譚瑞珠 訴 香港醫院管理局

DCPI 2262/2006

香港特別行政區

區域法院

傷亡訴訟2006年第2262號

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主審法官 ： 周兆熊法官

聆訊日期 ： 2007年10月24日及11月28日

頒下判案書日期 ： 2008年1月23日

判案書

1.被告人的申請，是要求本庭撤銷原告人的申索，因為原告人的傳訊令狀和申索陳述書 (1)並無披露合理的訴訟因由；(2)屬於惡意中傷、瑣屑無聊或無理纏擾；及/或(3)濫用法庭的法律程序。

2.在申索陳述書內，原告人指她的丈夫(李玉墀)於2003年12月5日在被告人屬下的伊麗沙伯醫院進行前列腺手術後，於2003年12月7日死亡。原告人指稱負責該手術的醫生Dr. Chu在處理手術前後過程中疏忽處理，導致李玉墀死亡。原告人對Dr. Chu的指控如下：

(1)	Dr. Chu為李玉墀進行手術前沒有向李玉墀及其家人說明手術之風險包括大量出血而導致死亡的可能性。如她在手術前曾告知病者及其家人有關的可能性，李玉墀將不會接受此手術。
(2)	李玉墀在手術進行中大量出血，但Dr. Chu並沒有採取正確及有效的措施替他止血，而當她發現止血無效時，亦沒有尋找顧問醫生(上級醫生)的協助，導致病人最終因繼續大量出血而死亡。

3.被告人指出，在原告人提交之三份醫生報告(一份是死亡報告，而另外兩份是獨立專家Dr. George C.G. Koo(“Dr. Koo”)的報告)中，Dr. Koo在報告內沒有提供任何意見支持原告人申索陳述書內的申索及有關醫療疏忽的指控。被告人作出以下的陳辭：-

‘	(1)	Dr. Koo在2006年7月27日的報告內，
		i.	第5.3段內說明：
			“	Thus it can be said that the patient and his family had adequate information about the risks of the operation, increased by the CRHD, and consented to the operation.”
		ii.	在第8.1段內說明：
			“	The diagnosis and treatment prescribed, that of open retropubic prostatectomy, for the medical problem of the deceased were proper, acceptable.”
		iii.	在第8.3段內說明：
			“	But it is arguable whether it amounts to negligence.”
	(2)	Dr. Koo在2006年8月30日的報告的第3段再次表示：
			“	I believe, the measures taken by Dr. Chu to stop bleeding fulfilled the standard of a reasonably competent surgeon.’

4.在陳辭書的第5點，被告人說：-

“

5.

獨立專家Dr. Koo的報告對於原告人全部兩項醫療疏忽指控並沒有給于支持的意見。從報告可見Dr. Koo認為李玉墀及其家人已得知足夠有關手術風險的資料及已同意接受手術。李玉墀在手術進行中大量出血時，Dr. Koo亦認為Dr. Chu有採取正確及適當的措施替他止血並其處理已達到一個合理的合資格外科醫生的水平。”

申索書的第(1)點指控

5.在誓章的第12段，原告人說：-

“	...如果醫生向他或他的家屬講解清楚手術的風險，我們肯定不會讓他接受此項手術。”

6.Dr. Koo的報告(2006年7月27日的報告)有以下與本案關連之點：

‘	1.11	……It was recorded in the note dated 3rd December, that the choice of surgical option for TURP or Open Prostatectomy was explained to the patient and that because of the size of the gland being over 200 gm, open prostatectomy was preferred and “better”.  He was informed of possible complications of the open operation including haemorrhage etc.  A formal Operation Consent Form in Chinese was signed by the deceased, witnessed and counter signed by Dr. Barry Fung, on the 3rd December 2003.  On the 4th December 2003, he was further seen by the anesthetist and the cardiologist and again, increased risk of the operation was conveyed and “accepted by the relatives”.
	3.3	When he was admitted for surgery on the 3rd December 2003, the choice of operation, between TURP and Open Prostatectomy was explained to the patient and with a gland size of over 200 gm, Open Prostatectomy was advised as the better choice.  The deceased agreed and signed the consent form for open surgery.
	5.2	It is also clearly written in the hospital notes that when he was admitted for surgery on the 3rd December 2003, he was told that the surgery will be an Open surgical procedure, and not TURP.  The reasons for the choice and the risks of such operation including that of haemorrhage were explained.  He then signed the consent form for Open Prostatectomy dated 3rd December.  Further, he was visited by the cardiologist for pre-op assessment and according to the written note, he met the patient and his relatives, informing them about the rather increased risk for surgery because of his cardiac problem….
	5.3	Thus it can be said that the patient and his family had adequate information about the risks of the operation, increased by the CRHD, and consented to the operation.
	8.	My opinion on whether the doctors of the treatment and diagnosis given by the doctors of QEH are considered as ‘proper’ and ‘acceptable’ from the medical point of view.
		8.1	The diagnosis and treatment prescribed, that of open retropubic prostatectomy, for the medical problem of the deceased were proper, acceptable
		8.2	However, the massive haemorrhage totaling 9,500 ml, twice the person’s normal volume of blood, during an elective open retropubic prostatectomy is not acceptable in my opinion, as it eventually caused the patient’s death.  No to mention the continued further heavy blood loss, after the operation that required a second operation.  Massive haemorrhage of that scale in the first operation should not be allowed as it is preventable and if it happens can be controlled by the various methods that I have listed above. ………
		8.3	But it is arguable whether it amounts to negligence.  The surgeon is well qualified, experienced and exercised the ordinary skill of an ordinary competent professional.  Unfortunately, the open operation is nowadays seldom performed and thus most of the present generation of urological surgeons do not have any substantial experience of this operation.  The above techniques and maneuvers for control of massive bleeding may not be well known to them.  When confronted suddenly with a complication that exceeds expectation and out of ordinary, an ordinary competent surgeon usually tries his or her best to persist with local suturing or cauterization, while active bleeding and oozing are still coming from multiple sites.  My recommendation would be that the surgeon, in such situation with a poor risk patient going into shock, should rapidly stop the bleeding by firm packing, then either call in a senior consultant for advice/help, or leave the pack in the raw prostatic fossa, close it, insert a large suprapubic catheter drain for the bladder urine and come away.  Any further measures can be dealt with another day when the patient is safe, out of shock and with no active bleeding.”
	(Underlines provided)

