Parents may sue hospital over child’s appendicitis death

Parents may sue hospital over child’s appendicitis death

Heartbroken parents of an eight-year-old boy who died from septic shock after an alleged case of misdiagnosis by Portimão Hospital are reported to be considering legal action.

As a full medical report on the tragic case was being fast-tracked, Pedro Nunes, president of Centro Hospitalar do Algarve (CHA), the administrative body in charge of the state hospitals in Faro, Portimão and Lagos, told the Algarve Resident: “There is a general public mistrust of the hospital – an exaggerated mistrust – but I am quite sure that Portimão (referring to Barlavento Hospital) is not to blame for what is simply a tragedy.

“Of course we have difficulties,” he admitted, when quizzed on the situation at Portimão state hospital. “We don’t have all the doctors we want, some are not as good as others, but we do have the means to treat people properly and people should always come back to us if their conditions do not improve.

“I have every faith that the eventual report on this case will show that our doctors acted properly.”

Nunes added that this “isn’t the first time a child has died in this way. There was a very similar case in Coimbra in 2004, and there the doctors were absolved”.

Nunes’ words, of course, bring little consolation to the parents of Paulo Rafael Silaghi, the child who died almost a week after being seen by doctors at Portimão state hospital.

Paulo’s mother Délia first took her son to hospital on Saturday, October 19. Online news service Sul Informação reports that Paulo was already suffering the classic symptoms of appendicitis – “fever, vomiting, stomach pains and diarrhoea” – but tests run did not lead the initial doctor to investigate further.

After running a number of tests, which included making the child hop from one foot to the other and jump off the examination couch, the doctor discounted Délia’s natural concern that it could be appendicits and sent the family home with the advice that Paulo should drink tea, the mother told Sul Informação.

When two days later the child’s condition had become worse, Délia Silaghi took her son to Portimão health centre. She told reporters that doctors there detected a urinary infection and after prescribing medication sent her son home.

The point where the tragedy seems to have spiked comes two days afterwards when the much sicker boy was taken to Hospital Particular de Alvor. There doctors finally diagnosed the real problem: acute appendicitis.

Délia Silgahi told Sul Informação that as the family did not have the €3,000 they needed for an operation, the hospital telephoned Portimão Hospital, advising them of Paulo’s condition and the need for an urgent operation.

The eight-year-old was rushed by ambulance to Portimão Hospital – but the operation did not take place.

“This is perfectly understandable under the circumstances,” Pedro Nunes took up the story. “The child’s condition was very bad by this time, and the surgeon on duty knew that the boy would have to be kept in intensive care after the operation. We have an intensive care unit at Portimão Hospital, but not for children. That is why the boy was rushed to Faro Hospital – where we do have a special paediatric intensive care unit. He was rushed at high speed, with a GNR escort. Faro opened their operation bloc and were waiting for him.”

But from all accounts, this last-minute speed to get things right came far too late.

Paulo Silaghi went into cardiac arrest in Faro, and despite being airlifted by helicopter to Lisbon’s Centro Hospitalar Lisboa Norte for even greater care, he died on Friday October 25 – six days after his mother first sought medical treatment for what were, after all, classic symptoms of appendicitis.

The question of whether the private Hospital Particular do Alvor could have done more was answered by both the hospital’s marketing department, and Pedro Nunes.

Marília Pais Cabrita, spokesperson for Alvor private hospital, confirmed the hospital “always does everything in its power” to operate on patients whose lives are at risk “whether they have money, insurance, or not. There are always ways of paying. It is not the first thing we think about in emergencies.

“The thing is that the little boy’s life was not in danger when our doctor saw him,” she told us.

And this is where the story gets confused. If Paulo’s life was not in danger in Alvor, but was by the time he had reached Portimão Hospital (only a short drive away), what had happened in the intervening minutes?

Pedro Nunes contends that the Hospital Particular do Alvor was not equipped to operate on Paulo Silaghi anyway, as it does not have a specialist paediatric care unit.

Amid doubts and questions, and awaiting Portimão Hospital’s full report, Sul Informação confirms that Paulo Silaghi’s parents “are advancing with a legal case against the doctors of the Centro Hospitalar do Algarve (CHA) and the Centro de Saúde de Portimão (health centre), alleging medical negligence”.

And in answer to our own questions on why classic symptoms of appendicitis were ignored, Pedro Nunes answered: “These could also be symptoms of gastroenteritis or a urinary infection.

“As I said before, in cases where a patient does not respond to treatment, we would always advise people to return to the same hospital.

“This is possibly where things went wrong. There was a mistrust in the hospital, and the child was taken elsewhere,” he concluded.

Hospital director blames appendicitis death on “mistrust, fear and despair”

In a report that ends with a kick in the teeth to “all those who for economic, social or political interests don’t hesitate to spread mistrust, fear and despair” about Portimão hospital, hospital director Pedro Nunes absolves his doctors of any wrong-doing in the tragic death of eight-year-old Paulo Rafael Silaghi.

“It is the understanding of this administrative council that the behaviour of all concerned on the two occasions that the child entered the hospital was adequate, in accord with the “state of the art” and would not have been different in any other hospital,” said Nunes’ fast-tracked report, released to the press late on Wednesday afternoon. “Seen in hindsight, which is always easiest, one could speculate that if the child had returned to (our) hospital during the four-day period in-between the first and second observations, the diagnosis could have been made and surgery could have been successful.”

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