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Doctor suspended as high death rate in emergency department is investigated

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7499.1044-g (Published 05 May 2005) Cite this as: BMJ 2005;330:1044
  1. Claire Wallerstein
  1. Madrid

    A Madrid hospital is at the centre of a legal and political storm after claims of an abnormally high death rate in its emergency department. Thirteen deaths at the Severo Ochoa Hospital are being investigated by the local public prosecutors' office. But defenders of the public hospital claim that local politicians have whipped up criticism to create support for privatisation in the health sector.

    In March, Manuel Lamela, the provincial health minister, received anonymous complaints relating to the sedation of hundreds of apparently terminally ill patients dating back more than two years. Inspectors from the provincial health department looked into 339 cases, of which sedation had been used in 151. They found no family consent in 57 cases and evidence of “doubtful or inadequate use of sedative drugs” in 25. They also found a series of “serious administrative errors,” such as doctors failing to follow the hospital's own guidelines on the use of sedatives, and sedation consent forms being left in a box separate from patients' records.

    A number of doctors and a manager at the hospital have now been suspended, and files on the 25 suspicious cases have been passed on to the public prosecutor's office. Twelve have so far been discarded. Three cases of alleged homicide through professional imprudence, backed by the association for victims of medical negligence, will be presented in preliminary hearings on 6 May.

    This story also, however, has a political dimension. Some health professionals believe that it has been cynically manipulated by the provincial government—controlled by the opposition conservative Popular Party—to raise fears about public hospitals to justify privatising them. The Popular Party's plans for eight more private hospitals in Madrid province form an important part of its manifesto. The College of Doctors and many of the country's medical unions have come out in support their colleagues at Severo Ochoa and are demanding the sacking of Mr Lamela.

    Some doctors at Severo Ochoa Hospital's, meanwhile, claim that guidelines on the use of sedatives did not filter down to the casualty unit until August 2004. They attribute the high number of deaths in the emergency department to rocketing admissions and a lack of beds in the palliative care ward.

    The hospital has refused to comment on ongoing legal proceedings, but a spokeswoman said, “So far, there is no evidence of any criminal culpability whatsoever. The investigation has rather been into administrative errors, and the staff involved have been relieved from their positions. Unfortunately this issue has been twisted and blown out of proportion by certain sectors of the media. The Severo Ochoa Hospital is one of the top 20 in the country, and its medical staff are highly professional, committed, and honourable people—that is not in doubt.”

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