Whistleblowing in healthcare is a crucial mechanism for maintaining the integrity and safety of healthcare services. It involves healthcare professionals raising concerns about unsafe practices, misconduct, or ethical violations within their organization. The importance of whistleblowing in healthcare cannot be overstated, as it directly impacts patient safety, the quality of care, and the overall trust in healthcare systems. In this article, we will explore the significance of whistleblowing in healthcare, the challenges faced by whistleblowers, and the measures that can support and protect them.
Whistleblowing in healthcare serves as a vital safeguard against practices that could endanger patient health or violate ethical standards. It empowers healthcare workers to speak up about issues that may not be visible to management or outside regulators. By identifying and addressing these issues early, whistleblowing can prevent harm to patients and avoid larger systemic failures. Furthermore, whistleblowing contributes to a culture of transparency and accountability in healthcare settings, which is essential for continuous improvement in patient care.
“As a member of the medical profession, I solemnly pledge to devote my life to the service of humanity. The health and well-being of my patient will be my primary concern…” reads the Pledge for Medical Doctors.
But there are also black sheep among doctors.
In recent years, cases of massive violations in doctors’ offices, clinics and care facilities have become known. But when children are involved, the case gets under the skin.
In various doctor’s offices, children were injected with saline solution instead of the approved vaccine. The following case was uncovered by a whistleblower.
In December 2022, a 64-year-old doctor in the district of Gifhorn, Lower Saxony was charged with 34 counts of assault, 85 counts of issuing incorrect health certificates, and six counts of joint commercial fraud by the Hildesheim public prosecutor’s office. He had injected the children and young people instead of the mumps, measles and rubella vaccination, saline solution. His 58-year-old colleague was an accomplice. As a result, the children had suffered unnecessary pain, the prosecution said.
The “fake” vaccinations are said to have been billed to health insurers, according to the September 9, 2022, “Zukunftspakt” Pharmacy. This had caused damage in the low four-digit range. After an anonymous whistleblower had set the investigations rolling, evidence was seized during raids. A blood test on those affected showed that they had no antibodies in their blood, as would be the case after a regular vaccination.
The “Redaktionsnetzwerk Deutschland” also reported that the doctor is said to have acted in consultation with the respective parents. This expands the circle of possible whistleblowers to over 80.
A year earlier, “Der Spiegel” (The German Mirror) reported on a 72-year-old general medical doctor in Bavaria who both issued false vaccination certificates and injected saline solutions instead of COVID vaccine to more than 200 patients. How the violations came to light was not mentioned in the report.
With the Corona pandemic, new channels for fraud and corruption emerged. In January 2023, a case was reported from Recklinghausen. Between June 2021 and January 2022, vaccination opponents had gone to a doctor who had certified false Corona vaccinations. To prevent the children from leaking, the doctor allegedly injected them with saline solution. The doctor was accused of more than 589 cases. His wife and doctor’s assistant had assisted him.
The case of the employee of a vaccination centre in Schortens, Lower Saxony, is similar. She allegedly diluted the vaccine in at least 15 people with saline solution because she was against the Corona measures. The authorities called on more than 10,000 potentially affected people to have a third or even fourth vaccination at the time as a precautionary measure. After the incident came to light, the district administrator ordered the four-eyes principle for drawing up the syringes.
A doctor from Garmisch-Patenkirchen was sentenced in August 2022 to two years without probation and to three years of disbarment. She had issued false mask exemption certificates in 309 cases and enriched herself through a donation account, according to t-online news. Her husband was known from the Reichsbürger scene, a right-wing radical group.
A doctor from Saxony is currently on trial. She is said to have issued false Corona attests on a large scale. Customers from Brandenburg are also said to have used them, the MOZ reported on 7 April 2023. Since the beginning of the pandemic, the 66-year-old is said to have issued 162 “courtesy certificates” to her patients, thereby earning EUR 12,500, according to a report by t-online.
An employee of a pharmacy in Munich had forged over 1,000 vaccination certificates. Her accomplice then sold the documents on the darknet and made over 130,000 EUR. She was sentenced to three years’ imprisonment and he to four years.
In Bavaria, there were about 6,000 preliminary proceedings for forged vaccination certificates, according to the Süddeutsche report in January 2023.
