Medical malpractice

A treatment error is present if medical treatment is not carried out in accordance with the generally recognized professional standards existing at the time of treatment, unless otherwise agreed ( Section 280 (1) BGB, Section 630a (2) BGB).

A treatment error is to be assessed as gross if the doctor or psychotherapist clearly violates proven medical or psychotherapeutic treatment rules or reliable medical knowledge and has made a mistake that no longer appears to be understandable from an objective point of view because a doctor or psychotherapist absolutely cannot undermine it may.

Reliable medical knowledge is not just the knowledge that has been incorporated into guidelines, guidelines or other express instructions. Rather, this also includes the elementary basic medical rules that are required in the respective specialist area.

Medical malpractice can result from doing or not doing something. As a result, the treating party may be liable under civil, regulatory or criminal law.

Malpractice

Treatment errors are colloquially often referred to as malpractice because the medical treatment was not carried out according to the rules of (medical) art ( Latin lege artis , English state of the art ). The original explanation of since the end of the 18th century emerging concept goes Rudolf Virchow back of the beginning of the 19th century the term malpractice as the health damage of a patient from want of proper attention or caution and contrary to generally accepted rules of medical science defines Has.

Definition of the fault

An error contains an undesirable difference between observed, measured or calculated states or processes on the one hand and true, fixed or theoretically correct states or processes on the other. The Institute of Medicine (IOM) defines failure as "failure of a plan or using a wrong plan to achieve a goal". A distinction is made between errors according to their cause or according to the event they occurred, but also according to the error behavior (cf. DIN 44.300).

Types of errors

The error can be of a purely medical nature, but it can also relate to organizational measures and incorrect behavior of subordinate or assisting people. A medical treatment error can also represent the missing or incorrect as well as incomprehensible or incomplete safety information (therapeutic information) of the patient about his own behavior in therapy.

What would have been the right treatment can be clarified by medical reports. Orientation towards medical guidelines , which are based on evidence-based medicine , can be helpful. However, such guidelines are not always to be equated with the scientific standard. The medical assessment has to take into account the freedom of therapy as well as different doctrines at the respective time of treatment.

The treating person owes the patient a faultless treatment according to service contract law , but not the healing. Malpractice can have civil and criminal penalties for the treating person. There are restrictions in medical law, for example. B. in dental implantology . A precise distinction should be made here as to whether the service contract (e.g. medical advice), the contract for dental services or, in the event of material failure, the Medical Devices Act applies.

Not every therapeutic failure is a medical error - complaints can also be known side effects or complications. It is often difficult to distinguish the consequences of the disease itself and the consequences of incorrect treatment.

causes

The causes of medical malpractice are complex and numerous. In addition to general human inadequacies, the focus is increasingly on external conditions that increase the risk of treatment errors. The following factors are given, for example:

Lack of “ error culture ”. Treatment errors were taboo and branded as individual failures instead of analyzing them and discussing causes and avoidance strategies.
Possible confusion, for example in the case of drugs with a similar name and / or similar packaging, right-left confusion, confusion of patients.
Communication errors between the practitioners.
Workload.
Ambiguity about responsibilities.

The endeavors to increase patient safety were further strengthened by the Patient Rights Act and the changes made.

Limits to Therapy Freedom

The doctor is free to choose the therapy. If there are several therapy alternatives, the patient must be informed about the respective risks. Here, too, the patient's consent requirement for the selected therapy exists. The freedom of therapy is limited, however. If there are several options that are similar to risk, the therapy with the greatest possible chance of success and if there are several options that are equivalent he must select the one with the lowest risk, otherwise the treatment can be classified as faulty. In the statutory health insurance , the economic efficiency requirement according to § 12 SGB V must also be taken into account, since those with statutory health insurance are only entitled to adequate, appropriate, economic benefits that do not exceed what is necessary.

