A detailed guide to appeals in Turkish medical malpractice cases, covering private and public hospital claims, istinaf, temyiz, enforcement, retrial, constitutional complaint, and Strasbourg options.

Appeals in Turkish Medical Malpractice Cases: What Happens After Judgment?

Appeals in Turkish medical malpractice cases do not follow a single path, because the route after judgment depends first on the type of defendant and the legal basis of the case. A malpractice claim arising from paid treatment in a private hospital or private clinic is often litigated in the consumer-law/civil-procedure sphere, while a compensation claim arising from treatment in a public hospital generally moves through administrative procedure. That distinction matters immediately after judgment because the time limits, the appellate court, the scope of review, and the rules on enforcement are not identical in the two systems. Under Law No. 6502, consumer courts hear disputes arising from consumer transactions, and those cases are procedurally conducted under the Sixth Part of the Code of Civil Procedure. By contrast, the Administrative Procedure Law governs proceedings before administrative courts, regional administrative courts, and the Council of State.

That is why the real question after judgment is not simply whether the losing party can “appeal.” The better question is: which appeal system applies, what must be filed, how quickly, and what can the higher court actually do with the decision? In Turkish medical malpractice litigation, that answer usually turns on whether the first judgment came from a consumer/civil court dealing with a private-provider dispute or from an administrative court dealing with a public-hospital compensation claim. In either route, ordinary appeals are time-sensitive, enforcement may continue unless special relief is obtained, and a poorly drafted appeal petition can permanently narrow the issues reviewed at the next stage.

Why the Post-Judgment Route Changes in Medical Malpractice Cases

In private medical malpractice disputes, the ordinary ladder is usually first-instance judgment → regional court of appeal (istinaf) → Supreme Court review (temyiz) if the decision is further appealable. The Code of Civil Procedure allows appeals against first-instance final judgments and certain interim-measure rulings, while later review by the Court of Cassation depends on whether the regional court’s decision is one of the decisions that can be taken to the Supreme Court. The same body of procedural law governs consumer-court proceedings because Article 73(4) of Law No. 6502 expressly sends consumer-court cases into the Code of Civil Procedure framework.

In public-hospital malpractice disputes, the ladder is different: administrative court judgment → regional administrative court (istinaf) → Council of State (Danıştay) only in the categories that remain open to cassation review. Article 45 of the Administrative Procedure Law sets the ordinary istinaf route for administrative and tax-court decisions, while Article 46 specifies which regional administrative court decisions may then be taken to Danıştay. Because public-hospital medical negligence claims are generally brought as full-remedy actions against the administration, the administrative route is especially important in serious injury and death cases. (Adalet Bakanlığı)

What Happens First in Private-Hospital Cases: The Istinaf Stage

If the malpractice judgment came from a consumer court or another civil first-instance court, the ordinary appeal is usually istinaf before the relevant regional court of appeal. The Code of Civil Procedure states that the period for filing istinaf is two weeks, and that the period starts when the judgment is duly served on each party. The appeal is made by petition, and the petition must identify the parties, the court and decision challenged, the date of service, the summary of the decision, the grounds of appeal, and the relief requested. The petition can be filed with the court that rendered the decision or with another local court for transmission.

This timing rule is critical in medical malpractice litigation because parties often wait for the full reasoning, collect a second medical opinion, or spend time negotiating before they realize the appeal clock has already started. Under the statute, the key trigger is service of the judgment, not the moment the losing party finally decides on a strategy. The Code also requires the appeal fees and notification costs to be paid when the petition is filed; otherwise the appellant risks a procedural rejection if the deficiency is not cured in time.

Once the appeal petition is filed, the first-instance court serves it on the other side. The respondent then has two weeks to submit an answer. Turkish civil procedure also recognizes a type of cross-appeal: even a party that did not separately appeal on time may, after being served with the other side’s appeal, challenge the judgment through its response petition. But that dependent appeal falls away if the main appeal is withdrawn or rejected without any merits review. In malpractice cases this matters a great deal, because hospitals and claimants often attack different parts of the same judgment: liability, causation, expert findings, the amount of pecuniary damages, moral damages, interest, or costs.

Does Filing Istinaf Automatically Stop Enforcement?

Usually, no. The Code of Civil Procedure states that filing istinaf does not automatically stay enforcement. The same rule is repeated later for temyiz. The law preserves the possibility of obtaining a stay through the execution rules, but the appeal itself is not enough. For ordinary malpractice money judgments, that means a losing private hospital, doctor, insurer, or claimant cannot assume that enforcement will be frozen simply because an appeal was lodged. The statute only creates an automatic finality barrier for certain categories such as family-law, personal-status, and real-rights decisions, which are not the usual structure of a medical malpractice damages case.

