Within the bounds of the hospitalization contract and the department's work, the hospital management is liable for compensation for its own as well as its staff's culpable faults (liability of the accomplices) by contract and by offense. For the same damage, subordinate and senior physicians are liable by offense for malpractice and organization faults. To the outside, the hospital management and the medical staff are common debtors. To the inside, the hospital management bears the consequences by itself in case of a light negligence of a staff member, the damage is divided for medium negligence, and the staff member has to bear it alone after severe negligence. Beside the hospital, the physician with an authorization for billing is the contract partner of the patient with private treatment (physician side-contract). In a general practitioner hospital, the contract partner of the patient is only the general practitioner (divided hospitalization contract) and for work with outside-patients as a sideline the physician with an authorization for billing. Usually, the hospital management insures itself and all staff members for claims on compensation occurring during hospital tasks.

Ambulatory Care↗

PubMed1994

[Obstetric peridural anesthesia with sufentanil. Is it contraindicated?].

The advantages of the addition of low-dose sufentanil to local anaesthetics in epidural analgesia during labour (improvement of analgesia, reduction of total dose of local anaesthetic, reduction of rate of instrumental delivery outweigh) far the disadvantages (pruritus, sedation, potential maternal and neonatal respiratory depression). In over 8000 cases, the addition of incremental sufentanil (7.5 micrograms) up to 30 micrograms has not caused any negative effects on newborns, and hence, the addition of sufentanil is justified; it may even be indicated. Sufentanil has not yet been registered for epidural analgesia in Germany, in contrast to other countries. In considering whether this fact may prohibit its use, two aspects should be discussed: therapy and clinical experiments. The difference lies in the purpose rather than in the method of administration. Ethical and legal requirements for clinical tests are anchored in the declaration of Helsinki and the code of the medical profession. The legal background for therapy is represented in the proviso of the German Civil and Criminal Codes as well as the code of conduct on professional liability of the physician. Pain during labour is no absolute indication for the addition of sufentanil, but there are considerable arguments for its superiority in comparison to other standard procedures: the side effects and complications are very limited. Justification of this method is relatively easy in view of the fact that sufentanil has already been registered for peridural analgesia in obstetrics in many other countries. Last but not least, the patient must give informed consent before any procedure can be performed.

Adult↗

PubMed1994