Alternative treatment methods may only be used if they do not cause any damage that would have been avoided if scientifically recognized healing methods had been used. In 2005, the Federal Constitutional Court ruled that statutory health insurance must also pay for alternative healing methods for seriously ill patients if they offer a reasonable hope for a cure or if there is a noticeable improvement in the course of the disease - if conventional medicine no longer sees any treatment options. In the proceedings, the constitutional judges found the 1997 judgment of the Federal Social Court " to be incompatible with the fundamentally guaranteed general freedom of action, the social principle and the fundamental right to life ".

Inform the patient

In the event of a malpractice, the patient is to be informed by the treating person on request or in order to avoid health risks. In Germany, this information obligation is now regulated in Section 630c Paragraph 2 Clause 2 BGB. The patient safety alliance has published a brochure on this, which is intended to help doctors and nursing staff overcome their fears and uncertainties when it comes to information. There it says:

“In the case of adverse events and malpractice, good communication and professional dealings with those affected and involved are ethically imperative. This is a core part of an advanced safety culture. Patients and relatives as well as employees involved rightly expect honest, fair action from those responsible, aimed at damage limitation and future damage prevention. "

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frequency

Germany

At the German Medical Association (BÄK), the complaints to the various expert commissions and arbitration boards for medical liability issues are summarized annually and have been published nationwide since 2006.

The number of applications was 12,232 in 2013 and shows a sustained slow increase from 10,280 in 2006.

In 7,922 decisions made in 2013, 1,864 cases (23.5%) were found to have a medical malpractice with resulting damage (2006: 1,562), plus 379 medical errors found without causality to the damage claimed (4.8%; 2006: 422 cases). In around 90% of the cases, both parties accepted the decision and even in a subsequent legal dispute, the decisions were "largely confirmed".

In the area of outpatient treatment, 2,385 decisions were made in 672 million treatment contacts. The main focus of errors was in diagnostics, especially in imaging procedures. In 2013, 6,498 applications were submitted for the inpatient area, most of which concerned treatment errors in the operating room or during invasive procedures. Of these, 2,148 applications were for trauma surgery and orthopedics , followed by general surgery with 1,081 applications, internal medicine , gynecology and neurosurgery . The most common recognized medical malpractice in the hospital involved the treatment of:

Hip joint wear with 73 recognized treatment errors (and 161,276 inpatient treatment cases in 2012)

Bone fractures of the lower leg and the upper ankle joint with 64 errors in 136,007 cases

Knee joint wear with 57 errors in 196,528 cases

Forearm fracture with 45 errors in 134,554 cases

Femoral fracture with 43 errors in 166,859 cases

Upper arm fracture and shoulder fracture with 40 errors in 111,323 cases

Like those of the MDK of the health insurance companies, this information is incomplete because there is no register for treatment cases. In addition, many medical errors go undetected. Due to the unevenly distributed specialist knowledge, many patients cannot even know or notice and only suspect years later that they (perhaps) have been treated incorrectly. An examination for this then usually does not take place. There are also no figures on cases in which doctors and patients had agreed to settle the claim without an arbitration board.

Since the publication of the report “To Err is Human” by the Institute of Medicine of the US National Academy of Sciences in 1999, the topic of medical risks, errors and patient safety has gained increasing interest in international literature.

The Medical Services of the Health Insurance (MDK) carried out 12,483 medical error assessments in 2012. They found a malpractice in 31.5% of the cases (in 2011 it was 32.1% of 12,686 cases). In addition, the causality of the damage could be proven in 21.7% of the cases. The MDK is activated when an insured person turns to the health insurance company with the suspicion of a malpractice. The identified proportion of incorrect treatments relates to the suspected cases submitted to the MDK. The assessment of whether there is a treatment error in a specific case is made on the basis of the patient or medical records and, if possible, on the basis of an additional personal memory log of the patient.

