Panel biased, says patients' rights group

  • 2000-02-17
  • By Jaclyn M. Sindrich
TALLINN – Estonia's medical aid quality commission has come under fire from the country's major patients' rights group, accusing it of partiality and making unfair rulings on complaints against doctors.

Pille Ilves, chairwoman of the Estonian Patients' Advocacy Association, said that since the board's inception in 1996, it has reviewed more than 200 cases alleging wrongdoing, yet none of the doctors accused have been found liable.

She pointed out a case against the private women's clinic, Fertilitas, in which the commission sent the Estonian Association of Gynecologists to investigate, even though the association chairman Ivo Saarma is the owner and chief physician of the clinic.

Merike, who identified herself but asked that her last name not be used, is involved in the case against the clinic and said that she does not approve of the way the doctors have treated her case.

She alleged that doctors at Fertilitas waited too long to operate on her dangerous tubal pregnancy. Her Fallopian tube had already ruptured when they performed the surgery, and the doctors then removed the tube entirely – a procedure which she said should not have taken place.

Merike claimed the doctors denied that alternative treatments were available, but later she discovered the opposite was true.

"I cannot have children in the normal way now. . .I understand that doctors make mistakes, but it is humiliating and awful to make the patient seem guilty," Merike explained.

She expressed frustration that the medical board has "lied about [her] treatments and health" in order to save the private clinic money and its reputation, she alleged.

Meelis Roosimagi, director of the Fertilitas clinic, said he did not wish to discuss the case before it goes to court.

He also explained that without prior consent, disclosing the clinic's information about the patient would be in direct violation of patient-doctor confidentiality.

However, Roosimagi maintained that Fertilitas is confident in its doctors' practices.

"We are sorry that the patient's health has been damaged," he continued, "but at the same time, it does not mean we have not done our work in the best possible way."

The clinic's chief doctor, Ivo Saarma, was unavailable for comment.

In another controversial case, the medical board's chairman, Peeter Mardna, investigated a complaint against his son, Mihkel Mardna, who was accused of involvement in a case where a patient went into a coma after being given the wrong method of anaesthesia.

Peeter Mardna scoffed at the accusations, asserting that his son was the surgeon, while the error was unequivocally the anaestheseologist's.

"In this specific case the anaesthesia was just not suitable for this patient. But it was absolutely acceptable," he said.

Mardna's son, Mihkel, was out of town and unavailable for comment.

He mentioned another case, in which a doctor was charged with giving two babies the wrong medicine, resulting in one of their deaths. Mardna said that the commission had not found the doctor liable because it was the pharmaceutical company that was actually at fault, and no action had been taken against it.

"In half of these cases the problem has nothing to do with quality but with communication problems between the patient and doctor. In another third of the cases, the treatment is far from ideal but absolutely acceptable," Mardna argued.

Ilves chalked such claims up to partiality, saying that the commission often based their decisions on irrelevant details such as the patients' "bad behavior.

Ilves complained that the 13-member commission, which was established by the Ministry of Social Affairs, consists entirely of medical professionals, but in order for it to be independent, lawyers and various public representatives must be included.

All purported dubious practices aside, an underlying problem is that patients are simply unaware of their rights, she said. Non-existent in Soviet times, legal recourse is not necessarily a natural concept for Estonians.

In an attempt to solve the problem, Ilves' association is taking part in a committee comprising medical experts from Tartu University, lawyers, several officials from the Social Ministry, and a nurse to draft the country's first detailed patients' rights law.

"I am optimistic but I am not sure how it will end in Parliament," Ilves said.

For now, she explained that little is being done because of conservative and "medically-oriented" factions in the Social Ministry who are more interested in their own versions of patients' rights laws.

Reforms of the medical commission itself are still under discussion, according to Sigrid Tappo, public relations officer for the Ministry of Social Affairs, who declined to state an official opinion regarding the dispute.

Head neurosurgeon of the Tallinn Medical Association, Andres Ellamaa, was more skeptical of the complaints against the commission, claiming that it was a typical situation and, of course, "all patients want to have a long-lasting life," he said.