A medical test goes wrong and a woman bleeds to death

A 25-year-old patient bled to death during a bronchoscopy in the Barzilai Medical Center, Ashkelon, last month in what the hospital's pulmonary unit director called "an irregular, sad and shameful" incident.

Layla Vuletic-Osher died on February 25. A medic involved in the procedure said her death was "appalling and shocking," and that the patient's blood spattered the walls, ceiling and some medical staff.

Vuletic-Osher, who immigrated from Serbia in 1992, left behind a 2-year-old daughter, Yasmin, who is being looked after by her family. The mother suffered for years from a severe failure of bone marrow blood production.

The bronchoscopy, a procedure to examine the throat, larynx, trachea and lower airways, was aimed at tracing the source of a severe infection the patient was suffering from; it included taking a sample of lung tissue for a biopsy.

The procedure was carried out with general anaesthesia in one of the hospital's internal medicine wards as all the operating theaters were occupied.

Dr. Zeev Weiler, director of Barzilai's pulmonary unit for the past 14 years, performed the bronchoscopy. Weiler told Haaretz yesterday that he had never encountered such bleeding in his medical career. Nurses who treated the patient subsequently required psychological counseling.

The hospital's management reported the incident to the Health Ministry and conducted its own probe.

The incident raised questions among the medical staff and the patient's family, who believe the Health Ministry must look into it. For example, why wasn't the patient, whose life was in danger, examined in an operating theater, where optimal treatment is available in case of complication? Why didn't the doctors (headed by Weiler) take a lung sample in a non-invasive way (by drawing fluid with cells from the lung) instead of using a procedure that led to massive, uncontrollable bleeding and death?

The patient's severe failure of bone marrow's blood-production probably resulted from aplastic anemia, a serious illness that inhibits such production.

Vuletic-Osher was treated in the hospital's hematology institute, which tried to find a bone marrow donor to renew her blood production. However, her family refused the request of the institute's director, Prof. Gil Lugasi, for an exam to determine bone marrow compatibility.

Vuletic-Osher's condition continued to deteriorate. In the weeks prior to her death she also suffered from a severe infection and was hospitalized in the internal medicine ward. She was given a powerful antibiotic for the infection, but in vain.

The X-ray examination findings indicated a possiblity of lung infection, and the doctors decided on the bronchoscopy at a joint meeting of lung, hematology, intensive care and infection experts.

At the meeting the doctors discussed the risk of bronschoscopy and the advantage of taking a sample in another way. Some doctors said it was important to carry out the procedure in an operating theater due to the failure of the patient's blood-clotting mechanism.

Haaretz found that the patient had signed a consent form for a less invasive procedure of lung flushing by Dr. Nelly Poliakov, a senior pulmonary unit doctor. But the patient had not signed a consent form for bronchoscopy.

Weiler commented that he had explained to the patient that he was going to perform the bronchoscopy.

Weiler said the procedure was urgent and could not wait until one of the operating rooms was available. He told Haaretz that the examintion had to be done while the hospital's pathology laboratory was working and could find the source of infection quickly. But a senior Barzilai doctor told Haaretz that in his opinion they should have waited for an operating room, and that the procedure, while crucial, was not urgent.

On February 14, the patient was given a blood infusion by general anasthesia in an attempt to improve her blood-clotting mechanism. During the bronschoscopy on the 25th, which was carried out by Weiler at about 2 P.M. with an anaesthetist and nurse from the pulmonary unit, the patient started to bleed massively and required blood infusion. Her condition deteriorated sharply and she was rushed to the Intensive Care Unit, where doctors tried in vain to resuscitate her. She died a few minutes later.

An internal medicine doctor who examined the patient's medical file at Haaretz's request said it was not clear why experienced senior doctors had failed to control the bleeding and stabilize the patient's condition after her collapse during the treatment.

Studies in the United States showed that taking a lung sample by bronchoscopy was not necessarily preferrable to the less invasive procedure to which the patient had consented.