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Hospital probed as patient dies in wait of operation

TT/Christine Demsteader · 13 Mar 2010, 09:30

Published: 13 Mar 2010 09:30 GMT+01:00

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At the time the elderly woman was admitted to the hospital, two operating rooms were occupied with surgeons carrying out a liver transplant and a blood vessel procedure.

Doctors diagnosed the woman with ileus, a blockage of the small or large intestine. But her condition was judged to be "relatively mild" and she was kept under observation.

As her condition progressively worsened, she underwent an operation seven hours after first being admitted to the hospital.

She died of organ failure a day after the operation took place. A so-called Lex Maria complaint was to filed in June 2008 and investigators have recently reported their findings.

Sweden’s National Board of Health and Welfare (Socialstyrelsen) points to "shortfalls in communication and cooperation" at Sahlgrenska as well as "unclear or non-existent" routines.

Investigators also expressed their surprise that one of Sweden’s largest hospitals could only cope with two operations at a time.

The inquiry noted the hospital was under significant pressure when the woman was moved to the intensive care ward. Nineteen patients were being treated, almost doubling the ward's ten-bed capacity.

Story continues below…

According to Sahlgrenska medical chief Mats Tullberg, the hospital has now taken measures to expand its intensive care ward.

”And we have made it clear to all personnel that if a patient needs emergency treatment, a further operating room must be opened,” he told newspaper Göteborgs Posten while assuring that no future patients will be afforded the same fate.

TT/Christine Demsteader (news@thelocal.se)

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Your comments about this article

11:23 March 13, 2010 by sherkovic
offcourse when a lot of immigrants will go to emergency with scars, toothaches, backpains, and migranes....geniune emergency patients will have to wait hours before they can be treated.

Sorry no offence intented to anyone. I myself am a foreigner here and work at the SUH but one thing I often see in my fellow foreigners is lack of proper knowledge on how and when to use emergency services!!

Apart from that, lack of availability of doctors is another very serious issue. Thats why I pray day and night to stay away from 'swedish health' system.
11:44 March 13, 2010 by fridayz
Obviously there is not enough doctors here in Sweden,

Swedish talented students must go to Poland to study medicine because there is a ridiculous limit of acceptance in Swedish medical schools.... and at the same time some doctors from other countries are imported here due to lack of doctors!!!

well........... In order to be a very rich doctor you should keep number of colleagues limited and people such as the lady in the article pay for your greed by their lives!
13:33 March 13, 2010 by asteriks
@sherkovic, don't be silly, there is no word in this article about immigrants, so I don't know from where you take story about immigrants in commenting this article. Are you trying to betray your roots just to kiss in ass Swedish authorities? Why immigration office didn't send you back to your country? you help them to deport other, that's how you got permission to stay in Sweden. and now, after your betrayal, are you trying to be bigger Swedish than Swedish? You are from Ex-Yugoslavia or something like that, so, if you betray your roots, you will betray Swedish one day before or later. No one like traitors, in any society in this world.

I am agreed only that Swedish health care system face lack of care and discrimination toward all poor people, poor Swedish and poor immigrants are in the same situation. They will care about saudi arabia royal family but not about poor Swedish man. how much money you have, that's how much they care for you.
14:12 March 13, 2010 by Twiceshy
so in sweden you die with free care.

in the usa you live and are homeless when you pay the bill.

what is better?
14:21 March 13, 2010 by krrodman
Every so often The Local reports on a medical issue. As a medical doctor working in the USA, I try to give an objective review of the issues. I am not an apologist for health care in the USA. That said, I am always surprised at how defensive Swedes are about health care in Sweden and at how unwilling Swedes are to accept the significant deficiencies in Swedish health care.

Let's look at this case: The woman was admitted with an "Ileus." An "ileus" is a medical condition that does not require surgery, so the initial diagnosis was wrong. No doubt she had a bowel obstruction with dead bowel, a severe life threatening condition that requires immediate surgery. It should not be difficult to distinguish between the two conditions. I am curious to know the tests that were performed on her to make the diagnosis. A simple x-ray of the abdomen should distinguish between the two conditions, and a battery of lab tests would often indicate the severity of the patient's condition. If there is any uncertainty in the diagnosis, a CT scan will be very helpful. I am a physician in a small hospital in the USA. We have two CT scanners and two MRI machines. Do we overtest? ABSOLUTELY. Do we waste resources? ABSOLUTELY. But, I can tell you this: no one dies for lack of a CT Scan.

