億4000万円の支払いを命じた。

 どこかで読んだ覚えのある事件でしたのでググってみたら、天漢日乗で取り上げられていました。

 「橿原救急搬送問題

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どこかで読んだ覚えのある事件でしたので

って、そりゃそうですよ↓(^^;

http://www.yabelab.net/blog/medical/2006/11/18-141355.php

 最近老化が進んでいるようです m(_ _)m

((((((^^;

えと、えと、倉庫に入って検索の使い勝手も悪化したみたいですし(あせあせ

さておき、本題ですが、自分の意思で飲酒して酩酊状態になったことについての過失相殺はどの程度斟酌されてこの額なんでしょうか。
訴額よりも小さいのは、損害の費目や計算期間などで削られただけで、過失相殺がなされていないか、非常に小さい割合にすぎないからだとしたら。

救急側に 「酔っぱらいなぞ二度と引き取るものか」 という強いインセンティブを与えてしまうのではないかという懸念が。。。
(いや、敗訴した時点ですでに、過失相殺の程度くらいじゃ閾値以下に抑えることが不可能なくらい強烈に動機付け済かもしれませんが)

 交通事故もそうですが、重篤(半身不随~昏睡)だと医療費や介護費が高額となり、死亡よりも損害賠償額が高くなってしまいます。民事損害賠償訴訟は、ペナルティではなく損害の公平な分担(合理的負担)が指導理念だからでしょう。

http://www.nhk.or.jp/news/k10015607901000.html
搬送先確保を義務づけ 法改正

m(_ _)m   

植物状態はお気の毒ですが、自分で大量に飲酒して転倒した過失は考慮されないのですかね。正直者が馬鹿を見るような社会にならないよう願いたいです。

個人的には過失相殺で2/3を減らして1/3だけの賠償にしたほうが良いと考えます。いずれにしても足らない分は生活保護などで税金から出るのでしょうけど。

 救急搬送は、自過失自損事故であっても、故意自損事故(自殺未遂とか)であってすら、救急搬送義務があるため、事故原因の過失性については、過失相殺自体に、なじまない類型の模様です。
 もちろん、救急搬送自体に対し、故意又は過失で妨げたり妨害したりすれば(暴れてストレッチャーを破壊したり、救急隊員に暴行を加えて重傷を負わせたりして、救急搬送の遅延を招いたりすれば)、それは別論ですが。

まわりが、最初にもらった金をいっぺんに使って後は生保というパターン。
 総額はさらにまします。
 福祉が生保の患者に直接お金を渡すと、最初の数日でギャンブルとお酒に使って、救急車で来院して入院を要求するそんなやからが見られます。いくつかの病院で搬送拒否にいたるのですが、こんなのも消防法改正でどうなるんですか?
こんなのが路上で数日過ごしていると、もともと不健康な生活をしてるんですからいずれ本当に入院が必要なだけ壊れます。
そして必ず法律により受け入れ先が強制されるわけですね。

受け入れる側も税金が使われるとすれば無駄遣いですね

救急搬送義務があるため、事故原因の過失性については、過失相殺自体に、なじまない類型

調べた限り、類似事案の先例は見つからなかったんですが、そうなのでしょうか。

医師の場合でも、応召義務は当然あることを前提にしても、素因減額(過失相殺の類推適用)が許されるくらいなので、「素因」よりも直接的な「過失」があれば、当然に過失相殺の対象となりうるかと思ったのですが。。。

 訴因減額が認められる事案でも、損害の公平な分担の指導理念から、類推適用が制約される例もございます。ここらへんまでいくと過去の極端例ばかりですので、判例集にも載ってないようです。
 一般的にいえば、企業体(大会社)や公的サービス(公務員)の義務を厳格に捉えて、労働者や一般国民の過失や落ち度を緩く評価・認定し、損害賠償と賠償額を認めやすい傾向にあります(トホホ。
 ♪どーせ税金ひとのカネ~……。

被害者?救済のために裁判所が心を砕いているのはある程度理解できます。しかし、日本の公共セクターが予算=税の削減や職員減で青息吐息の状況でこういった判決が続くといわゆるモンスターを跋扈させて、公共サービスなどの一層の低下を来すおそれがあるのではないかと。

本来はこういった訴訟は、原則通りの判決、各自の負担として、かわいそうな被害者の補償や生活保障は別個に公共の負担で行うのが筋だと思われます。司法を曲げてまで被害者を救済するのが目的になれば司法そのものの自殺行為です。

 公務員の立場では「直ちに賛成できませんが,そのとおりで否定できない,とかように考えております。」_| ̄|O(苦しい議会答弁

ある年の正月、非脳外科病院で当直中、酔っ払い運転のバイクが転倒事故をおこし、救急搬送。来院時は大トラ。頭部に明らかな外傷は見られず、かといってそのまま返せる状態でもなく、急性アル中として、入院へ。翌朝になり看護師から、なんか変!(優秀な看護師がいっぱいいる病院ではありません。)
明らかに、アルコール中毒とは違う意識状態低下で、CTをとることなく(技師呼び出しのため、時間節約のため)頭部外傷があったと仮定して、脳外科対応病院を検索するも近隣はすべて”意識状態に問題のある頭部外傷患者の受け入れ不能”ようやく隣県の大学脳外科に受け入れを受諾してもらい搬送。急性硬膜下出血。(今回と同じ病態)緊急手術してもらいセーフ。
       
