When Gaza’s doctors err, remedies are rare

Manal Al-Turk Seidam, was 32 and pregnant when she entered a maternity hospital in July 2006 suffering from sharp abdominal pains. Her doctor told her that the fetus’ heart had stopped beating and it would have to be aborted.

The procedure is common and simple to do medically, but in Seidam’s case it turned deadly. Her doctor accidentally opened holes in her uterus and intestines, and then tried to fix the problem surgically. He told the family the problem was cleared up.

But on September 14, 2006, seven weeks after the initial operation, an ailing Seidam was moved to Al-Shifa Hospital. Doctors found that her intestines were damaged. Seidam eventually stopped breathing on her own and her situation grew so severe she was moved into a hospital in Israel. But it was too late: She was exposed to a bacterial shock and died, leaving two daughters behind.

Seidam’s story didn’t end there. It continues to this day in a maze of delays and official waffling over who was responsible for her death and what steps would be taken.

Medical malpractice in the Gaza Strip is something doctors, hospitals and the government would rather not talk about. Nor does the law have much to say on the matter. To get a sense of the problem the best way is to visit the offices of the Independent Commission for Human Rights (ICHR), where cases like Seidam’s are documented. 

“There‘s no framework for medical responsibility in Gaza,” said Consultant Mohammed Abed, the Hamas government’s attorney-general. “Neither the Health Ministry nor the committees involved with it know how to deal with medical malpractice. They don’t know how to penalize doctors who commit mistakes or how to evaluate the situation, so they resort to general rules, which aren’t always accurate or strong enough.”

The odds were stacked against them but Seidam’s family, nevertheless, filed a malpractice complaint. The Gaza Health Ministry responded by saying the matter was out of its hands: “The hospital that Seidam first entered isn’t governmental. Therefore, the ministry can’t be responsible and can’t do anything about it.”

Sa’id Al-Turk, Seidam’s father, would not accept that. He was informed by his lawyer that under the 2004 Palestinian Public Health Law No. 20, the ministry not only licenses non-governmental health institutions but is required to monitor them. 

Armed with the new information, Al-Turk reactivated his complaint in 2007. Three years later, in September 2010, an answer came: Yes, there was a problem with how his daughter was treated, but the reasons for it are “mysterious.” Perhaps, it was due to some deficiency in the hospital’s administration.

Meanwhile, Al-Turk pursued a second route through the Doctors Syndicate, which assigned a committee on June 28, 2007 to investigate Seidam’s death. The panel collected the material related to the case but then ceased further action or follow-up, blaming the internal divisions and  the armed conflict between Hamas and Fatah that erupted at the time and left Hamas in control of Gaza.

Finally, the Doctors Syndicate asked Al-Turk to provide an autopsy report of Seidam’s body, which is impossible because she has been dead and buried since 2006.

It is now six years since Seidam was treated and the doctor her family holds responsible for her death still works at the same hospital and still performs surgery. “This murderer should be placed behind bars. The lives of others will remain in danger until he is jailed and punished,” Al-Turk says bitterly.

According to Suleiman Al-Ghalban, head of the legal department in Gaza’s Health Ministry, the government only appoints a committee to investigate alleged malpractice when the charges are deemed worthy of examining.

Of hundreds of complaints the ministry has received since 2008, according to Al-Ghalban, 116 were deemed worthy of investigating. Among those, 35 were deemed to be justified. However, in no case was a doctor dismissed or ordered to pay compensation to the victim or his family. At most, doctors had to accept a delay in receiving a promotion, a cut in salary or demotion, or accept a written warning.

But Ehab Al-Nahal, a dentist and researcher in the ministry’s medical malpractice unit, says the number of investigations is misleading because the investigations themselves are not done properly. 

“The follow-up that is done by assigned committees isn’t commensurate with the seriousness of the complaints,” he told The Media Line. “We need to have a medical and legal body that conducts deeper and more accurate investigations of these complaints and decide how to act on them. We cannot just rely on doctors working at Gaza’s Health Ministry and their judgment.”

The Health Ministry does not have staff or facilities at hospitals where patients and their families can file complaints. They have to personally apply their complaints to the ministry or apply it through a human rights organization. “The Health Ministry isn’t really concerned about these complaints. If anything, they wish there were fewer of them,” Al-Nahal says.

The ICHR has called for an on the Palestinian parliament to enact laws penalizing those found guilty of medical malpractice. It has urged the Health Ministry to take more responsibility and initiative.

Khamis Al-Najar, a deputy in the Palestinian Legislative Council, says the Doctors Syndicate should also have an active role in order to “defend or punish any doctor. The syndicate also should include all doctors and medical personnel.”
 
In another case, Naser Moqbel, was admitted to the emergency room in Kamal Odwan hospital in Jabaliya in northern Gaza, with abdominal pains. The doctors couldn’t agree on the cause. One pointed to the absence of abdominal fluids to say Moqbel’s appendix hadn’t burst and that he was in no immediate danger. Other argued over the results of a blood test he had taken.

One of the doctors finally began surgery, but soon emerged from the operating room to inform the family that it was too late: Moqbel’s appendix had burst. A second doctor diagnosed the problem as something else, leaving the family confused. Whatever had happened, Moqbel’s health started deteriorating. His family tried to transfer him as soon as possible to an Israeli hospital, but the permit took time and by the time he was admitted it was too late. Moqbel died in Israel. An examination of the case was terminated without any conclusions and no doctor was punished.

Ebtisam Muheisin (Um Ashraf), 53, was admitted to the government’s Al-Shifa hospital in August 2011 after falling in her kitchen. It was the fasting month of Ramadan and the emergency room was nearly empty. The one doctor working there told the family to take Um Ashraf for a CT scan. But because there were no nurses, Um Ashraf’s son and a friend carried her to the procedure, which had to be repeated twice. Without any training in handling an injured person, they caused her immense pain and may have exacerbated her condition. 

Finally diagnosed with a broken pelvis, Um Ashraf was told she needed a surgery and placed in a ward. There, she waited for 10 days, during which time she received only one medical check-up and no attention from nurses, leaving her family to take care of her. When her urine was found by family members to be black, they found the sole nurse on duty napping in a patient’s bed. Awoken, she responded that it was “urine infection” and went back to sleep.

Um Ashraf finally was taken for surgery on September 4 at 8:00 a.m. Three hours later, her doctors informed the family she was dead. Based on an autopsy, the Health Ministry ruled she had died of a stroke “naturally” or due to anesthesia. Um Ashraf’s case has yet to be investigated despite wide coverage in the local media.