Girona woman's death after treatment delays sparks outcry

Doctors group calls for an inquiry after woman succumbs to aneurysm; family files lawsuit against hospital, which denies any wrongdoing

A 65-year-old Girona woman, who died from complications of aneurysm in September after she could not get quick treatment at four different hospitals, was not operated on immediately at Barcelona's Vall d'Hebron because there were "technical failures" in the surgery, a hospital spokesman said Monday.

The fallout from the incident, in which María del Carmen Mesa's family has charged that woman spent 65 hours from hospital to hospital before she was treated, has become a public relations nightmare for the internationally famous Vall d'Hebron hospital and the CiU Catalan nationalist bloc government of premier Artur Mas, which has been heavily criticized for sweeping cutbacks in the healthcare system.

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The equipment used to perform an angiography, which helps surgeons determine the quickest and least invasive manner to proceed, was not functioning properly. Surgeons were obliged to postpone the surgery for 30 hours, the spokesman said. The operating room at Vall d'Hebron was closed at the time because of "maintenance purposes and not because of the cutbacks," the spokesman added.

Juan José Sendín, president of the medical association OMC, called the series of events "incomprehensible."

"I can't tell you whether she wasn't treated because of cutbacks but a death has occurred and it must be investigated," Rodríguez Sendín said.

Suffering from an aneurysm, Mesa was shuffled between four public hospitals in Catalonia before finally being operated on. Her family believes the delay was a major factor in her death, six days later.

In the intervening period - from September 7, when she was first admitted, and September 10, when an operation was finally performed - the woman suffered further complications, including renewed bleeding, which worsened her already critical condition.

Mesa woke up during the night of September 7 with a severe headache and lost consciousness, two common signs of an aneurysm. She was taken from her home in Tossa de Mar to a hospital in Blanes, where she was admitted at 5.10am.

After determining the seriousness of her case, doctors there sent Mrs Mesa to the better-equipped Josep Trueta Hospital in Girona, where she was admitted at 10.17am. The Girona doctors diagnosed Mrs Mesa with an arterial aneurysm and warned her family that she needed an urgent operation.

However, the doctors said the operation could not be performed at Josep Trueta, according to the complaint later filed by the family with a Barcelona court, because the hospital had been "affected by the recent realignment of services by the health department [of the regional government]." The realignment meant that "this type of serious pathology (with bleeding) must be treated in the center designated by the health map, in this case, the Vall d'Hebron Hospital [in Barcelona]."

Mrs Mesa was transferred by ambulance to Vall d'Hebron at 5.29pm on September 7. She was classified as grade four - the most urgent - on the Fisher grading scale, which measures subarachnoid hemorrhage. She was admitted to the ICU and new tests were performed, but she was still not operated on because "the operating rooms at Vall d'Hebron were closed." Neurosurgeons there assured the family that she would be operated on the following day.

"If they had treated my mother on time, they could have probably saved her life, but that chance was shattered because there wasn't an operating room available," explains Natalia Fuertes, one of the late woman's three daughters. "I don't believe this is an isolated case and that is why we have gone to court and made this incident public."

According to the complaint filed by the family, since April "operating rooms at Vall d'Hebron that had been used in the afternoons for over a decade were no longer in use." This, "along with the fact that the hospital had become a reference in Catalonia for emergencies of this type, caused the services to be swamped, which negated the possibility of providing Mrs Mesa with the treatment she needed that afternoon."

On the morning of September 8, Mrs Mesa was sedated and sent to the operating room in Vall d'Hebron for an embolization ? a procedure that was not performed because, once Mrs Mesa was there, her doctors realized that they did not have the necessary equipment.

The doctors' report states: "In the room that we were assigned for the angiography there was no road-mapping system so we were unable to perform the endovascular surgery."

Again, Mrs Mesa's operation was postponed until the following day, September 9. Later in the day on September 8, she suffered further complications, with additional bleeding. The next morning, the family was told that the operation could not be performed because there were no operating rooms available.

Given the risk presented by the new bleeding, according to her medical report, Mesa was transferred again - this time to Barcelona Clinic Hospital. She was finally operated on at 11.34pm that evening. The next day, on September 10, she was returned to Vall d'Hebron.

Six days later, on September 16, she would die there.

After EL PAÍS first reported on the case, hospital officials as well as regional health authorities defended the care that was provided to the mother. "She was cared for according to the seriousness of her illness, with the appropriate personnel and resources that the hospital had at hand, which are the same as they were last year as well as the previous year," the hospital said in a statement.

A regional health department spokesman said that Mrs Mesa's case did not present any anomaly beyond what is normal in these types of patients. The spokesperson stated that "in no way can her death be attributed to a lack of personnel or resources that prevented her from being properly attended to." Four days after they filed their complaint, on September 22, the family received a letter from the citizens' service unit. "We will review your case. As soon as we have any information, we will notify you as to where you can contact us."

For Fuertes, the daughter, the situation is "intolerable."

"There were doctors and nurses who told me to file a complaint because this should not have happened. One female doctor, who had nothing to do with the incident, hugged me while crying, because she was aware that no attempts were made to save her."

Medical care guaranteed by striking Catalan doctors

The effects of spending cuts on Catalonia's public hospitals will be compounded on Tuesday and Wednesday by a doctors' strike. Aware of the precarious situation that care centers will find themselves in on November 15 and 16, the physicians' union Médicos de Cataluña has asked patients for their "understanding" in an open letter. The statement laments the consequences of this protest, but justifies the walkout as "an act of responsibility" to maintain the quality of public health services "in the face of the deterioration caused by the cuts."

The statement served as a response to the Catalan government's assertion last week that the strike is "irresponsible." But the union, which represents a majority of public health physicians, says that responsibility lies with the regional government for having ordered "the closure of beds, operating rooms, hospital wards and night-time emergency services at primary care centers." Doctors' representatives say that all they want is to be able to offer the best health service with adequate resources and time frames.

In any case, the union said that all emergencies will be seen to during the two day-strike, both at primary care centers and hospitals.

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