Selection of the ten most common medical errors identified nationwide by the MDK in 2011 and 2012:

Art	Number 2011	Number 2012
Osteoarthritis of the knee	159	131
Hip arthrosis	140	152
Dental caries	134	124
Femur fracture	111	105
Pulpitis	108	156
Fracture of the lower leg	85	81
Pressure ulcer	81
Back pain		58
other dental diseases	73	66
Forearm fracture	67
Otherwise. Disc damage		50
Disc damage	58	50

The German Dental Association criticizes the fact that the number of treatment errors is not related to the number of actual treatment cases. Without reference to the total number of treatment cases, the absolute numbers of treatment errors published by the MDK are not meaningful and do not allow any conclusions to be drawn about the relative frequency of treatment errors and thus the overall quality of treatment. It is also criticized that it cannot always be concluded with certainty that a treatment error has occurred, and that the labeling of a damaging event as a treatment error is also subject to the discretion of the expert, since the assessment by the MDK is only carried out on the basis of the patient's treatment documents and memory logs.

United States

United States statistics from 1984 estimated that 44,000 to 98,000 people died in hospitals each year due to malpractice. The "Centers for Disease Control and Prevention" currently report 75,000 patients who per year suffer death in hospitals alone due to infections. This is one of many causes and only affects a single treatment situation. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care study by John T. James, PhD estimated 400,000 unnecessary deaths annually in hospitals. Less than a quarter of the treatments are done in hospitals. If you include all care facilities, the numbers are higher.

Another study found that between 2000 and 2002, among the 37 million hospital admissions, over 1,140,000 incidents involving patient safety occurred. Hospital costs associated with medical errors were estimated at $ 324 million in October 2008 alone.

Between 15,000 and 19,000 malpractice lawsuits are filed annually. Estimates have to be used as the starting point, as the statistical results relating to medical errors are probably poorly documented and knowingly falsified.

Clarification options

Out of court clarification: Direct negotiation between the patient or his representative and the doctor's liability insurance; Arbitration boards and expert committees of the medical associations, psychotherapist associations and dentists associations; Medical Service of Health Insurance (MDK); Expert services in the dental field for those with statutory health insurance

Judicial clarification: Civil courts; Criminal complaint to the police or the public prosecutor's office

Independent evidence procedure

An Independent proof method can be performed when the evidence is threatened by loss of evidence ( § 485 para. 3 ZPO). In the event of a treatment error, this may be necessary in order to secure the findings before the condition could be changed by further necessary treatment measures (hence the earlier designation of evidence preservation procedure ). In the evidence procedure, the evidence can be provided by a court-appointed expert. Private reports, on the other hand, are not admitted as evidence in court, but only as a qualified party presentation.

Arbitration boards

If a medical error is suspected, a private medical report can help. The arbitration boards offer another possibility to clarify whether the medical treatment was carried out properly. However, the procedure only gets underway if the accused doctor or the accused institution consents to the arbitration procedure. To examine complaints and questions of liability, the medical profession in Germany has set up expert commissions and arbitration boards at the state medical associations , the state psychotherapist chambers and the state dental chambers . The doctor's insurer or the hospital operator bears the costs of an expert consulted by the arbitration board and the applicable flat-rate procedure fee. The patient making the application only has to bear his / her costs including the costs of his legal representative and any travel costs. It is at the discretion of the doctor or psychotherapist involved to agree to the arbitration procedure requested by the patient.

Social law

The health insurance companies should support the insured in pursuing claims for damages ( Section 66 SGB V ), for example by requesting the medical documents from the doctor and presenting them to an expert from the Medical Service of Health Insurance (MDK) for examination. If the suspicion of a malpractice is confirmed, a written report will be prepared, which will be made available to the insured free of charge. In the dental field, defect reports can be drawn up according to the expert procedure in contract dental care.

With the Act to Strengthen the Supply of Medicinal Products and Aids (HHVG), the legislature specified the support of insured persons in the pursuit of claims for damages that arose when claiming insurance benefits from malpractice. In addition to the support services of the health insurances, depending on the requirements of the individual case, a factual and legal check of the documents submitted by the insured for completeness and plausibility, with the consent of the insured, the request for further documents from the service provider, the initiation of a socio-medical assessment by the medical professional Service of the health insurance according to § 275 paragraph 3 number 4 SGB V as well as a final overall assessment of all available documents including the result of any assessment by the medical service.

