Lemon juice case BGH reverses chief physician judgment

Lemon juice against wound infection

The BGH overturned a verdict against a chief physician who treated an 80-year-old female patient for wound healing with commercial lemon juice. The patient died two weeks later as a result of a wound healing disorder.

22.12.2010

The Federal Court of Justice (BGH) today overturned a verdict against the then chief physician of the St. Antonius Clinic. The physician had previously been sentenced by the Regional Court for treating a wound of an 80-year-old female patient with a non-sterile lemon juice and not informing the patient prior to the first procedure. Two weeks after the lemon juice therapy, the woman died.

The BGH today rejected a judgment in the so-called „lemon juice case“. The former chief physician of the St. Antonius Clinic in Wegberg, North Rhine-Westphalia, had treated an 80-year-old patient with a non-sterile lemon juice. About two weeks after treatment, the patient died from the infection at the surgical wound. Now, the trial against the doctor must be rolled up again, as the supreme judge of the Federal Court on Wednesday in Karlsruhe judged. Thus, at the request of the defendant, the judges overturned the judgment of the district court Mönchengladbach. However, the state judges had not considered it proven that the elderly woman died as a result of the treatment. However, in January 2010, the judges sentenced the former Chief Physician to one year and three months probation for a fatal injury. Whether the physician can now expect a milder judgment in the revision, although unclear, but very likely due to the verdict of the Federal Court of Justice.

Patient treated with lemon juice
In the specific case, an elderly woman was operated on the intestine. After the procedure, the patient's wound had become inflamed. The doctor then treated the surgical wound of the 80-year-old woman with a lemon juice that had not been previously sterilized. After two weeks, the woman died as a result of a wound infection. Whether the use of lemon juice was responsible for the death of the patient, the judges could not find at that time. However, the accused doctor would have had to inform the deceased about the possible use of lemon juice prior to the first operation, the state judges said. Because of the wound healing disorder was namely a second medical intervention. However, the legal opinion contradicted the BGH judges. According to this, the physician was not obliged to inform the patient in advance that lemon juice was also used in cases of complications due to a wound healing disorder.

If there is a risk of further illnesses or physical injuries during the procedure, the attending physician must, in exceptional cases, only inform the patient before the first operation about further dangers and methods of possible follow-up treatment. However, that would only be the case if post-treatment involved a massive risk, such as the loss of an organ. In the case under negotiation, however, such a circumstance did not exist, according to the judges. Furthermore, the federal judges stressed that the risk of treatment with non-sterile lemon juice „only a certain additional bacterial load“ has been. In this case, it would not be comparable to the danger to the future life of a patient who is at risk of losing the organ through the aftercare.

According to the previous judicial findings, the former chief physician was merely guilty of enlightening the patient about the use of lemon juice prior to the second operation. Because this intervention is in the opinion of the BGH judges to one „untried outsider method“. Accordingly, there is only one dangerous bodily injury. According to all findings, the physician could not be accused of a bodily harm resulting in death, since neither the use of the lemon juice insert nor the second operation could be the cause of death. Now, the Landesgericht Mönchengladbach must again negotiate the case. There, the judges should examine whether a conviction "on another factual basis" comes into consideration. The facts available to date are not enough to convict the physician of a bodily harm resulting in death.

Lemon juice for wound healing?
During the trial at the district court, the doctor testified that he used a commercially available lemon for the treatment and touched it with his bare hands. The lemon had been cut in half with a knife. Then he filled the lemon with a syringe. The accused then impregnated the juice with a strip and then placed it on the wound of the patient. One expert at the time had stated in the process that so far no clinical data or empirical data would have been available which indicate that lemon juice is used for wound healing. Such a method is rather uncommon and unexplored. The BGH judgment bears the file number AZ: 3 StR 239/10. (Sb)

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Picture: Peter Kirchhoff