[Legal aspects of quality assurance : Example of operative intravitreal injection therapy]. / Rechtliche Aspekte der Qualitätssicherung : Beispiel der intravitrealen operativen Injektionstherapie.

BACKGROUND: In the legal evaluation of medical treatments it is important to know which legal and contractual regulations apply. OBJECTIVE: This article discusses in which context treatment errors play a role and are identified as such. MATERIAL AND METHODS: Relevant German legal framework conditions are discussed and examples with reference to intravitreal injection therapy are given. RESULTS: The civil law treatment contract between physician and patient results in the medical obligations of a service contract. As a consequence, the physician is obliged to provide the patient with treatment according to the current generally accepted professional standard, including information obligations, the certainty of a diagnosis, the execution of treatment and aftercare. Before claims for compensation and damages for pain and suffering can be enforced, proof of a treatment error and the causal connection must be provided. In court, mostly expert opinions are used to assess what the professional standard is and whether the physician was sufficiently qualified, whether informed consent and documentation met the legal requirements and whether a (gross) treatment error must be assumed. The Patients' Rights Act emphasizes the importance of an open error culture by requiring a practitioner to inform patients of third party/own treatment errors on request or in order to avert health risks, if circumstances are discernible to the practitioner that justify the assumption of a treatment error. CONCLUSION: Although ophthalmologists cannot guarantee healing or success but only the treatment, there are many medical obligations for intravitreal therapy. Increased standards of quality assurance can be implemented within the framework of selective contracts.

[Legal aspects of networking of medical activities]. / Vernetzung arztlicher Tätigkeiten aus juristischer Sicht.

Medical networks lack a legal definition. From the viewpoint of social law, this term means a form of organization of joint-service providers in a non-specified composition for the undertaking of medical care activities; from the point of view of occupational law, this consists of a loose form of joint practice. Such medical network can conclude treatment contracts with the patients and exchange patients' medical records. A practice network can take over services as contract partner of hospitals or other institutions, in the interest of improved competition chances within the integrated care system. The joining of a third partner is basically left open by the MBO, however according to SGB V this is possible only after approval by all contract partners. In advance of a planned medical care center, is it recommended to found a physician network as starting model. Before single practices fuse into a single enterprise, management-, tax-, legal-, as well as psychological aspects must be considered.