だいぶ前に大都市圏で実際に私が経験したことですが、こんな体制の病院は地方にいけば、まだ山ほどあるはずです。
このような患者をすべて脳外科対応としたら、(今の流れからすれば、対応とすべきですが)対応医機関は限られるはずです。ありとあらゆる酔っ払いが搬送されることになれば、脳外科対応のできる医療機関は破綻します。(;現実に当地では脳外科を持った医療機関が酔っ払いの搬送を断るために、救急隊が搬送を泣きつきます。あるチューとしかいっていなかったのに来て見れば、頭に止血用の三角巾が巻いてあることなどしょっちゅうです。)
 実際に受け入れ機関で、対応に失敗したら、(失敗しかねません)この額の訴訟になるわけですから、救急などやっていいられません。

 危機管理としては、やはり”酔っ払い患者の受け入れ困難”の受け答えで、最後は”たらいまわし”報道になると思います。
法律的にこのような患者の強制受け入れであれば、管理者としては救急告示医療機関の取り下げになります。
 当地も輪番体制がぎりぎりのところまで来ておりますが、この法制により一気に崩壊することは”相当に”ありえます。

 産科と同様に”スーパー救急病院”の指定しかないと思いますが、東京のように財政状況の豊かでない地方自治体などではやってけるんでしょうかね?

財政状況の豊かでない地方自治体などではやってけるんでしょうかね?
やっていけないでしょう。いずれ犠牲者が増えてくるでしょうけど、崩壊のスピードの方が早そう。まして、事例の判決のように崩壊加速ターボチャージャーが、、、

No.6 omizo さんが引用されておられるNHKの報道「搬送先確保を義務づけ 法改正」が、気になっていましたが、次の「消防法の一部を改正する法律案」と思います。(平成21年 4月24日参議院可決)

改正法案

第三十五条の五が従来「削除」であったのが、これを復活し、都道府県が、傷病者の搬送及び傷病者の受入れの実施に関する「実施基準」を定めることの条文を追加しています。

NHKの報道にあるような、搬送先確保を義務づけではなく、実施基準の作定義務であり、NHKは、世の中に誤解をまき散らし、人々を不安に陥れ、不信感を深め・・・・。と嫌になります。念のため、第三十五条の五は次です。

第三十五条の五 都道府県は、消防機関による救急業務としての傷病者(第二条第九項に規定する傷病者をいう。以下この章において同じ。)の搬送(以下この章において「傷病者の搬送」という。)及び医療機関による当該傷病者の受入れ(以下この章において「傷病者の受入れ」という。)の迅速かつ適切な実施を図るため、傷病者の搬送及び傷病者の受入れの実施に関する基準(以下この章において「実施基準」という。)を定めなければならない。

  実施基準においては、都道府県の区域又は医療を提供する体制の状況を考慮して都道府県の区域を分けて定める区域ごとに、次に掲げる事項を定めるものとする。

 一 傷病者の心身等の状況(以下この項において「傷病者の状況」という。)に応じた適切な医療の提供が行われることを確保するために医療機関を分類する基準

 二 前号に掲げる基準に基づき分類された医療機関の区分及び当該区分に該当する医療機関の名称

 三 消防機関が傷病者の状況を確認するための基準

 四 消防機関が傷病者の搬送を行おうとする医療機関を選定するための基準

 五 消防機関が傷病者の搬送を行おうとする医療機関に対し傷病者の状況を伝達するための基準

 六 前二号に掲げるもののほか、傷病者の受入れに関する消防機関と医療機関との間の合意を形成するための基準その他傷病者の受入れを行う医療機関の確保に資する事項

 七 前各号に掲げるもののほか、傷病者の搬送及び傷病者の受入れの実施に関し都道府県が必要と認める事項

  実施基準は、医学的知見に基づき、かつ、医療法(昭和二十三年法律第二百五号)第三十条の四第一項に規定する医療計画との調和が保たれるように定められなければならない。

  都道府県は、実施基準を定めるときは、あらかじめ、第三十五条の八第一項に規定する協議会の意見を聴かなければならない。

  都道府県は、実施基準を定めたときは、遅滞なく、その内容を公表しなければならない。

  前三項の規定は、実施基準の変更について準用する。

ある経営コンサルタント さま

お調べいただきありがとうございます。

 すいません。 

「消防法の一部を改正する法律案」だとしても、私が予測していたように、法律が定める義務の主体は地方自治体であって、病院・医療従事者ではないようです。

指定される病院は与えられる権利(≒補助金)を確認し、義務>>>権利であれば、民間病院は辞退するべきです。

問題は、自治体と一蓮托生の自治体病院ですが、これは恐らく指定対象となるでしょう。

こんな指定を受けた病院の勤務医は早く逃げ出すべきです。
そして、指定を受けたら返上するよう、勤務医が声を上げるべきです。
補助金をもらうのは病院でも、実際の医療を担当するのは数人の現場の医師を含む医療従事者であって、その負担は人の能力を超えています。

