Medical Malpractice
Cases

A complication is one of the known and accepted risks of medical science that can arise even when a medical intervention has been properly planned and carried out. Malpractice, by contrast, rests on the allegation that, in the specific case, the required care, the medical standard or a legal obligation was breached. This distinction should be made not by looking only at the name given to the outcome, but by examining the entire course of treatment.

When assessing whether a complication gives rise to liability, the following questions in particular are addressed:

• Was the risk medically foreseeable before the intervention?
• Was the patient informed of the risks and alternatives in an understandable way?
• Was there the necessary indication for the intervention?
• Was the intervention carried out on the right person, at the right site, by the right method and under the right conditions?
• Were the early signs of the complication noticed in time?
• Once it arose, was an appropriate and timely intervention made?
• Was the need for a consultation, referral, intensive care or re-intervention assessed?
• Was the process shown in the medical records in a verifiable way?

Where the patient was not informed about a foreseeable risk, or the complication was not noticed in time or was not managed appropriately, the label “complication” alone does not remove liability. Conversely, not every damage that arises unavoidably despite an intervention in line with the medical standard can be regarded as physician error.

For the patient, the aim is not merely to show that an unexpected outcome occurred. A procedure or omission contrary to the medical standard, the damage, and the causal link between that conduct and the damage must be established through the medical records. An independent legal and medical preliminary review before applying makes it possible to set aside unfounded allegations and to identify the real points of dispute.

In work carried out on behalf of patients and their relatives:

• A chronology of the course of treatment is prepared.
• Missing medical records and images are requested.
• The standard for diagnosis, treatment, surgical procedure and follow-up is examined.
• The information and consent process is assessed.
• It is determined which person or institution is responsible for which procedure.
• Complication, medical practice error and organizational fault are distinguished.
• The temporary or permanent effects of the damage and future needs are examined.
• Obtaining a scientific opinion from the appropriate specialty is planned.
• The relationship among the administrative, consumer, private law, insurance and criminal routes is mapped out.
• Application and litigation claims are limited to what the concrete records support.

If the medical assessment finds no deviation from the standard, or the causal link cannot be established, that too is an outcome that must be explained realistically. The legal process should be built not on a promise of a definite result but on the objective data of the file.

A defense against a malpractice allegation cannot rest solely on the explanation that “a complication occurred.” The conformity of the decision to intervene with the medical data on the date of the event, the patient’s initial condition, accompanying diseases, alternative causes, the treatment applied, follow-up, consultation and the record-keeping should be presented as a whole.

Within the scope of the defense:

• The complaint, the action and the medical records are compared.
• It is determined which procedure and which person the alleged error is attributed to.
• The medical standard on the date of the event and current scientific sources are examined.
• The natural course of the disease, personal risks and alternative causes are assessed.
• Indication, technical performance, follow-up and referral decisions are addressed separately.
• The scope of the information and consent records is examined.
• The physician’s personal act is distinguished from the hospital’s organizational liability.
• In teamwork, the allocation of duties and responsibilities is determined.
• The expertise, method, use of the records and reasoning in the expert report are reviewed.
• Timely notification to the professional liability insurer and coordination of the defense are ensured.
• The Professional Liability Board, disciplinary, criminal and compensation processes are conducted consistently.

The seriousness of a medical outcome is not, by itself, proof of fault or causation. The defense should be built not on a retrospective assessment of the outcome but on the clinical conditions at the time of the event and on verifiable medical records.

Informed consent is not merely having a standard form signed. The patient should be told the diagnosis, the proposed intervention, the purpose of the intervention, the reasonable risks, the alternatives, the circumstances affecting the likelihood of success and the probable consequences of refusing the intervention, in a way the patient can understand.

In a consent review:

• Whether the information was provided before the intervention and at a time suitable for making a decision
• The competence of the health care professional who provided the information
• The patient’s age, decision-making capacity and legal representation
• Language, interpreting, literacy and communication needs
• Disclosure of the risks specific to the intervention
• Alternative treatments and the consequences of no intervention
• The patient’s opportunity to ask questions and to decide
• Emergency or presumed-consent conditions
• Withdrawal of consent or refusal of treatment
• Consistency between the form, the oral information and the medical records

Even in an intervention that is technically in line with the medical standard, a failure to inform may give rise to a separate legal assessment with regard to the patient’s right to determine his or her own future. By contrast, not every deficiency in a form automatically results in all the medical damage being attributed to the physician; damage and causation are examined separately.

