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Medical malpractice charges in Germany – A survey
Legal Medicine 11 (2009) S132–S134
Contents lists available at ScienceDirect
Legal Medicine journal homepage: www.elsevier.com/locate/legalmed
Medical malpractice charges in Germany – A survey Reinhard Dettmeyer a,*, Johanna Preuss b a b
Institute of Forensic Medicine, University of Gießen, Frankfurter Str. 58, D-35392 Gießen, Germany Institute of Forensic Medicine, University Hospital Schleswig-Holstein/Campus Lübeck, Kahlhorststr. 31-35, D-23562 Lübeck, Germany
a r t i c l e
i n f o
Article history: Received 17 December 2008 Received in revised form 9 January 2009 Accepted 2 February 2009 Available online 9 March 2009 Keywords: Medical malpractice charges Autopsy Expert opinion
a b s t r a c t Since decades, studies concerning medical malpractice charges in Germany were published, written by forensic pathologists and regarding lethal courses and the question of causality. Previously published studies comprise higher numbers of medical malpractice charges and determine who e.g. informed the prosecution, which clinical subjects are involved, the kind of charges and whether such allegations can be appropriately assessed by means of a forensic autopsy. A survey is given, focusing on the results of studies from German Institutes of Forensic Medicine. Ó 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Medical malpractice is an underestimated world-wide problem of high relevance and often disregarded, although several approaches can be found to investigate and handle malpractice charges [1–10]. In Germany, a rising number of medical malpractice charges is evident and different institutions can be involved to clarify the charges (Table 1). Especially the ‘‘Expert panel” for extrajudicial claims – organized by the Medical Associations – tries to give answers to patients questions combined with a malpractice charge [11,12] (Table 2). Also the patients can contact their Health Insurance Company, which works with a special Medical Service in store [13] (Table 3). The Health Insurance Companies do have an own interest in medical maltreatment, because in cases of accepted errors of treatment, they can try to get back the full costs they have had. Nevertheless, since a few years, specialized lawyers can be ask, because the German Bar Association’s established a ‘‘specialist solicitor for medical law” (Table 4). As far as the patient and/or the relatives inform the prosecutor – primarily in cases of grave error in treatment/bodily injury just with lethal course – an official preliminary proceeding will follow, including a forensic autopsy and, if necessary a confiscation of medical records to order a forensic expert opinion (Table 5) [13–16].
* Corresponding author. Tel.: +49 (0) 641 99 41410; fax: +49 (0) 641 99 41419. E-mail address: [email protected] (R. Dettmeyer). 1344-6223/$ - see front matter Ó 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.legalmed.2009.02.021
2. Studies on medical malpractice charges from German Institutes of Forensic Medicine Previous studies on medical malpractice charges from German Institutes of Forensic Medicine have been published (Table 6) [17–22]. Recently, a multicenter study was supported by the German Ministry of Health (BMGS-study) with data from 17 German Institutes of Forensic Medicine [21]. Out of 4450 cases, most often, proceedings were initiated by the certification of death as unexplained or unnatural (1715; 38.5%) and in 1303 (19.3%) cases it was not possible to clarify, who informed the prosecutor. In 831 out of 4450 cases (18.7%) complaints by relatives caused preliminary proceedings and 271 (6.1%) another physician reported an offense to the police. Together with the findings of former studies, ‘‘classical” constellations of medical malpractice charges were found (Table 7). In the BMGS-study, finally only a very small number of medical malpractice charges with lethal course were accepted as culpably caused medical maltreatment including the causality between medical maltreatment and death (Table 8). Nevertheless, in Germany it is a rare case, that accused physicians have to appear in court to defend themselves. Surgery is the most common medical discipline involved. Gynecology, obstetrics, internal medicine and general medicine were also involved frequently. In psychiatry, the charges claimed suspicion of e.g. drug overdose or faulty monitoring of patients. The charges were divided into different types: e.g. incorrect diagnosis, mistakes in medical treatment or non-recognition of complications after operations but also cases of confusion in localization or of syringes [23]. Special questions arise concerning cases of ‘‘Exitus in tabula” or errors in medication prescribing [24–29]. The findings of the studies corroborate the high number of preliminary proceed-
S133
R. Dettmeyer, J. Preuss / Legal Medicine 11 (2009) S132–S134 Table 1 Institutions attented with medical malpractice charges.
