The majority of doctors in the Anesthesia and Intensive Care Unit (ICU) at Sfântu Pantelimon Hospital have announced their resignation from on-call shifts, leading to a halt in hospital admissions. This comes in the context of two doctors from the ICU being accused of premeditated murder. The head of the ICU department states that the doctors are not afraid but prefer to work in places where they are “not being trampled on.”
The patients in the Intensive Care Unit are still being cared for, says the doctor. “It is not, strictly speaking, a spontaneous strike, we are here to take care of the patients who are in ICU. Of course we won’t throw them out. I just notified all the sections, since we resigned from the guards, for the time being, no interrogations can be made. I am very sorry for the situation. The resignation from the guards, from tomorrow, the resignation from the hospital at the moment when we manage to solve the patients in intensive care, we cannot leave them. The resignation follows. We are all leaving. All colleagues,” said the head of the ICU department at the Pantelimon Hospital, Florina Pompilian.
She explained that there are 12 doctors in the ATI department. While the two doctors are being investigated, one is on leave, and another doctor “doesn’t know if he will resign yet”, the other eight doctors decided to give up their guard. The doctor says that the pressure reached somewhere “incredibly bearable”.
“We are not afraid of anything, but we cannot carry out our activity in such conditions. It’s a tough specialty, but it’s a specialty that’s hot right now. We prefer to go to some places where we have peace and where we are not trampled on. It is inadmissible to have a complaint every week that we did not save a patient with neoplasm for eight years, that we did not give the dose of noradrenaline, I don’t know how much the owner thinks so. (…) Gentlemen anesthetists in this country, have you ever been asked by a relative when the central venous catheter was changed? What are we talking about?”, said Florina Pompilian.
The manager of the Saint Pantelimon Hospital, Bogdan Socea, said that the doctors from the Intensive Care Department decided, on Thursday, to go on strike, as a sign of protest. “The ICU doctors from the hospital decided to go on a spontaneous strike and not give anesthesia to chronic or scheduled patients. Of course, it provides emergency services, the guard, plus patients who are in therapy. 10 interventions were postponed to the first hour. I am preparing a paper in which they will all sign that they will resign both from the contract with the guards and from the contract with the hospital”, said Bogdan Socea.
The manager of St. Pantelimon Hospital, also explained that a patient in the intensive care unit generates higher costs than the medical unit can bear, as it is underfunded. He explained that there was no reason for anyone in the hospital to rush to take other patients to ICU. Moreover, the manager said, “at ICU it was not so crowded that the release of beds was justified.”
The internal investigation was done professionally by five renowned doctors from the hospital, with a specialty other than ICU. The investigation concerned medical aspects. The prosecutor’s office has completely different means of proof,” said the manager.
“The internal investigation could not check those injection machines, could not download the memos. The doctors who were part of the internal commission did not have the same tools at their disposal as the Prosecutor’s Office. They went to statements, medical prescriptions and studying the observation sheets, just like at the College of Doctors. Medical prescriptions and doses must be entered in the observation sheet. What happened (…) remains for the prosecutor’s office and the judiciary to express their opinion”, said Socea on Thursday.
Referring to the hypothesis that such a practice could be justified by the hospital’s need to make money, Socea said: “I can’t find the logic. It is a lie. This year ICU is at a lower level than last year, the funds were smaller”. He mentioned that at the time of the patients’ death “the ICU ward was not so crowded”. “There were, I think, two patients waiting in the UPU, but nothing would justify such an attitude,” added Socea.
Şerban Bubenek, the president of the Romanian Society of Anesthesia and Intensive Care, told Digi24, that the two doctors from the St. Pantelimon Hospital cannot be accused of premeditated murder and that they acted correctly in the case of the patient who ultimately died in hospital.
According to Şerban Bubenek, who cites “scientific evidence”, high doses of noradrenaline cannot be administered for long periods of time, but should be returned to regular doses in patients with low blood pressure.
“It is not a question of interruption (of noradrenaline treatment in the case of the deceased patient – n.r.). It is said that the mammoth doses, documented in that document, of 15 ml/hour, 20 ml/hour, are mammoth doses, given that from the reports and the data there they had an average blood pressure of 3o to 45 mm of mercury column whole days. That is, their blood was no longer circulating through them almost at all, and there was no way to oxygenate them. Maintaining such a tension is only cosmetic and whenever we are in this situation, the recommendation of the guidelines is to return to the therapeutic dose, not to let the mammoth doses go forward, which is what our colleagues did, from what is understood there , that they reduced to 1 ml/hour, which means between 100 and 150 nanograms, so physiological doses. It is scientific evidence. At the therapeutic dose in this situation of prolonged hypotension with mammoth doses, it is not a mistake, it is a correct attitude. There can be no question of premeditated murder,” said Şerban Bubenek on Thursday.
