It was one of the biggest medical scandals in Germany: the former Bottrop pharmacist Peter Stadtmann underdosed thousands of cancer drugs over the years, earning tens of millions of euros.

In 2018, the Essen Regional Court found him guilty of drug counterfeiting and billing fraud in the amount of 17 million euros and sentenced him to twelve years in prison and a lifelong ban from working.

The Federal Court of Justice later confirmed the verdict, Stadtmann still has a constitutional complaint pending.

Hinnerk Feldwisch-Drentrup

Editor in the department "Nature and Science".

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Starting tomorrow, Thursday, around thirty lawsuits for damages will begin at the district court: Former patients and relatives of the deceased are suing for compensation for pain and suffering - this involves difficult scientific and legal issues.

So it is unclear in which of his patients Stadtmann injected less active ingredient than prescribed into the infusion bag, sometimes no active ingredient was found - or the wrong one.

In the criminal proceedings, the regional court was only able to compare the quantities of active ingredients that Stadtmann bought according to his bookkeeping and that he had given away - although the judges made the estimates in his favor, they came up with 14,500 counterfeit drugs.

The question is also difficult

Claim for pain and suffering recognized in the first trial

In February, a senate of the district court had to decide on similar issues in a first trial - the widow of a cancer patient demanded 25,000 euros in damages.

The Senate ruled that Stadtmann or his insolvency administrator, against whom the proceedings were directed, would have to prove that the patient received a correctly dosed drug - the insolvency administrator only denied underdosing in general.

According to the Senate, the widow generally has the burden of proof, but it is beyond her ability to provide evidence of the dosage of the drugs that her husband received.

Stadtmann and the insolvency administrator, on the other hand, can be expected to do this.

In their verdict, the judges recognized a claim of 10,000 euros;

but only because her husband has received treatment and IV fluids,

The man received his last infusion from Stadtmann in November 2016, the day police raided the pharmacy and arrested Stadtmann – the patient died the following year.

However, the judges did not see it as proven that he would have lived longer with the right dose of medication.

According to one reviewer, only one in five patients responds to the drug they received at all.

The proceedings are now with the Hamm Higher Regional Court – but they are currently on hold because the widow has died in the meantime.

Therefore, the judges at the district court can only rely on this first procedure to a limited extent.

According to the lawyer Manuel Reiger, who has filed 28 lawsuits for damages for his clients, nobody knows whether the treatments have had any effect at all.

Stadtmann's behavior is to be regarded as a gross breach of duty, so that a reversal of the burden of proof also applies to the question of whether underdosing led to poorer prognosis and earlier death.

Trust "ruthlessly abused"

It is very uncertain which claims are to be realized, says Reiger in view of the insolvency proceedings - according to an interim report, claims of around 125 million euros have also been registered by health insurance companies, but only around 680,000 euros have been recognized.

"The insolvency administrator blocks everything," says Reiger.

According to the report, this assumes that around 11 million euros are available.

The lawsuits filed by the lawyer are also directed against Stadtmann in order to be able to realize claims even after the conclusion of the insolvency proceedings.

In August, he also lost a lawsuit before the Gelsenkirchen administrative court against the withdrawal of his license to practice medicine: the judges ruled that he was “unreliable and unworthy” of practicing the profession – because he “ruthlessly abused” the trust of his patients in order to protect his personal financial interests to satisfy interests.