The half-hearted reforms, the lack of treatment protocols for a number of diseases and the continuous shortages faced by Albanian hospitals have made the boundary unclear when a case with injury or death of the patient is the result of “negligence in treatment”. As a result, family members get dragged through the court system for years, with the faint hope that there will be justice for their relatives.
Author: Fjona Çela
Blerta Pepa was only 16 years old when she died during a knee operation. The event happened in 2017, in a private hospital in the capital. The autopsy stated that the cause of death was malignant hyperthermia, a complication that appeared during the operation, according to what the doctors of the private hospital declared, but Blerta’s family claims that everything happened due to the carelessness of the white shirts. The forensic report also found that before the surgical intervention, dantrolene was used, a drug that is considered life-saving in such cases, but which had no effect on Blerta.
Currently, the case of the death of the 16-year-old is in the Supreme Court, while the mother of the deceased, Lindita Pepa, tells INA MEDIA that she has been wandering the doors of the courts for 5 years in search of justice for the girl.
“We never expected this to happen to us. We thought we were going to get better treatment. I borrowed that money. I will avenge my daughter’s life, but I have no faith in justice for 5 years. Since May 15, 2017, I can’t sleep at night, I don’t know where to go to find justice”, Lindita tells INA MEDIA , her voice trembling.
The lawyer of the case has appealed the decision, withdrawing from this process after this action and leaving Lindita with the big dilemma of what path this case will take.
Just like Lindita, every year, dozens of family members come to the courthouse in search of justice for the loss of their relatives inside the hospital doors.
The fault of the doctor or the health system?
Data provided by Investigative Network Albania show that, despite numerous accusations in the media, few cases find their way to court.
In the Court of First Instance, Tirana, where the largest public and private hospitals are located, there are only 3 cases pending and 2 decisions announced. It is a criminal case with the charge of “Malpractice”, for the period 2020-2022.
More specifically, these court cases were finalized with 1 non guilty verdict, according to which 6 defendants were found not guilty and 1 verdict of guilt with one defendant declared guilty. However, the data provided by the Ministry of Justice present another reality, which Albanian patients face in hospitals, as they seek recovery.
According to this institution, 15 cases were registered throughout the country in 2020 related to the charge of “Malpractice”. Of these, only 5 of them have been completed and 10 of them are still in trial. At the end of the trial of these 5 cases, only 2 white shirts were punished, of which, one with a fine and the other with license suspension.
Facsimile of progress of medical malpractice trials throughout 2020
The data proves that, although more than two years have passed, most of these trials have not yet been completed, leaving patients and their families at the doors of the courts, with the faint hope that justice will act. However, the number of complaints, which have claims against doctors, is much higher than the one that goes to court, this is because the first “court”, where most of the cases with claims for negligent treatment go, is the Doctor’s Order.
In case the doctor is found guilty, UMSH revokes the license for a period of 4 months, as well as issues a notice with a warning for license suspension.
“From 2005 to 2021, in the National Disciplinary and Professional Trial Commission (Appeal), as the highest decision-making body on complaints that have passed all levels of trial, 20 decisions have been reviewed and taken, of which only 3 have been tried for careless medication or negligence in medication. Out of these three cases, 2 doctors were found responsible”, the Order of Doctors of Albania told INA MEDIA in an official response .
But making a decision, whether we are dealing with medical negligence or not, is extremely delicate and complex.
The half-hearted reforms, the lack of treatment protocols for a number of diseases and the continuous shortages faced by Albanian hospitals have made the boundary unclear as to when a case of injury or death of the patient is the result of “negligence in treatment “.
Otherwise known as malpractice, in any case, when there is damage to the patient’s health or death, it is the forensic experts who must prove whether the doctor fulfilled the mission or neglected the patient.
Medicine is a profession regulated by Law no. 10171/2009 “On regulated professions in the Republic of Albania”, but in no country in the world is there any concrete article that determines how a doctor should act. This is regulated by the Code of Medical Ethics and Deontology, approved by the Order of Doctors of Albania, which sets some guidelines on how the doctor’s profession should be practiced. However, in article 27, the “Bible” of doctors says that the doctor must prescribe those diagnostic procedures, “which in his judgment he evaluates as the most suitable for the circumstances of the patient, scientifically proven and contemporary.”
“He must formulate his prescriptions in accordance with clinical guidelines and approved protocols, in a clear and understandable way for the patient and for others”, – it is further stated in article 27 of the Code of Medical Deontology.
However, Albania has a health system, anemic and fragile, with numerous shortages in medical equipment or therapy, even in the clinical guidelines themselves.
As a result, Fatmir Brahimaj, president of the Order of Doctors of Albania, considers that in our country the burden of a decision for medical negligence is “compromised” by many factors.
“First of all is the doctor’s ability to make the correct diagnosis, then there are the conditions in which the doctor works, which means: Are there conditions for making a diagnostic protocol? Perform the necessary tests?
Third, after perorming the diagnostic protocol, does he have the possibility to undertake a treatment (therapeutic) protocol? That is, as the protocol says, the first choice is this drug, the second choice is this drug, and so on. Undoubtedly, the lack of protocols also plays a role, which have not been approved for all diseases”, Brahimaj explains the complexity of the process for INA MEDIA.