The Support Compensation Act grants state compensation for damage to health as a result of certain medical care measures suffered in the GDR , if the injured party is not entitled to civil law compensation.

civil right

According to German civil law, the treatment error is a violation of the obligations under the treatment contract ( § 630a ff BGB ). According to § 280 BGB, the treating party must pay compensation if he is responsible for the breach of duty and the breach of duty is the cause of the damage. In the event of impairment of immaterial legal assets (bodily harm), a claim for compensation for pain and suffering can also be considered in accordance with Section 253 (2) BGB . The treatment error is also an unlawful act ( offense according to § 823 Paragraph 1, 2 BGB), which can also lead to claims for compensation by the patient. In addition, claims against the hospital for which the doctor may have acted as a so-called helper come into consideration with clinicians .

According to Section 630f of the German Civil Code ( BGB), the treating person is obliged to record all essential measures and their results, in particular the anamnesis, diagnoses, examinations, examination results, findings, therapies and their effects, interventions and their effects, consent and explanations. This documentation can facilitate the later clarification of a suspected medical error.

damages

The material compensation often includes the loss of earnings of the patient or his household damage . Travel expenses for close relatives to hospital visits can also be claimed. Often the patient incurs further costs for medication, bandages or physiotherapy later on.

The claim for damages of the injured patient includes the necessary medical treatment costs, insofar as the patient has borne them himself. Insofar as the health insurance company has borne the costs, it can assert the claim transferred to it by means of recourse.

personal injury compensation

The doctor can also owe compensation for pain and suffering. The Celle compensation table of the Higher Regional Court of Celle can provide reference values . According to the case law of the Federal Court of Justice, all relevant circumstances of a case may be taken into account for an appropriate compensation for pain and suffering ( § 253 BGB), including the degree of fault of the injuring party, the duration of pain, life restrictions and the economic circumstances of the injuring party as well of the injured party etc. In an international comparison, however, the amount of compensation for pain and suffering is low. Compensation for pain and suffering has both a compensatory and a satisfaction function; it is transferable and inheritable. The motion for compensation for pain and suffering is one of the few cases where an indefinite motion is permissible. The amount of compensation for pain and suffering can be left to the discretion of the court. A compilation can be found in Beck's table of compensation for pain and suffering .

Burden of proof

The objective burden of proof for a malpractice lies with the plaintiff , i.e. the patient or his heir. The plaintiff must also prove that the malpractice caused damage . The expression medical liability used today in civil law emphasizes this question of causality : not every mistake by the doctor creates an obligation to pay compensation ; rather, concrete damage must be due to this error. The problem of causality is a focus of many damages litigation in the area of medical liability law.

Shifting the burden of proof

However , the plaintiff can reverse the burden of proof if he can prove that the damage he is claiming is based on a gross medical error.

Gross medical malpractice

A gross medical error is presumed by the case law if:

"[...] the doctor clearly violated proven medical treatment rules or established medical knowledge and made a mistake which from an objective point of view no longer appears understandable because a doctor absolutely must not undermine it"

- Continuation of BGH , judgment of June 11, 1996

Establishing a gross malpractice is a legal issue; that is, it is taken by the court and not by the medical expert. According to the BGH, an expert's report can only provide reasons for a decision.

If there is a gross error in treatment, the causality of the gross error for the damage is rebutted .

Evidence can also be facilitated if evidence has not been properly stored. Incomplete or falsified documentation, including subsequent changes or allegedly lost documents as well as unsecured or unregistered access to change options in databases of the case files, can also lead to a reversal of the burden of proof. Burned and not reconstructed, but discarded documentation are also rated. For example, in its judgment of December 12, 2001 , the Hamm Higher Regional Court assessed gross violations of the obligation to provide findings by a clinic pathologist in Essen as gross treatment errors and therefore reversed the burden of proof.

Failure to provide medical information (therapeutic information) can also constitute a gross treatment error. Then, here too, an objective reversal of the burden of proof would have to be assumed.