The doctor says the law needs to be changed so that prosecutors can call on medical experts in such cases.
“Unfortunately, the highest mortality in the world is in intensive care. Perhaps it is time that the Romanian legislation must face these challenges – it is a challenge that causes damage in society, causes the demotivation of the medical body, causes the fear of the sick. These things must be discussed correctly”, said Şerban Bubenek.
He insisted that, in his opinion, the two doctors at Pantelimon Hospital cannot be charged with premeditated murder. “In this specific case, precisely in this specific case, it is an interpretation – in my opinion, with a modest experience of 40 years of intensive care – a misinterpretation, which probably does not come from ill will, comes from nothing but from not knowing the state of shock – they are doctors who learn all their lives -, and our two colleagues are young people, who have European diplomas in anesthesia (…). It is not a question of poorly trained colleagues, they are peaks that Romanian society cannot anathema and punish before discussing seriously, on real and scientific bases. (…) It cannot be premeditated”, Şerban Bubenek also pointed out.
Dr. Săndesc also explained how an injectomat works, according to the protocol of the ICU departments.
“The injectomat is used to administer a correct dose, an exact dose per unit of time: “It is a syringe that is inserted into a device and allows adjustment in milliliters per hour. If you didn’t have this device, you would put in a 500 milliliter bottle and adjust with manually adjusted drops, which will not ensure dosage accuracy. This is the purpose of the injectomat. It is used exactly for this type of medicine, whose effect is very strong. Above all, to avoid overdose – because, even in high doses, Noradrenaline can cause death,” he explained.
Săndesc confirms that, depending on the type of injectomat, the devices can store in memory the dose administered to a patient. The ATI doctor believes that “it is natural to seek this information, for the investigation”. However, Săndesc emphasizes that “I would insist on a medical analysis of the case and to see if the reduction of a dose can be related to the determination of death or is, in fact, a justified medical measure. This is taking into account the fact that at the very high doses that were administered, there may have been no response from the patient. And the data from the specialized literature show that keeping these very high doses in a patient with refractory shock can themselves determine death”.
The nurse at the Saint Pantelimon Hospital, detained on charges of perjury in continuous form, was placed under judicial control. Instead, the two doctors, accused of intentionally causing the death of a patient in a serious condition in intensive care, will be taken to court with a proposal for preventive arrest.
Injectomats are medical devices that administer treatment to patients, like automatic syringes, in a pre-programmed and controlled manner in fine amounts. The devices have an internal memory. While the correct doses appear on the observation sheets at the St. Pantelimon hospital, the data from the memory of the injection machines proved that a little noradrenaline was actually administered to the 54-year-old patient, claim medical sources under the condition of confidentiality. For their part, judicial sources stated that in addition to the case of the deceased patient, to which the Prosecutor’s Office refers and on the basis of which they obtained warrants from the judge, there are “approximately five” such possible cases, treated by investigators as murder.
Health minister says he has no reason to resign
The Minister of Health, Alexandru Rafila, declared on Thursday that he has no reason to resign in the scandal at the St. Pantelimon Hospital, because the crime in question – premeditated murder – is not the responsibility of his ministry.
“I have no reason to take this situation personally because it is a crime involving premeditated murder and in such a situation I do not believe in any way that it is my responsibility or that of the Ministry of Health for such accusations . So from this point of view I have no reason to resign, we have a lot of projects, we are rebuilding the health system, we are reforming the health system, so it is a questionable issue because it created a lot of emotion, but the resignation for something that we could neither control nor influence in any way… because one more thing, there is one thing that I ask you to remember: no one can intervene regarding the individual medical decision of the doctor, neither can the minister Health, nor the manager of the institute, is his professional decision”, said Alexandru Rafila when asked, on Thursday, if he thinks he should give up his position as minister.
After two doctors from the Department of Anesthesia – Intensive Care of the Sf. Pantelimon Hospital in Bucharest, accused of qualified murder with premeditation, were detained following the death of a 54-year-old patient who was unjustifiably reduced the dose of noradrenaline, the representatives of several formations political parties requested the resignation of the Minister of Health.