Malpractice Sentence / A Warning to Physicians

Let's hope that the important ruling yesterday over a botched operation that left a 3-year-old dead will serve as a warning to Israeli physicians who have forgotten the importance of the Hippocratic Oath. Dr. Svetlana Rousso-Lupo was given an eight-year prison term for manslaughter in the death of Neta-Li Boroski four years ago.

"Unfortunately, patients dying at hospitals due to medical malpractice is all too common," Judge Zvi Garfunkel wrote in the ruling. He stated that only one physician had previously been found guilty of manslaughter in Israel, and that "Neta-Li's parents made a noble decision when they decided to donate her organs as a result of her tragic, sad and unnecessary death.

They gave other children life. Perhaps the organ donation will not be the only change brought about by Neta-Li's death; maybe the practice of medicine will change."

What kind of change is he referring to? A change in the norms that allowed an anesthesiologist to sit down on a chair, wrap herself with a blanket, put her feet up on a stool and, with a book on her chest, go to sleep - after turning off the alarm that would have alerted her to her patient's trouble.

But perhaps the four-month community service sentence for Dr. Haim Stolovitz, the operating surgeon and one of Israel's top optometrists, was of even greater importance.

"By completely ignoring the monitor and its sounds, he is guilty of negligence," Garfunkel wrote. "He did not take responsibility for his actions and believes he acted lawfully, although it is clear he was negligent by ignoring the patient's vital signs. Following a patient's vital signs is both a norm and a matter of principle, so the surgeon cannot place the blame fully on the anesthesiologist and ignore his duties."

In his ruling, Garfunkel showed great courage in rejecting testimony backing Stolovitz by senior physicians. He also ignored assertions by the Israel Medical Association, the Israel Surgical Association and the Israeli Society of Anesthesiologists that said there are sharp divisions of responsibility between surgeons and anesthesiologists, ruling that such norms are improper.

"Neta-Li's parents did not seek revenge but justice," the judge wrote. "It is my hope that justice has been done."