The misdiagnosis is critical here because the more severe condition would have required her to be in an intensive care unit, and once in the intensive care unit the cascade of organ failure that led to her death would have been recognized at an early stage, and perhaps prevented.

The lack of resources is apparent at every level of care. It is shocking that a major hospital is not capable of running more than 2 operating rooms. Again, by comparison, my small community hospital is staffed to run 2 emergency operating rooms at all times including nights, weekends and holidays. And, if by chance a third surgical emergency came into the hospital, additional staff would be brought into the hospital to open up another operating room. Obviously, the costs to maintain this level of care in the USA is staggering.

It is well recognized that the rationing of medical resources in countries with socialized medicine is, at times, deadly. Because the waiting time for open heart surgery is longer in countries with socialized medicine than in the USA, more patients die of heart attacks before they get their life-saving surgery. Similarly, dialysis, a very expensive therapy, is limited in countries with socialized medicine. Patients with renal failure die at a much younger age in countries with rationed care than in the USA.

Please do not attack me by writing about the problems with health care in the USA. I AGREE WITH YOU. Health care in the USA is a mess. The best kept secret is that health care in Sweden is a mess as well.
14:42 March 13, 2010 by ameribrit
People die in the US as well as in the rest of the world secondary to misdiagnosis. The problem usually lies with the physician in my experience. (which is fairly extensive by the way) I have seen Pts misdiagnosed both in the US and here in Sweden. It is not a direct fault of whether the system is pay for service as in the US or the socialized system in use in Sweden. As in any profession, there are the ones that came top in the class and there are the ones that came bottom. Both are allowed to practice. It is just a crap shoot as to which one is on duty when you get sick.

@asteriks, you may be right in some of your posts, but you will never be taken seriously until you stop ranting. If you present your view in a constructive coherent manner I, and others on here may be able to make some sense out of what you are trying to say.
15:31 March 13, 2010 by krrodman

I completely and totally agree with you, and my point was not to suggest that doctors in the USA do not misdiagnose. Rather, my point was to suggest that there is a different emphasis in the USA and Sweden. In the USA the proverbial glass is always partially empty, and there is no limit to the number of tests that we are willing to do in order to be 100% certain in our diagnosis. Needless to say, we waste gobs of money in the process, and at times injure patients with extra tests and surgeries.

Alternatively, my experience tells me that Swedish medicine has the opposite emphasis, and is willing to accept much more uncertainty in order to save money. The differences are staggering. I injured my shoulder and had an MRI within 48 hours. My father-in-law in Hassleholm waited 4 weeks to get a plain x-ray of his painful knee. It turns out that the 4 weeks was not critically important because the source of his pain was chronic osteoarthritis. If, however, the source of his pain was metastatic cancer, the delay in diagnosis would have been very important.

I submit that our patient may not have been the subject of a simple misdiagnosis. Rather, the minimalist approach of Swedish health care system will create these types of mistakes. Incarcerated dead bowel is a rare diagnosis when compared to the much more common diagnosis of a bowel ileus. (as if my father-in-law had metastatic cancer rather than just an arthritic knee) . Simply put, I am concerned that the Swedish doctors in this case were only too willing to accept the common diagnosis rather than do the additional tests to rule out the more rare, but more deadly, diagnosis of dead bowel.
16:52 March 13, 2010 by Sjayna
sherkovic, stop blaming immigrants, its not their fault that the emergency ward works badly! IF some of them lack the basic knowledge of how/when to use the emergency services, contact the Swedish Goverment and blame them.

