“Manifestly deficient” conditions in Faro A&E prompt surgeon boycott

As of last Sunday, surgeons attached to Faro state hospital’s A&E department have applied a moratorium on ‘supplementary work’ (overtime) citing “manifestly deficient” work conditions within the health unit.

While authorities insist the boycott won’t affect staffing rosters (see box story), they have declined to comment on the doctors’ ominous bottom-line: that they themselves won’t “accept any responsibility for eventual medical acts and surgeries practised by doctors who do not belong to the surgical service of Faro Hospital”.

The surgeons also warn that current conditions in the A&E department of the region’s capital have increased the risk of “involuntary clinical errors being committed”.

Braving it through these last two points, health authorities found themselves once again under fire just days later when regulatory entity ERS released a damning report highlighting failings in hospitals throughout the country – with particular emphasis on sub-optimum care in Portimão.

The report also had criticism for the private sector. In Lisbon’s private CUF Descobertas, for example, a failing in radiotherapy equipment meant cancer patients had to go five days without treatments “in cases where treatment should have been daily”.

But the worst cases, clearly, were those that resulted in complaints from devastated families who felt they had lost loved ones for lack of sufficient attention.
One referred to an elderly woman transferred from one northern hospital to another (despite the second saying it had no space for her).

The woman ended up having to stay in the observation room of the casualty ward at Hospital da Feira, where she did not receive ‘continuation of the level of care’ that she required – and had been receiving at the first hospital, Hospital de Gaia.

The situation “undermined the conduct of the care to be provided”, said ERS’ report and the woman ended up dying of heart failure two days later.

The situation was quite simply “inadmissible”, say regulators.

Both hospitals involved have now been told to change their procedures and ensure nothing like this happens again; while the hospital centre to which Hospital da Feira belongs has been “instructed” to avoid leaving patients in A&E departments who should be given beds on wards.

The centre was further told to ensure that should patients be kept for any time in the observation ward of casualty departments, their conditions will need to be constantly monitored and accompanied so that any changes can be dealt with.

The death of the 74-year-old woman has been taken seriously enough for ERS to send its findings to the Doctors Association and the Public Ministry, for a decision on whether ‘eventual responsibility of the professionals involved’ should be considered.

In Portimão, the “very grave failing” detected was eventually archived, but with a chilling observation by ERS officials that there were “strong indications that more cases” just like the one investigated “could currently subsist”.

Pressed for a response, hospital authorities refused to comment on this aspect of the censure, referring us instead to a statement put out over the weekend (see below).

The Portimão case centred on a patient with cancer who was left for so long (almost two months) awaiting results of ‘vital tests’ that he died before a treatment plan could be formulated.

ERS’ report catalogued a litany of failings – including a two-week long period where crucial biopsy material that should have been sent for analysis simply languished ‘unsent’.

Calling for an immediate speeding up of procedures to “avoid the same errors and serious shortcomings”, ERS said it planned to instruct Portimão hospital on new proceedings to adopt in order to guarantee cancer patients in future “permanent and timely access” to all necessary tests and exams.

The regulator further requested CHUA (the university hospital centre of the Algarve) to “expedite and diligently” conduct examinations with other providers “widening its network of partner entities” and to “review internal procedures” so that all requests (in future) can be expedited efficiently to meet the established guaranteed maximum response times.

Health minister Marta Temido has stressed that the delays in the Portimão case “had nothing to do with financial reasons”.

Sources close to the hospital, however, have told the Resident that almost every problem in the building stems from a “chaotic chain of command”.

Two crises, two statements: “business as usual”
CHUA addressed both crises in two separate statements, dated November 28 and 30 respectively:

In the first “on the findings of health regulatory authority ERS”, it stressed that it has “introduced a series of new procedures and mechanisms of articulation with other entities in the sense of improving capacity of response in these kind of exams”.

As to the “strong indications” that similar cases could still be ongoing, there was no comment.

In the second statement, “on emergency surgery in Faro hospital”, CHUA insists that Faro A&E is “functioning normally and will continue to function normally during the month of December”.

It ‘reminded’ the press that “shifts are dynamic work instruments, subject to constant updating and readjustments” and that it is absolutely the discretion of “our professionals” to opt in or out of “extraordinary hour” schedules.

CHUA didn’t address the doctors’ warning about ‘current conditions’ in A&E increasing the risk of “involuntary clinical errors being committed”, but it did say that it was well-versed in hiring agency staff who it considers know hospital practices well “as well as the organisation of the service”.

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