Regardless of what the law stipulates, Brahimaj says that, when judging a doctor, all these factors must be taken into account. The further you get away from Tirana, the more staff absences are in hospitals.
“If you make a correct judgment, you will not ask the same thing, even from the one who is a doctor at QSUT, and from the one who works in Tropoja or Konispol, because the conditions are different, but sometimes there is a shortage everywhere, in all hospitals”, – admits Brahimaj.
Finding fault in the case of negligent medication is also made more difficult by the lack of an autopsy. Before the 1990s, every death that occurred within the doors of the hospital was subject to an autopsy, to scientifically determine the factors that led to the patient’s death. After the 90s, this procedure was almost forgotten, in many cases adding to the doubts about the causes of death. This procedure should be requested by the doctor first, in cases where there are doubts, and then approved by the family.
The President of the Medical Order considers it harmful that autopsies are no longer performed, as according to him, autopsies are also the best way to learn from mistakes.
“It has changed in a negative sense. Of course, I don’t think it is necessary for every death in the hospital, as there are cases that are very clear,” – explains Brahimaj. – “The autopsy, among other things, has another purpose, to learn from the mistakes, if a mistake was made. Only when the autopsy proves it, that is, when you open it and see what happened, it is called “fully proven”, – concludes the head of the Order of Doctors of Albania.
The criminalization of “medical malpractice” was strongly sought to be changed by medical associations along with the Physician’s Order throughout 2016. They demanded that “medical malpractice” be separated from “negligent medicine” and “negligence in treatment”, and to reduce the sentence from 7 years, as provided by the Criminal Code, to 2 years, when it was proven that the doctors had been negligent.
“Medical negligence is when the doctor knows that something should be done and does not do it or does something that he knows will fail, but still does it, but when he performs a procedure that is considered normal to do and fails, this is a mistake of medicine, not of the doctor”, explains Brahimaj.
“One thing was gained, at least now the doctors are not arrested together with the team”, Brahimaj concludes.
Referring to the law no. 44/2019, “Negligent medication” is known as “Negligence in medication” and provides for the penalty of fine or imprisonment, respectively according to Article 9 of the Criminal Code of the Republic of Albania.
“And this offense, when it has caused the death of a person, is punishable by imprisonment for up to two years”, – defines article 9 of the new Criminal Code.
Meanwhile, the Ministry of Health until the moment of submission of this article did not give any answer referring to the request for information.
In court with the doctors
Dressed in a lot of ambiguity, suspicions of wrong medication lead dozens of cases before the Doctor’s Order. Some of them are lured by the compensation they may receive, if it is proven that the doctor was wrong.
“More than half of the complaints are resolved in a meeting here at the Doctor’s Order. In some cases, the patients’ claims are exaggerated and they do it to get compensation, in a few other cases it is proven that the doctor was negligent”, says the Doctor’s Order.
In our country, the number of cases where the hospital has been found guilty and has been forced to compensate patients can be counted on the fingers of the hand. Currently, the Vlora hospital has compensated the patients in two cases and in one case the one in Lushnja for the mistakes of the doctors. In all three of these cases, the amount of compensation is 31 million ALL, money that is taken from the hospital’s budget.
For years, the Ministry of Health and the Health Care Fund have put forward the idea of insuring the doctor, so that it is the doctor or the medical team, who makes a mistake, that have to pay the compensation and not the hospital budget, but nothing has changed yet.
However, this is not the case of three members of the same family from Kosovo, who died at “Mother Teresa” hospital in Tirana, in May 2021. The report of the Forensic Institute concluded that the 3 Albanians from Kosovo died as a consequence of consuming poisonous mushrooms. This conclusion of the forensic medicine was not accepted by the son and daughter-in-law of the deceased, who are pursuing the case in the Court of First Instance in Tirana.
“Our family’s lawsuit is against the 3 doctors for the crime of “negligent medicine”. Normally, after such a case, the state itself has to open a process against the doctors. We will go to the end of the case in an absolute manner”, – said to INA MEDIA the son of the Haliti couple, Haki, who says that, in an effort to save the lives of their family members, he had to spend large sums on QSUNT.
In January 2022, another death in Elbasan led to more accusations against the white shirts. The father of a 3-year-old girl, Agim Islami, says that the girl had a virus for several days and was being cured at home based on the prescription given by the doctor of the Elbasan hospital, but when she returned two days later to the hospital, as soon as they put the serum in her, the girl passed away.
“Without ever getting sick, I don’t know how my daughter passed away. I was not there at that moment, because I had gone to get some other medicines, which were needed, at the pharmacy. We didn’t know what to do, we were completely stunned by what happened”, he said in tears.
The lawyer of the family, Eduart Musaraj, accuses that the case against the doctor Gentian Alla has been delayed due to bureaucracy and corruption.
