The Gaza Strip- Anyone who hears the laughter of 7-year-old twins Nada and Shatha Saidam while playing in the backyard of their home in Gaza, would believe they are living a happy childhood. No one would realize that these laughs conceal the deep pains that have accompanied them since their mother died as a result of a medical error during a dilation and curettage procedure.
No Medical Errors Law
On August 6, 2006, “Manal”, then 32, felt severe abdominal pains. She was rushed to private hospital specialized in delivery, infertility and in-vitro fertilization since she had been treated there in the past. After the physician examined her, it was clear that she was carrying a stillborn fetus. This required immediate dilation and curettage, a relatively simple procedure by medical professional standards. The procedure soon turned serious when the surgeon perforated the uterus and the intestines during the operation. He admitted in a letter to the family (copy attached) that he had perforated the uterus, which required that he opens up her abdomen to perform an operation to rectify the situation. He informed the family that the small intestines were intact. However, a report (copy attached) issued by Al-Shifa’ Hospital on September 14, 2006, after she was taken there, admits that the intestines sustained severe damage during the procedure.
After doctors failed to control her serious situation due to a respiratory system failure caused by “bacterial shock”, she was transferred to the Israeli hospital of “Soroka” Medical Center in Beer Sheeva inside the 1948-occupied territories. Doctors there tried to treat her as best as they could, but the infection had spread throughout her body. She died, leaving behind children and a family that will, forever, endure pain and suffering forever.
“Only God commits no errors”
Medical mistakes/negligence is a phenomenon that is not restricted to one country. According to World Health Organization, one of every ten patients around the world sustains damage while receiving medical treatment and heath care. However, Gaza Strip hospitals, governmental and private alike, whose number does not exceed ten, have witnessed a number of medical errors that have been documented in reports by the Independent Agency for Human Rights and the Palestinian Ministry of Health. In Gaza, there is no law that regulates the relationship between doctors and patients, or covers medical errors.
The problem is not restricted to the absence of a law for medical malpractices.
The penal code, as set by the High Commissioner for Palestine in 1936, remains the reference for penalties in the Gaza Strip, first put under Egyptian administration and then under Israeli occupation.
Lawyer Adnan Abu Musa says there are several factors behind why this code has not been changed. “After the Palestinian Authority was established in 1994, the draft Penal Code was presented to the Legislative Council and subjected to discussion and deliberation, but several articles faced wide opposition from Islamic, secular and leftist currents. Some of them wanted it to have an Islamic tone, while others preferred to reduce the penalties related to honor and ethics. This led to freezing the law in 1998.
Since Hamas’ take over of the Gaza, the Legislative Council has not meet with full representation.
Manal’s family filed urgent complaints with the Ministry of Health and the Public Prosecution in the Gaza Strip. The Ministry responded by saying that the hospital where the surgery took place is a non-governmental institution, and hence, it is not under the Ministry’s administrative jurisdiction (attached is a copy of the response).
This response contradicts the second article of the Palestinian Public Health Law number 20 of the year 2004 which stipulates that the Ministry of Health is responsible for licensing and monitoring non-governmental health establishments.
Mr. Suleiman Al-Ghalban, Director of the legal Department at the Ministry of Health in Gaza asserts this contradiction by pointing out that the Ministry of Health is the party which grants licenses to private hospitals and is responsible for monitoring.
Manal’s family did not accept this response. After the Palestinian rift in 2007, the family resubmitted its complaint to the Public Prosecution when it found out that the original complaint file is not available. The family waited for the Ministry’s response until July 2010. The response admitted a mistake was committed (copy attached). It kept the reason vague, however, and no measure was taken against the physician who performed the operation. The Ministry mentioned in its response that the reason for the death may have been a technical administrative error at the hospital, and that the issue can only be decided through a report from the forensic medical examiner. Manal’s father, Sa’id Al-Turk wonders: “The Ministry’s response gave us nothing. Is it logical that an autopsy is carried out on my daughter’s corpse four years after her death to find out the reason behind her death, which was admitted by the Ministry?”
Although the Ministry of Health considered the reason behind Manal’s death a vague mistake, a source inside the Ministry revealed that one of the doctors who admitted Manal Saidam at Al-Shifa’ hospital in Gaza emphasized that what happened to her was “one of the most horrible crimes he had seen.”