A diagnostic error can take the form of the disease never being identified, a wrong diagnosis being made, a delay in diagnosis, or the necessary differential diagnosis process not being carried out. Not every wrong diagnosis, or diagnosis that later changes, is malpractice. What is examined is whether the physician carried out a reasonable diagnostic process in light of the symptoms, findings, tests and risks at the time of the event.

The main subjects of review:

• Adequacy of the history and the physical examination
• Assessment of the differential diagnosis options
• Ordering of the necessary laboratory and imaging tests
• Correct and timely interpretation of test results
• Communication among pathology, radiology and the laboratory
• The need for consultation and referral to a higher-level center
• Calling the patient back for a check-up or follow-up
• Notifying the patient of a critical result
• The effect of the delay in diagnosis on the course of the disease and on treatment options
• Whether the outcome would have been different had the diagnosis been made in time

In a misdiagnosis file, causation often rests not merely on the delay in diagnosis but on the concrete effect of that delay on the treatment possibilities, the stage of the disease and the prognosis.

A surgical dispute is not limited to a technical event that occurred during the operation. The surgical indication, choice of method, team and hospital conditions, preoperative preparation, the surgical performance, foreign-body and count checks, pathology, monitoring for bleeding, infection and follow-up after discharge are assessed together.

The main areas of work in this field:

• Surgical indication and alternative treatments
• Suitability of the surgical method to the patient’s condition
• Preoperative tests and risk assessment
• Verification of side, organ or level
• Surgical technique and team responsibility
• The operative note, video, images and device records
• Allegations of bleeding, organ injury and retained foreign bodies
• Taking, labeling and tracking the pathology specimen
• Monitoring postoperative pain, fever, infection and vital signs
• The decision on re-operation, consultation, intensive care or referral
• Discharge information and the follow-up plan

That a surgical risk is written in the consent form does not in itself mean that the intervention was technically properly performed or that the complication was managed correctly. Likewise, the materialization of a risk does not by itself mean a technical error.

Anesthesia and intensive care processes require multidisciplinary review because of the patient’s systemic risks, the drugs used, airway management, monitoring, devices, team communication and postoperative observation.

Our scope of work:

• Preanesthetic assessment and risk classification
• Allergy, medication and previous anesthesia history
• Choice of anesthesia method and dose
• Airway, oxygenation and circulation management
• Monitoring and anesthesia follow-up records
• Emergence, recovery and postoperative observation
• Procedures performed under sedation
• Intensive care admission, follow-up and discharge decisions
• Adequacy of devices, alarms, consumables and personnel
• Review of causation with permanent neurological damage or death

In an anesthesia and intensive care file, not only the physician’s act but also the hospital’s obligations regarding device maintenance, drug safety, team and organization should be assessed.

Pregnancy, childbirth and newborn files may include the records of the mother and the child and the practices of obstetrics, perinatology, neonatology, anesthesia, midwifery and nursing together. Because the development of the event within minutes is significant, monitoring charts and time records should be examined in detail.

Main topics:

• Identification of risks in pregnancy and regular follow-up
• Assessment of screening, ultrasound and laboratory results
• Management of preeclampsia, gestational diabetes, infection and other risks
• Determining the method and timing of delivery
• Fetal heart rate and labor records
• The decision to move to cesarean section or assisted delivery
• Shoulder dystocia, bleeding and emergency obstetric interventions
• Newborn resuscitation and the intensive care process
• Allegations of hypoxia, cerebral palsy and neurological damage
• Maternal death, infant death and permanent care needs
• The division of duties among the midwife, physician, anesthesia and hospital team

The child’s future care, rehabilitation, education and support needs may be assessed in the calculation of damage together with their lifelong consequences. Medical causation and future needs require separate specialist reviews.

In emergency health services, decisions on assessment, intervention and transfer are often made within limited time and with limited information. Without disregarding these conditions, the legal review assesses whether the urgency was correctly determined, whether the necessary stabilization was achieved and the effect of any delay on the outcome.