7.Dr. Koo認為李玉墀及其家人已得知足夠有關手術風險的資料及已同意接受手術。原告人則指在手術前她從未見過任何一位外外科醫生。上述報告沒有提及手術的風險包括大量出血而導致死亡的可能性。第5.2段提及出血，但沒有提及大量出血的風險，他的親人亦沒有被告知手術過程中會有大量出血的風險。很明顯，有關的醫務員未能預知會有“heavy rapid bleeding, towards an unacceptable amount”的發生。如果大量出血的風險是預知的，被告人應會告知李玉墀以及他的親人。本案沒有證據證明被告人曾告知李玉墀或他的親人手術過程中會有大量出血的風險。

8.Dr. Koo的報告(日期為2006年8月30日)的5.2段說：“When the deceased was admitted to the hospital on the 3^rd December 2003, the medical record confirms that Dr. Barry Fung, Dr. Chu’s assistant had explained to the Deceased possible complications of the operation, which includes haemorrhage.  I believe heavy bleeding, haemorrhage, was one of the complications as advised.”如果上述的medical record有提及“heavy bleeding, haemorrhage”一詞，Dr. Koo不應用“I believe”這兩個字，因此該medical record理應不含”heary blooding, haemorrhage”一詞。 Dr. Koo只是相信“heavy bleeding, haemorrhage”的併發情況已對李玉墀解釋過，這只是他的推斷。再者，根據Shorter Oxford English (Sixth Edition, 2007) “haemorrhage”是“An escape of blood from the blood vessels; bleeding, esp. when profuse.” 按這一意思，“heavy bleeding”不等於是“haemorrhage”，因此第5.2段的結論不穩妥。

申索書的第(2)點指控

9.2006年7月27日的報告的第8.3段的內容是“But it is arguable whether it amounts to negligence.”這句子的隱含意思是它亦可構成疏忽。

10.日期為2006年8月30日的報告的第1.1(f)有以下的內容：-

“	My criticism is that of the surgeon’s judgment at the first operation, when the patient was having such heavy rapid bleeding, towards an unacceptable amount.  Special, speedy and extra-ordinary measures could be applied, methods that may not be familiar to a reasonably competent surgeon.”

11.如果該些上述的“Special, speedy and extra-ordinary measures”是Dr. Chu所熟識，而她沒有採取該些措施去進行止血，表面疏忽的證據便會成立，因此關鍵之點在於Dr. Chu是否熟識該些措施。但Dr. Koo在他的報告沒有披露這一點。在第3段，Dr. Koo說，“I believe, the measures taken by Dr. Chu to stop bleeding fulfilled the standard of a reasonably competent surgeon.”在第5段，Dr. Koo說，“But with the small number of cases of open prostatectomy that the surgeon did each year and presumably went well, my guess is that Dr. Chu might not be trained on these special methods as they are seldom needed to be used in practice.”這進一步證實Dr. Koo不清楚Dr. Chu 是否知道或是熟識上述的有關措施，因此Dr. Koo在第3段的結論有商榷之處。

12.本庭只能在清晰的情況下才可以剔除原告人的申索。被告人提出的論據不充份，因此本庭撤銷它的申請。

訟費

13.本庭頒下臨時訟費的命令：被告人須支付原告人是次申請的訟費，如與訟雙方未能同意訟費的款額，該款額由訟費評定官評定。如在14天之內，與訟任何一方不向本庭提出申請，是項訟費命令作實。

原告人 ： 親自進行訴訟，無律師代表

被告人 ： 由梁國案律師(孖士打律師事務所律師)代表