Ramallah, West Bank (PNN), Mohammad Hmeidan Mubarak suffered from rectal haemorrhaging and anaemia and checked into a hospital in search of a solution for his ailment.
The lab results indicated that he was inflicted with cancer of the colon.
Family members reacted with fear to the results and were worried about his reaction to the news. They all gathered to comfort him without revealing the cancer results for at least a month after they came out. The situation remained tense while the family members went through a mix of feelings: fear, worry and pain at their father’s suffering.
Despite this, his son Ibrahim says: “my father was aware that something was not right what with all of us by his side.”
Their love for their father drove family members to seek a cure for his illness. They took the same sample for re-examination, this time at the King Hussein Cancer Centre in Jordan. The result came as a nice surprise, no cancer but an ulcer!
This is one of many stories that have been reported from medical laboratories in the West Bank indicating a number of problems lurking behind the doors of these labs. These vary from permit issuing to quality control as well as professional values, all awaiting the promised follow-up by the Ministry of Health.
One laboratory gave an all-clear result to patient (A.A) who had sent a colon biopsy for examination. This same patient is now undergoing chemotherapy after another lab discovered that he was indeed suffering from colon cancer.
This reporter managed to get a hold of the results for these tests. She did not stop there. She decided to send in her own blood sample for testing.
She worked on the assumption that the medical laboratories were not following the proper procedures for sample testing, which provided inaccurate results.
She asked for different labs to do a routine test of triglycerides. The results that came back varied between 87 and 125, a variance that may not be significant for someone who did not suffer from any ailments but they would be significant in case of an ill patient.
She also asked the lab to test calcium levels in the blood sample under the same conditions. The sample was tested by four different private laboratories and the correct result was repeatedly shown as 9.49. However one of the lab results came back as 7.5 indicating a deficiency since the normal levels for calcium in the blood range between 8.6 and 10.03.
Medical Errors in Privately and State owned Laboratories
Baha’a says his daughter Asinat Asfour, four months, suffered from a foul smell emitting from her urine. They took her for testing at the Ramallah Medical Centre, which showed that the child carried the staph epldermidl and morganll morganeella bacteria.
After a difference of opinion with the Ramallah hospital, the father took his child for further testing at other hospitals. Results came back negative for both
Asfour adds that he filed a complaint against the Ramallah State Hospital with the Ministry of Health, but he has yet to receive a response.
H.L. was about to lose her unborn child had she accepted the results of her blood test at theHealth Directorate in Bethlehem when she was in the early days of her pregnancy.
She explains that her blood type is O negative and hence, she required an ante D injection as soon as her labour started to protect her child from anti-bodies that may reject the mother in the first instances of labour.
She was however provided with the test results that showed that her blood type was A which meant she did not need the injection. Had she relied on the results, she would have lost her baby, according to the medical information provided on this case.
Reasons for Error
Adel Tafesh, the director of a private laboratory, confirms that it is possible for errors to occur but they differ depending on the stage of testing.
Tafesh explains that sample testing goes through three stages. The first stage is prior to testing, when the sample is obtained. There are certain procedures that need to be applied and if these were not followed properly the sample would be contaminated and a faulty result obtained.
Tafesh also warns that not writing the patient’s name on the sample might lead to it being confused with another sample and the wrong result given.
According to him certain conditions must prevail for each test, without which the results would be inaccurate.
As to the second phase, which involves testing the sample; errors can occur if the equipment was not routinely calibrated. This is done by testing an identified sample, the results of which are known. This is the “control” stage — and if the results do not match the standard, then the equipment needs to be calibrated.
The third phase takes place after the testing when the results are written out and mistakes can also happen during this.
Tafesh points out that most tests where mistakes occur involve ones that require microscopic readings. Technicians should pay proper attention to the samples no matter what their monetary worth in order to get a correct analysis.
He also says that errors have gone down in numbers as a result of better equipment and better expertise.
The creation of an independent union for medical technicians has helped cut down on the number of wrong analysis results. The union has trained employees and helped them develop their skills. Monitoring by the Ministry of Health has also played a role in this.
Ministry of Health Procedures
Osama Najjar, director of medical laboratories and the blood bank at the Ministry of Health and the head of the lab technicians union says that variations in test results are possible anytime and anywhere, but “can be controlled.”
He revealed further procedures that the Ministry of Health plans to implement at labs as part of reforms. These include providing trained quality control experts at each lab who would enforce internal quality control measures and start a process of central monitoring for the results from all labs in the West Bank.