In this context:

• Emergency call and ambulance dispatch records
• Arrival at the scene and the process of transport to the hospital
• Triage classification and waiting time
• Vital signs, initial examination and reassessment
• Emergency tests, intervention and consultation
• Heart attack, stroke, trauma, sepsis and other time-sensitive conditions
• The hospital’s capacity and referral to a higher-level center
• The patient’s refusal of transfer or admission
• Emergency department observation and the discharge decision
• Causation between the delay and the damage

Emergency department congestion alone does not remove the duty of care; however, the assessment should be made on the basis of the actual conditions of the event, the resources available and the principles of medical prioritization.

In disputes over medication and infection, the prescription or the microbiology result alone may not be sufficient. The choice of drug, dose, time of administration, and allergy and interaction checks are assessed together; as regards infection, so are preventive measures, the risk level, diagnosis, culture, antibiotics and the isolation process.

Our areas of work:

• Wrong drug, dose, route or time of administration
• Overlooking a known allergy or drug interaction
• Checks and monitoring for high-risk drugs
• Prescription, pharmacy and nurse administration records
• Prevention and early diagnosis of hospital-acquired infection
• Sterilization, isolation and infection control procedures
• Culture, antibiogram and antibiotic management
• Post-discharge medication and care instructions
• Communicating the follow-up appointment and warning signs
• Delay in the presentation of the complication, and the readmission process

The occurrence of a hospital-acquired infection does not in itself prove organizational fault. The type of infection, the patient’s personal risks, the measures that should have been taken, and whether the records show that the measures were applied should be examined.

In dental practice, diagnosis, the treatment plan, imaging, implant placement, prostheses, orthodontics, root canal treatment, anesthesia and oral and maxillofacial surgery may involve different fields of specialty. Cosmetic expectations should be distinguished from the functional purpose of treatment.

Our scope of work:

• Allegations of an incomplete or faulty treatment plan
• Assessment of implant position, nerve damage and bone structure
• Prosthesis, crown and fit problems
• Root canal treatment and infection follow-up
• Orthodontic treatment and long-term follow-up
• Complications of tooth extraction and oral and maxillofacial surgery
• Radiological examination and measurement records
• Records of the materials and products used
• Repeating the treatment, and claims for the fee and compensation
• Defense on behalf of the dentist and the clinic

A legal assessment should not be made solely on the basis of an image of the result without the treatment plan, the initial records, X-rays, measurements, photographs and follow-up records.

In cosmetic interventions, medical necessity, the patient’s expectations, the scope promised by the physician, simulations and images, the technical nature of the intervention, the healing process and the need for revision are assessed together. Not every cosmetic procedure should automatically be regarded as a contract involving a commitment to a result; the specific contract and the purpose of the intervention should be examined.

In this field:

• Rhinoplasty, facial, breast and body contouring surgery
• Hair transplantation and non-surgical cosmetic procedures
• Laser, fillers, botulinum toxin and similar procedures
• Pre-procedure photographs, planning and information
• The distinction between a cosmetic result and functional damage
• Allegations of asymmetry, scarring, infection, tissue loss and nerve damage
• Revision surgery and the need for additional treatment
• The effect on the contract of results promised in advertising or promotion
• Claims for refund of the price, re-treatment and compensation
• The liability of the physician, the clinic and the intermediary

Before-and-after photographs should not be treated as proof of technical error on their own without examining at which stage of healing they were taken and whether they were prepared under standard conditions.

Procedure-specific review: In nose, face, eyelid, ear and breast surgery; liposuction, abdominoplasty and body contouring; hair and eyebrow transplantation; and filler, botulinum toxin, laser and skin procedures, the indication, authority, product, dose/technique, information and follow-up are each investigated separately. For procedures offered under the name of PRP, mesotherapy, peeling, microneedling or stem cell/ozone, compliance with the legislation is also checked separately. This enumeration is neither a treatment recommendation nor a statement that the procedures are lawful under all conditions.

Damage connected with a medical device may arise from a design or manufacturing defect in the device, a lack of maintenance and calibration, incorrect installation, user error or the selection of an unsuitable device. In order to identify the responsible party, health service liability and product liability should be distinguished from one another.