From a practical standpoint, this is one of the most misunderstood parts of the post-judgment phase. A party may celebrate having filed an appeal and then discover that the other side has already moved toward execution. In medical malpractice cases, especially where the first-instance court has awarded large pecuniary and moral damages, the enforcement question can become almost as urgent as the merits of the appeal itself.

What the Regional Court of Appeal Can Actually Do

The regional court of appeal does not function like a purely symbolic review body. Under Article 352, it first conducts a preliminary review on the file to check matters such as timeliness, whether the decision is final, whether appeal conditions were met, and whether any reasons were stated. If the file passes that stage, Article 353 gives the regional court several important powers. It may set aside the judgment without reaching the merits in certain serious procedural situations, such as lack of jurisdiction, participation of a disqualified judge, or a decision given without collecting or evaluating any of the material evidence offered by the parties. It may also reject the appeal on the merits, correct the reasoning and re-decide, or complete limited deficiencies and then render a new merits judgment itself.

That power is especially important in Turkish medical malpractice cases because a flawed first-instance decision may fail for procedural reasons long before the higher court reaches the substantive medicine. For example, a consumer court may have decided the case without properly evaluating the objections to an expert report, without collecting the full hospital file, or without discussing crucial medical records. In such a scenario, the regional court may either remand because the foundational process was broken or directly correct the legal result where a full retrial is unnecessary.

The scope of private-law istinaf review is also narrower than many litigants assume. Article 355 provides that review is limited to the grounds stated in the appeal petition, except for issues of public order, which the regional court may raise on its own. Article 357 generally bars new claims, counterclaims, interventions, amendments, and new evidence, although it allows consideration of evidence that had been properly offered below but was wrongly not examined, or evidence that could not earlier be produced because of force majeure. As a rule, cases are examined with a hearing unless they fall into the no-hearing categories in Article 353.

In malpractice practice, this means the appeal petition matters enormously. If counsel does not identify the key errors—such as a causation mistake, misuse of an expert opinion, failure to address informed-consent arguments, or incorrect damage calculations—the regional court may not fully reconstruct the case on its own. The best appeal petitions in medical negligence files therefore do not simply repeat the statement of claim or defence; they isolate the legal and evidentiary errors that fit the appellate standard.

The Next Step in Private Cases: Temyiz Before the Court of Cassation

If the regional court’s decision is one of the decisions open to further review, the next stage is temyiz before the Court of Cassation. Article 361 gives a one-month period from service of the regional court’s decision to file the cassation petition. The same article also makes clear that even the party who formally prevailed can seek cassation if it still has a legal interest in challenging part of the outcome. But Article 362 lists categories of regional court decisions that are not open to cassation, including decisions below the statutory monetary finality rules and certain types of cases. In other words, not every private medical malpractice judgment can reach the Supreme Court.

That point deserves emphasis because many litigants assume that “appeal” always means there is a full three-level path. In fact, some private medical disputes become final at the regional-court level because the case does not satisfy the statutory conditions for Supreme Court review. For medical malpractice practitioners, this means that the istinaf stage is often the decisive ordinary remedy, not just a warm-up for Yargıtay.

At the temyiz stage, the Court of Cassation usually reviews the case on the file. Article 369 says the Court is not bound by the parties’ stated cassation grounds and may also examine other issues that are clearly contrary to law. The same article allows oral hearing in certain categories and sufficiently high-value claims if requested in the cassation or response petition, while preserving ordinary file-based review as the default model.

The possible outcomes are not limited to a simple “approved” or “reversed.” Article 370 allows the Court of Cassation to uphold the decision, to uphold it with corrected reasoning, or to correct certain legal or obvious errors and affirm. Article 371 lists classic reversal grounds such as wrong application of law or contract, defects in procedural preconditions, unlawful refusal of evidence, and procedural mistakes or omissions that affected the outcome. In medical malpractice cases, these provisions are the legal backbone for attacks on defective expert evaluation, misapplied burden-of-proof analysis, unreasoned damage calculations, or overlooked consent and record issues.

What Happens After a Reversal in Private Cases?

The answer depends on what exactly the Supreme Court reversed. Under Article 373, if the Court of Cassation reverses a regional court decision that had merely dismissed the istinaf application on the merits, the regional court decision is lifted and the file is sent to the first-instance court or another appropriate first-instance court. If, however, the regional court had itself corrected the decision or rendered a fresh merits ruling, then the file goes back to the regional court of appeal or another appropriate regional court.

