Last update - 00:00 01/04/2007
Ministry report: Soroka surgery conditions may be dangerous
By Ran Reznik, Haaretz Correspondent
Soroka Medical Center in Be'er Sheva, the largest medical facility in the south of Israel, suffers from a lack of basic medical equipment and services - a situation that "might cost human lives," according to the conclusions of an inspection by the Health Ministry.
The report shows that procedures such as caesarean sections and the administering of anesthesia are performed by interns without a specialist present. The report warns that this and the lack of crucial equipment might impair the response to complications during surgery.
The report also lists violations of proper medical protocol such as the fact that medical equipment potentially contaminated after use in gynecological operations was being hauled through the same entrance for doctors and patients on their way to operating rooms. Dangerously crowded conditions in Soroka's delivery room also contribute to the grave sanitary conditions at the facilities, the report said.
The Health Ministry made the inspection that formed the basis for the report on December 13. The final report on the inspection, conducted by a crew of 30 employees of the ministry, was submitted in March to Soroka's director-general, Dr. Eitan Hai-Am.
According to the report, in 2006 the hospital reported 160 irregular mortalities in which there was a fear that death was caused by a medical malfunction. There were 350 non-fatal irregular medical instances.
The auditors noted that three of the 10 beds in Soroka's delivery room were "positioned in a crowded manner, making it difficult for medical personnel to enter the room in case of an emergency requiring immediate resuscitation." They established that this "could cost human lives."
The inspection revealed that the operating room in the gynecological ward had only one oxygen station supplying five different machines, including the anesthesia machine. "This alignment is improper and could put human lives at danger," the report reads. A senior physician told Haaretz that this particular alignment meant patients under anesthesia in the operating room were dependent on one source of oxygen. In case of an obstruction in the oxygen flow, patients could suffer permanent brain damage within minutes, and even death.
The report, co-signed by Dr. Michael Dor, executive head of the medical administration of the Health Ministry, and Ruti Freund, in charge of nursing in the ministry, found other omissions in the gynecological ward. It noted the patients were "put in unnecessary danger" from the presence of used surgical equipment in supposedly sterile scrub rooms, where doctors prepare for operations.
"This is a grave omission prevalent in many hospitals in Israel," said the senior physician. "It means contaminations are present with the patients and the doctors. This is a well-known means of contamination."
Soroka's delivery room, according to the report, has only one heart monitor for women in labor, and only one instrument to measure oxygen saturation in the blood. "This represents an unnecessary risk to the lives of the patients," the report stated.
In addition, the report found that the operating room in the ward was in need of more resuscitation carts and that the recovery room in the gynecological ward required downward reclining beds. These are designed for emergency cases such as sudden drops in blood pressure, and according to a senior physician, they could be crucial in saving lives.
As for personnel training, the inspection revealed that the anesthetists at Soroka had "at best completed the initial stages of their internship, and in many cases not even that." According to the report, anesthesia administered without the presence of a specialist endangered patients, especially in preparation of caesarean procedures, which constitute "the most perilous of anesthesia procedures." In the report, the Health Ministry warned Soroka's management that at least one anesthetist was required to remain on call in the operating rooms.
Some patients, according to the report, have been presented with consent forms for surgical operations after their sedation was underway for surgery, thereby voiding their signature. The inspection revealed the hospital was in need of additional beds.
A further source of risk was discovered in Soroka's laundry room, where the same carts were used to haul dirty linen to the laundry room as for distributing clean ones to the various wards. The workers responsible maintain, however, that the carts are thoroughly cleaned.
Soroka, owned by Clalit Health Services, holds 1,000 hospital beds. Its medical staff attend to 200,000 patients annually in the emergency room. The staff perform 30,000 surgical operations per year. The hospital's maternity ward registers 12,000 births every year. In addition, about 500,000 people receive medical attention every year in Soroka's outpatient clinics and medical facilities.
The hospital's management responded to the findings of the inspection by saying that "most of the omissions found in the report have already been resolved, including the introduction of more medical instruments and resuscitation carts." The management said that currently used medical instruments were no longer being hauled through sterile areas.
"The new maternity ward that is being built will answer the needs of the patients in the future," they added. In addition, the management claims the hospital was "changing its procedures and duty sheets to meet the requirements specified in the report."