In this context:

• Preserving the device’s brand, model, serial and lot information
• Reviewing the Product Tracking System (ÜTS) and traceability records
• Use, maintenance, calibration and malfunction records
• User training and authorization
• Alarm, software and operation logs
• The liability of the manufacturer, importer, distributor, hospital and user
• Product recalls and safety notices
• Safekeeping of the device and technical examination
• Causation between health service fault and product defect

That a product has a license or a certificate of conformity does not mean it is free of defects in every specific case; nor does the existence of a device malfunction in itself give rise to the physician’s personal liability. Details concerning product law should be addressed on the separate Medical Device Law and Product Liability page.

The liability of a health care institution does not consist only of employing the physician. The institution may be obliged to establish and operate an appropriate system of personnel, devices, drugs, hygiene, records, on-call duty, consultation, laboratory, imaging, blood products, intensive care and emergency response.

The main subjects reviewed from the organizational standpoint:

• Assignment of sufficient and authorized health care personnel
• On-call and team scheduling
• Consultation and access to specialists
• Capacity of the operating room, intensive care and emergency department
• Maintenance and calibration of medical devices
• Safety of drugs, blood and consumables
• Infection control and sterilization
• Timely communication of laboratory and imaging results
• Verification of patient identity, side and procedure
• Security of records, archives and the information system
• Emergency, referral and complication management
• The division of duties between an independently practicing physician and the hospital

The physician’s individual medical decision and the institution’s system or organizational deficiency are separate areas of fault. This distinction should be made clearly in litigation and defense strategy.

Medical records form the foundation of a malpractice file. Gaps in the records, an allegation that they were altered afterward, or their being kept in fragments in different systems may affect both the understanding of the medical event and the assessment of proof.

The main records that should be preserved and examined:

• Patient admission, identity and presentation records
• Examination notes and anamnesis
• Discharge summaries (epikriz) and discharge documents
• Informed consent and refusal-of-treatment forms
• Surgery, anesthesia and safe surgery checklists
• Nurse observation and medication administration charts
• Consultation, referral and follow-up records
• Laboratory, pathology and microbiology results
• The originals of radiology images and reports
• Intensive care, monitoring and device records
• Prescription, drug supply and MEDULA-linked records
• Ambulance, call center and triage records
• Camera recordings, only insofar as they relate to the dispute and are lawful
• Hospital information management system access and change logs
• Invoices, payment and insurance documents

Documents should be requested not only as PDF printouts but, where necessary, in their original digital form that preserves the diagnostic quality of the image. Obtaining, sharing or publishing the records on social media unlawfully may in addition give rise to liability.

Access to the patient file: Under Article 16 of the Patient Rights Regulation (Hasta Hakları Yönetmeliği), the patient, his or her authorized attorney-in-fact or legal representative may inspect the records and obtain copies. e-Nabız records are useful; however, it is not assumed that all the surgery, anesthesia, nurse observation and device records are found there. It is important to keep the date of the request and the response given.

In malpractice disputes the review by a court-appointed expert is often decisive; however, an expert report is not beyond legal scrutiny. The panel conducting the review must be composed of the right fields of specialty, must assess all the records, must determine the medical standard as of the date of the event and must establish a reasoned connection between the outcome and the fault.

The following points are reviewed in the expert examination:

• Field of specialty and composition of the panel
• Whether all the medical records in the file were examined
• Whether missing records and contradictions were identified
• Explanation of the medical standard on the date of the event
• Separate discussion of each alleged act or omission
• Distinguishing a complication from a management error
• Separating the damage from the natural course of the disease
• Establishing the causal link with scientific reasoning
• Separate assessment of the physician’s, the team’s and the institution’s liability
• Answering the parties’ objections and scientific sources

An expert opinion obtained by a party under the Code of Civil Procedure (Hukuk Muhakemeleri Kanunu, HMK) may be used to identify the medical questions in the file, to show deficiencies in the expert report and to make the scientific discussion concrete. However, the legal functions of an expert opinion and of a court-appointed expert are distinct from one another.

For compensation liability, the deviation from the medical standard, a legally protectable damage and the causal link between them must be assessed together. More than one disease, the prior state of health, a delay in treatment, the patient’s failure to follow recommendations or the act of a third party may affect the causation assessment.