Table 7 ‘‘Classical” constellations of medical misadventures/malpractice charges.
Expert panel for extrajudicial claims – Medical Associations Health Insurance Company – which has a Medical Service in store – to claim against the injuring party Office of the Public Prosecutor/Police – in cases of error in treatment including lethal courses Specialized lawyers (according to the Bar Association’s professional regulation on further education)
Well-known complications of surgical operations (bursting of suture, secondary bleeding, injury of the bowel wall with delayed peritonitis) Misinterpretation of symptoms – e.g. beginning heart attack misinterpreted as backache Insufficient prophylaxis of thrombosis Deficient nursing treatment with ensuing decubital ulcers Sudden death on the operation table (‘‘Exitus in tabula”) ‘‘Manipulation of indication”
Table 2 Expert panel for extrajudicial claims – organized by the Medical Associations.
Table 8 German BMGS-Study – accepted malpractice charges (selected disciplines) [21].
Only out of court Exempt of charges Concerned physician must not cooperate Patient get’s a medical opinion in written form supporting or not supporting further claims Experts do not decide on compensation for immaterial damage (smart money)
Medical discipline
No. of error in treatment causing death
Surgery Internal medicine General medicine Orthopedics Gynecology (without obstetrics) Pediatric
39 (3.1%) 35 (5.0%) 3 (13.6%) 1 (0.8%) 4 (4.5%) 10 (11.5%)
Table 3 Health Insurance Company. Asks the patient to assign claims Works with a Medical Service in store – to claim against the injuring party Medical Service provides experts for all medical topics Medical Service writes an expert opinion only for the Health Insurance Company
ings with the charge of ‘‘involuntary manslaughter” and the relatively low number with the charge of ‘‘bodily injury caused by negligence”. 3. Conclusion
Table 4 Specialized lawyers. According to the Bar Association’s professional regulation on further education, since a few years lawyers can get the title ‘‘specialist solicitor for medical law” Advice patients and act for them Obtain an medical opinion Claim for damages and compensation for immaterial damage – on trial and out of court
Table 5 Office of Public Prosecutor/Police. In cases of (grave) error in treatment/bodily injury Lethal courses Initiates a forensic autopsy exclusively Confiscation of medical records Accused physicians must not cooperate Orders a forensic expert opinion
The forensic pathologist is competent for the ‘‘ascertainment and interpretation of autopsy findings” and an excellent resource to address questions of alleged medical misadventure. There is an increasing number of medical malpractice charges in Germany. Requested by the prosecutor, the forensic pathologist is the only one competent for interpretation of autopsy findings. He has to clarify the causality to death or bodily injury. Nevertheless, if necessary, it should be a matter of course, to request for further specialty expertise. Although there is no legal obligation, all cases of death in connection with medical interventions should be investigated by a forensic autopsy, which should be obligatory. With regard to the listed studies from German Institutes of Forensic Medicine, an important result is, that in a predominant number of cases, forensic autopsy leads to exculpation of the incriminated physicians [14]. Conflict of interest None.