The lower court does not always have to agree. Article 373 also allows the first-instance court or the regional court, depending on the posture of the file, to comply with the Supreme Court’s reversal or to insist on its own earlier view. If there is insistence, the dispute goes to the Civil Chambers General Assembly of the Court of Cassation, and compliance with that body’s ruling is mandatory. The same article also states that if, after reversal, the first-instance court gives a new decision in line with the reversal, that new judgment can again be taken to cassation.

This procedural architecture explains why some Turkish medical malpractice files continue long after the first appellate reversal. A complicated causation dispute, a defective expert-report process, or a serious jurisdictional error can send the case back for a new judgment, and that new judgment may itself generate another appeal. In practice, “after judgment” can therefore mean several more years of appellate litigation if the case contains major procedural or expert-evidence problems.

Public-Hospital Cases After Judgment: The Administrative Route

When the malpractice claim is against a public hospital or other public healthcare body, the ordinary appeal route is different from the private-law model. These cases generally arise as full-remedy actions against the administration, and Article 13 of the Administrative Procedure Law requires the injured person to apply to the relevant administration within one year of learning of the harmful act and in any event within five years of the act before bringing the judicial claim. Once the administrative court gives judgment, Article 45 opens the istinaf path to the regional administrative court within thirty days of service, subject to the statutory finality thresholds and categories in the same law. (Adalet Bakanlığı)

The regional administrative court’s powers are also substantial. Article 45 states that if it finds the first-instance decision lawful, it dismisses the istinaf application; if it finds the judgment unlawful, it lifts the first-instance decision and gives a new merits ruling itself. In certain foundational problems—such as lack of jurisdiction or a disqualified judge—it accepts the appeal, removes the judgment, and sends the file to the proper court. Decisions of the regional administrative court that are not open to cassation under Article 46 become final, and those final regional decisions are sent back to the first-instance court for service within seven days. (Adalet Bakanlığı)

In administrative malpractice appeals, the enforcement rule also matters. Article 52 states that filing istinaf or temyiz does not automatically suspend execution. A stay may be granted against security by the competent regional administrative court or Danıştay, and rulings on stay applications during appeal are themselves final. The same article further provides that when the decision is reversed, execution stops automatically. This is an especially important provision in public-hospital compensation cases involving payment orders, institutional obligations, or rulings that could otherwise move forward while review is pending. (Adalet Bakanlığı)

When Does a Public-Hospital Case Reach Danıştay?

Not every regional administrative court decision goes to Danıştay. Article 46 lists the categories that remain open to cassation review, including certain regulatory cases and, crucially for malpractice litigation, full-remedy cases above the statutory monetary threshold. The same law’s Ek Madde 1 states that the monetary thresholds in the statute are increased through the annual revaluation mechanism. The cassation period is thirty days from service of the regional administrative court’s decision. The cassation petition is filed through the decision-making body, and the other side has thirty days to respond. (Adalet Bakanlığı)

This means that some public-hospital malpractice judgments will become final at the regional administrative court, while others—typically larger full-remedy cases—may proceed to Danıştay. Because the thresholds are not static, counsel should always check the threshold applicable under the statute for the relevant filing framework rather than assume that a case is or is not cassation-eligible. (Adalet Bakanlığı)

At the Danıştay stage, Article 49 gives the high court the classic cassation options: it may affirm the decision, affirm it with corrected reasoning, correct removable defects and affirm, or reverse for lack of jurisdiction, unlawful adjudication, or procedural error capable of affecting the outcome. Article 50 then regulates the consequences of reversal: the file goes back to the relevant lower body, which re-examines the case, completes any necessary investigation, and decides again. The regional administrative court may comply with the Danıştay reversal or insist on its prior decision; if it insists, the matter goes to the Administrative or Tax Chambers Board of Danıştay, whose ruling is binding. (Adalet Bakanlığı)

For medical malpractice practitioners, the public-law route has one practical consequence that is easy to underestimate: the case remains strongly document-driven all the way up. Administrative litigation is fundamentally written, and the appellate stages do not operate as a broad opportunity to rebuild the case from zero. If a claimant or the administration wants to attack the expert evaluation, causation model, or damage methodology, those criticisms need to be framed in a way that fits the written appellate structure and the specific legal grounds recognized by the statute. (Adalet Bakanlığı)

Extraordinary Remedies After the Ordinary Appeals End

Even after the ordinary appeal route is exhausted, Turkish law still recognizes limited extraordinary avenues. In private-law proceedings, Article 374 of the Code of Civil Procedure permits retrial/reopening of proceedings (yargılamanın iadesi) against judgments that are final or have become final, and the following articles list specific grounds such as newly obtained documents that could not previously be secured, fraud affecting the judgment, false expert evidence, false testimony, or a later European Court of Human Rights violation finding. In the administrative sphere, Article 53 of the Administrative Procedure Law likewise allows yargılamanın yenilenmesi on limited grounds, including later-discovered documents, fraud, false expert evidence, contradictory final judgments without lawful basis, and an ECHR violation finding. These are not second appeals; they are exceptional reopening mechanisms for narrow situations.

