Healthcare Complaints about medical treatment

If patients feel that they have received poor or incorrect treatment or believe that their doctor has breached medical duties, they have the right to make a complaint.

Reasons for a complaint can include:

• insufficient information received from the doctor
• medical malpractice (treatment errors)
• inadequate medical care
• violation of their duties in connection with their affiliation to the statutory health care system
• violation of patient rights
• data misuse in a practice or clinic
• violations of hygiene regulations
• unreasonable waiting times, for example long waiting times in the event of a medical emergency

It is advisable for patients to try and talk to their doctor first, for instance to clear up potential misunderstandings.

If the dispute cannot be resolved through a conversation, there are various official complaint options open to patients. On the one hand, there are several institutions that provide advice on legal options, including in individual cases. On the other, patients can contact an official complaints office with their concern and receive support from this within the scope of a complaints procedure. This applies to both those with statutory and private insurance.

The advice and support received in relation to a complaint are usually 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.

If expert opinions have to be obtained, this can, however, be associated with costs. The arbitration procedure for complaints about dental treatment via the 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: 

The Independent Patient Advice Service for Germany (Stiftung Unabhängige Patientenberatung Deutschland – UPD) offers free, independent, quality assured and confidential advice on matters relating to healthcare and healthcare legislation. 

Statutory health insurance funds and private health insurance companies can be a good first port of call, especially in the case of suspected medical malpractice. Their patient service teams will provide you with information about how to proceed and help you clear up any questions relating to organizational matters or insurance law.

The Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen – KV) can help with problems relating to outpatient medical treatment. 

Patient advice centers of Dental Associations and Associations of Statutory Health Insurance Dentists (Kassenzahnärztliche Vereinigungen – KZV) provide advice on complaints about dental treatment. 

The federal state data protection authorities are responsible for questions relating to the handling of personal medical data. 

The consumer advice centers provide information and advice, especially about patient rights and billing matters.

Some federal states such as Bavaria, Berlin, Lower Saxony and North Rhine-Westphalia also have state government patient representatives who act as additional points of contact for patients.

Self-help organizations can also offer valuable support and experience. 

If patients wish to file a complaint, they can contact specific complaints offices. These independently review the matter and take action if necessary or forward the case to the responsible body.

If there are any claims for compensation, some complaints officers help to resolve the concerns and claims through arbitration hearings if possible. This aims to avoid legal proceedings, which are usually associated with high costs and can take a long time. If this is not possible, the complaints offices can help patients to prepare for legal proceedings, for example by helping them gather evidence to prove medical misconduct. 

The right point of contact differs depending on the nature of your complaint.

The following can all be potential points of contact:

• Statutory health insurance funds or private health insurance companies
• 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 funds and private health insurance companies

The statutory health insurance funds are obligated, especially in the case of treatment errors and compensation claims, to support their insured persons in complaints procedures. They also provide assistance in the case of complaints relating to the following areas:

• prescriptions for medication, therapeutic services and medical aids
• referrals
• sick notes

Under certain conditions, private health insurance companies can also support people who are insured with them. Information can be obtained from these companies directly.

The contact addresses of the statutory health insurance funds 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 relating to violations of medical duties. Examples of such violations include:

• insufficient information
• breaches of the duty of confidentiality
• refusal to allow patients to view their own treatment documents

If patients or relatives suspect medical malpractice, they can also contact the arbitration board in the respective Chamber of Physicians. This should make it easier for those involved to settle such disputes out of court. 

The contact addresses for the Chambers of Physicians can be found on the German Medical Association website.

Chamber of Psychotherapists

Complaints against a psychological psychotherapist can be submitted to a Chamber of Psychotherapists. However, any complaints against medical psychotherapists must be addressed to the relevant Chamber of Physicians.

The contact addresses for 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 provide outpatient treatment to people with statutory health insurance need approval as a doctor affiliated with the statutory health care system or special 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 fund 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 federal state supervisory authorities 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 funds, 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 about medical treatment.

In many cases, you can initially submit complaints verbally, for example by telephone or in a face-to-face consultation with the employees of a complaints office. For your matter to be officially reviewed, however, most offices require a written complaint.

Complaints should contain 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 grounds for your complaint that is as accurate as possible (who? When? Where? How?)
• any copies of documents of significance to the complaint

The complaints offices will usually also ask you to release the doctor or other people involved in the treatment from the obligation to maintain confidentiality. Only with this permission can they ask the doctor for comments. 

If a complaints office reviews a complaint and regards it to be justified, it can take action independently providing it is authorized to do so. If not, it will forward the complaint to the responsible office, which can impose official sanctions, such as a reprimand or a fine. In the event of serious violations, a trial for professional misconduct can be initiated or the authorization as a statutory health physician can be withdrawn, among other things.