Malpractice in the Diagnosis and Treatment of the Slipped Capital Femoral Epiphysis Experience of Arbitration Offices (Schlichtungsstelle) of the Northern German Medical Boards (Arztekammern)

Introduction: Expert commissions (Gutachter-kommissionen) and arbitration offices (Schlichtungsstellen) in Germany are expert panels for the extrajudical resolution of malpractice claims. The performance of arbitration panel proceedings ("Schlichtungsverfahren") is based on the German medical and insurance jurisdiction. Method: 39 arbitration panel proceedings concerning supposed malpractice in the diagnosis and treatment of slipped capital femoral epiphysis were evaluated in regard to the involved clinics and physicians and, respectively, the medical specialties, type of slippage (acute or chronic), malpractice and the disabilities caused by malpractice. Results: In 28 cases (72%) the malpractice was confirmed, the average of confirmed failures in all proceedings being about 30%. The failures could be classified as misdiagnosis followed by inadequate treatment and failures in operative treatment. Minor and moderate permanent disabilities due to malpractice remained in 8 cases, severe permanent disability resulted in 14 cases due to osteonecrosis of the femoral head. Discussion: The results are discussed with regard to the avoidance of mistakes in diagnosis and treatment and the problems of medical assessment.