Lawsuit for Financial and Moral Damages Due to Hospital Infection

What is a hospital infection?

Hospital-acquired infections (HAIs) refer to infections that were not present when a patient was admitted to the hospital but develop during or in connection with the healthcare they receive. In current medical literature, this concept is often healthcare-associated infections . These infections can occur at surgical wound sites, in intensive care units, after the insertion of urinary or intravenous catheters, in patients on ventilators, during dialysis, childbirth, prosthetic or implant surgery, orthopedic surgery, cancer treatment, or during prolonged hospitalization.

Hospital-acquired infections don't always mean hospital or doctor error. Some patients may be more susceptible to infection due to factors such as age, immune system, chronic illness, diabetes, cancer treatment, need for intensive care, open wounds, prostheses, or prolonged hospital stays. However, legal liability may arise for hospitals and healthcare personnel in cases where the infection was preventable, sterilization rules were not followed, hand hygiene was not maintained, isolation measures were not taken, antibiotic administration was incorrect, catheters or probes were left in place for unnecessarily long periods, surgical site cleaning was inadequate, or the infection was detected late.

According to sources within the Ministry of Health, the primary objective of infection control committees is the prevention, monitoring, and control of healthcare-associated infections. Infection control programs include risk assessment, surveillance, prevention strategies, training, and feedback mechanisms.

In what situations does a hospital-acquired infection qualify for compensation?

For a compensation claim to be filed due to a hospital-acquired infection, it is not sufficient for an infection to have occurred alone. For legal liability to be established, a causal link must be created between the infection and negligence in the hospital's services. In other words, it must be shown that the infection developed in the hospital environment or during healthcare services, that the hospital failed to take necessary precautions, or that it intervened late or incorrectly after the infection developed.

For example, liability for compensation may arise if a severe infection develops at the surgical wound site but operating room sterilization records are incomplete; if an infection occurs after prosthetic surgery and antibiotic prophylaxis is not properly administered; if pneumonia develops in a ventilator-dependent patient in intensive care but oral care, aspiration, and infection control protocols are not applied; or if a urinary tract infection and sepsis develop due to an unnecessarily long retention period in a urinary catheter.

Conversely, if all infection control measures were taken, the patient was in a high-risk group, the infection developed as a known and unavoidable complication, and was treated appropriately and promptly, the mere presence of infection may not be sufficient grounds for compensation. Therefore, the basis of the lawsuit should not be the claim that "an infection occurred," but rather that "the infection was preventable, the hospital failed to take necessary precautions, or there was a delay in treatment.".

Hospital's Infection Control Responsibility

Hospitals' obligation to prevent and control infections stems not only from a general duty of care but is also regulated by specific legislation. The Regulation on Infection Controlin Inpatient Treatment Institutions regulates the establishment, duties, powers, and working procedures of infection control committees in inpatient treatment institutions to prevent, control, identify, and resolve healthcare-associated infections. The regulation covers both public and privately owned inpatient treatment institutions and their personnel.

In this context, the hospital is responsible for establishing an infection control committee, preparing an infection control program, providing training to employees, ensuring hand hygiene, implementing isolation measures, conducting surveillance, determining sterilization and disinfection rules, developing an antibiotic use policy, and initiating rapid investigations in case of suspected outbreaks. Sources from hospitals affiliated with the Ministry of Health clearly state that infection control committees carry out duties related to hand hygiene, isolation, surveillance, rational antibiotic use, sterilization, disinfection, medical waste management, and employee training.

These obligations are crucial in compensation cases because the court, through expert opinion, examines whether the infection control program was actually implemented at the hospital where the infection developed, whether records were kept regularly, whether there was an increase in infection rates in the relevant ward, and whether specific measures were taken for the individual patient.

Most Common Types of Hospital Infections

Hospital-acquired infections can occur in various clinical settings. In practice, one of the most frequent subjects of compensation claims postoperative surgical site infection. Infections can have serious consequences, particularly in orthopedic prosthesis surgeries, heart surgery, brain surgery, cesarean sections, abdominal surgeries, cosmetic surgery, and operations involving implant and foreign body placement.