“Maha” and the Overdose
How can a victim be compensated if he has lost his life? Even if he did not, nothing can compensate the victim for his/her affliction.
This is what happened to Maha Khalil Ata Abul Sa’aleek, who went to Nasser Medical complex in the city of Khan Younis, south of the Gaza Strip on August 11, 2010.
Before doing the laboratory tests that normally precedes a Caesarean Section procedure, she was admitted to the operating room and got her anesthesia intravenously. The effect was weak, so she was given another dose through a mask.
Maha gave birth to a daughter, named Sama. Maha, however, fell unconscious and had a seizure after the two anesthesia doses reacted. She turned blue while the doctors tried to resuscitate her heart, but were unsuccessful.
Her father, who was present at the time of the operation, said: “After the operation, Maha was taken to the women’s post operative ward, but the nurse in charge refused to admit her, saying she was not normal. She was transferred to the intensive care unit for 72 hours of observation.”
The father adds: “When the doctors gave up on her situation, she was transferred five days later to the Rabin Hasharot Hospital in Israel. Tests performed there showed that Maha had severe brain-cells damage due to an excess dose of anesthesia.”
Doctors could not treat Maha since her situation had reached a point of no return. She was transferred to Al-Wafa medical rehabilitation hospital in Gaza, on the last day of August 2010, for medical care due to her hopeless situation. Since then, she lies on her bed in hospital, clinically dead, blind and suffering from total coma and quadruple motor paralysis and severe breathing problems. This is what Dr. Hameed Abu Musa, Director of Al-Wafa’ Rehabilitation Hospital emphasizes: “We consider her clinically dead… She is totally immobile, and requires continued care.”
The doctor who performed Maha Abul Sa’aleek’s surgery refused to talk to us.
The director of Al-Wafa Hospital reveals that the absence of a complete team at the emergency room and a team of doctors is to be blamed for her situation.
Doctors’ Union: The Absent Role
The Palestinian Doctors’ Union formed a fact-finding committee on June 28, 2006 after the family of victim Manal Al-Turk filed a complaint. The committee was able to obtain the reports on the case, but Palestinian infighting and the separation between Gaza and the West Bank prevented them from identifying the causes.
Dr. Jihad Al-Attal, from the union says: “In the past, the Union used to receive a patient’s complaint regarding a medical error or negligence and present it to the doctor against whom it was submitted, and wait for his response. As a result, an investigation committee would be formed, comprising all areas of specialization related to the complaint. The committee would also interrogate the doctor concerned and would investigate all aspects of the case and draw its conclusions.” He adds: “But since the division, when we send to the hospital requesting the file of the patient who filed the complaint, the hospital management refuses to deal with us. The Ministry of Health also refuses to deal with us and we are not allowed any more to form committees or to issue decisions.”
This was also cited by Khamis Al-Najjar, member of the Palestinian Legislative Council. “In order to identify the responsibility against the doctor, there should be a union that includes all doctors operating in Gaza’s public and private sectors, to direct the judiciary to all investigations in cases of medical errors.”
Manal Al-Turk’s family continues to hold accountable the doctor who performed the operation at his hospital and wants him punished. They have appointed a lawyer demanding that the law be implemented against the doctor who committed an error and continues to work. The lawyer filed a case against him in court. “Before filing a lawsuit, I tried to meet the doctor. After many attempts mediated by some doctors, he accepted to see me. He refused to admit responsibility and to pay compensation to the family. We agreed to sit together once again. After that, he expressed readiness to pay a nominal amount as a sign of compassion, but not as an admittance of responsibility. Then he started to procrastinate, and did not communicate with me.
“Now he even refuses to recognize parties responsible for the medical sector in Gaza. And he threatened me by saying: You can publish what you want, but if you write one word that touches me, I will cut your head off.”
Mohammad Abed, the public prosecutor in Gaza, says the absence of a medical malpractice law in Gaza increases the complexity of such cases as the ministry cannot clarify what the medical mistakes are.
Hence, and due to the absence of this law, the Ministry of Health in Gaza, according to Mr. Abed, always resorts to “special standards like general texts and principles and some frameworks that identify the responsibility”.
The ministry does not form investigation committees for all complaints received because some of them are malicious.