Review headings:

• The medical standard that was to be applied on the date of the event
• The specific duty of care alleged to have been breached
• The type, onset and permanence of the damage
• The natural course of the disease and personal risks
• Alternative medical causes
• The contribution of more than one person or institution
• The patient’s provision of information, attendance at check-ups and compliance with treatment recommendations
• Whether the outcome could have been prevented had appropriate conduct been shown
• The concrete basis of an allegation of loss of a chance of treatment or recovery
• The relationship between the degree of fault and the calculation of compensation

Assessments that start from the outcome, such as “there is fault because the outcome was bad” or “there is no fault because it was a complication,” are not sufficient.

The burden of proof is not determined by a single sentence. The general rule in Article 190 of the HMK, the regime for breach of contract in Article 112 of the Turkish Code of Obligations (TBK), and the specific allegation are assessed together. Showing that the information and consent were duly provided is also important; it cannot be said that the entire burden of proof rests on the patient in every case.

The compensation that can be claimed because of malpractice is determined according to the nature of the event, the extent of the damage, the patient’s age, income, working capacity, care and treatment needs and the basis of liability. Compensation is not a means of punishment but a claim aimed at making good a damage recognized by law.

Items that may be assessed in the case of bodily injury:

• Past and future treatment expenses
• Expenses for drugs, prostheses, medical devices and rehabilitation
• Temporary and permanent loss of working capacity
• Damage arising from the impairment of economic prospects
• Caregiver, attendant and home care expenses
• Transportation, accommodation and necessary ancillary expenses
• Operations or treatments that will have to be performed in the future
• Non-pecuniary damages

Items that may be assessed in the case of death:

• Funeral expenses
• If death did not occur immediately, damages for treatment and loss of working capacity
• Compensation for loss of support
• Relatives’ claims for non-pecuniary damages

Interim payment, the starting date of interest, the date of calculation, social security payments, insurance coverage and the prevention of duplicate collection should also be assessed. Actuarial calculation and the assessment of medical disability or care needs are different fields of expertise.

Entitlement: A claim for loss of support does not depend solely on being an heir; the support relationship is established separately. Claims that pass to the estate of the deceased are distinguished from the relatives’ personal claims. Relatives’ non-pecuniary damages are assessed under the conditions of death or serious bodily injury. A fixed tariff cannot be set for the amount of compensation, and the outcome cannot be guaranteed.

Where damage is alleged to arise from a public health service, the core dispute is mostly addressed within the framework of the administration’s service fault or the principles of no-fault liability. Before a claim is directed at a public official directly, the Constitution, the Civil Servants Law, the Administrative Procedure Law (İYUK) and the special provisions in health legislation should be assessed together.

In these files:

• Correct identification of the health facility and the administration it belongs to
• Determination of the date of damage and of learning of it
• Assessment of the requirement and time limit for the preliminary application to the administration
• Calculation of the time limit for the action after rejection or implied rejection
• A full remedy action in the administrative court
• Preservation of evidence and protection of the records; and, if there is an administrative act that can be made the subject of an action, the conditions for a stay of execution
• Distinguishing service fault, organizational fault and the medical practice
• Whether a claim can be directed directly against public personnel
• The court-appointed expert and the calculation of compensation
• The appeal (istinaf) and, if the conditions are met, the further appeal (temyiz) process

For certain personnel working at a state university, a criminal investigation may be subject to the special procedure in Higher Education Law No. 2547. The compensation and criminal routes do not follow the same procedure.

In private health services, although the patient’s contractual relationship is mostly established with the health care institution, the form of employment and contract of the physician who performs the treatment may also affect liability. The hospital’s organizational liability, the act of the auxiliary person and the physician’s personal medical practice should be examined separately.

In this context:

• Patient admission and treatment contract
• Assessment of the consumer transaction and the court with subject-matter jurisdiction
• Applicability of mediation as a condition precedent to litigation
• The proper respondent: the hospital, physician, company and insurer
• The private hospital’s organizational liability and liability for auxiliary persons
• Relationships among the medical office, the clinic and the intermediary
• Package health service and health tourism contracts
• Claims for refund of the price, re-treatment and compensation
• Preservation of evidence and the conditions for an interim injunction
• The action, appeal to the regional court of appeal and, if the conditions are met, appeal to the Court of Cassation

The judicial route concerning a foundation university hospital or an institution with a special status should be determined not by starting from the name of the institution but by examining its legal status and the specific service relationship.