The second most common group is intensive care unit (ICU) infections. ICU patients are at high risk of infection because they may have weakened immune systems, be on ventilators, have intravenous access, have urinary catheters, and remain in the hospital for an extended period. However, this high risk does not absolve the hospital of its obligation to take precautions. In the ICU, hand hygiene, isolation, catheter care, ventilator care protocols, patient environment cleaning, and antibiotic administration must be carefully implemented.

The third group is catheter and probe-related infections. Intravenous catheters, central venous catheters, urinary catheters, drains, dialysis catheters, or similar medical devices can become a source of infection if they are not inserted correctly, left in for unnecessarily long periods, or if care guidelines are not followed.

The fourth group consists of hospital-acquired sepsis cases. If the infection spreads to the bloodstream and causes organ failure, the patient may be admitted to intensive care, suffer permanent organ damage, or die. In sepsis cases, it is crucial to know when the first signs of infection appeared, when antibiotic treatment was initiated, when cultures were taken, and whether the decision to admit the patient to intensive care was delayed.

Postoperative Infection and Surgical Site Liability

Postoperative infection is one of the most important issues in hospital-acquired infections. Surgical site infection can sometimes remain a superficial wound infection; however, it can sometimes affect deep tissues, prostheses, implants, bones, the abdominal cavity, or organ systems.

In cases of alleged postoperative infection, the following questions are asked: Was proper skin preparation performed before surgery? Was the operating room sterilized? Were the instruments used sterile? Was antibiotic prophylaxis administered at the correct time and with the correct medication? Was the surgery time prolonged? Was there contamination during surgery? Were foreign objects, prostheses, or implants used? Was proper wound care performed after surgery? Were signs of infection detected in a timely manner?

For example, if a patient has redness, discharge, fever, foul odor, severe pain, or wound dehiscence at the surgical site, but these findings are not taken seriously and the patient develops sepsis or requires a second surgery due to delayed intervention, the hospital may be held liable.

Intensive Care Unit Infections and Hospital Responsibility

Intensive care unit infections are of particular importance in terms of patient safety. ICU patients may already be in a critical condition; however, this does not justify neglecting infection control. Preventing infections in the ICU requires hand hygiene, bedside equipment cleaning, isolation, ventilator care protocols, catheter care guidelines, appropriate antibiotic use, and regular surveillance.

In the promotional materials of the infection control unit affiliated with the Ministry of Health, it is stated that active and passive surveillance is carried out in clinics, especially in intensive care units, surgical site infections are monitored procedure-specifically, and hand hygiene compliance is regularly evaluated.

These records are important for the case. If there was an increase in similar infection cases in the intensive care unit where the patient was admitted during the same period, if the same microorganism was found in more than one patient, if there was a lack of isolation, or if the infection control committee did not take precautions despite this increase, the hospital's organizational fault may be strengthened.

Late Diagnosis and Late Treatment of Infection

In hospital-acquired infections, responsibility may arise not only from the onset of infection but also from delayed or incorrect treatment after the infection develops. Signs of infection are often identified by fever, chills, redness, discharge, foul odor, pain, low blood pressure, increased pulse rate, deterioration in laboratory values, elevated CRP/procalcitonin levels, or a positive culture.

Despite these findings, liability for compensation may arise if the patient's complaints were ignored, a culture was not taken, antibiotic treatment was delayed, an infectious disease consultation was not requested, the surgical site was not opened and cleaned, the decision for intensive care was delayed, or the patient was discharged prematurely.

In sepsis cases in particular, hours count. Rapid intervention is necessary when the infection spreads to the bloodstream, blood pressure drops, organ function deteriorates, or the patient's overall condition worsens. The hospital's defense that "infection can always occur" may not be sufficient if there is a delay in intervention or incomplete records.

Hospital-acquired infection in a private hospital

If a hospital-acquired infection occurs in a private hospital, private surgical center, private maternity hospital, or private clinic, then private law liability arises. Since a private hospital provides healthcare services to a patient in exchange for payment, it is responsible not only for the individual error of the physician but also for the operation room, intensive care unit, sterilization, nursing, cleaning, waste management, infection control, and hospital organization.