Table 6 Previous studies on medical malpractice charges from German Institutes of Forensic Medicine (selected disciplines; modified following Pluisch, 1990 [22]). Authors
Surgery
Internal medicine
General medicine
Orthopedics
Gynecology (without obstetricts)
Pediat.
v. Brandis and Pribilla (1973) Eisenmenger et al. (1978) Figgener (1981) Schmidt (1982) Kohnle (1983) Mattern and Kohnle (1984) Althoff and Solbach (1984) Mallach (1989) Pluisch (1990) Janssen and Püschel Dettmeyer, Egl and Madea (2004) Preuss, Dettmeyer and Madea BMGS-study (2005)
48 41 22 37 12 15 22 214 10 24 81 1266
20 35 7 8 10 11 9 93 8 10 35 698
26 44 16 16 13 7 10 124 7 11 22 22
3 2 – – 3 3 4 – 7 – 5 127
10 28 6 7 7 8 8 58 6 6 46 88
– 16 3 3 3 3 4 15 3 7 3 87
The cited data in this table (last line) and in Table 8 are derived from a study supported by the German Federal Ministry of Health and Social welfare (BMGS) [21].
S134
R. Dettmeyer, J. Preuss / Legal Medicine 11 (2009) S132–S134
Acknowledgements The authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence their work.
[13] [14]
References
[15]
[1] Kohn L, Corrigan J, Donaldson MS, editors. Institute of Medicine (IOM). To err is human: building a safer health system. Washington, DC: National Academy Press; 1999. [2] Özdemir MH, Cekin N, Can IÖ, Hilal A. Malpractice and system in anaesthetic procedures in Turkey. Forensic Sci Int 2005;153:161–7. [3] Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. [4] Saukko P. Behandlungsfehlerbegutachtung und – regulierung in Finnland. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 225–34. [5] Mierzewski P, Pennanen P. Health for All! Human rights for All!! Patient safety for All!!! Recommendation Rec (2006)7 of the Committee of Ministers of the Council of Europe member states on management of patient safety and prevention of adverse events in health care. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 1–10. [6] Struve CT. Improving the medical malpractice litigation process. Health Aff 2004;23:33–41. [7] Brennan TA. The Institute of Medicine reports on medical errors – could it do harm? N Engl J Med 2000;342:1123–5. [8] Sakamoto N, Maeda S, Ikeda N, Ishibashi H, Nobutomo K. The use of experts in medical malpractice litigation in Japan. Med Sci Law 2002;42:200–6. [9] Medical malpractice systems around the Globe: Examples from the US-tort liability system and the Sweden – no fault system. Health, nutrition and population (HNP). Human Development Sector Unit. Europe and Central Asia Region. World Bank Document. [10] Wieland M. The economic analysis of German medical malpractice law – with emphasis on the allocation of burden of proof for causation. Erasmus programme in law & economics. University of Hamburg, Germany, Academic Year 2000/2001. [11] Laum HD. Die Behandlungsfehlerbegutachtung bei den Gutachterkommissionen und Schlichtungsstellen der Landesärztekammern. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 89–94. [12] Vinz H, Neu J. Malpractice claims relating to the diagnosis and treatment of acute appendicitis – decisions of the Norddeutsche Schlichtungsstelle (Expert
[16]
[17] [18] [19]
[20]
[21]
[22] [23]
[24] [25] [26] [27]
[28]
[29]
panel for extrajudicial claims resolution of the Medical Associations in Northern Germany). Z ärztl Fortbild Qual Gesundh wes 2007;101:553–63. Dettmeyer R, Madea B. Rechtsmedizinische Gutachten in arztstrafrechtlichen Ermittlungsverfahren. Medizinrecht 1999;17:533–9. Madea B, Preuss J, Vennedey C, Dettmeyer R. Begutachtung von Behandlungsfehlervorwürfen im Strafverfahren. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 105–18. Dettmeyer R, Preuss J, Madea B. Malpractice – role of the forensic pathologist in Germany. Forensic Sci Int 2004;144:265–7. Dettmeyer R, Egl M, Madea B. Medical malpractice charges in Germany – role of the forensic pathologist in the preliminary criminal proceeding. J Forensic Sci 2005;50:423–7. Lignitz E, Mattig W. Der iatrogene Schaden. Berlin: Akademie-Verlag; 1989. Eisenmenger W, Liebhardt E, Neumaier R. Ergebnisse von ‘‘Kunstfehlergutachten”. Beitr gerichtl Med 1978;36:215–21. Preuss J, Dettmeyer R, Madea B. Spezielle Fallgruppen aus der BMGS-Studie: Exitus in tabula. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 127–38. Preuss J, Dettmeyer R, Madea B. Spezielle Fallgruppen aus der BMGS-Studie: Vorwurf der fehlerhaften Arzneimitteltherapie/Medikationszwischenfälle. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 139–52. Preuss J, Dettmeyer R, Madea B. Begutachtung behaupteter letaler und nichtletaler Behandlungsfehler im Fach Rechtsmedizin. Bundesweite MulticenterStudie im Auftrag des Bundesministeriums für Gesundheit und Soziales (BMGS). Available from: http://www.bmgs.bund.de/deu/gra/publikationen/ pforschung.php. Pluisch F. Die rechtsmedizinische Begutachtung von ‘‘Behandlungsfehler”Vorwürfen. Med. Diss., University of Bonn, 1990. Dettmeyer R, Driever F, Becker A, Wiestler OD, Madea B. Fatal myeloencephalopathy due to an accidental intrathecal vincristin administration – a report of two cases. Forensic Sci Int 2001;122:60–4. Dettmeyer R, Reber A. Exitus in tabula. Anästhesiologische und medizinrechtliche Aspekte. Der Anästhesist 2003;52:1179–90. Dettmeyer R. Behandlungsfehler. In: Dettmeyer R, editor. Medizin & Recht. Springer; 2006. p. 337–66. Lesar TS, Briceland L, Stein DA. Factors related to errors in medication prescribing. JAMA 1997;277:312–7. Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, et al. An alternative strategy for studying adverse events in medical care. Lancet 1997;349:309–13. Brennan TA, Leape LL, Laird N, Hebert L, Localia AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I. N Engl J Med 1991;324:370–6. Philipps DP, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet 1998;351:643–4.
Contents lists available at ScienceDirect
Legal Medicine journal homepage: www.elsevier.com/locate/legalmed
Medical malpractice charges in Germany – A survey Reinhard Dettmeyer a,*, Johanna Preuss b a b
Institute of Forensic Medicine, University of Gießen, Frankfurter Str. 58, D-35392 Gießen, Germany Institute of Forensic Medicine, University Hospital Schleswig-Holstein/Campus Lübeck, Kahlhorststr. 31-35, D-23562 Lübeck, Germany
a r t i c l e
i n f o
Article history: Received 17 December 2008 Received in revised form 9 January 2009 Accepted 2 February 2009 Available online 9 March 2009 Keywords: Medical malpractice charges Autopsy Expert opinion
a b s t r a c t Since decades, studies concerning medical malpractice charges in Germany were published, written by forensic pathologists and regarding lethal courses and the question of causality. Previously published studies comprise higher numbers of medical malpractice charges and determine who e.g. informed the prosecution, which clinical subjects are involved, the kind of charges and whether such allegations can be appropriately assessed by means of a forensic autopsy. A survey is given, focusing on the results of studies from German Institutes of Forensic Medicine. Ó 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Medical malpractice is an underestimated world-wide problem of high relevance and often disregarded, although several approaches can be found to investigate and handle malpractice charges [1–10]. In Germany, a rising number of medical malpractice charges is evident and different institutions can be involved to clarify the charges (Table 1). Especially the ‘‘Expert panel” for extrajudicial claims – organized by the Medical Associations – tries to give answers to patients questions combined with a malpractice charge [11,12] (Table 2). Also the patients can contact their Health Insurance Company, which works with a special Medical Service in store [13] (Table 3). The Health Insurance Companies do have an own interest in medical maltreatment, because in cases of accepted errors of treatment, they can try to get back the full costs they have had. Nevertheless, since a few years, specialized lawyers can be ask, because the German Bar Association’s established a ‘‘specialist solicitor for medical law” (Table 4). As far as the patient and/or the relatives inform the prosecutor – primarily in cases of grave error in treatment/bodily injury just with lethal course – an official preliminary proceeding will follow, including a forensic autopsy and, if necessary a confiscation of medical records to order a forensic expert opinion (Table 5) [13–16].
