Medical mistakes kill the patients - Syria

“The Deadly Scalpel”

Marwa Al- jurdy, Ahmad Haj Hamdo- Damascus: 

Tasnim has entered Damascus hospital ” Almojtahed ” at the end of last August for a routine reviewing, because she has Asthma, with a shy smile the young girl had sat on the bed, then the nurse gave her a “Needle” and immediately has screamed “Her breath stopped”, then Tasnim was taken to the Intensive Care Unit.

A few minutes later, two nurses got out and tried to reassure her father who was waiting outside and they have said:” it’s okay, nothing important”, however the intensive care doctor was more frank and said:” Her condition is critical and she is now on the artificial respirator, if she stayed alive, she will be injured with a brain damage due to hypoxia in the brain”.

After few Hours, her heart had been stopping several times, and was revived many times, but no response anymore:”she died and the torch went out” her father Mohmad Alarab is complaining with a broken heart.

Al Almahayini private hospital which is located close to the governmental Damascus hospital “Almojtahed”, the young boy Hussni has entered it , at mid of last April ,for making “the deviated septum” surgery for nose, but he went out of the hospital lying on people shoulders, like Tasnim as a dead body.

Hussni’s father noticed cramps in his son body after the surgery, meanwhile the doctor has considered it as Signs of waking up from anesthesia, ten minutes later his breath had stopped with a bulged neck and without any movement, then he entered into coma, that necessitated transferring him to the intensive care unit, and in the sixth day his heart had stopped twice and the spirit went out.

The trio forensic doctors’ report ,which we has obtained copy of it , is attributing the death reason to” careless and lack care from the doctor in fixation the tampons ,in order to stop the Immediate bleeding, and that led to slide one of it to the respiratory stream in the pharynx, in spite of happening this kind of problems is rare, but the doctor didn’t take care or give enough care toward the child’s right ,due to not fixation the tampons from outside, and this is our experience unanimous” .

Like Tasnim and Hussni, this investigation has documented the death of five persons during six months, and hand’s amputation of a sixth person , after they have been treated or subjected to surgeries in the Syrian governmental & private hospitals, at areas which under control of the Syrian government.

All the deaths had resulted of medical careless & lack of caution, in spite of that no one has been accounted as a doctor or hospital, due to not existing a medical accountability law in the country, in addition the multiplicity of associations, governmental and judicial references, in the careless’ complaint or medical mistakes.

The tracks of medical mistakes & negligence complaints are controlled by the general laws as follow:

Punishments & Civil Law, Doctor’s Association Law, Medical Professions Practicing’s Law, and all of them don’t define the medical mistake, and not achieving the principle of fair accountability for the medical bodies of the committed mistakes.

Minister of Justice chancellor , the judge Fouad Darwish , sees that there is no need to medical accountability law ,due to “the current punishment law is inclusive for all of the medical mistakes situations ,and The judiciary is the house of ruling”.

The lawyer Kamal Salman is talking about the collusion of the formed medical committees by the courts according to punishments law,” and Lack of their integrity and bias”.

And according to the Syrian punishments law, there are affected persons who lost /700/suits in front of Syrian courts, under the heading of causing harm, including some lawsuits against doctors & hospitals due to medical negligence or shortening, between years of 2014-2017, and the courts had decided to disclaimer of doctors and hospitals responsibility under the pretext lack of intention and free will to commit the mistake or medical negligence.

Escape and Neglect

After entering Hussni the intensive care unit, his father surprised that the doctor (Y.B), who had conducted the surgery did not follow up his son medical condition.

Unexpectedly, the (Y.P) doctor’s father has attended and he is also otologist to where Hussni is laying in, and after the greeting he told them that “(Y.B) will not come to follow up Hussni as of today, because he has departure Syria to avoid joining the military service), these words were as a shock to Hussni’s family.

Before the sunset of the fifth day, the Anesthesiologist Imad Alkhtab , had examined on Hussni’s nose at the intensive care room ,and he did not find  the “tampon” in the left nostril, according to the medical reports which we have , which are compliant with the technical consultation for the doctor Imad Feda , who is specialized in the nasal surgery.

After Hussni death at the sixth day, his father went to the General Prosecution and sued the hospital and its cadres, and the General Prosecution decided to transfer the body to the central Damascus hospital for anatomy.

The Forensic Medicine’s report had attributed the death reason to brain Hypoxia ,which is resulted from closure of the upper respiratory streams due to sliding the nasal “tampon” , after a deviated septum – surgery for the nose , which is divides the nose into two parts , the left & right parts.

The judge decided to assign police looking for the doctor (Y.B) and bringing him to the General Prosecution in Damascus as soon as they catch him, the Court began to consider the case, and no one of the defendant parties attended, only the released Anesthesiologist Imad Feda’s lawyer.

