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2007.10.05 (Fri)

損害賠償法と医療

More Doctors in Texas After Malpractice Caps - New York Times
By RALPH BLUMENTHAL
Published: October 5, 2007
http://www.nytimes.com/2007/10/05/us/05doctors.html?_r=2&th&emc=th&oref=slogin&oref=slogin
テキサスで医療過誤に対する損害賠償額に上限を設定したら、医者が殺到していますよ、という話。それまでは“patient friendly”な州として知られていて、人口当たりの医者の数も少なかったのが、上限設定後は医者の数が増加に転じて、医療過誤保険の保険料も下がり始めた、とのこと。
まあ、本当にそれが賠償額キャップに起因するのか、そもそもそれによって患者がより良い医療を受けられるようになったかについては分からない、ということは記事中でも指摘されているが。検証のためにはもっとシステマティックな調査が必要だろう。

記事によると2003年の憲法修正で上限設定が入ったとのことだが、件のテキサス憲法の条項はこれかな:
"Article 3 - LEGISLATIVE DEPARTMENT
Section 66 - LIMITATION ON LIABILITY FOR NONECONOMIC DAMAGES
(a) In this section “economic damages” means compensatory damages for any pecuniary loss or damage. The term does not include any loss or damage, however characterized, for past, present, and future physical pain and suffering, mental anguish and suffering, loss of consortium, loss of companionship and society, disfigurement, or physical impairment.
(b) Notwithstanding any other provision of this constitution, the legislature by statute may determine the limit of liability for all damages and losses, however characterized, other than economic damages, of a provider of medical or health care with respect to treatment, lack of treatment, or other claimed departure from an accepted standard of medical or health care or safety, however characterized, that is or is claimed to be a cause of, or that contributes or is claimed to contribute to, disease, injury, or death of a person. This subsection applies without regard to whether the claim or cause of action arises under or is derived from common law, a statute, or other law, including any claim or cause of action based or sounding in tort, contract, or any other theory or any combination of theories of liability. The claim or cause of action includes a medical or health care liability claim as defined by the legislature.
(c) Notwithstanding any other provision of this constitution, after January 1, 2005, the legislature by statute may determine the limit of liability for all damages and losses, however characterized, other than economic damages, in a claim or cause of action not covered by Subsection (b) of this section. This subsection applies without regard to whether the claim or cause of action arises under or is derived from common law, a statute, or other law, including any claim or cause of action based or sounding in tort, contract, or any other theory or any combination of theories of liability... (Added Sept. 13, 2003.)"
Tex. Const. art. 3, § 66
available at http://tlo2.tlc.state.tx.us/txconst/sections/cn000300-006600.html
(b)項が医療過誤に対する上限設定、(c)項が民事賠償一般についての規定ですな。記事の書きぶりだと憲法修正自体で上限設定が入ったように読めて「随分大味な対応だな」との印象を持ったのだが、条文自体を読む限り、この憲法修正が直接キャップを設定したわけではなく、かかる立法をしてもいいよ(may)という授権を議会に対して行ったという条項。だが、そのような授権がなくても同様な立法を行う権限は議会を持っているはずで、何故にわざわざこのような憲法修正をする必要があったのかはちょっとよく分からない。背景事情は調査していないが、たぶん法的な意義よりも政治的な意味合いのほうが大きいのだろう。(*1)

訴訟を恐れて医者が廃業する――特に小児科や産婦人科――という話は日本でも(ようやっと)話題に上るようになった。このエントリの話は、例えば出産時の事故に対する無過失補償制度の導入の議論などと通底する。

(私の関心から見た)日米の背景事情の差異の一つは、この「不法行為改革tort reform」が州法の変更として行われている点。50の州(=法域)がそれぞれの政策判断に基づいて「法発展の実験室」(Brandeis)として機能する、例だな、と。複合法域国家ならではのやり方。

翻って単一法域国家の日本ではどうなるか。同様なこと、例えばある地方自治体が「わが県内での医療過誤に対する損害賠償については○○万円を上限とする」というような条例(あるいはもうちょっと控えめに「○○県の県立病院における医療過誤に対する?」)を制定したら、どうなるか(*2)。直観的にはたぶん裁判所は効力を認めないだろう、とは思うのだが、根拠がすぐに思いつかない。民法90条?ちょっと違う気がする。憲法上の条例制定権能の解釈問題かな。憲法や地方自治法の文献が手元にないので調べられない。
(確かボン基本法には「民法は連邦の領域」という条文があったと記憶するが、それに相当する憲法政策的判断の日本における根拠は如何、という疑問。)

【More・・・】

*1 07/10/09 09:25追記もしかしたら損害賠償額の制限が、財産権の侵害だとかいう州憲法に関する司法判断があったのかも知れない。(未調査の思いつきメモ)
*2 あー、病院一般は民法だが、県立病院だと国賠だ。さらにややこしいな。
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