"[...] A violation of the attending physician's duty to provide therapeutic information (safety information), which is to be assessed as a gross treatment error, regularly leads to a reversal of the objective burden of proof for the causal connection between the treatment error and the damage to health, if it is appropriate to cause the damage incurred; a probability of a result of a check-up is not necessary in such a case […] A reversal of the burden of proof is to be assumed if the gross malpractice is likely to cause the damage; The error does not have to suggest or make the damage likely "

- Continuation of BGH, judgment of April 27, 2004

Further typical conditions for a judicial order to reverse the burden of proof are:

failure to collect findings

obviously incorrect treatment, i.e. gross treatment errors and also medication errors

Transmission of germs through infection in a controllable area

Use of faulty devices, incorrect or undocumented device settings or neglected device maintenance (expired test mark periods).

However, a doctor is not necessarily liable for gross malpractice if the patient refuses urgently needed subsequent treatment by another doctor ( OLG Koblenz ). The patient is therefore obliged to cooperate if he can thereby reduce the damage - even in the case of a gross treatment error ( damage reduction obligation ).

Facilitation of evidence

The doctor is subject to an obligation to document his findings, the diagnoses and the treatments undertaken or initiated. Failed documentation does not itself constitute an independent basis for claims in malpractice proceedings. The court can conclude from the non-documentation of a measure requiring a record that the measure did not take place, which can lead to easier evidence for the patient.

The case law grants similar simplifications for the proof of fault ; In the context of contractual liability, it is assumed that the person must represent by law.

Statute of limitations

The claim for damages can no longer be enforced once the statute of limitations has expired . Claims for damages due to treatment errors are subject to the regular three-year limitation period. The three-year limitation period begins at the end of the year in which the claim arose and the obligee became aware of the circumstances giving rise to the claim and the person of the debtor, or would have to become aware of it without gross negligence ( Section 195 in conjunction with Section 199 Para. 1 BGB). In the area of doctor's liability, knowledge of treatment failure or treatment complication does not usually convey knowledge of treatment error. Rather, the patient must have become positively aware of those treatment facts that - with regard to the treatment error - suggest a medical misconduct and - with regard to the causality of the damage - a causal link between the consequences of the damage and the treatment error when viewed objectively.

Criminal law

According to jurisprudence, any faultless therapeutic treatment is an actual bodily harm ( Section 223 StGB ), which is not, however, punishable as long as it is carried out with the effective consent of the patient. This is undisputed for faulty treatments. Because the patient has not consented to it, the act is also illegal. In criminal proceedings , the patient may be a joint plaintiff or a witness . If the patient dies as a result of the malpractice, negligent homicide or, in exceptional cases, even manslaughter may be considered. If the person treating has acted in accordance with the facts, unlawfully and culpably and this can be proven, he can be convicted for the act.

Professional ethics

In addition, medical errors can have legal consequences. The medical associations , dentists' associations or the competent professional courts decide on this on the basis of the respective professional regulations or the (dental) medical associations within the framework of their disciplinary regulations.

Professional law

In particularly severe cases, the admissions committee can order the partial or complete suspension of admission as a contract (dental) doctor / contract psychotherapist or the withdrawal of admission in accordance with Sections 26, 27 of the Admission Ordinance for Contract (dental) doctors / contract psychotherapists. As a last resort, the responsible state government can order the withdrawal of the license to practice medicine, which amounts to a professional ban .

literature

Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors and the Board on Health Care Services. Edited by Philip Aspden et al. National Academies Press, Washington, DC, 2007. ISBN 978-0-309-10147-9 .

Medication Errors. Ed. Michael R. Cohen. 2nd Edition. American Pharmacists Association, Washington, DC, 2007. ISBN 978-1-58212-092-8 .

