[What went wrong? Analysis of Medical Malpractice Arbitration Proceedings Conducted by a German Arbitration Board after Breast Reductions].
BACKGROUND
The Arbitration Board for Medical Liability Issues of the Medical Association of North Germany ("Norddeutsche Schlichtungsstelle") is responsible for 10 federal states in Germany (Berlin, Brandenburg, Bremen, Hamburg, Mecklenburg-Western Pomerania, Lower Saxony, Saarland, Saxony-Anhalt, Schleswig-Holstein and Thuringia) and is the largest arbitration board in Germany. The data available from the Norddeutsche Schlichtungsstelle provides an insight into sources of malpractice during the treatment of reduction mammoplasty.


METHODS
We analysed patient request, expert opinions prepared by independent physicians on behalf of the Norddeutsche Schlichtungsstelle and the final verdicts of 88 arbitration proceedings after breast reduction mammoplasties performed between 2000 and 2007. This data allows for each case to be addressed from different viewpoints. Furthermore we analysed the statistical data entered into the Medical Error Reporting System by the arbitration board.


RESULTS
Among the 88 patient requests after reduction mammoplasty, the arbitration board found a causal relationship between damage caused to a patient's health and medical malpractice in 37 cases. Therefore, 42% of requests resulted in a liability case. This is a higher rate than that of general arbitration proceedings, where only in 24% of all cases a causal relationship is confirmed by the Norddeutsche Schlichtungsstelle. Most patients were operated on by gynaecologists. In 92% of liability cases, mistakes happened during the planning and the performance of the surgical procedure, mainly during planning (65%) and surgical incisions (41%). The patients mainly complained about scars (78%), asymmetry (68%) and skin necrosis of the areola (24%). Financial disadvantage was mentioned less often (46%) than psychological stress (70%).


CONCLUSIONS
The higher rate of liability claims may be due to the fact the surgical procedures changing the shape of breasts are more complex than generally expected. Not only the surgery itself, but also the adequate planning and aftercare are of predominant importance for patient satisfaction. All these factors lead to the relatively high rate of medical malpractice in plastic aesthetic breast surgery. Also the communication factor should not be underestimated.
Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln Pyrmont, Hameln.
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Allert
Lungenklinik, Ev. Lungenklinik Berlin Buch, Berlin.
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Flechtner
Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Hannover.
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Vogt
Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie, Sana Klinikum Hameln Pyrmont, Hameln.
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Herold
D000328:Adult; D002983:Clinical Competence / Q000331:legislation & jurisprudence; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D005260:Female; D005858:Germany; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D016462:Mammaplasty / Q000331:legislation & jurisprudence*; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D017008:Negotiating; D012086:Reoperation; D013043:Specialties, Surgical / Q000331:legislation & jurisprudence