Why don't we have enought doctors? Because The Swedish Medical Associations only goal has been to get unreasonable salaries (greediness goes always hand in hand with a low morality) instead of recommending an correct/adequate number of education places to the Swedish Goverment, which has obeyed this 'orders' without long-term calculation and believing the stupidity that the state would save some money.
17:41 March 13, 2010 by warrk21
Please go to www.departedngone.com and LET THE WORLD KNOW that we have lost a Good Life.

(Departed N Gone)
18:35 March 13, 2010 by canam
@Sjayna - who exactly is being greedy? Doctors? My sambo is a doctor and her and her friends make no where near what a doctor would make in the UK, Canada, or US. Doctor's get paid more because they deserve to be paid more. Next time you go to school for 6-10 years and usually deal with people on the worst day of their lives, then maybe you can call them selfish. Until then keep sweeping the streets and lament your own choices in life.
19:55 March 13, 2010 by Iraniboy

Are you suggesting that staff in shagrenska are so stupid that they make themselves busy with an immigrant with a scar and forget about a needy old woman who needs urgent help?!!

I think the article also suggest the same thing. You said you work there?! Have you noticed the level of stupidity to comprehend what is urgent and what is not? Maybe you can help them!
21:08 March 13, 2010 by glamshek
This is a very big problem here in Sweden. Even a third world country like Pakistan has got better Doctors who do not feel shy of doing their job. The doctors here do not have thta good standard. And this could be one reason why they are putting this issue under the carpet. The hospitals must raise the general standard here in Sweden. It is alarmingly low.
00:59 March 14, 2010 by anony1
humanity and responsibility is case here, a bit off topic, but I feel this is the problem here.

if there is social healthcare, without anyone inside it feeling responsible for this system, they just act like children doing their compulsory school homework just because they should do it, but they don't like it. it won't help anyway

hope people in sweden be as caring to their system, as their system is to themselves.
11:59 March 14, 2010 by cattie
I greatly appreciate the comments written here from various points of view. Right now a dear friend lies in Sahlgrenska, she is the mom of a two-year-old. She has a collapsed lung requiring surgery. She has been in hospital for several weeks, it took weeks for diagnosis and now waiting over two weeks, on a respirator, for surgery. The wait is not for medical reasons or to see test results. She is waiting for an Operating Room. The waiting is unpleasant for everyone. However, I can´t help but think of impact on her toddler who is longing for his mamma.

In the USA, the profit-oriented hospitals and insurance companies would have had her in and out of hospital in days. It saves money to treat patients quickly because hospital time is really expensive in the USA. It seems hospital time may be less expensive in Sweden. Nurses are certainly paid a fraction of what nurses are paid in America.

It occurs to me that triage rationing may not save the Swedish Society all that much money in the bigger picture. All the days of sick leave paid while people wait for diagnosis or treatment. The greater numbers of people who end up permanently on disability for lack of prompt care. The cost of many, many sick days and hospital days waiting just for diagnostic equipment. Of course, the final decisionmakers on rationing policies are politicians. Their cost-benefit analysis uses totally different criteria.

Also, do not forget the impact of torts on diagnostics and treatment in USA. One of the drivers of the high cost of care is the USA is the malpractice lawsuits. If each serious medical mistake in the Sweden would cost a the hospital millions of kronor, you better believe there would be many more safeguards. Which raised the question, if lawyers are the watchdogs for medical care in USA who really performs medical oversight in Sweden? Is it adequate? Is their any patient advocacy with any teeth? Who is accountable for systemwide decisions that negatively impact outcomes for both doctors and patients?
12:20 March 14, 2010 by sherkovic
@asteriks!! you are one stupid ass i have ever seen in my whole life. for my 4 line comment you wrote 1 whole page. You have blown things out of proportion...I am not blaming immigrants ... I am telling here what I have seen and what I think could be a probable cause which some will agree while others may not which is totally ok. if you dont agree with it then be a gentleman and stop mocking at me. Show that you are learned and educated person and behave yourself!! Dont try to act like rude, illeterate and lifeless person!! (which I can smell from your words and your behaviour).

You took it very personal, seems like you are one of those famous immigrants who end up living in sweden on social money and aint gotta life!!!

Be a MAN now and stop the witch hunt on me!! Get a life now...do something creative!!
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