Doctors give themselves vaccines

No corona vaccinations in private practices : Some doctors vaccinate “illegally” - and still have a clear conscience

Reza S. doesn't have a guilty conscience. On the contrary. “We paediatricians,” he says, “have a lot of experience with vaccination.” And the 68-year-old also has a lot of professional experience. Since 1989 he has not only treated young patients, but sees himself as a “family doctor”. Nevertheless, the Iranian-born doctor from the Hessian would prefer not to have his real name mentioned here.

Because Reza S. - with the help of a pharmacist friend - violated the regulations. In the past two weeks, he has vaccinated more than 100 of his partially seriously ill patients against corona. And that despite the fact that he gave up his seat at the cash register six years ago and only practices as a private doctor.

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In fact, the Federal Ministry of Health (BMG) had ordered pharmacies in a general decree of March 31st to “dispense vaccines against COVID-19 exclusively to medical practices participating in contract medical care”.

[Do you have any questions about vaccination against the coronavirus? We answer them: Tagesspiegel Live on April 22nd]

The reason for the exclusion of private physicians was limited delivery quantities, as a BMG spokesman confirmed on request. “Pharmacies should only accept orders from contract doctor practices that supply them with medical supplies.” Only in the next step should “all doctors, especially those who work as private outpatients, who can obtain vaccines from pharmacies”. Uncertain timing.

Lawyer sees violation of the principle of equality

The Federal Association of Private Doctors (PBV) sees this regulation, which incidentally is subject to fines, not only its members, but also their patients "massively disadvantaged". And a private doctor in Berlin is already defending himself legally. Michael Oppel - according to his website concentrating on "health checks, holistic orthopedics and integrative medicine as well as sports medicine and general practitioner medicine for acute and chronic illnesses and injuries" - requests in an urgent application to the Berlin administrative court to be equated in the vaccination campaign with contract doctors and his patients to be allowed to vaccinate as well.

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According to his own statements, he had already ordered vaccines and ordered patients to be vaccinated when his pharmacy informed him that it would not work that way. According to his lawyer Frank Lansnicker, the regulation came as a surprise. Before that, the federal government had never spoken of the exclusion of private general practitioners from vaccinating.

It constitutes "a blatant violation of the principle of equality if private general practitioners are to be removed from the right to provide services," says Lansnicker's urgent application to the Berlin Administrative Court, which is available to the Tagesspiegel Background (Az: VG 14 L 161/21) . “There is no objective reason for the unequal treatment. In addition, the limitation to the statutory health insurance physicians is incomprehensible when it comes to the fact that as many patients as possible should be vaccinated as quickly as possible, which has obviously not been achieved in the vaccination centers so far. "

Dangerous delay for the seriously ill?

Apparently, the judges see it similarly - at least at the Cologne Administrative Court, which is responsible for another proceeding against the Federal Republic of Germany in the same matter. In a letter dated April 15, which is also available in the background, the chamber can see "currently no decisive reasons" for the different treatment of private doctors. The federal government will now be asked to comment on it.

Oppel himself declares in his urgent application that he finds it “unethical and against the professional code to have to follow instructions that do not correspond to my tasks to help my patients entrusted to me”. He also treats many elderly and seriously ill people with a high risk of infection in his practice.

If the latter are under 60, they “now have to wait until the beginning of June for a vaccination at the vaccination center with Biontech or Moderna, with the greatest risk to life and limb, due to the ban on receiving AstraZeneca vaccinations”. After all, vaccinations in other general practitioners' practices are currently "more than unlikely" due to a lack of patient information and the requirement not to vaccinate non-practice patients.

The pediatrician Reza S. also feels discriminated against and hindered in the performance of his medical duties. “You pretend that we private doctors are just a kind of wellness doctor,” he complains. He also said that he had patients in his small town in West Germany who - because they were bedridden or at particular risk due to previous transplantation or chemotherapy - could not simply be sent to a vaccination center.

This is one of the reasons why he disregarded the guidelines and started vaccinating on his own initiative. That was in the middle of his Easter vacation. On the first day, he said he was in the practice until half past nine in the evening, and managed more than 50 patients. And as long as his pharmacist supplies him with vaccines contrary to the regulation, he wants to continue with them. Simply out of a sense of duty and “without a cent fee”, as he emphasizes.

In fact, the number of private doctors and patients excluded by the regulation is manageable. According to the PBV, there are only about 15,000 privately practicing physicians in Germany, and about half want to take part in the corona vaccinations. It is not known how many of them work as general practitioners. And the association also has to fit with the number of patients who are cared for by private physicians alone.

Problems with authentication and data transfer

The PBV had already prepared a complaint, said a spokeswoman. But they are still waiting because the ministry is now showing itself to be cooperative. "Mr. Spahn informed us that he welcomes and supports vaccinations against COVID-19 in private practices." According to reports, there are mainly problems with the secure authentication of participating medical practices and their data transfer. Solutions still have to be found here.

Protest also came from the Hartmannbund. The head of the North Rhine Regional Association, Stefan Schröter, said there was “no justifiable substantive reason” for excluding private medical colleagues from expanding vaccination options. In order to be able to vaccinate the population as quickly as possible, the vaccination campaign must be supported on the broadest possible shoulders. It is "in everyone's interest to create as many low-threshold opportunities as possible to receive the vaccination".

Even the Association of Private Health Insurance (PKV) is not happy about the exclusion of private doctors. "We support the concern that private doctors are involved in the vaccination campaign of resident doctors on an equal footing, especially when they act as general practitioners for those with private insurance," said association spokesman Stefan Reker of the Tagesspiegel Background. The common goal should be "that with the increasing availability of vaccines as many doctors as possible can vaccinate patients". It is true that chronically ill privately insured persons could “easily turn to any contract doctor practice”. If possible, patients should "be able to be looked after by their trusted general practitioners and specialists" during the corona vaccination.

Health Minister Jens Spahn (CDU) had already argued that there was not enough vaccine when the private health insurance association wanted company doctors to be included in the vaccination campaign. The infrastructure of the company doctors is "particularly well suited to reaching many people in a short time," emphasized the PKV association director Florian Reuther. The association had "already received numerous inquiries from health insurance companies whose company doctors are immediately available to vaccinate the workforce - but are unfortunately not yet allowed to order a vaccine". Now company doctors should be allowed to vaccinate from June, as Health Minister Jens Spahn announced on Monday.

Ministry of Health refers to model projects

Overall, “a rapid further development of the vaccination campaign and thus a greater involvement of private medical practices in the future can be assumed,” the BMG spokesman assured the Tagesspiegel Background. Until then, they and company doctors could "already carry out vaccinations against the coronavirus SARS-CoV-2 as part of model projects". The prerequisite for this, however, is "that they are provided with vaccines by the federal government or a state".

According to the National Association of Statutory Health Insurance Physicians (KBV), the vaccination campaign is picking up speed even without private and company doctors. Last Thursday, a new daily record was reached with around 739,000 vaccinations. And this week, according to the KBV, 55,000 general practitioners are taking part in the vaccination campaign. That is 10,000 more than in the previous week "and even 20,000 more than at the start".

In addition, the BMG gave the promise that the quantities of all vaccines suitable for the practices would be significantly increased from the end of April. As a result, "together with the general practitioners, the specialists could also increasingly participate in the vaccination process," says KBV boss Andreas Gassen happily. “The vaccination spurt”, he prophesied, “will then become a vaccination turbo”. According to the Robert Koch Institute, a total of almost 22.4 million people in Germany have been vaccinated against Covid-19 so far, of which more than 5.5 million have already been vaccinated twice (as of April 19).

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