All attempts of the persons, who has prepared this investigation to communicate with the doctor (Y.B) are failed, because he is abroad, a few days after Hussni death, the (Y.B) has posted on Facebook website and he was blaming the Anesthesia Staff, saying:” the patient went out of the operation room and what happened to him: hypoxia and heart stops, because of over dose which led to throat cramping and respiratory failure, and this is fully responsibility of the Anesthesia staff.

The Medical Committees” Negative Solidarity”

The power to form medical committees with experience & specialists is to “the Doctors’ Association”, because it is the concerned body and has lot information about the doctors, according to the Head of Hospitals Division at Directorate of Damascus Health and the member in the Doctor’s Association Imad Shaaban.

The medical committees consist of three levels: the first includes three doctors are chosen by the Association, the second: of five doctors in case of needing to another technical experience, and in case of appealing the results of any of the both mentioned committees, will be formed a committee of seven doctors, and according to Shaaban:” The decisions of those not final, the final word to the judge at the court or to the Disciplinary Council at the association”.

The Minister of Justice chancellor Fouad Darwish is referring that there is a negative sympathy between doctors:”and rarely these committees decide that their Colleagues have been committed a mistake, the doctors don’t vilify reputation of each other “, and Darwish sees ” the medical committees like these cases close the road in front of the affected persons to recover their rights.  

The lawyer kamal salman sees that ” there are medical committees intentionally delay in writing their reports and absent from trials in order to prolong the length of litigation seeking for amnesty, the forgiveness by affected persons over the time , or falling the sentence over time also “.

And he is saying: “I have medical mistakes’ lawsuit since 2011 and has not been finishing, up to date, and most of the doctors in the medical committees don’t say the reality in case of presence a complaint or suit against other doctor, for their fear from making similar mistakes in the future”.

The Head of Lattkia doctors Ghassan Fendi agrees with Salman , and he suggests” to form a judicial authority specialized in doctors lawsuits  , in addition to set criteria for choosing doctors who are taking decisions like these kind of lawsuits”.

How to lose your hand at Syrian hospital?

The child Haidar Issa (9 years old) broke his hand after falling from bicycle in 6th of July 2017, thus he was transferred to Alhafa hospital in Lattakia countryside, over there the doctor had stitched  the wound in his hand, then he put a splint over it ,but the pain didn’t leave the child hand and reached to his shoulder until the appearing of mild swelling in the broken hand’s fingers and changing its color to blue, and when the child’s father went back to the same doctor, he only cut the splint without examining the wound which was aggravated.     

Next day the child fingers color changed from blue to black, this time his father transferred him to the national hospital in Lattakia, where they decided to amputation his hand after urgent surgery intervention “for saving his life”.

His father took him to Al- othman hospital, hoping to find solution except the amputation, but the doctor decided the same solution, here the shocked father was notified:” the doctor who was responsible of the son, had made a mistake, he must expanding the splint about 3cm, in order to relieve the pressure on the hand and the gauze must be removed after he has cut the splint, in order to open the rotten wound”.

Haidar’s father submitted a complaint to the Doctors’ Association Branch in Lattakia, thus the association has formed trio medical committee decided that the doctor is innocent.

Five – persons committee was formed and had decided all the parties including the child’s family are responsible on what happened to the nine- years- old child, due to their delay in transferring the child to the hospital, according to head of doctors in Lattakia, who promised the parent to obtain appropriate compensation from the doctors.

But Haidar’s family considered that two million Syrian pounds (4 thousand dollars) is a bit of money, and they decided to file a lawsuit in front of the general prosecutor in Lattakia, on 3 October 2017, against 12 doctors who had dealt with Haidar situation in both hospitals (Alhafeh & National).

But the court didn’t appoint until now the first session date, which has been adjourned several times, upon the defendant doctors’ demand, every time Haidar’s father is asking about the lawsuit developments at the Judicial Palace, he has been informing that: “the suit may takes many years”.

The head of Lattakia doctors Ghassan Fendi, sees: “there is a dereliction from the doctors and it must be determined”. But he did not adopt any opinion, because the investigation is still ongoing.

Today Haidar’s father has to go to Charities, seeking to whom can help him to obtain artificial hand for his child, while the doctor is supposed to be accounted .

The Complaint’ Maze

Tasnim who has died after hours of her entering Damascus hospital ” Almojtahed” for a routine checkup due to the asthma, her case is still sticking without equity, her father Mohamad Alarab is saying:”After the nurse has given my daughter a needle, immediately she broke down on the floor, stopped moving and started saying: I can’t breathe, then her lips color changed to blue”.

Tasnim’s medical report states that:”she exposed to sudden loss of consciousness and central blueness after her entering in half an hour, and reached the intensive care unit with heart stop & respiratory failure.

Then her heart was resuscitated three times, and did not respond in the fourth time, then they had announced her death”, but the report has not been provided a reason for lost consciousness and what followed it from heart stop & respiratory failure.

