Complaints about medical treatment

If patients feel that they have received poor or incorrect treatment or believe that their doctor has broken the rules, they can make a complaint.

Reasons for a complaint can be:

• insufficient information received from the doctor
• treatment error
• inadequate medical care
• violation of their duties in connection with their affiliation to the statutory health care system
• denial of patient rights
• data misuse in a practice or clinic
• violations of hygiene regulations
• unreasonable waiting times

But it is often a good idea for the patient to first of all try and talk to their doctor, for instance to clear up potential misunderstandings.

If the dispute is not resolved by having a conversation, there are various options open to patients to fight back. On the one hand, there are various institutions giving advice on the legal options and advising in individual cases. On the other, patients can contact an official complaints office with their concern and receive support from them in a complaints procedure. This applies to both those with statutory and private insurance.

The advice and support received with a complaint is free of charge. Patients do not have to pay for medical reports from the Medical Review Board of the Statutory Health Insurance Funds or an arbitration board of the Association of Statutory Health Insurance Physicians.

However if expert opinions have to be obtained, this can be associated with costs. The arbitration procedure for complaints about dental treatment through the State Dental Association is also chargeable in some federal states.

Before you lodge an official complaint, it is a good idea to get some expert advice about your options.

As a patient, you can contact various centers, including:

• Germany’s independent patient advisory (UPD)
• Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen – KV)
• Statutory health insurance providers
• Patient advice centers of (State) Dental Associations and the Associations of Statutory Health Physicians (KZV)
• Self-help organizations
• Consumer advice centers
• Patient representatives of the state governments (currently only in Bavaria, Berlin, Lower Saxony and North Rhine-Westphalia)
• Data protection authorities of the federal states

If patients wish to file a complaint, they can contact specific complaints offices. These offices investigate the matter independently and, if necessary, introduce sanctioning measures.

If there are any claims for compensation, they help to resolve the concerns and claims, if possible, in arbitration meetings. This is to avoid legal proceedings, which are usually associated with some costs and can take up a lot of time. If this is not possible, the complaints offices help patients to prepare for legal proceedings. They assist them for example in gathering evidence to prove medical misconduct.

Depending on what you want to complain about, one of a number of different centers available will be the right point of contact:

• Health insurance provider or private health insurance company
• State Chamber of Physicians
• Chamber of Psychotherapists
• Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen – KV)
• Dental Association
• Associations of Statutory Health Insurance Dentists (KZV)
• Data protection authorities of the federal states

Statutory health insurance providers and private health insurance companies

The statutory health insurance providers are obligated, especially in the case of treatment errors and compensation claims, to support their insured persons in complaints procedures. They also help with complaints about prescriptions for medicines, remedies and aids, referrals or medical certificates for sick leave.

Private health insurance companies can also support their insured persons under certain conditions. You will get information about this from your private health insurance company.

The contact addresses of the statutory health insurance providers can be found on the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) website.

The contact addresses of the private health insurance companies can be found on the National Association of Private Health Insurance (Verband der Privaten Krankenversicherung) website.

State Chamber of Physicians

The State Chamber of Physicians where the practice or hospital is located is responsible for complaints against a doctor. If patients or relatives suspect medical malpractice, they also have the option of contacting the arbitration board in the respective State Chamber of Physicians. They should make it easier for those involved to settle such disputes out of court.

The contact addresses of the state chambers of physicians can be found on the German Medical Association website.

Chamber of Psychotherapists

Complaints against a psychotherapist can also be submitted to a Chamber of Psychotherapists. But any complaints against medical psychotherapists are to be addressed to the Chamber of Physicians.

The contact addresses of the State Chambers of Psychotherapists can be found on the Federal Chamber of Psychotherapists website.

Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen – KV)

Doctors who want to treat people with statutory health insurance need approval as a doctor affiliated with the statutory health care system or authorization. In doing so, they are entering into certain contractually defined obligations. If a doctor violates these, complaints can be filed with the local Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung). The same applies if psychotherapists do not comply with their duties in connection with their affiliation to the statutory health care system.

Reasons for a complaint are for example if treatment is refused without sufficient reason or a necessary home visit is declined.

The contact addresses of the Associations of Statutory Health Insurance Physicians can be found on the National Association of Statutory Health Insurance Physicians website.

Chamber of Dentists (Zahnärztekammer) or Association of Statutory Health Insurance Dentists (Kassenzahnärztliche Vereinigung)

If your complaint is about a dentist there are a number of different contact points. If you suspect medical malpractice, the health insurance companies or the arbitration boards of the Association of Statutory Health Insurance Dentists and the Chamber of Dentists in the relevant federal state are the correct points of contact. The health insurance provider is responsible for complaints about defective dentures.

The contact addresses of the arbitration boards can be found on a joint advice portal of the Federal Dental Association and the National Association of Statutory Health Insurance Dentists website.

Data protection authorities of the federal states

The supervisory authorities of the federal states for data protection are the right points of contact for complaints about unauthorized data processing and data misuse.

The contact addresses of the state data protection authorities can be found on the Data Protection Conference website.

Hospitals must set up complaints departments that can be easily contacted. They are obligated to inform the patients about these options and process complaints quickly and transparently.

In most hospitals there are patient advocates, also called ombudsperson. As independent and usually volunteer contact persons, they communicate the complaints and concerns of patients to the responsible departments of the hospital.

Complaints about deficiencies in the hospital can also be addressed to the statutory health insurance providers, for example staff shortages or lack of hygiene.

Since hospitals are under state supervision, it is also possible to complain to the competent supervisory authority. This is normally found in the Health Ministry of the federal state you are in. But this option is more suitable for complaints about evidence of significant fundamental deficiencies in a hospital than complaints about an individual issue.

Since doctors employed in hospitals are also members of the Chamber of Physicians, you can also contact the relevant Chamber with your complaint.

A complaint must be made in writing. Please make sure it contains the following information:

• your full name and address
• the full name and address of the doctor about whom you wish to complain
• a factual description of the case that is as accurate as possible and why you are complaining (Who? When? Where? How?)
• any copies of documents of significance to the complaint

The complaints offices will also ask you to release the doctor or other people involved in the treatment from the obligation to maintain confidentiality, also known as authorization for release of medical information. Only with this permission can they ask the doctor for comments.

If the complaints offices find that the complaint is justified, they will take sanctioning measures and, for example, issue a reprimand. In the event of serious violations, a trial for professional misconduct can be initiated or their authorization as a statutory health physician be withdrawn, among other things.

The process used for the complaints and arbitration procedures will depend on the specifications of the respective complaints office. You can obtain information about the exact process from advice centers or the institution where you file the complaint.