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 P a n o s P i c t u r e s 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 R e u t e r s 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