Tasnim father’s complaint to “Syria Doctors Association – Damascus branch” which dated on 27 August 2017, and the Association’s response was:” it doesn’t accept the cases against bodies- institutions but only against doctors”. And due to the father doesn’t know the name of the responsible doctor of her situation, so he did not complete the complaint procedures.  

At the same day he submitted a complaint to Ministry of Health, and he had met the Minster of Health, who promised him verbally to make an investigation.

Later, he went to the hospital to ask about the Ministry of Health’s investigation and they notified him, that his complaint was transmitted to “the Central Commission for Control & Inspection”. (Independent commission which making sure of applying the law, assessment of work & employees performance, determining of deficiencies in work, and suggesting solutions to treat them).

Then he went to the commission headquarter to inquire about it, he did not find any complaint in his name or under any other name. He submitted a complaint to the commission on 7th of last September.

Ten days later, the complaint was transmitted to Presidency of Ministers Council, under No. 1/2019, but it has been stilling under the investigation, the Head of Hospitals Division at Directorate of Damascus Health Imad Shaaban, is justifying not forming a medical commission to follow up Tasnim’s case, due to submitting her parents the complaint to non- judicial body.

Three legal ways to sue doctor:

  1. The civil way: The affected person and heirs demand a civil compensation for the occurred harm, according to article 164 of the Civil Law which provide that” every one made a mistake and causing a harm for other he will be committed  to compensates the other”.
  2. The disciplinary way: The affected person submits a complaint to the association which the doctor affiliates it, to impose the disciplinary punishment.   
  3. The penal way: The affected person demands the court, to impose the penal punishment on the defendant, in addition to the civil compensation.

The complaint’s tracks in front of the association /judiciary/government:

The chief of Al-mojatahed hospital, Haitham Al-hussaini, refuses commenting on Tasnim’s file, because it has been seeing in front of The Central Commission for Control & Inspection.

Al-hussaini is explaining, the Association refuses to receive the complaint:” because it is doesn’t against a doctor in his clinic ,but it is against governmental hospital, falls within the institutions of the state, thus the Ministry of Health will transfer it to the control & inspection’s commission in this case”.

And he sees that: “The matter is integrated and related to the Emergency Department, Chest Division and Intensive Care Unit, not to the doctor himself”.

The head of Syria doctors Abdulkader Hassan says that:” The association is not the only body where the complaint is submits to”, referring that the disciplinary council has only received two complaints in year of 2017.

The judge Fouad Darwish is explaining the Scarcity of complaints in front of the association, due to the absence of complaint’s culture to association, most of people are going to courts, and that limits the lawsuit, between the legal (compensation) and penal (punishment).

Absence of the medical accountability is aggravating the problem

In August of 2017, Oula (23 years old) entered to Alyarmouk hospital in Daraa to make a cesarean surgery, new born Lujain saw the light, but her mother entered into coma for eight months, after she has exposed to stroke during birth, which has disabled her body’s functions until she died.

Oula’s husband sued the medical cadre at Darra court, according that, three doctors were arrested for a few days, then they had been released, and the accused doctor (woman) has departure, according to Head of Daraa Doctors Yassir Nasir , and the case is still considering  in front of the judiciary.

A survey of Ministry of Health & Damascus University in cooperation with the United Nations Population Fund, states that 90% of motherhood deaths are resulting from mistakes in diagnosing; lack of equipment or care lack, the survey included all Syria governorates in 2008.

By reviewing archive of the Justice Palace, the person who prepared this investigation found that 700 suits have classified between years of 2014-2017 under both items: ” the causing in harm or causing in death”, due to the absence of private law related to the medical mistakes, as we were notified by the responsible over there, under condition not to reveal his name.  

The lawyer Kamal Salman is clarifying that:”The lawsuits which filed against doctors don’t win mostly, due to the absence of strict law for doctors’ accountability and to convict the doctors”.

And Salman sees that the civil & penal deterrent has a weak impact,” neither covers the harm nor accomplishes the lawmaker purpose to fair the victim”. And he asserted: “The medical mistakes will not stop without accounting doctors”.

Also Salman demands law legislation for medical accountability, which takes into the account tightening of the penal and disciplinary punishments progressively, and increasing of compensation amount and speed of litigation proceedings, and reparation the harm, considering that the punishments law is insufficient to achieve that.

Up to date of the investigation publishing, the justice has not been accomplishing for families of Tasnim , Hussni and Oula with her daughter who lost the mother’s tenderness at moment of her birth, and no one of the doctors & hospitals  have been accounting , who caused a tragedy for these families, while Haider has been waiting of the judiciary to give him a fair compensation , which provides him artificial hand enables him to play with the neighborhood’s children.

This investigation was completed with support from Arab Reporters for Investigative Journalism (ARIJ) www.arij.net and in partnership with Syrian Investigative Reporting for Accountability Journalism (SIRAJ), under the supervision of editor Musaab Shawabkah.