Medical care is a fundamental human right, and the Hippocratic Oath, which symbolizes a physician’s duties, compels those swearing it to keep patients from harm.

Medical care is a fundamental human right, and the Hippocratic Oath, which symbolizes a physician’s duties, compels those swearing it to keep patients from harm.

But although ethical standards in medicine are universal, the situation in Egypt is treacherous; public health budgets are very small and private hospitals are more investment projects than institutions dedicated to health care. Public hospitals, meanwhile, are in very bad shape and lack both resources and maintenance.

Although no official figures are provided by the public health sector, the Egyptian Association for the Defence of Medical Negligence Victims, a legal aid organization, estimates that around 2,000 to 3,000 people die as a result of medical negligence every year.

According to the association’s board chairman Ayman Rabeh, these figures are based on the number of complaints received by the Egyptian Doctors Union as well as statistics released by the district attorney’s office. But the guilty party, whether a doctor or a hospital, often escapes unpunished due the lack of an effective accountability mechanism to protect the rights of patients.

Deadly hospitals

In the latest chapter of this long, shocking story, young novelist Nadin Shams died last March through medical negligence. After finding she had a fibroid tumour in her uterus, Nadin went to gynaecologist Ismail Abulfutooh, who told her that she needed surgery.

He chose another surgeon Khairi Saber, to assist him in the operation, performed on March 10 at the private Egypt International Hospital. During the operation, a series of medical errors led to Nadin’s death.

According to the testimonies of doctors from outside the hospital who were familiar with her condition, the surgeons failed to fix the colon’s tract outside the body to rectify their errors. Nadin also received inappropriate post-surgical treatment and antibiotics were wrongly administered, which weakened her body. Her condition deteriorated rapidly, causing her eventually to suffer a massive stroke and one-sided paralysis.

After Nadin’s death, the hospital issued a preliminary report describing “the real cause of death,” followed by another report in which the cause of death was falsified. The victim’s husband Nabil Qutt filed a lawsuit against the two surgeons and the hospital’s board chairman, accusing them of negligence and deliberately leaving his wife to die to cover their errors.

Nabil wants his case to go to court and hopes that similar cases are not dismissed simply because of the incapacity of the law, but no decision on his case has yet been made.

Deteriorating health system

Dr. Jane Lomell, public health specialist and member of the Health Services Supervision Partners – a group working to uncover medical malpractices – thinks ordinary citizens are often unaware of their rights simply because they do not understand medical terms. Even doctors in private clinics, where a check-up can cost 400 Egyptian pounds, rarely explain to patients their condition in simple language.

Lomell believes that the inability to call doctors to account frequently makes them indifferent to patients. When medical errors occur, it is too easy for hospitals to cover them and protect their doctors. They often even refuse to open the victim’s medical file to their family.

“Guilty doctors, backed by hospitals, can easily deny any knowledge of their victims or any responsibility for the surgery they performed,” she explained. “Families find it difficult to prove anything and if they managed to spark an outcry and threaten to expose the guilty party, hospitals and doctors often resort to corrupt methods to escape responsibility, such as bribery or intimidation.”

Commenting on Nadin’s case, Lomell added, “An aspect of the deterioration in the country’s health sector is that Nadin’s family was unable to admit her to another hospital because hospitals sometimes refuse to admit patients with such critical condition – this is illegal and immoral.”

Early death

The untimely death of Norhan, a 20-year-old student at Alexandria University, was another testament to medical negligence in the country.

Eight months before her death, Norhan found out that she had spinal curvature. Her eldest brother Hisham told Correspondents that Norhan went with her mother to orthopaedist Mahmoud Yaser, who told them she needed surgery and referred her to consultant Tarek Fagi and the neurologist and orthopaedist Tarek Allam. The three doctors agreed that an operation was necessary and that they would perform it together.

After the eight-hour operation, Norhan had to be put on life support. The head surgeon told her family that during surgery Norhan had suffered circulatory failure and severe bleeding and that they had been forced to close the wound in order to enable her to breathe on her own and allow her vital organs to function.

They promised that they would continue the operation later and that Norhan would be in good health within 48 hours. Then another doctor told them that an error had occurred and that young Norhan had died.

Norhan’s family consulted specialists from outside Egypt, and after examining the x-rays they all concluded that Norhan had died of brain atrophy and blood clots in the heart and lung. They also believed that the spinal cord had been damaged by a scalpel during the surgery.

Hisham went to the police to file charges the next day, Norhan’s body was referred to the medical examiner, and the doctors who performed the surgery were called for questioning. “They plucked the tender flower of our life,” Hisham said. “She was the apple of our eye and we will never waive her rights.”

Doctor’s rights vs patient’s rights

Doctors are to blame in most medical negligence cases, but what is their professional status, and why do they make fatal errors? Dr. Amr Shouri, a member of the Egyptian Doctors Union, said the health sector lacks adequate work regulations.