Martin Lindner: To err is medical . In: Image of Science . 2/2004, pp. 18-23, ISSN 0006-2375

Stefanie Bachstein: You could have lived. Verlagsgruppe Lübbe, 3rd edition 2007, ISBN 3-404-61480-1 . Foreword by Prof. Dr. med. Thomas H. Loew, University Hospital Regensburg. Stefanie Bachstein's book shows the traumatization of both sides, that of the doctor and that of the person affected after a fatal medical error. The book received a special mention as part of the 2004 Journalism Prize from the Hamburg Health Foundation. Info u. Reading sample (letter to the doctor) at www.stefanie-bachstein.de

Michael Imhof: Medical treatment errors - What to do? A guide for patients, relatives and medical staff, Schulz-Kirchner Verlag, Idstein 2011, ISBN 978-3-8248-0867-0

Herbert Pröpper, Johann Neu: An extrajudicial way to an agreement. Work and results of the North German arbitration board for medical liability issues . Hamburger Ärzteblatt 1/2012, pp. 12-17

Marina Tamm: The scope of liability in the event of medical misconduct and legal enforcement issues in medical liability law, JURA 2009, 81

Bente Vibeke Heinig: On the frequency and characteristics of the allegations of treatment errors from the Institute for Forensic Medicine at the University Medical Center Greifswald 1996–2008 ; Dissertation, 2015.

Eckart Roloff , Karin Henke-Wendt: Damaged instead of cured. Major German medical and pharmaceutical scandals . Hirzel, Stuttgart 2018, ISBN 978-3-7776-2763-2 (with several chapters on treatment errors)

Web links

Wiktionary: medical malpractice - explanations of meanings, word origins, synonyms, translations

Individual evidence

^ BGH, judgment of October 25, 2011 - VI ZR 139/10

^ BGH, judgment of September 20, 2011 - VI ZR 55/09

^ Giovanni Maio : Malpractice. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 814.

↑ G. Heberer and L. Schweiberer, Indication for Operation (PDF; 1.8 MB), Springer Verlag 2nd edition (1981) ISBN 3-540-10385-6

↑ Institute of Medicine ( Memento of the original from July 2, 2006 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ German Medical Association, Glossary Quality Assurance ( Memento of the original dated February 4, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ Guidelines are not to be equated with the medical standard, Dtsch Arztebl 2008; 105 (37): A-1937 / B-1665 / C-1629
↑ BDIZ (Ed.) Expert Handbook Implantologie, 1st edition 2002 ISBN 3-929851-90-3 - Breisach: Med. Verl.- und Informationsdienste 2002
↑ K. Müller: Liability problem, chap. 5.2. + 5.3. October 2003 in: Current status of dental implantology, Ed. HJ Hartmann, Spitta Verlag 2000, ISBN 3-921883-23-7
↑ Martin Hansis, Senior Physician at the Medical Service of the Central Associations of Health Insurance Funds in Deutsches Ärzteblatt, p. 453 (2002)
↑ Brochure: Learning from mistakes, Deutsches Ärzteblatt (PDF; 452 kB)
↑ Doctors want to learn better from treatment errors. ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2
↑ Every mistake counts: error reporting and learning systems for doctors. ( Memento of the original from September 18, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ Every tooth counts: error reporting and learning systems for dentists.
↑ Patient safety alliance
↑ Federal Constitutional Court - judgment of December 6, 2005 (AktZ.:1 BvR 347/98)
↑ Talking is gold ( Memento of the original from July 4, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 870 kB) @1@ 2

↑ Medicine in Germany - Almost 3,900 medical errors nationwide. In: Süddeutsche Zeitung of April 18, 2007

^ T. Gerst, E. Richter-Kuhlmann: Efforts to Transparency : Deutsches Ärzteblatt 2014, Volume 111, Issue 26 of June 27, 2014, Pages A1192-A1193

↑ Jennifer Litters: There are still many medical errors - hip and knee: This is where the most surgical mishaps occur . In: Focus Online . Retrieved November 11, 2014.

↑ Kohn LT, Corrigan JM, Donaldson MS (eds.) To err is human. Building a safer health system. Washington, DC: National Academy Press, 1999.

↑ Leape LL, Berwick DM. Safe health care: are we up to it? Br Med J 2000; 320: 725-6.

↑ Reducing error. Improving Safety. Focus issue Br Med J 2000; 320 (7237).