* Corresponding author. Tel.: +49 (0) 641 99 41410; fax: +49 (0) 641 99 41419. E-mail address: [email protected] (R. Dettmeyer). 1344-6223/$ - see front matter Ó 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.legalmed.2009.02.021
2. Studies on medical malpractice charges from German Institutes of Forensic Medicine Previous studies on medical malpractice charges from German Institutes of Forensic Medicine have been published (Table 6) [17–22]. Recently, a multicenter study was supported by the German Ministry of Health (BMGS-study) with data from 17 German Institutes of Forensic Medicine [21]. Out of 4450 cases, most often, proceedings were initiated by the certification of death as unexplained or unnatural (1715; 38.5%) and in 1303 (19.3%) cases it was not possible to clarify, who informed the prosecutor. In 831 out of 4450 cases (18.7%) complaints by relatives caused preliminary proceedings and 271 (6.1%) another physician reported an offense to the police. Together with the findings of former studies, ‘‘classical” constellations of medical malpractice charges were found (Table 7). In the BMGS-study, finally only a very small number of medical malpractice charges with lethal course were accepted as culpably caused medical maltreatment including the causality between medical maltreatment and death (Table 8). Nevertheless, in Germany it is a rare case, that accused physicians have to appear in court to defend themselves. Surgery is the most common medical discipline involved. Gynecology, obstetrics, internal medicine and general medicine were also involved frequently. In psychiatry, the charges claimed suspicion of e.g. drug overdose or faulty monitoring of patients. The charges were divided into different types: e.g. incorrect diagnosis, mistakes in medical treatment or non-recognition of complications after operations but also cases of confusion in localization or of syringes [23]. Special questions arise concerning cases of ‘‘Exitus in tabula” or errors in medication prescribing [24–29]. The findings of the studies corroborate the high number of preliminary proceed-
S133
R. Dettmeyer, J. Preuss / Legal Medicine 11 (2009) S132–S134 Table 1 Institutions attented with medical malpractice charges.
Table 7 ‘‘Classical” constellations of medical misadventures/malpractice charges.
Expert panel for extrajudicial claims – Medical Associations Health Insurance Company – which has a Medical Service in store – to claim against the injuring party Office of the Public Prosecutor/Police – in cases of error in treatment including lethal courses Specialized lawyers (according to the Bar Association’s professional regulation on further education)
Well-known complications of surgical operations (bursting of suture, secondary bleeding, injury of the bowel wall with delayed peritonitis) Misinterpretation of symptoms – e.g. beginning heart attack misinterpreted as backache Insufficient prophylaxis of thrombosis Deficient nursing treatment with ensuing decubital ulcers Sudden death on the operation table (‘‘Exitus in tabula”) ‘‘Manipulation of indication”
Table 2 Expert panel for extrajudicial claims – organized by the Medical Associations.
Table 8 German BMGS-Study – accepted malpractice charges (selected disciplines) [21].
