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World Report

462 www.thelancet.com Vol 371 February 9, 2008


A debate about the professional
standards of doctors has been raging
in Romainia after a serious case of
medical malpractice came to light.
Sebastian Lungu was born in August
last year in one of Bucharests top
hospitals, the University Hospital,
with serious brain damage that
meant he could not see, hear, or
swallow anything. His mother, Alina,
has launched legal action against
the hospital. She claims she was left
entirely unattended by medical sta
during parts of the birth and her son
suered brain damage when she was
left alone for 45 minutes. During this
time her son did not get any oxygen
because her umbilical cord had
become wrapped around his neck.
She said that if someone had been
there to check on the baby they would
have noticed the problem sooner
and the brain damage would not
have occurred. I was left all alone for
45 minutes. They said there was a shift
change. The nurse told me she could
see the babys head and just showed
me what to do at the next contraction
and left, she said.
The complaint was ignored until
the Romanian media recently took
up the case. An investigation by
the Romanian Doctors College, the
regulatory organisation for doctors in
the country, followed, which agreed
with Alina Lungus claim.
Subsequently, the doctor on duty
Cristian Radoiwas suspended for
6 months and the doctor who was
supposed to manage the birthMirela
Moarcasfor a year. Two nurses who
were on duty and were supposed to
be at the mothers bedside during
the birth were also sanctioned by the
Medical Nurses Association.
The health ministry has also agreed
to cover the expenses of medical
treatment abroad with specialists for
the baby. But it is not expected that
his condition will improve much.
The case has provoked furious
debate among the Romanian public
and politicians, because it has
highlighted what most Romanians
claim are lethally poor standards in the
entire health-care sector.
According to gures from the
Doctors College there are thousands
of formal complaints made by
patients against doctors every year.
In the capital Bucharest last year the
Doctors College received 140. In
the past 10 years there have been
1200 complaints with 485 of them
from relatives of patients who have
died. But in that time only three
doctors have lost their licences to
practise.
A poll by the Doctors College in the
third largest city in the country, Iasi in
eastern Romania, showed that 12% of
patients felt that they had been on the
receiving end of a mistake by a doctor
and 54% said such mistakes were down
to a lack of professional education
by doctors. Some Romanians involved
in legal action against doctors have
claimed that doctors cover up their
own and other doctors mistakes.
Another poll by the Doctors College
in Iasi, which surveyed doctors,
showed that 38% of them would not
inform their patient if he or she had
been the victim of a medical error.
76% of them said, however, that they
know other doctors who made errors,
but 20% said they would never say
anything about a mistake a colleague
made. Another 20% of the doctors
said that if they noticed one of their
colleagues making a medical mistake
they would warn them and try to
cover it up.
Adrian Chesa from Arad, in western
Romania, has launched legal action
against three doctors after they
failed to diagnose his 12-year-old son
with appendicitis. The child died of
septicaemia 1 week after rst being
taken to the doctor by his parents and
being treated for what was diagnosed
as a bladder complaint and being sent
home with medication.
After an investigation by the local
Doctors College, which found the
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Medical malpractice cases spark debate in Romania
A series of serious medical malpractice cases have sparked a nationwide debate about the
standards of health care in Romania after the parents of a newly born baby blamed hospital sta
for the irreversible brain damage their son was born with. Carmiola Ionescu reports.
The case has...highlighted what
most Romanians claim are
lethally poor standards in the
entire health-care sector.
Hospital managers believe that medical migration has aected standards of care
The printed journal
includes an image merely
for illustration
World Report
www.thelancet.com Vol 371 February 9, 2008 463
three doctors guilty of malpractice,
one of the doctors received a written
reprimand, another a warning, and
a third was given a vote of censure,
which means the doctor cannot be
promoted or take any professional
exams for 6 months.
Chesa, who is using a clause in
Romanian law that allows people
to le criminal complaints against
individuals, is hoping the trio will be
tried on charges of unlawful killing.
These sanctions are not serious
[enough], these doctors killed my son.
They are only covering up for each
other.
Local media have since reported
scores of complaints against doc-
tors and the health minister,
Eugen Nicoalescu, has criticised the
functioning of the Doctors College
and its role in ensuring doctors achieve
the highest professional and ethical
standards.
The Doctors College is the only
professional body entitled to take
measures against doctors over mal-
practice. All of the 42 counties in
Romania have their own Doctors
College to deal with complaints in their
region. But the health minister has no
power over the Doctors Collegea
situation Eugen Nicolaescu is unhappy
with. He said a lack of protocols within
the College governing the treatment of
patients meant that it was very di cult
to clearly show when a procedure
had not been followed correctly and
punish doctors. The Doctors College
has never fullled its duties. They work
the way they want and there is nothing
I can do about it, he said.
But the Doctors College has defended
itself amid the growing criticism of
doctors professional standards. The
President of the Bucharest Doctors
College, Sorin Oprescu, said: There
are 11 000 doctors in Bucharest and it
is not normal that all of us should be
blamed for the dozen or so who did
not respect the Hippocratic Oath.
We have never covered up any
case of malpractice or doctors making
mistakes. Those guilty of mal practice
or making mistakes have paid and will
continue to pay. The only thing doc-
tors are guilty of in many complaints
is a decient communication with
their patients.
I admit there have been doctors
who were at fault for their patients
death or injury but their number is
insigni cant compared to those who
are beyond any criticism. He added:
The system is like this because the
health ministry has never done enough
to avoid getting to this stage.
Doctors also say the lack of money
in the health-care system is doing
nothing to help the standard of care
for patients in hospitals. The health
system receives 35% of Romanias
national gross domestic product
of roughly 100 billion. The sector
is millions of euros in debt and the
past few years have seen a number of
doctors strikes and industrial action by
other medical sta, including suppliers
withholding medical equipment and
even medicines as they demand out-
standing bills be paid.
Doctors say there are also severe sta
shortages because so many doctors
have moved abroad for better paid
positions. There are not enough
doctors and they work 10 to 16 hours a
day with whatever medical means they
have and when they do not have what
they need they improvise, said Doctors
College president Vasile Astarastoae. His
predecessor Mircea Cinteza said: The
entire system will only get the worse
if current nancing is maintained.
The health system needs double the
money it gets now.
A recent study by the Sanitary
Solidarity trade union of medical
workers said that 57% of hospitals
managers believe that the pro-
fessional level of the medical sta
in Romania has decreased due to
migration of medical sta. In the
same study, 54% of doctors said they
would work abroad citing their main
reasons behind such a desire being
better wages and working conditions.
Only 15% of doctors questioned said
they earned more than 500 a month
with the remainder saying their
salaries were lower than that.
The Romanian Government
has announced a 22% pay rise for
doctors in 2008, but admits that
some hospitals are in a poor physical
state. Health minister Nicolaescu
said: When hospitals are renovated
and properly equipped the quality
of medical services will rise. No
investments have been made in
Romanian hospitals for 30 years.
Carmiola Ionescu
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Romanian doctors have been campaigning for higher salaries and better working conditions
When hospitals are renovated
and properly equipped the
quality of medical services will
rise.
The printed journal
includes an image merely
for illustration