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Biomedical subjects

K Ulsenheimer

Publications and source records attributed to K Ulsenheimer.

At least 19 recordsLinked to original sources
PubMed1998

["Codes, guidelines, standards". Risk or chance for the doctor or patient ].

As far as the law concerning liability is concerned, guidelines, codes of practice, and medical standards are not contrasting concepts, nor do they indicate material differences; instead, those terms describe more or less precisely the care that a physician is required to exercise when treating patients and that a judge is required to assess in a trial. Guidelines, codes of practice, and standards thus take effect not directly, but indirectly, in that both physician and judge retain a certain discretion in making decisions in a particular case. The current obsession with guideline--primarily based on economic considerations and present in all specialist areas--together with the increasingly detailed rules that are being issued, carries the risk that to medical profession may of its own doing become too restricted, that physicians will become limited in their choice of treatment, and that the criteria by which liability is assessed will become stricter, thus increasing the physician's risk of being held liable under civil or criminal law. We need to prevent a development taking place in which "medical standards" become "standardized medicine", leading to a situation in which only what is stipulated in the form of a guideline or a code of practice will be paid for (and hence only that can be done).

Germany↗
PubMed1998

[The filmless hospital--a legal challenge].

PURPOSE: This article concerns the legal aspects of digital archiving of radiological images, in particular with regard to the resolution passed by the 37th Committee meeting of the Federal Board of "RöV" (x-ray ordinance). Concepts of filmless hospitals must therefore be tested for compliance with all present legal requirements. MATERIAL AND METHODS: The literature concerning the legal aspects of digital medical archiving of x-ray documents is reviewed. The concept of a digital archive was compared with these aspects and tested for compliance with the respective legal rules. RESULTS: There are no legal obstacles to realizing our concept of a filmless hospital. However, there are no civil court rulings on record, since there have not been any legal proceedings to date. CONCLUSIONS: There are no legal objections to a complete digital archiving in a hospital in the absence of any court rulings to the contrary.

Confidentiality↗
PubMed1998

["Guidelines, codes of practice, standards". Risk or chance for physician and patient?].

As far as the law concerning liability is concerned, guidelines, codes of practice, and medical standards are not contrasting concepts, nor do they indicate material differences; instead, those terms describe more or less precisely the care that a physician is required to exercise when treating patients and that a judge is required to assess in a trial. Guidelines, codes of practice, and standards thus take effect not directly, but indirectly, in that both physician and judge retain a certain discretion in making decisions in a particular case. The current obsession with guideline--primarily based on economic considerations and present in all specialist areas--together with the increasingly detailed rules that are being issued, carries the risk that to medical profession may of its own doing become too restricted, that physicians will become limited in their choice of treatment, and that the criteria by which liability is assessed will become stricter, thus increasing the physician's risk of being held liable under civil or criminal law. We need to prevent a development taking place in which "medical standards" become "standardized medicine", leading to a situation in which only what is stipulated in the form of a guideline or a code of practice will be paid for (and hence only that can be done).

Decision Making↗
PubMed1998

[Withholding medical care as a physical injury--manslaughter and withdrawal of treatment].

Withholding therapy may cause a charge of manslaughter and the intended withdrawal of therapy may result in proceedings because of second-degree murder, requested homicide and omission of help, respectively. According to the criminal law, negligence of the duty to help does not require a guarantor position of the physician but the intent for punishableness. Otherwise, the physician is liable for negligence only if he holds a guarantor position for the protection of the patient's life and health. The facts of manslaughter require the violation of medical care which is not equal to the violation of common or mostly acknowledged rules of medical science. Another requirement for liability is causality. Thus, is has to be proven without doubt that the patient's death would have been avoided if the omitted therapy had been applied. The legal requirements on the principle of causality are high. Therefore, negligence can be proven in many cases but the proof of causality does not succeed and the charges have to be dropped. In such a case, it is totally wrong to attempt a charge of omission of help since the criminal law requires intent and is not a collector for neglected medical procedures.