The foundation university’s public legal personality and the operator that actually provides the service are taken into account; these institutions are not automatically placed within the ordinary courts under the heading of private hospital. In a claim that has the nature of a consumer transaction, merely calling it a “tort” does not in itself remove the subject-matter jurisdiction rules of consumer law. The exceptions within the scope of mediation as a condition precedent to litigation and the consumer arbitration committee are checked against Article 73/A of Law No. 6502 and the current monetary thresholds.

In criminal investigations conducted because of the medical procedures and practices of health care professionals relating to examination, diagnosis and treatment, the Professional Liability Board or the special investigation procedure in Law No. 2547 may come into play, depending on the personnel’s status. The legal process is not the same as the expert assessment in a direct compensation action.

In Professional Liability Board processes:

• Identification of the complaint and the medical procedure imputed
• Examination of the personnel’s institutional and employment status
• Assessment of the preliminary review file and the medical records
• The written and oral defense of the health care professional
• Submission of scientific sources and expert opinions
• The decision to grant or not to grant an investigation permit
• Objection to the Ankara Regional Administrative Court against the Board’s decision
• Coordination with the investigation of the Office of the Chief Public Prosecutor (Cumhuriyet Başsavcılığı)
• Review of criminal negligence, fault and causation
• Joint planning of the disciplinary, compensation and insurance processes

Under Supplementary Article 18 of Law No. 3359 and Article 9 of Law No. 4483, the time limit for objecting to an investigation permit decision is 10 days from notification. The right of application, the notification and the competent authority are checked according to the type of decision. A different permit system may apply to persons subject to the procedure in Article 53 of Law No. 2547.

In a criminal investigation, a bad medical outcome does not by itself show that an offense has been committed. The negligent conduct imputed, foreseeability, the duty of attention and care, causation and personal responsibility should be assessed separately under the criteria of criminal procedure.

A criminal complaint is submitted to the public prosecutor’s office; the filing of a public action depends on the indictment and its acceptance. The act that may be imputed, including injury or killing by negligence, is determined according to the specific case; “malpractice” is not in itself the name of a single offense. The filing or acceptance of a compensation action does not by itself create a criminal record.

Compulsory Financial Liability Insurance for Medical Malpractice (Tıbbi Kötü Uygulamaya İlişkin Zorunlu Mali Sorumluluk Sigortası) is examined in terms of the period in which the policy was issued, the profession and risk group, the dates of the event and of the claim, the scope of coverage, exclusions, serial losses and notification obligations. An insurance policy regulates not the existence or absence of medical liability but the scope within which the liability that has been established is covered.

In this field:

• Examination of the policy, renewals and endorsements
• Determining the relationship of the event and the claim to the policy period
• Notification to the insurer and coordination of the defense
• Scope of coverage and exclusions
• Defense costs and the policy limit
• More than one health care professional or policy
• The insurer’s payment, rejection or underpayment actions
• The route to the Insurance Arbitration Commission (Sigorta Tahkim Komisyonu) or the court with subject-matter jurisdiction
• The conditions for recourse against the health care professional for compensation paid by the administration
• Professional Liability Board review of recourse and the link to a final criminal judgment

As regards recourse against health care professionals working in public institutions and state universities, Law No. 3359 and the current Professional Liability Board regulations should be taken as the basis. The recourse relationship between private health care institutions and insurers is examined separately under the contract and the general provisions.

Current public insurance regime: Supplementary Article 18 of Law No. 3359 also regulates the application, after the administration’s payment based on a final decision, to the health care professional’s insurer within the degree of fault and the coverage. This route is separate from the decision on recourse against the personnel. For state university personnel, the university’s statutory final decision stage is also taken into account.

In malpractice disputes there is no single statute of limitations or time limit for bringing an action. In public health services, the time limits for the preliminary application to the administration and for administrative actions may come into play; in private health services, the contract, tort, consumer or insurance relationship; in a criminal file, the time limits for the complaint and the statute of limitations for the action; and before the Professional Liability Board, a special objection period tied to notification of the decision.