Both systems also recognize a form of kanun yararına review for certain final decisions, but that mechanism does not function like an ordinary party-driven appeal that reopens the merits for the litigants. In administrative procedure, Article 51 expressly states that a “for the benefit of law” cassation decision does not remove the legal consequences of the already final decision. That is why parties in medical malpractice cases should not treat extraordinary remedies as substitutes for timely istinaf and temyiz. (Adalet Bakanlığı)

Constitutional and Strasbourg Review After Domestic Appeals

After ordinary domestic remedies are exhausted, a party may consider an individual application to the Turkish Constitutional Court if the case involves an alleged violation of a constitutional right falling within the individual-application system. The Constitutional Court’s own materials state that ordinary remedies must be exhausted first, reflecting Article 148 of the Constitution and Law No. 6216, and that the individual application must generally be filed within thirty days from the date the domestic remedies were exhausted, or from learning of the violation where no remedy existed. In a medical malpractice context, this route is most relevant where the complaint is no longer just about a wrong medical outcome, but about fair-trial defects, access-to-court problems, ineffective investigation, or serious rights-based procedural failures. (Anayasa Mahkemesi)

After the domestic process is fully exhausted—including the Constitutional Court stage where it is an effective remedy—the European Court of Human Rights may become relevant. Under Article 35 of the Convention, the Court deals with a case only after domestic remedies have been exhausted and within four months of the final domestic decision. The ECHR has also explained in its own guidance that the four-month period applies from the final national judicial decision. For Turkish medical malpractice files, Strasbourg is therefore a final human-rights layer, not a substitute for missed domestic appeal deadlines. (ECHR)

Practical Lessons for Medical Malpractice Litigants After Judgment

The most important practical lesson is that the first appeal petition often shapes everything that follows. In private-law cases, the regional court of appeal is largely confined to the grounds stated in the istinaf petition except for public-order issues, and new claims or entirely fresh evidence are generally restricted. In administrative cases, the written structure is equally unforgiving. That is why a malpractice appellant should not file a generic petition saying only that the first-instance court “misjudged the facts.” The petition should identify the precise legal and evidentiary defects: which expert finding was flawed, which hospital record was ignored, which causation step failed, which damage item was miscalculated, and which procedural error affected the judgment.

The second lesson is that appeal and enforceability are separate questions. In both the civil/consumer path and the administrative path, filing istinaf or temyiz does not automatically suspend execution. That becomes critically important where a hospital, insurer, or administration is facing a substantial award, or where a claimant is trying to collect compensation before the higher courts rule. The losing party must therefore think simultaneously about merits strategy and about stay mechanisms.

The third lesson is that not every malpractice case reaches the highest court. Some private cases end at the regional court of appeal because the Supreme Court route is closed by the statutory finality rules. Some public-hospital cases end at the regional administrative court because they do not fall within Article 46’s cassation categories or statutory threshold. For that reason, lawyers should treat the first appeal as potentially decisive instead of assuming a later court will correct whatever is missed now.

Conclusion

Appeals in Turkish medical malpractice cases are highly structured, but the structure changes depending on whether the judgment came from the private-law/consumer side or from the administrative side. In private-provider cases, the ordinary sequence is usually first-instance judgment, two-week istinaf, and then one-month temyiz if the regional court’s decision is further appealable. In public-hospital cases, the ordinary sequence is administrative-court judgment, thirty-day istinaf to the regional administrative court, and then thirty-day cassation to Danıştay only in the categories the law keeps open. In both systems, filing an appeal usually does not by itself stop enforcement, and in both systems the appellate body can do much more than simply say yes or no. It may remand, re-decide, correct, affirm, reverse, or trigger a further loop of review after remand.

So, what happens after judgment in a Turkish medical malpractice case? The short legal answer is: service, deadline, appellate petition, enforceability analysis, and then a carefully limited higher-court review whose shape depends on the forum that delivered the first judgment. The practical answer is even sharper: once judgment is served, every day matters, and the quality of the appeal petition often determines whether the case ends quickly, is corrected on review, or returns to the lower court for another round of litigation.