Euthanasia, Passive↗
PubMed1998

[Quality assurance by experts].

The predominance of medical experts in hearings on so-called professional malpractice has frequently been bemoaned, but is indispensable since lawyers lack the necessary knowledge and requisite expertise. Court decisions are therefore essentially dependent on the quality of expert medical opinions, which in turn are dependent on the professional competence of the expert and on whether the expert is aware of the judicial demands made of him, i.e. whether the expert correctly understands his status and function within the scope of the civil or criminal proceedings. For example,the fact that court practice allows for differing standards (i.e. that medical standards can vary within limits) is important for the expert's appraisal, as is also knowing to what extent he is bound by the assignment and which requirements apply for proving causality (i.e. of an error leading up to damage) in civil and criminal proceedings. Strict objectivity, comprehensible language, restriction to one's own special field, preparation of the report within a reasonable time, intellectual integrity, no dealing with legal issues, ex ante assessment of the case and personal responsibility for the opinion are other important precepts that must be adhered to in order to avoid a miscarriage of justice. Quality control as exercised by specialised experts is therefore of vital significance.

Clinical Competence↗
PubMed1998

[Quality assurance and risk management in gynecology and obstetrics].

A glance through the relevant supreme court cases of the last five years will conclusively reveal that obstetrics is currently the sector with the largest number of liability claims, despite the fact that German obstetrics hold a leading world position. This high risk entails high insurance premiums, which can threaten the existence of those exercising the profession and which can therefore not be increased indefinitely. Thus the causes of these exploding liability claims in the medical sector have to be combated, i.e. the origins of damage have to be tracked down in order to identify and eliminate or at least reduce the risks. This future-oriented approach of damage prevention is known as risk management, and entails almost complete elimination not so much of maltreatment but most certainly of deficiencies in information, organisation and documentation as well as equipment. Seen from this point of view, risk management represents a form of quality control based on relevant judicature and statutory provisions. American experience shows that risk management activities are indispensable today, and that only proactive and preventive risk control, as opposed to limited reactive risk control, is capable of stemming the flood of liability claims in the medical sector.

Germany↗
PubMed1997

[The legal obligation for postoperative pain therapy].

Postoperative pain therapy, i.e., the symptomatic treatment of acute post-surgical pain, is an interdisciplinary obligation of the anaesthesiologist and managing surgeon toward the patient. The failure to provide appropriate pain therapy, in particular withholding analgesic agents, can be regarded as malpractice and result in civil, criminal, and professional legal consequences. As with other medical treatments, the patient must be adequately informed about pertinent details prior to the use of pain therapy, particularly in regard to specific risks and feasible alternative measures. All pain therapy employed must be duly recorded.

Anesthesiology↗
PubMed1997

[Legal aspects of teleradiology].

It is hoped that the implementation of teleradiology will improve the quality and economic effectiveness of health care in the future. The German federal government has submitted a bill for a legal statute, thereby creating the necessary framework to guarantee the essential "document security". The responsibility of those involved with orderly data transmission as well as the limited responsibility for physicians' findings are both governed by general liability. General principles apply also with regard to professional discretion. Authorized utilization of external networks depends upon the quality of data security. Networks with unlimited-public access may not be used without explicit consent from those concerned.

Computer Communication Networks↗
PubMed1997

[Special therapeutic processes from the viewpoint of the lawyer].

The particular schools of therapy never have been exactly defined--neither by law nor by judicature. Despite being in contrast to the scientifically based classical medicine, its application is basically accepted by the judicature within the general scope of the therapeutic autonomy of the physician. There are however, special limitations to be observed by the naturopath in order to protect the patient. Thus, disciples of alternative schools of therapy must always consider carefully whether or not methods of the classical medicine should be preferred for the sake of the patient's health. In addition, they must inform the patient about all therapeutic alternatives. Special problems may arise if parents reject proven measures of the classical medicine to be applied to their minor children. In such a case the child's benefit has priority to the parent's rights.

Adult↗