A private hospital may argue that infection is an unavoidable complication. However, for this defense to be accepted, it must demonstrate that infection control measures were taken, sterilization and disinfection records are regular, antibiotic prophylaxis was correctly administered, infection symptoms were assessed promptly, and the patient received appropriate treatment.

In private hospital infection cases, consumer law, breach of contract, tort, and health law are considered together. However, if there is a severe infection, sepsis, organ loss, intensive care, permanent disability, or death, the case should be prepared not only as a claim for reimbursement of service fees but also as a comprehensive claim for material and moral damages.

Hospital Infection at State Hospital

If a hospital-acquired infection occurs in a state hospital, city hospital, training and research hospital, or public university hospital, the process often falls under administrative law. Healthcare services provided in state hospitals are public services. If this service is poorly provided, delayed, or not provided at all, the administration may be considered to have committed a service defect.

Patients or their relatives who suffer harm due to infection in a public hospital should generally first apply to the relevant administration, requesting compensation for their losses. If the application is rejected or remains unanswered, they should file a full judicial review case in the administrative court. Article 13 of the Administrative Procedure Law stipulates that individuals whose rights have been violated by administrative actions must apply to the administration within one year from the date they learned of the action, and in any case within five years from the date of the action.

When filing a lawsuit against a state hospital, it is crucial to correctly identify the defendant. This could be a Ministry of Health hospital, a university hospital, or another public health institution. Applying to the wrong administration, missing deadlines, or failing to adequately specify damages can lead to serious loss of rights.

What types of compensation can be claimed for hospital-acquired infections?

A patient who suffers harm due to a hospital-acquired infection may claim compensation for both material and moral damages if the conditions are met.

Compensation claims may include medical expenses, antibiotic and medication costs, additional surgery costs, intensive care costs, private hospital expenses, wound care costs, physical therapy and rehabilitation costs, medical device costs, prosthesis or implant replacement costs, transportation costs, caregiver costs, temporary disability, permanent disability, loss of income, and disruption of economic future.

For example, if a prosthetic implant was removed due to infection after surgery, the patient underwent a second surgery, and was unable to walk for months, not only the cost of the first surgery but also the second surgery, treatment, physical therapy, caregiver, loss of work capacity, and emotional distress should be calculated together. If organ damage occurred due to sepsis, lifelong treatment and loss of work capacity should also be evaluated separately.

Compensation for emotional distress is claimed due to the patient's suffering, fear, risk of death, intensive care period, prolonged hospital stay, permanent scarring, organ loss, limited mobility, psychological trauma, social isolation, and decreased quality of life.

If the patient has passed away, their relatives may claim compensation for loss of support, funeral expenses, and moral damages. Spouses, children, parents, and other individuals who had a supportive relationship with the deceased may claim compensation for material and moral damages resulting from the death.

How is a hospital-acquired infection proven?

In hospital-acquired infection cases, the proof process is technical and based on documentation. First, the timing of the infection, the identified microorganism, the connection between the infection and the hospital stay, the patient's risk factors, and the precautions taken by the hospital are examined.

Evidence that can be used includes surgical notes, anesthesia forms, nurse observation records, intensive care unit records, culture results, antibiotic treatment records, laboratory results, CRP/procalcitonin values, infectious disease consultations, wound care forms, fever monitoring charts, catheter and probe insertion/removal records, sterilization records, operating room cleaning records, infection control committee records, epicrisis, discharge documents, and, in case of death, the autopsy report.

According to the Patient Rights Regulation, patients can directly review and obtain copies of their health files and records, either directly or through their legal representative. Therefore, patients or their relatives should request all medical records in writing if they suspect a hospital-acquired infection.

The incompleteness of records is important. For example, if culture results are missing from the file, nurse observation forms are incomplete, catheter care records are not kept, antibiotic administration times are unclear, sterilization records cannot be presented, or infection control committee records are not submitted, this should be further evaluated in the expert examination.