Only out of court Exempt of charges Concerned physician must not cooperate Patient get’s a medical opinion in written form supporting or not supporting further claims Experts do not decide on compensation for immaterial damage (smart money)
Medical discipline
No. of error in treatment causing death
Surgery Internal medicine General medicine Orthopedics Gynecology (without obstetrics) Pediatric
39 (3.1%) 35 (5.0%) 3 (13.6%) 1 (0.8%) 4 (4.5%) 10 (11.5%)
Table 3 Health Insurance Company. Asks the patient to assign claims Works with a Medical Service in store – to claim against the injuring party Medical Service provides experts for all medical topics Medical Service writes an expert opinion only for the Health Insurance Company
ings with the charge of ‘‘involuntary manslaughter” and the relatively low number with the charge of ‘‘bodily injury caused by negligence”. 3. Conclusion
Table 4 Specialized lawyers. According to the Bar Association’s professional regulation on further education, since a few years lawyers can get the title ‘‘specialist solicitor for medical law” Advice patients and act for them Obtain an medical opinion Claim for damages and compensation for immaterial damage – on trial and out of court
Table 5 Office of Public Prosecutor/Police. In cases of (grave) error in treatment/bodily injury Lethal courses Initiates a forensic autopsy exclusively Confiscation of medical records Accused physicians must not cooperate Orders a forensic expert opinion
The forensic pathologist is competent for the ‘‘ascertainment and interpretation of autopsy findings” and an excellent resource to address questions of alleged medical misadventure. There is an increasing number of medical malpractice charges in Germany. Requested by the prosecutor, the forensic pathologist is the only one competent for interpretation of autopsy findings. He has to clarify the causality to death or bodily injury. Nevertheless, if necessary, it should be a matter of course, to request for further specialty expertise. Although there is no legal obligation, all cases of death in connection with medical interventions should be investigated by a forensic autopsy, which should be obligatory. With regard to the listed studies from German Institutes of Forensic Medicine, an important result is, that in a predominant number of cases, forensic autopsy leads to exculpation of the incriminated physicians [14]. Conflict of interest None.
Table 6 Previous studies on medical malpractice charges from German Institutes of Forensic Medicine (selected disciplines; modified following Pluisch, 1990 [22]). Authors
Surgery
Internal medicine
General medicine
Orthopedics
Gynecology (without obstetricts)
Pediat.
v. Brandis and Pribilla (1973) Eisenmenger et al. (1978) Figgener (1981) Schmidt (1982) Kohnle (1983) Mattern and Kohnle (1984) Althoff and Solbach (1984) Mallach (1989) Pluisch (1990) Janssen and Püschel Dettmeyer, Egl and Madea (2004) Preuss, Dettmeyer and Madea BMGS-study (2005)
48 41 22 37 12 15 22 214 10 24 81 1266
20 35 7 8 10 11 9 93 8 10 35 698
26 44 16 16 13 7 10 124 7 11 22 22
3 2 – – 3 3 4 – 7 – 5 127
10 28 6 7 7 8 8 58 6 6 46 88
– 16 3 3 3 3 4 15 3 7 3 87
The cited data in this table (last line) and in Table 8 are derived from a study supported by the German Federal Ministry of Health and Social welfare (BMGS) [21].
S134
R. Dettmeyer, J. Preuss / Legal Medicine 11 (2009) S132–S134
Acknowledgements The authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence their work.
[13] [14]
References
[15]
[1] Kohn L, Corrigan J, Donaldson MS, editors. Institute of Medicine (IOM). To err is human: building a safer health system. Washington, DC: National Academy Press; 1999. [2] Özdemir MH, Cekin N, Can IÖ, Hilal A. Malpractice and system in anaesthetic procedures in Turkey. Forensic Sci Int 2005;153:161–7. [3] Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. [4] Saukko P. Behandlungsfehlerbegutachtung und – regulierung in Finnland. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 225–34. [5] Mierzewski P, Pennanen P. Health for All! Human rights for All!! Patient safety for All!!! Recommendation Rec (2006)7 of the Committee of Ministers of the Council of Europe member states on management of patient safety and prevention of adverse events in health care. