Have doctors been obliged to serve in nursing homes?

In Wrzburg, doctors are said to have been obliged to work in nursing facilities rather than in their practices. This is causing harsh criticism.

The National Association of Statutory Health Insurance Physicians (KBV) is heavily criticized for the city of Wrzburg. The KBV claims on its website that the city administration has assigned contract doctors to certain nursing facilities in order to secure general medical care there in the Corona crisis. In the context, the association refers to this as an “obligation”. The authorities compelled doctors to “more or less abandon their patients in order to take care of people in a nursing home with immediate effect who they don’t know and who, conversely, don’t know the doctors”.

Have doctors been assigned to homes?

The city, district and health department of Wrzburg, in coordination with the Bavarian Ministry of Health, have issued a rule that has been in effect since April 1, town hall spokeswoman Claudia Lother confirms when asked by this editorial team. Since then, the rule of thumb is that only a few, selected doctors provide care for residents in homes. “The goal is to reduce the total number of contacts from outside into the care facilities,” said Lother. Two decrees were created for this purpose: Firstly, the general practitioners who currently care for most or many patients in a home are declared responsible for this facility. Secondly, all other doctors are prohibited from accessing these facilities. The emergency medical service, emergency medical care and specialized doctors are excluded.

Is such an order legally correct?

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The basis for the disposition are the Bavarian Disaster Protection Act (BayKSG), the Bavarian Administrative Procedure Act and the Infection Protection Act. In the BayKSG, for example, it says in Article 9: “The civil protection authority can demand the provision of services, material and work services and dispose of things to order to ward off disasters.” The KBV describes the legal basis as questionable.

How many doctors are there?

The city informs that a total of around 40 general practitioners have been ordered to care in the Wrzburg nursing homes. The division of general practitioners is carried out by the supply physicians who advise the disaster management leadership group in the city of Wrzburg and the district office in Wrzburg.

How does the family doctor association in Lower Franconia assess the situation?

Dr. Christian Pfeiffer, district chairman of the family doctor association, knows the criticism. He is of the opinion that communication with the doctors sometimes “went wrong”. Pfeiffer explains this above all with the situation-related compulsion to act, which required a quick decision on this availability. “You actually have to try to take the doctors with you,” Pfeiffer told the editorial team. That worked less well on the urban side than on the district side, he says. As Pfeiffer confirmed, there was an additional letter in the district in which District Administrator Eberhard Nu informed about the necessity of the measure. The press office of the Wrzburg town hall emphasized that there had also been a letter from the official, Wolfgang Kleiner.

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How does an affected doctor feel about the situation?

“It’s been going well so far. The old people’s home supports us in everything,” says Dr. Wynfrith Batzner, who has been responsible for all patients of the Juliusspital Seniorenstift together with two colleagues since the beginning of April. Before that, he looked after around 70 patients in this home and was given so many more overnight. “It was a challenge,” said Batzner. He had to spend at least half an hour preparing each patient’s medical records. “It was a stroke of luck that I had vacation before, even if I had imagined it differently.” The general practitioner would also have hoped for better communication between the authorities: He received the last letter of this kind from the Bundeswehr about 40 years ago for his sample. “I don’t want to reproach anyone. But a nice cover letter would have been nice.”

How do doctors work in their new role?

The KBV speaks of a seven-day week for the doctors. The service period is 14 hours on five days and eleven hours on two days. The city contradicts: “There are no working hours, but rather a telephone on call from 8 a.m. to 10 p.m. during the week and from 9 a.m. to 8 p.m. on weekends,” said spokeswoman Lother. In addition, not only a family doctor is assigned for this time with on-call service, but at least two practices or community communities with several doctors each share these times. At the weekends, the obligated doctors can combine their availability by telephone. “This merger should include a maximum of four facilities and a maximum of eight doctors,” said the town hall spokeswoman.

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It is criticized that the city “ordered” doctors without protective material. Is that correct?

Claudia Lother cannot understand this accusation. According to the town hall spokeswoman, the doctors who are responsible for the care receive protective equipment from the respective care facility and can request protective material from the civil protection authority if required. The doctors are informed about this. The general medical care in the respective doctor’s office also remains unaffected. In group practices, the medical doctor who is in charge of a nursing facility is taken on by the medical colleagues. In individual practices, the representation is regulated according to the general rules of representation (similar to vacationing for general practitioners).

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