↑ MDS: Treatment error statistics of the MDK 2011 ( Memento of the original from December 9, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ MDS: Treatment error statistics of the MDK 2012 ( Memento of the original from June 26, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 950 kB), p. 6, Essen, Munich May 2013 @1@ 2

↑ MDS: Treatment error statistics of the MDK 2012 ( Memento of the original from June 26, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 950 kB), p. 4 f @1@ 2

↑ German Dental Association, evaluating treatment error assessment in relation to the actual treatment cases ( memento of the original from April 7, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 96 kB) @1@ 2

↑ How Many Deaths Are Due to Medical Error? Getting the Number Right . Effective Clinical Practice, November / December 2000 .. 2000. Archived from the original on May 18, 2014. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
^ Data and Statistics - HAI - CDC
↑ John T. James: A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care . In: Journal of Patient Safety . 9, No. 3, September 2013, pp. 122–128. doi : 10.1097 / PTS.0b013e3182948a69 . Retrieved April 23, 2015.
↑ Errors kill 15,000 aged patients a month: study . Reuters. 2010.
↑ Number of malpractice suits per year . Numberof.net. 2010. Archived from the original on July 8, 2010. Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ German Medical Association: Expert commissions and arbitration boards at the Medical Associations ( Memento of the original from September 18, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ Annexes 6, 9, 10a, 10b, 12 and 14 to the federal collective agreement - dentists (BMV-Z), for example § 4 of Annex 12
↑ Act to Strengthen the Supply of Medicines and Aids (Medicines and Aids Supply Act - HHVG)
↑ Drafts and explanations: Act to strengthen the supply of therapeutic products and aids (Medicinal Products and Aids Supply Act - HHVG) . German Bundestag. Retrieved March 16, 2017.
↑ German Bundestag printed matter 18/11205: Recommendation for a resolution and report by the Committee on Health (14th committee) on the draft law of the federal government - printed matter 18/10186 - "Draft of a law to strengthen the supply of therapeutic aids (Medicinal and Aid Supply Act - HHVG) . German Bundestag. P. 62. February 15, 2017. Retrieved March 16, 2017.
↑ Celler compensation table
^ BGH, permanent case law, Senate decision of September 30, 2003 - VI ZR 78/03 - VersR 2004, 219
^ Beck's table of compensation for pain and suffering online
↑ BGH, judgment of June 11, 1996 , Az. VI ZR 172/95, full text = VersR 1996, 1148
↑ Jurion: BGH, July 21, 1998, VI ZR 15/98
^ BGH, judgment of October 25, 2011 , Az. VI ZR 139/10, full text
↑ OLG Hamm, judgment of December 12, 2001, Az. 3 U 119/00 .
↑ BGH, judgment of April 27, 2004 , Az. VI ZR 34/03, full text = VersR 2004, 909
^ BGH judgment of June 28, 1988 (VI R 217/87)
↑ BGH judgment, in VersR 1991, 467 ff.
↑ BGH judgment, NJW 2007, 1682 ff.
↑ OLG Koblenz (decisions of June 27 and August 27, 2012; Ref .: 5 U 1510/11) ( Memento of the original of October 17, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , accessed September 14, 2012 @1@ 2

↑ Jurion: BGH VI ZR 170/88

↑ BGH, judgment of October 31, 2000, VI ZR 198/99, published in BGHZ 145, 358

↑ Bavarian State Medical Association, Medical Professions Chamber Act (PDF; 235 kB)

↑ KZV Baden-Württemberg Disciplinary Code ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2
↑ KV North Rhine Disciplinary Code ( Memento of the original from October 8, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 42 kB) @1@ 2

↑ Admission ordinance for contract dentists

↑ Admission Ordinance for Contract Doctors

[1] BGH, judgment of October 25, 2011 - VI ZR 139/10

[2] BGH, judgment of September 20, 2011 - VI ZR 55/09

[3] Giovanni Maio : Malpractice. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 814.

[4] G. Heberer and L. Schweiberer, Indication for Operation (PDF; 1.8 MB), Springer Verlag 2nd edition (1981) ISBN 3-540-10385-6