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The X Virus Case—Leeway for Contractual Steering of Hospital Treatment

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Abstract

The regulatory framework governing the treatment of patients in hospitals is quite complex and differs significantly from other industries insofar as the patient and the hospital have very limited influence over the design or the outcomes of the relationship between them. Through five different cases, the reader will be confronted with the questions whether the patient-hospital relationship can be qualified as a contractual relationship and whether it shows contractual elements, both allowing the parties to influence treatment and hospital stay. Furthermore, the reader will be familiarized with the unique aspects of patient consent, the patient/proxy-payor-provider constellation and bioethical principles that encompass the treatment from patient admission to patient discharge. The case study suggests that, although the CM Approach may not be suitable for steering the entire hospital stay of an individual patient, some of its elements can nevertheless be useful to highlight the possibilities for a compliant and efficient handling of the patient-hospital relationship.

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Notes

  1. 1.

    For further reading (see [34] [35]).

  2. 2.

    For Germany, cf. [49].

  3. 3.

    For the United States, cf. Schloendorff v. Society of New York Hospital, in which the court held that “[…] a surgeon who performs an operation without his patient’s consent commits an assault for which he is liable in damages” [50].

  4. 4.

    [36]: Here, a cancer patient undergoing radiation therapy was not informed about the long-term side effects of treatment, as the physicians claimed that providing such information would cause undue psychological distress to her.

  5. 5.

    In this case, a patient was nearly paralyzed in the course of treatment against back pain but was not informed about this risk by the defendant physician prior to the laminectomy procedure. For more details, please see http://www.lawandbioethics.com/demo/Main/LegalResources/C5/Canterbury.htm.

  6. 6.

    The concept of physician self-incrimination is detailed in §630c II (2) BGB.

  7. 7.

    According to §263 StGB, “[…]maintaining an error by pretending false facts or by distorting or suppressing true facts shall be liable to imprisonment not exceeding five years or a fine.” Even the attempt is punishable.

  8. 8.

    Examples of negotiable treatment details could of course be the approximate date of when the procedure is to be initiated, optional ancillary hospital services like accommodation or translation services, or—if medically permissible—the question between local anesthesia or full sedation.

  9. 9.

    §13 IV SGB V allows publicly insured patients to seek medical treatment at an accredited institution within the European Economic Area and Switzerland, but limits monetary reimbursement only to the equivalent that would be payable in Germany.

  10. 10.

    For more information, see https://thieme-compliance.de/en/access-to-e-consentpro-software/.

  11. 11.

    Original term: Gespaltener Krankenhausaufnahmevertrag. Within the AVB, a contract draft concerning patients treated by an attending physician is provided (cf. [9], pp. 10–16).

  12. 12.

    Original term: Totaler Krankenhausaufnahmevertrag.

  13. 13.

    cf. [22], pp. 195–199. The patient information disclosure notification is mandated according to §39 Ia (9) SGB V.

  14. 14.

    In the United States, the Supreme Court case of Cruzan v. Director, Missouri Department of Health established the right to refuse treatment in 1990 [44].

  15. 15.

    cf. Article 3—Right to integrity of the person in the EU Charter of Fundamental Rights.

  16. 16.

    The German term ärtzliche Weisungsfreiheit, or ‘physician’s freedom from directive’ is perhaps a more fitting description for the occupational freedom from constraints. The concept is also mirrored in §1 II of the German Federal Medical Practitioner’s Act (Bundesärzteordnung (BÄO)).

  17. 17.

    Essentially, the patient may officially file protest at the association-level ombudsperson, as depicted in Fig. 10.4.

  18. 18.

    According to §1 I (4) FPV, a transfer constitutes a discharge from the sending hospital and an admission by the receiving hospital within 24 h.

  19. 19.

    In many countries, procedural guidelines, such as the Canadian Joint Statement on Resuscitative Intervention exist to determine who should be involved in such a decision.

  20. 20.

    While in Germany a database for patient declarations of intent does exist with the Federal Notary Chamber (Bundesnotarkammer), there are no legal obligations for physicians to consult these (cf. [29], pp. 66–67).

  21. 21.

    For the US Supreme Court Case on such a scenario (see [44]).

  22. 22.

    For a timeline listing of recent euthanasia legalization in various countries, please see https://euthanasia.procon.org/view.timeline.php?timelineID=000022#2000-present.

  23. 23.

    cf. §3 (7) Rahmenvertrag Entlassmanagement.

  24. 24.

    In several US states, the median annual cost for a single bedroom in an assisted living facility exceeds $70,000 per annum (cf. [30]). In Germany, even at the maximum care level, the co-payment of an average patient exceeds that of the basic long-term insurance plan (cf. [11]).

  25. 25.

    Rahmenvertrag über ein Entlassmanagement beim Übergang in die Versorgung nach Krankenhausbehandlung nach §39 Abs. 1a S.9 SGB V, Az. BSA-Ä 1–16.

  26. 26.

    GKV-Spitzenverband (Spitzenverband Bund der Krankenkassen),https://www.gkv-spitzenverband.de/ english/english.jsp.

  27. 27.

    Kassenärztliche Bundesvereinigung (KBV),http://www.kbv.de/html/about_us.php.

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Authors and Affiliations

  1. SRH Hochschule Berlin, Berlin, Germany

    Frank Wittig

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  1. Ernst-Abbe-Hochschule Jena, Jena, Germany

    Ralph Schuhmann

  2. Contractual Management Institute Berlin, SRH Hochschule Berlin, Berlin, Germany

    Bert Eichhorn

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Wittig, F. (2020). The X Virus Case—Leeway for Contractual Steering of Hospital Treatment. In: Schuhmann, R., Eichhorn, B. (eds) Contractual Management. Springer Vieweg, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58482-8_10

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