Rushing to Misjudge

It appears that the ombudsman's unit of the Health Ministry hurries to adopt accounts - that of the physician or of a medical institution - which are prima facie unreasonable without exploring the depths of the circumstances.

Until her medical examination, A., an 80-year-old woman, was comparatively healthy for her age. In the fall of 2001, after complaining of stomach pains, she was given a barium x-ray exam to check her digestive system. The examination was made at the x-ray institute of Kupat Holim Clalit health maintenance organization (HMO) in Ramat Gan.

While the examination, performed by a senior physician at the institute, was under way, A.'s son heard his mother screaming with pain. Entering the examination room, he found her - according to his description - unconscious and her legs covered in blood. A. was rushed to hospital, where it transpired that the examining physician had by mistake inserted the enema through the vagina instead of the rectum, causing a large wound which brought on the bleeding. A. was operated on but died of a severe infection 15 days after the examination at the clinic.

A.'s family asked the Health Ministry to investigate the case. In September 2002, they received a letter from Prof. Shimon Glick, the ministry's ombudsman, stating that according to the Mednes insurance agency, which insures the HMO, what happened was a "rare but known" mishap with a barium enema. "We think that the place to deal with the outcome of the case is at the civil rather than the disciplinary level."

About a month ago, the family filed a civil suit for damages, based on the opinion of Prof. Yaakov Bar Ziv, one of Israel's leading experts in this field. He attributes grave failings to the physician that did the examination, saying that they were the cause of A.'s death. The family's lawyer, Prof. Daniel More, a lecturer on medical malpractice in the Faculty of Law of Tel Aviv University, says the case indicates that the Health Ministry is not doing one of its most important jobs, namely to investigate thoroughly complaints against physicians with the aim of supervising their activity and deterring other cases of negligent behavior. The Health Ministry stated in response that Glick had decided, at his discretion, not to set up a commission of inquiry in this case.

However, this case is not an exception. In the past few years there have been other examples which show that investigations by Glick's unit of complaints against physicians are sometimes superficial, insufficiently professional and even give rise to suspicion of a cover-up. In these cases, it appears that the ombudsman's unit hurries to adopt accounts - that of the physician or of a medical institution - which are prima facie unreasonable without exploring the depths of the circumstances. Health Minister Danny Naveh and his director general, Prof. Avi Yisraeli, have also not fulfilled their promises to effect a significant change in the functioning of the ombudsman's unit and have not replaced its senior personnel.

The cover-up of investigations of malpractice is attested to, perhaps more than anything, by the findings of an investigation by a Health Ministry commission, which was recently reported in this newspaper. The commission investigated the death of Mordechai Nava, who underwent heart surgery at the hands of Prof. Aram Smolinsky at Sheba Medical Center, Tel Hashomer, a state hospital. The commission found that the surgeon left the hospital, abandoning the patient, who was bleeding in the heart, to a junior resident.

Senior members of the ombudsman's unit, Prof. Marcel Elyakim and Uri Riftin, who first investigated the case in 1997, accepted the hospital's explanations. But these explanations were afterward sharply criticized by the commission of inquiry, which stated that they were at variance with the facts. In the wake of the initial investigation, Glick stated that Nava had received "the best possible treatment." In reaction, the Health Ministry said only that the recommendation following the second inquiry is to file a complaint against Smolinsky.

Another case is the death of Sharon Ifergan. According to a suit filed by his family, which is now being dealt with in court, he died in 2001 at the age of 42 after being operated on unnecessarily in the surgical ward of Soroka Medical Center in Be'er Sheva. The suit is based on notations in his medical file, according to which Ifergan underwent surgery to remove gallstones even though a resident stated that it was unlikely that any such gallstones existed and even though an expert declared explicitly, after the resident's opinion, that there was no sign of gallstones.

Prof. Solly Mizrahi, the director of Soroka's Department of Surgery, explained to Prof. Elyakim, who was examining the family's complaint, that he supported the diagnosis that confirmed the presence of gallstones. The hospital has not yet entered a defense. In this case, too, Prof. Elyakim accepted the hospital's account. It was only recently, after the family's lawyer sharply criticized the hospital's account, that the ministry decided to appoint a commission of inquiry into the event - four years after the patient's death.

The Health Ministry stated in response that after "doubts arose" concerning the diagnosis, based on Mizrahi's testimony, a commission will be established. The ministry did not provide the reaction of Prof. Elyakim, winner of the Israel Prize for Medicine in 2001, to the complaints about the examinations he made in this case nor in the case of the patient who was abandoned bleeding on the operating table.