There was another case against two doctors of the Lezha hospital, where a 3-year-old child died in January 2017 from a virus. In the investigative file, it is stated that initially the child was presented to the hospital with clinical signs of muscular hypotonia, coma and breathing difficulties. After receiving treatment at the hospital for the above symptoms, the child was sent home. His health condition worsened and he was sent to Tirana from the Lezha hospital, but he died a few hours later. After the serious incident, the family sued two doctors of the Regional Hospital of Lezha, PL and KK. The latter were taken as defendants by the court under the charge of negligent treatment, while the suspicions were that they did not give him the proper medical assistance, which became the reason for the loss of the 3-year-old’s life in January 2017.
Although both doctors denied the charges, the Judicial District Court, Lezhë, in November 2019 found doctor KK guilty of “negligence in medical treatment”, who was sentenced to one year of imprisonment, which was converted to probation for two years, simultaneously removing the right to exercise public functions for two years. The other doctor was acquitted.
Covid-19, a flood of complaints for doctors
The pandemic caused by Covid-19 and the way patients are treated has increased suspicions and accusations against doctors for wrong medication.
The white shirts themselves admit that there have been many of them who have abused the medications given, due to the fear created by this pandemic.
“Unfortunately, there were many cases where dexamethasone treatment was abused, either because of the dose or because of the duration of the medication. It was not checked whether this treatment with cortisone could really improve the condition of the patient with Covid, but it could worsen the situation in terms of other diseases, mainly diabetes and hypertension”, – admits doctor Florian Toti to INA MEDIA. However, he says that there are no exact figures regarding the wrong medication, even though from the findings in the field and from the accusations, this number turns out to have increased.
Home treatment of Covid patients and inflated prescriptions are just the tip of the iceberg of what happened during the pandemic. With a government decision, family doctors were included in the Covid-19 treatment scheme and were given the right to issue anti -Covid medication prescriptions for outpatient treatment in home conditions.
The prescription included two very strong third generation antibiotics, cortisone, (dexamethasone), blood thinners, mostly xarelto, and vitamins. There were among them who also prescribed antivirals, such as favira, up to €200 for several days’ treatment or remdesivir, up to €500 a dose. These medications in Europe were deemed ineffective in the second year of the pandemic.
However, the biggest surprise of the established prescription was that these strong medications were given to the patient on the first day of infection or even sooner, at the first sign, without waiting for the response of the swab, with the argument: “To prevent the disease in time”.
“Hundreds of thousands of sick people were treated through WhatsApp, virtually, receiving lots of antibiotics, antivirals and lots of other drugs. Personally, I know many cases of patients who have been treated abroad for the damage caused by the antibiotics they received “by the fistful” in Albania”, – claims the emergency doctor, Ilir Allkja.
Even doctors from within the walls of Infective today see differently what happened with the pandemic.
“When things began to clarify and antibiotics were released, there was abuse. The family doctors seem to have gone towards marketing, since they recommended the latest generations, even though they had tried them before and they had no effect. I was astonished by the dose quantity and the way of use”, says a doctor of Infective disease on the condition of anonymity.
Even for the suicides that occurred in the hospital, the doctor, in addition to the difficult psychology, also finds the fault in the cortisones and their way of use.
“Dexamethasone, which was used and actually gave positive results in the hospital, it must be said that it also gives side effects when used in high doses. One of these effects is the creation of hallucinations”, explains the doctor.
“For example, at the Sanatorium they used 2×2 cortisone, and it must be explained that cortisol is high in the morning and drops at dinner. But when you supply a person with 2×2 cortisone during the day, the cortisol level at dinner is very high and the stress is very high as well. Consequently, this has caused those patients to commit suicide and the cases, as a reminder, have been late at night and early in the morning” – the doctor, who wishes to remain anonymous, told INA MEDIA .
Aurora Meta Dollenberg, a doctor from the Federation of Albanian Doctors in Europe, says that the pandemic highlighted the many deficits of the Albanian health system. She confesses that she has followed several cases of patients in Albania and makes serious accusations against doctors.
“From the monitoring of the patients that I have had in treatment in the Albanian community in Germany, we have come across both extremes, either neglect of treatment, or overdose with unsuitable, very expensive medications and with severe side effects”, she explains for Investigative Network Albania.
According to her, this great “experiment” has caused great damage to the health of the population, both in lost lives and in the long-term consequences of the wrong medication, which have started to come to light lately.
Doctors themselves are worried about the increasing cases of negligence by white shirts, but a large part of the blame lies with the health system.
“Albania had, but still has, an anemic health system. Examinations are expensive, “free medicine” is a promise out of reality, so doctors are forced to treat patients apriori “, concludes Allkja.
Ky shkrim është pjesë e projektit që mbështetet financiarisht nga Zyra e Mardhënieve me Publikun e Ambasadës së SH.B.A. në Tiranë. Opinionet, gjetjet, konkluzionet dhe rekomandimet e shprehura janë te autor-it/ve dhe nuk përfaqesojnë domosdoshmërisht ato të Departamentit të Shtetit. / This article is part of a project that is financially supported by the Public Relations Office of the US Embassy in Tirana. The opinions, findings, conclusions, and recommendations expressed are those of the author(s) and do not necessarily represent those of the Department of State.