When people talk about medical negligence and other problems in the health sector in Mozambique, the finger is always pointed at the public sector, since it has more functional problems due to its lack of funds and human resources. However, this article focuses on a private institution accused of allegedly being involved in a situation of medical negligence. This case shows that private institutions also contribute to the negative rating of the National Health System as a whole.
A few weeks ago, the Citizen Observatory for Health (OCS) received a call from a lady who named Telma Galimoto, reporting a problem in which she was a victim.
Gailmoto, aged 33, accuses CliniCare – a clinic based in Maputo – of being involved in the perforation of her bladder, in a clear failure of surgical intervention by a doctor, when he intended to carry out a laparoscopy examination, a surgical approach designed to treat various diseases in the abdominal and pelvic region. This technique is often indicated in gynecological practice, bariatric surgery, the treatment of appendicitis and abdominal hernias, among other situations.
According to the patient, the surgical procedure she was going to have with the doctor, Agostinho Daniel, who works at CliniCare, was only going to take a few hours. However, after the doctor realized the mistake, he had made, he demanded that she paid for her own hospital stay so that he could correct the error.
“I booked a laparoscopy at CliniCare, it’s a relatively simple procedure, it doesn’t involve any hospitalization. It’s a matter of getting there and getting it done. During the procedure, I ended up contracting other side effects, i.e. the doctor perforated my bladder, and as a result I had to have surgery to correct the problem”, she said.
Telma didn’t refuse to be hospitalized, but denied to pay the costs at the clinic, since it wasn’t in her plans and she didn’t have the money to do so.
“I rang my sister to ask for financial help, and she thought it was strange, as we had agreed to go home together. I ended up telling her what was really going on, that during the laparoscopy process the doctor acknowledged that he had perforated my bladder, and had to make a cut in my abdomen to correct the mistake”, she continued to explain.
“The surgery should have been carried out by a urologist, but he’s a gynecologist. However, he ended up doing two surgical procedures in one day, and the second procedure was without my consent”, she added.
Because the patient’s sister didn’t have the money available for hospitalization at that time, the doctor suggested that she should be taken to the publicly-owned Maputo Central Hospital (HCM), where she could be under the care of her doctor friends.
“I spent the night there, and at 9am I was sent home. I left with my belly open and later I discovered that during those interventions, some compresses were left inside me, which ended up causing infections”, she revealed.
It should be noted that the patient went to the HCM without a transfer note, so much so that first thing in the morning, the professional who had been in charge her sent her home, even though she was still in pain.
Other medical intervention to remove bladder compresses
Telma later approached CliniCare to see if it would intervene in her case, but the answer she got was “this was a medical error, we are an institution…”.
Because she was still in pain, she later went to another clinic and was referred to an imagiologist. Having seen the case, she underwent surgery to remove the compresses from inside her, as illustrated by some of the images from the tests she underwent.
“I showed the photos to the doctor and the management of CliniCare and it turned out that the compresses were there. However, the same doctor who made the mistake said that I was paranoid,” she said.
“I no longer feel when I want to urinate”
As a result of this negligence, the patient now complains of side effects, as she can no longer detect the manifestation of urine before the act of urinating. As a result, she is forced to urinate every two hours.
“This situation has affected my marital and family relationships,” she confessed.
For the patient, an apology from the doctor would be enough to demonstrate humanism, although it couldn’t undo the mistake that had already been made. However, whenever she tries to have a friendly dialogue with Agostinho, the doctor reacts arrogantly.
“I haven’t even heard him apologizing for perforating my bladder or forgetting the compresses on my stomach. To make matters worse, Clinicare and the doctor don’t open up any space for negotiations”, she said.
As a way of alerting other patients to this case, Telma assures that she will take the case to court if necessary.
“The doctor responsible for this whole situation is very relaxed and shows no concern about facing justice, and doesn’t even fear being questioned by the Medical Association.”
The case, as the images illustrate, has already been submitted to the Mozambican Medical Association and if there is no solution, other higher authorities, the Minister of Health or the Prime Minister, will intervene.
Doctor refuses to talk about the case
Following the case, the OCS tried to contact the doctor involved to hear his position on the accusation made by the patient. After several attempts, the doctor was not open to making any statements about the case, but simply said that our team could only discuss the matter with the patient’s permission. This argument, however, is inconsistent given that the patient herself complained to the OCS.
“I have nothing to declare because the patient had not commented on any knowledge of the case on the part of the OCS”, she said.
In a note responding to our request for a reaction, CliniCare said that the matter had been referred to the competent authorities, and that it “does not think it ethical to make any kind of pronouncement on the complaint that OCS has received.”
Case already under observation by the Medical Association
The Mozambican Medical Association, through its president, Gilberto Manhiça, acknowledges the existence of the case and says that it is already being legally processed.
Without commenting in depth on the case, the president only explained that, after receiving the complaint from the patient, accompanied by her lawyer, a case was opened.
“When the problem is in the gynecological area, it’s the College of Gynecology and Obstetrics that makes the assessment. If it’s a surgical problem, then it’s the College of Surgery that analyses it. If it involves two different areas, which is the case here, we refer it to both and each one gives their opinion on what happened”, he said.
Manhiça also said that, at the moment, the necessary information has been provided to analyze the problem “and we are now waiting for an opinion on these matters.”
“In order to avoid inappropriate reactions from the people who are going to intervene in the process, we call for common sense until the process is over. Then we will be able to comment on the case”, he concluded.
There must be criminal accountability
From a legal point of view, OCS heard lawyer Henriques Perreira Júnior. According to him, the situation is very sensitive and can be seen in several ways, as a genuine medical error, as well as a medical error derived from negligence, the latter criminal.
“We have the Penal Code, which is law 24/2019 of 24 December, which in its article 81, talks about intervention and discusses the offence of physical integrity. This would fall a little within this scope because we don’t have a specific law on medical error,” he emphasized.
The lawyer also mentioned Resolution 73/2007, of 18 December, which talks about the Rights and Duties of Patients, an instrument that guides the treatment and monitoring of patients and the responsibilities of the doctor himself.
He explained that there are technical errors, which are considered involuntary, but this case is considered negligent, as the doctor forgot medical material in the patient’s body. Especially when you’re dealing with invasive surgeries, opening the body, forgetting an instrument can be considered negligence and, therefore, there should be accountability, not only civil and administrative case at the level of the Ministry of Health, as well as the Order of Doctors, but also criminal at the level of the Public Prosecutor’s Office and the bodies of justice.
“If it’s proven that there was negligence, there should be accountability. I don’t know if it’s joint and several or not. Liability will depend a lot on the type of contract, because there are doctors who rent a place in a clinic to work, but there are others who have a contract with the clinic and work on behalf of that organization. So, if that’s the case, the clinic won’t avoid this responsibility”, he explained.