[Sudden death in medical practice. Quality assurance and control as a task of forensic medicine]

During the last twenty years 72 deaths occurred in Cologne in medical practices. The cause of death was determined by autopsy on judicial order in 13 cases only. Public interest in complete diagnosis existed only in case of acute death during a medical intervention. Where there was no such interest, but clarification was possible in the sense of a quality control, the autopsy rate was below 20%. In all other cases the cause of death was certified in accordance with clinical findings, usually as cardiac death. In 87% of all cases the death certificate had been signed by the doctor who had last treated the patient. In 57% the certified cause of death could be based on a knowledge of the underlying disease. A closer collaboration between practising doctors and forensic pathologists is desirable for the purpose of quality control.