The Importance of Expert Reports

In hospital infection cases, expert reports largely determine the outcome of the case. It is extremely important that the expert panel includes specialists in infectious diseases and clinical microbiology. Depending on the nature of the case, specialists in general surgery, orthopedics, obstetrics and gynecology, intensive care, anesthesia, cardiovascular surgery, urology, neurosurgery, microbiology, nursing practices, and forensic medicine should also be included in the panel.

The expert should answer the following questions: Was the infection hospital-acquired? Was the patient at high risk of infection? Were the necessary precautions taken to prevent infection? Were sterilization, disinfection, hand hygiene, isolation, and catheter care procedures followed? Was antibiotic prophylaxis and treatment appropriate? Was the infection diagnosed in a timely manner? Did delayed intervention increase the harm? Is there a causal link between the infection and death, organ loss, or disability?

Incomplete expert reports must be challenged. In particular, simply stating that "hospital-acquired infections are possible" and closing the case is insufficient. The report must thoroughly evaluate the specific patient's records, culture results, the hospital's infection control obligations, and whether the harm was preventable.

Can a criminal investigation be opened?

If a hospital-acquired infection results in serious injury, organ loss, permanent disability, or death, a criminal investigation may be initiated. Depending on the nature of the incident, charges of negligent injury or negligent homicide may be considered. However, criminal liability requires that it be demonstrated that specific healthcare personnel violated their duty of care and diligence.

In investigations into medical procedures and practices by healthcare professionals, the Professional Responsibility Board process may be initiated under Annex 18 of Law No. 3359 on Basic Health Services. Law No. 3359 regulates the fundamental principles of healthcare services and is a basic law covering both public and private healthcare services.

Criminal investigations and civil lawsuits are different. A criminal case investigates the criminal responsibility of individuals, while a civil lawsuit aims to compensate the patient or their relatives for material and moral damages. However, the forensic medical report and expert assessments in the criminal case can be important evidence in a civil lawsuit.

What should the patient or their relatives do?

If a hospital-acquired infection is suspected, the first step is to request all medical records in writing. This includes surgical notes, intensive care unit records, nurse observation forms, culture results, antibiotic treatment records, laboratory results, infectious disease consultations, sterilization records, and the hospital's medical summary.

The second step is to establish a chronology of events. When was the patient admitted to the hospital? When was the surgery performed? When did fever, discharge, wound deterioration, or signs of sepsis begin? When was the culture taken? When were antibiotics started? When was the decision for intensive care made? When was the patient discharged or died? This chronology forms the basis for expert examination.

The third step is to differentiate between private and public hospitals. In private hospitals, private law, consumer law, and malpractice liability come into play; in public hospitals, administrative appeals and full judicial review cases arise.

The fourth step is to identify the damages. If the patient is alive, medical expenses, disability, permanent impairment, caregiver expenses, and emotional distress should be prepared; if the patient has passed away, loss of support, funeral expenses, and claims for moral damages by relatives should be prepared.

Conclusion: Records and expert examination are decisive in hospital infection cases

Hospital-acquired infections (HAIs) are serious and sometimes life-threatening conditions that can develop during healthcare. Not every HAI is automatically a cause for compensation. However, legal liability may arise if the infection was preventable, if the hospital failed to comply with its infection control obligations, if there was a lack of sterilization or hand hygiene, if catheter/probe care was faulty, if antibiotic administration was incorrect, if isolation was not performed, or if the infection was diagnosed and treated late.

A patient who suffers harm due to a hospital-acquired infection may claim compensation for treatment costs, intensive care expenses, additional surgery costs, rehabilitation costs, caregiver costs, loss of earning capacity, permanent disability, and moral damages. If the patient has passed away, their relatives may claim compensation for loss of support and moral damages.

In these types of cases, the most important evidence is medical records, culture results, antibiotic records, nurse observation forms, intensive care unit documents, infection control records, and sterilization documents. A strong case should not only be based on the claim of "infection contracted in the hospital," but should also demonstrate, with concrete medical records, the connection between the infection and healthcare services, the hospital's negligence, the harm caused, and the causal link.