恐らく駆け込み的に救急指定を外す民間病院が続出することでしょう。
逃げ遅れた病院には、云億円の権利を有した患者が止め処もなく押し込まれてくることでしょう。

何人を手当したかで評価されるのではなく、誰か一人でも究明できなかったら罰を与えられる病院システム・ゲームって、参加する理由が見つからないし、参加しないのが一番得点が高そうです。


私は、「消防法の一部を改正する法律」のみで、議論はできず、都道府県が定める「実施基準」が、議論の対象であると思います。

但し、そこには厚労省か総務省のガイドラインが示され、都道府県はそれに単純Followしてしまう可能性はあるものと思います。一方、この法案に関する内閣法制局の提出理由には、次のようにあり、協議会が設置されると思います。

消防法の一部を改正する法律案

傷病者の搬送及び受入れの迅速かつ適切な実施を図るため、都道府県が傷病者の搬送及び受入れの実施基準を定めるとともに、当該実施基準に関する協議等を行うための消防機関、医療機関等を構成員とする協議会を設置する等の必要がある。これが、この法律案を提出する理由である。

Med_Law さんの懸念については、可能性があると思いますし、自治体病院側が声をあげていかないと、一旦実施基準が決定してしまうと、それを変更するのは容易ではないと思います。

協議会は、医療機関の管理者又はその指定する医師が必須のようなので、医療側がその意図を反映することは可能だと思います。もっとも、うまく機能すればの話ですが。

第三十五条の八 都道府県は、実施基準に関する協議並びに実施基準に基づく傷病者の搬送及び傷病者の受入れの実施に係る連絡調整を行うための協議会(以下この条において「協議会」という。)を組織するものとする。

  協議会は、次に掲げる者をもつて構成する。

 一 消防機関の職員

 二 医療機関の管理者又はその指定する医師

 三 診療に関する学識経験者の団体の推薦する者

 四 都道府県の職員

 五 学識経験者その他の都道府県が必要と認める者


ところで、重要なのは第三十五条の七だと思います。これを無視して、搬送先義務づけと言ってもあまり意味がないかと思いました。

第三十五条の七 消防機関は、傷病者の搬送に当たつては、実施基準を遵守しなければならない。

  医療機関は、傷病者の受入れに当たつては、実施基準を尊重するよう努めるものとする。


努力目標みたいですから、医療機関に義務は課せられないものだと思いました。日本はルールよりも「世間さま」が重視されるので、努力目標と言ったところで通らないことがあるかも知れませんが。

法案を読んでみて思ったのですが。以下に記しているような基準が決まってなかったのですね。

一 傷病者の心身等の状況(以下この項において「傷病者の状況」という。)に応じた適切な医療の提供が行われることを確保するために医療機関を分類する基準

 二 前号に掲げる基準に基づき分類された医療機関の区分及び当該区分に該当する医療機関の名称

 三 消防機関が傷病者の状況を確認するための基準

 四 消防機関が傷病者の搬送を行おうとする医療機関を選定するための基準

 五 消防機関が傷病者の搬送を行おうとする医療機関に対し傷病者の状況を伝達するための基準

 六 前二号に掲げるもののほか、傷病者の受入れに関する消防機関と医療機関との間の合意を形成するための基準その他傷病者の受入れを行う医療機関の確保に資する事項

 七 前各号に掲げるもののほか、傷病者の搬送及び傷病者の受入れの実施に関し都道府県が必要と認める事項

つまり、日本の救急は

・どのような症状の場合はどのような病院へ行くか
・どこの病院がどのような救急が得意なのか
・患者受け入れの際のルール

を決めないまま、行き当たりばったりで救急搬送の要請をしていたことになり、これでは搬送先がなかなか決まらないのも当然だと思いました。


今までなかったことが疑問の様な法律ですね。

http://72.14.235.132/search?q=cache:www.nhk.or.jp/news/k10015607901000.html
NHKの見出しのつけ方はどうかとは思いますがそれだけの問題だと思います。

私の書き方が、過剰であったことは、確かです。

でも、NHKは、報道の最初の出だしを、

救急患者が医療機関から受け入れを断られるケースが相次いでいることを受けて

と始めており、内閣法制局の提出理由のように
救急患者の搬送及び受入れの迅速かつ適切な実施を図るため

と言ったような、表現にしてもらえないかと私は思います。

救急患者の受け入れ拒否が本当にあるのでしょうか?医療機関が他の救急患者の為に、新規患者を受け入れられない時に、受け入れできないと伝えることは、当然であり、単なる受け入れ拒否ではありません。昔からあった話のはずです。

No.22 しま さんが書いておられることが、本質だと思います。NHKは、本質を正しく伝えず、誤解をまねく表現を含んでいると思います。

「消防法の一部を改正する法律」が、5月1日に公布となりました。
http://kanpou.npb.go.jp/20090501/20090501h05063/20090501h050630006f.html

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