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 1–10. [6] Struve CT. Improving the medical malpractice litigation process. Health Aff 2004;23:33–41. [7] Brennan TA. The Institute of Medicine reports on medical errors – could it do harm? N Engl J Med 2000;342:1123–5. [8] Sakamoto N, Maeda S, Ikeda N, Ishibashi H, Nobutomo K. The use of experts in medical malpractice litigation in Japan. Med Sci Law 2002;42:200–6. [9] Medical malpractice systems around the Globe: Examples from the US-tort liability system and the Sweden – no fault system. Health, nutrition and population (HNP). Human Development Sector Unit. Europe and Central Asia Region. World Bank Document. [10] Wieland M. The economic analysis of German medical malpractice law – with emphasis on the allocation of burden of proof for causation. Erasmus programme in law & economics. University of Hamburg, Germany, Academic Year 2000/2001. [11] Laum HD. Die Behandlungsfehlerbegutachtung bei den Gutachterkommissionen und Schlichtungsstellen der Landesärztekammern. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 89–94. [12] Vinz H, Neu J. Malpractice claims relating to the diagnosis and treatment of acute appendicitis – decisions of the Norddeutsche Schlichtungsstelle (Expert
[16]
[17] [18] [19]
[20]
[21]
[22] [23]
[24] [25] [26] [27]
[28]
[29]
panel for extrajudicial claims resolution of the Medical Associations in Northern Germany). Z ärztl Fortbild Qual Gesundh wes 2007;101:553–63. Dettmeyer R, Madea B. Rechtsmedizinische Gutachten in arztstrafrechtlichen Ermittlungsverfahren. Medizinrecht 1999;17:533–9. Madea B, Preuss J, Vennedey C, Dettmeyer R. Begutachtung von Behandlungsfehlervorwürfen im Strafverfahren. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 105–18. Dettmeyer R, Preuss J, Madea B. Malpractice – role of the forensic pathologist in Germany. Forensic Sci Int 2004;144:265–7. Dettmeyer R, Egl M, Madea B. Medical malpractice charges in Germany – role of the forensic pathologist in the preliminary criminal proceeding. J Forensic Sci 2005;50:423–7. Lignitz E, Mattig W. Der iatrogene Schaden. Berlin: Akademie-Verlag; 1989. Eisenmenger W, Liebhardt E, Neumaier R. Ergebnisse von ‘‘Kunstfehlergutachten”. Beitr gerichtl Med 1978;36:215–21. Preuss J, Dettmeyer R, Madea B. Spezielle Fallgruppen aus der BMGS-Studie: Exitus in tabula. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 127–38. Preuss J, Dettmeyer R, Madea B. Spezielle Fallgruppen aus der BMGS-Studie: Vorwurf der fehlerhaften Arzneimitteltherapie/Medikationszwischenfälle. In: Madea B, Dettmeyer R, editors. Medizinschadensfälle und Patientensicherheit. Häufigkeit – Begutachtung – Prophylaxe: Deutscher Ärzte-Verlag; 2007. p. 139–52. Preuss J, Dettmeyer R, Madea B. Begutachtung behaupteter letaler und nichtletaler Behandlungsfehler im Fach Rechtsmedizin. Bundesweite MulticenterStudie im Auftrag des Bundesministeriums für Gesundheit und Soziales (BMGS). Available from: http://www.bmgs.bund.de/deu/gra/publikationen/ pforschung.php. Pluisch F. Die rechtsmedizinische Begutachtung von ‘‘Behandlungsfehler”Vorwürfen. Med. Diss., University of Bonn, 1990. Dettmeyer R, Driever F, Becker A, Wiestler OD, Madea B. Fatal myeloencephalopathy due to an accidental intrathecal vincristin administration – a report of two cases. Forensic Sci Int 2001;122:60–4. Dettmeyer R, Reber A. Exitus in tabula. Anästhesiologische und medizinrechtliche Aspekte. Der Anästhesist 2003;52:1179–90. Dettmeyer R. Behandlungsfehler. In: Dettmeyer R, editor. Medizin & Recht. Springer; 2006. p. 337–66. Lesar TS, Briceland L, Stein DA. Factors related to errors in medication prescribing. JAMA 1997;277:312–7. Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, et al. An alternative strategy for studying adverse events in medical care. Lancet 1997;349:309–13. Brennan TA, Leape LL, Laird N, Hebert L, Localia AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard medical practice study I. N Engl J Med 1991;324:370–6. Philipps DP, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet 1998;351:643–4.