Al-Ghalban goes into more detail: “From beginning 2008 and until June 2011, we received hundreds of complaints about medical errors. We formed 116 investigation committees. Thirty five cases touched on private hospitals and 81 on state hospitals. The committees were only able to prove 11 mistakes in private hospitals and 24 in public ones.”
He adds: “These cases do not warrant taking punitive measures against doctors. Hence, disciplinary measures were taken against negligent doctor, including delaying his promotion, reducing his rank or demoting them, sending a warning or salary deduction.”
Number of Medical Errors Proved Since the Beginning of 2008 until the End of June 2011
The Ministry of Health leaves the opportunity open for individuals and legal rights organizations to submit complaints dealing with medical malpractice. This discourages most people from doing so.
Dr. Ehab Nafe’, a researcher in the medical errors issue in the Gaza Strip hospitals admits to this. “What takes place in terms of committees, investigations and follow-up does not ascend to the level that should actually be disclosed. Committees which investigate in medical errors cases are normally formed from colleagues in the profession to investigate an error committed by a doctor.”
Al-Nahhal demands the creation of a judicial medical body to investigate cases of medical errors, and not leave it up to doctors to investigate each other. Al-Nahhal discloses that there is no special system for disclosing medical errors in Gaza hospitals, let alone the magnitude of such problems. “The Ministry of Health is not really concerned about this issue, and wishes that the volume of complaints is reduced.”
The Story is Repeated
Families of Maha Abul-Sa’aleek and Manal Al-Turk submitted complaints to the Ministry of Health and to public prosecution demanding that the doctors who have caused the present situation be held accountable and that the families be compensated according to the law. The Ministry quickly responded in favor of the doctors. It said that what happened to Maha was probably a medical complication (attached is a copy of the letter).
The surgery consultant, Dr. Ahmad Shahwan, emphasized that “the doctor who performed the operation on Maha administered the anesthesia using an artificial respiration arrester without inserting a respiration tube. This method is dangerous, but he did not have an alternative, and he took the responsibility because he had to anesthetize her.”
The phenomena of medical errors phenomenon is difficult to measure. But the independent Citizen Rights Agency in 2008, the Agency received 3 complaints and another 18 in 2009. The public prosecutor received 8 complaints in 2010.
Bahjat Al-Hilou, from the Agency says: “After receiving complaints from people and the families of victims, we address the party concerned; namely, the Ministry of Health. But the truth is that we receive standard responses about medical errors that do not get close to providing any level of satisfaction to the victims or to human rights organizations.”
He adds: “We receive answers like ‘we are investigating and will let you know later’. Or they tell is that “the error resulted from possible complication, without admitting the possibility of negligence. Sometimes we do not receive any response at all.”
Two Victims, One Doctor !
The series of medical errors continues in the hospitals of the Gaza Strip.
Nasser Muqbil died recently after being admitted to a hospital and underwent an operation to remove his appendix. But doctors gave him conflicting medical diagnosis, according to his brother. “Before operating on Nasser, a blood test was carried out, showing that the white blood cells count was very high, at over 31,000. There was a disagreement in the hospital, and some staff blamed that on faulty reading due to outdated lab equipment. This was confirmed by the intensive care doctor. Nasser’s situation deteriorated after the surgery and he was moved from the Kamal Adwan Hospital to Soroka Hospital in Israel, where he passed away.
Dr. Ahmad Shahwan, a surgeon, said after inspecting all his medical reports: “When the surgeon opened up his abdomen, his intestines were severely degraded from the puss in his abdomen. This was documented in the medical report. Intestinal movement during the operation caused further degradation and increased the severity of the case. This could have easily caused another perforation that may not be seen.”
The doctor who treated Nasser, and whom the family accuses of causing his death, he refused to take responsibility, blaming another doctor. We obtained a written certificate from a source in the hospital asserting that the first doctor was the one who supervised the surgery. (Attached is a copy of the certificate)
Nasser’s case was not the only one. We found out that another person from the “Radwan” family was victim of a similar situation to Nasser’s. (Attached is the report on the “Radwan” case.)
Shatha, Nada, Shams and Sama were deprived of the kindness of their mothers as a result of a medical error or negligence. Until when will medical errors and protection from such acts remain absent from the Ministry of Health’s list of priorities???.
This report was completed with the support of Arab Reporters for Investigative Journalism (ARIJ) and under the supervision of Walid Batrawi.