In the review of time limits:

• The date of the medical procedure and of the occurrence of the damage
• The date on which the damage and the responsible party became known
• Whether the treatment is continuing
• Whether the health service is public or private
• Applications previously made to the administration
• Whether there is a criminal investigation
• The date of notification and claim to the insurer
• Mediation or consumer arbitration committee application
• Cases of a child, guardianship or death
• The foreign element and notification

A table of time limits prepared on the basis of the specific dates is part of the first legal review. The start, interruption or suspension of the time limits is assessed separately.

• Administrative act: Under Article 13 of the İYUK, the framework for the preliminary application of one year from learning and five years from the act is examined with regard to the learning of the damage and special circumstances. After rejection or the expiry of the statutory response period, the litigation calendar is calculated separately.
• Tort: The two-year and ten-year periods in Article 72 of the TBK, and the conditions for applying a longer criminal statute of limitations, are assessed.
• Contract: A five-year period for claims arising from a mandate (vekâlet); the special/general provisions applicable to hospital, work contract, defect or other contractual relationships are researched separately. The starting date is not necessarily the date of the procedure in every file.
• Complaint and permit: For offenses prosecuted only upon complaint, the time limits tied to learning are distinguished from the objection period tied to notification in the case of an investigation permit. Waiting for the outcome of the criminal file is not a safe course with respect to the other time limits.

The health service that a foreign patient receives in Türkiye may constitute a multi-party relationship involving the health facility, the physician, the health tourism intermediary, a foreign agency, the insurer and the payment institution. The contract, promotion, translation, consent, medical records, complication follow-up and the treatment costs after the patient’s return to his or her country should be assessed together.

Our scope of work:

• Foreign patient and package health service contracts
• The liability of the intermediary and the health facility
• Information in a foreign language and the use of an interpreter
• The comprehensibility of informed consent
• The effect on the contract of pre-treatment promotion and promises of results
• Post-treatment follow-up and complication management
• Additional treatment and damage records in the patient’s country
• Foreign insurance and payment disputes
• Applicable law, the jurisdiction of the Turkish courts and arbitration
• Foreign documents, apostille, translation and notification
• Enforcement in another country of a decision rendered in Türkiye
• Transfer of health data abroad

The ability to communicate in Turkish, English, German and Russian contributes to the flow of information and documents conducted with foreign patients, health care institutions, insurers and foreign legal advisers. When necessary, coordination is established with legal and medical experts in the foreign country.

Many preparatory and representation steps can be taken without coming to Türkiye; however, stages such as an examination, a medical board, an expert examination, or those at which the competent authority requires personal attendance are planned separately. Remote representation does not mean that all steps in every file will be completed outside the country.

The relationships established between the patient and the physician, the hospital and the intermediary may not rest on the same type of contract. The duty of care, the commitment to a specific result, the organizational obligation and non-contractual liability are examined separately.

• Mandate versus contract for work: The purpose of the intervention, the specific promise and the contract as a whole are assessed. A single contract type and a single time limit are not applied to every cosmetic or dental treatment.
• Emergency intervention: In emergencies where consent cannot be obtained, the statutory conditions and the records are examined. Urgency does not remove the duty to exercise the necessary care during the procedure.
• Exclusion-of-liability clause: The statement “I accept all risks” does not make faulty practice lawful in advance. Articles 115–116 of the TBK, professional permission and the unfair contract term provisions in consumer law are examined together.
• Factors affecting liability: The patient’s condition, compliance with follow-up recommendations, the act of a third party and force majeure are assessed only through their effect on damage and causation in the specific case; they do not create an automatic exemption.

The resolution of a medical dispute through negotiation is assessed by setting out the claim items and future needs. A refund of the price, an offer of revision or an insurance payment does not mean that all damage has been compensated.

• The persons, damages and periods covered by the settlement or release text, and its statements of waiver of rights, are examined.
• For continuing treatment, future care expenses and damages that cannot yet be determined, the scope is written out clearly.
• The payment date, installments, security, expenses, confidentiality and enforceability conditions are determined.
• Criminal conciliation and mediation in a civil dispute are not the same process; their conditions and their effect on other claims are assessed separately.
• The finalization of the decision, its enforceability, collection from the administration or the insurer, legal remedies and the recourse stages are followed according to the file.