Senior doctors earn very well and go to work whenever they want in both the public and private sectors alike, while low-ranking doctors work under difficult conditions for long hours and low wages, often without contracts. This is true both in the public and the private sectors, though conditions and pay in the private sector are slightly better.

After the death of Nadin Shams, many of her friends and co-workers, as well as numerous political activists, called on the High Committee for Doctors’ Strike to take a stand against medical negligence, given that strikes staged by doctors always receive strong support from political parties and civil society.

In his article entitled “Human Lives Not Cases, Doctors Not Merchants,” published in the Al Masri Al Youm newspaper in March this year, lawyer and political activist Ziad Olaimi wrote that doctors seeking to reform the health system should take an unequivocal stand against colleagues who kill Egyptians through negligence.

Dr. Amr Shouri pointed out that Egyptian doctors also need better resources and equipment, and are demanding better regulations to ensure humane working hours and fair pay. “When we negotiated with the Ministry of Health, one of our demands was professional liability, but our demand was put on the shelf,” he said, before adding that he was one of a group of doctors currently drafting a bill of rights for patients.

Contaminated blood

Mohammed Abdelrahman is an independent lawyer from Alexandria who has been working on medical negligence since 2008. He is retained by a number of clients whose children suffer from haemophilia and are dependent on daily transfusions – at a cost of 300 to 800 Egyptian pounds per transfusion.

When two of his clients found in 2011 that their children had received blood infected with hepatitis C, Abdelrahman and his clients filed charges with the district attorney to investigate the matter. Two weeks ago (three years later) a report was issued which said that no resources were available to screen the blood stored in blood banks.

Abdelrahman said the blood stored in a single container is sometimes given to at least four different people. Screening one container costs around 1,350 Egyptian pounds, and the donors’ blood is not screened prior to donation. When he asked doctors about the matter, he was told that screening blood only helps identify antibodies – not HCV. Abdelrahman also discovered threre was indeed a device for screening blood at the Ministry of Health, but former Health Minister Hatem Gabali prohibited its use on the grounds that its operation and maintenance costs were too high. “Blood screening became inadequate ever since and now has to be carried out manually by doctors,” Abdelrahman said.

The law does not protect patients

Despite all the lawsuits, negligent doctors often escape punishment. Attorney Ahmad Mohammed Jabr, member of the National Group for Human Rights and the Health Services Supervision Partners, also believe that negligent doctors escape punishment because victims are ignorant of the law. Many are unable to file a complaint to the district attorney’s office properly. He also believes the law itself is flawed and easily manipulated, and penalties should be made harsher.

Jabr pointed out that all private and public hospitals are supervised by the Health Ministry, but although all medical licenses must be regularly renewed, the highest number of negligence incidents occur in hospitals affiliated to the ministry.

Moreover, the ministry’s budget allocated to medical services is not supervised, and even though the ministry has the authority to close down any hospital and revoke its license, this has never happened to date. The Doctors Union also has the authority to terminate the membership of negligent doctors, but, Jabr argued, it does not seriously investigate violations – even though they sometimes amount to murder.

Who calls doctors to account?

Head of the Doctors Union’s inquiry committee Dr. Khaled Samir said that if a doctor commits an error, victims of their families should refer to the district attorney’s office or the Ministry of Health for legal action.

“In 2013, the Union received 413 complaints and penalties were imposed for 34 of them, but some complaints are still pending investigation,” he said. “Most complaints come from private hospitals, partly because difficult operation are often not performed in public hospitals.”

“Penalties imposed by the Union include warning, caution, fine, temporary suspension, and termination of membership,” Samir added. “The disciplinary rules are designed to protect the medical profession, not patients’ rights. Of course supervision is needed, but the country has 82,000 medical institutions. Even if the Ministry of Health planned a supervisory visit every three months, that would mean 300,000 visits – and the ministry does not have those resources.”

In terms of health service spending, Egypt is ranked 118^th worldwide. While the average annual spending on health is $2,000 per citizen, Egypt only pays $130 – and the government only pays a small portion of that amount.

Correspondents tried to contact the ministry, but that requires a press license approved exclusively by the minister’s office, and the process took too long for the purposes of this article.

Lomell said there needed to be more campaigns against negligent doctors and hospitals and doctors who caused the deaths should be boycotted, while Ahmad Farouk, member of the High Committee for Doctors’ Strikes and official spokesman of the “Doctors of Tahrir” group, suggested that the rules of medical supervision and accountability applied in the US should be used as a model.

American hospitals includes an independent commission comprising doctors, hospitals, and patients’ representatives, which monitors the performance of the hospital, submits its recommendations to the judiciary if any medical error occurs. Another example is the higher council for health, an independent body that exists in many countries in charge of monitoring the quality of health services provided to the public.