“Patients who feel they have been treated badly or incorrectly, or assume that their doctor has violated medical obligations, have the right to complain.” says the Federal Ministry of Health’s page on complaints.
There, various bodies are listed that patients can use as a contact point for their complaint. For example, the health insurance funds or the Association of Statutory Health Insurance Physicians (KV). The Patients’ Rights Act is the basis for this.
The Association of Statutory Health Insurance Physicians in turn refers to the health insurance funds as the first point of contact on its website. Further possibilities are complaints by telephone or by email. Anonymous complaint options have not been created.
Many medical practices or medical care centres still do not have an anonymous reporting point for patients or staff. A research at several large hospitals showed that only e-mail addresses or own feedback or opinion forms are provided, which do not guarantee anonymity. The user rather gets the impression that the pages were created for quality management. It is not made clear to the user that information about irregularities or suspicions of violations of the law or even criminal offences can also be reported.
In addition, there are use cases where a confidential patient complaints office is not sufficient. What happens, for example, if the patients are children and cannot exercise their rights themselves, or if even the parents have a hand in the alleged assault? What happens if the patients do not suspect anything about what the treating doctor has done? In such cases, only “insiders” can provide clarification or at least report a suspicion, such as employees of the doctors’ practices or relatives of those affected. In the past, anonymous whistleblowers have often set the ball rolling. It is therefore all the more important that anonymous reporting points are also created at the complaints offices.
The Whistleblower Protection Act will oblige practices, medical centres and hospitals with more than 50 employees to set up a reporting office from December 2023. If the law comes into force before December, different regulations could apply.
However, the majority of medical practices are excluded due to the small number of employees. According to the Federal Statistical Office, there were a total of 64,754 medical practices across Germany in 2019. The Association of Statutory Health Insurance Physicians, on the other hand, speaks of 99,658 practices employing around 330 thousand medical assistants and thus an average of 3.3 per practice.
According to Prof. Dr. Thomas Jaeschke, CEO of Dr. Jaeschke AG and an expert for whistleblowing in the healthcare sector, an anonymous whistleblowing system in a medical practice or a medical centre is an indispensable tool for risk and quality management. It enables the early detection and correction of violations, errors and grievances before they can lead to major problems. It thus contributes to the continuous improvement of the quality of care and medical services as well as to minimising potential liability risks.
It can be assumed that doctors as perpetrators have no vested interest in clearing up (anonymous) reports that concern their own practice. In order to close the glaring gap, further adjustments to the law are needed. For example, the Association of Statutory Health Insurance Physicians and the health insurance funds could be obliged to set up anonymous reporting offices and to publish an annual report on the clarification of reports.
Despite its importance, whistleblowing in healthcare is fraught with challenges. Many healthcare professionals who consider whistleblowing fear retaliation, such as job loss, ostracization by colleagues, or legal action. These fears can discourage individuals from coming forward, allowing unsafe or unethical practices to continue unchecked. Additionally, the process of whistleblowing can be complex and unclear, leaving potential whistleblowers uncertain about whom to approach and how to report their concerns effectively.
To encourage whistleblowing in healthcare, it is essential to establish strong support systems and protections for whistleblowers. This includes creating clear and accessible reporting channels, ensuring confidentiality for those who raise concerns, and implementing strict non-retaliation policies. Healthcare organizations should also foster a culture that values openness and transparency, where staff feel empowered and safe to speak up about any concerns.
Training and education are equally important in promoting whistleblowing in healthcare. Healthcare professionals should be educated about the importance of whistleblowing, how to identify issues that should be reported, and the processes for reporting them. By demystifying whistleblowing and emphasizing its role in safeguarding patient care, healthcare organizations can encourage more individuals to come forward with their concerns.
Whistleblowing in healthcare is a critical component of maintaining the safety, integrity, and quality of healthcare services. By enabling healthcare professionals to report unethical or unsafe practices, whistleblowing helps protect patients and ensures that healthcare organizations operate at the highest ethical standards. However, to fully realize the benefits of whistleblowing, it is crucial to support and protect those who have the courage to speak up. Through implementing robust protections, fostering a culture of transparency, and providing education on whistleblowing, healthcare organizations can create an environment where raising concerns is not only encouraged but celebrated as a key part of patient care excellence.
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