Najjar adds that the ministry, in cooperation with the external monitoring programme for labs affiliated to the University of Jerusalem at Abu Dees, will be carrying out mandatory controlling and monitoring of external testing carried out by all licensed labs.
100 Unlicensed Laboratories
This reporter has taken note of dozens of unlicensed laboratories in various areas both in what is known as Area “A” under Palestinian Control and Area “C” under Israeli Control. According to Najjar the labs that were not licensed were all in Area “C” as it is difficult for the Palestinian Authorities to get to this area.
Tests were carried out to prove that these labs were practicing without permits. The reports of technicians providing statements to the fact that the labs were not licensed were also recorded by this journalist.
Some said, “we do not want to get a permit” and others said, “our papers are currently at the Ministry of Health.” However sources at the ministry revealed that no such papers exist. Other excuses included the fact that permits required a certain square footage of space in order to be licensed. But the recorded testimonials gathered by this reporter indicated that one of the labs lacked a number of things. Not only did it not have a microscope and a centrifuge; officers there sent their blood samples to another lab to be tested and added ten Shekels to their prices!
A number of labs belonging to one of the recognized national societies in the West Bank were also unlicensed.
As to the labs belonging to the national society, he said the ministry had sent them several memos stating the need for getting a permit, but to date no response has been received.
Najjar says that the union does not recognize the expertise of the technicians who work at that society even if this exceeded twenty years.
He also confirmed that many labs were issued with closing orders but they were not enforced.
According to available statistics Najjar claims that the number of licensed labs was 200 while there were 100 labs operating without permits.
A number of doctors and technicians – who asked to remain anonymous – confirmed the existence of secret agreements between doctors who would send patients to certain lab technicians in exchange for a share of the cost.
He claims that a number of these agreements were discovered and the perpetrators were severely punished. He said his department also conducts secret monitoring of labs that have not been dealt with. He urges doctors to maintain their allegiance to the Hippocratic Oath and not to deal with patients as customers.
Samples Transferred by Taxi!!
Based on personal testimonials gathered from others, this reporter has come to learn that some laboratories send test samples to other labs, relying on the services of a taxi driver without providing the necessary conditions to maintain the viability of said sample. Needless to say the tests carried out on these samples are inaccurate.
Other violations include lab technicians who claim they have sent samples for testing outside the Palestinian territories while falsifying the results. The samples may have not been sent in the first place or were not transferred properly, which of course means the results are incorrect.
Taking to task….
He says 16 lab technicians went before investigative committees and four were charged with sentences varying from suspension of license for a certain period of time to shutting down laboratories or limiting the type of tests that can be carried out.
Explanations for Errors made by Ministry of Health Labs
Najjar explains that the Ministry of Health labs are under a large amount of strain due to increased demand from the public and not enough employees. This, he says, causes some errors to happen. However, he does point out that matters should improve with the new monitory and quality control regulations.
Ma’en Idees, lawyer and researcher at the Independent Authority for Human Rights says that the law in effect in the Palestinian territories is the punitive law from 1960.
In accordance with this law, any deviation from the norm will incur the offender punishment if he acts wrongfully and harms people or gives an incorrect treatment.
Idees claims that people are unaware that labs could produce wrong results. They work on the assumption that the results are always correct. In his research, he was told by a lab technician that in some cases, test samples that were re-examined gave results that were opposite to initial ones, which meant that treatments had to be reversed.
“Health” shoulders the blame
Idees says that the Ministry of Health is responsible for compensating the patient for any damage that may occur since it the authority to which complaints are submitted. In turn, the Ministry will start its own investigation if the establishment the complaint is being filed against is state-owned.
According to Idees if the issue is within labs that are owned by the private sector, the unions usually take over the matter.
Committees kill Complaints
What ends up happening in most cases is that the committees inadvertently kill the complaints as doctors and employees are not condemned for their actions and no error is registered. They do, however, issue recommendations for punitive measures against the perpetrators or order the closures of establishments, so in essence the condemnation is implied but not official.
This is due to the shared “work code” amongst the doctors who feel if they indict their fellow doctors, they might in turn suffer in a similar manner.
For his study, “Medical Errors – Towards Legal Protection for Medical Errors,” Idees relied on a number of sources including complaints that were and the responses from the Ministry of Health in the West Bank, the courts and the Ministry of Health in Gaza.
This investigation was supported by Arab Reporters for Investigative Journalism (ARIJ) and coached by Hussam Izzedine.