Carla Hannover and Gabriel Dez / La Paz
When Wilma Torrez said yes to Richard Arias (54), she promised to accompany him not only in moments of joy, but also in those of adversity and pain. Two years ago, Torrez had to assume the leadership of the Association of Victims of Malpractice in Health of Cochabamba after her husband was paraplegic after a maxillofacial surgery performed on March 2, 2018, at the Los Angeles Clinic in that city.
Arias entered surgery for a tumor, identified as benign, in the jaw that must be removed and in that place a peron vascular graft must be performed. The family questions the ability of the professional who cared for him.
Several specialists agree that many of the cases of medical malpractice occur due to poor training of health professionals. In Bolivia there are around 30 medical schools, 11 of these belong to public universities, and another 19 are from the private sector. As the experts explain, a large part of these faculties do not guarantee quality in teaching.
Until recently Javier Pearanda was dean of the Faculty of Medicine of the Universidad Mayor de San Andrs (UMSA) in La Paz. Today he is the current rector a.i. of that higher house of studies. For him, one of the great weaknesses of the health system and one of the causes of cases of medical malpractice has to do with the unplanned training of medical professionals and particularly with the proliferation of private universities, the inadequate labor market , and postgraduate training with limited and insufficient fields, he indicates.
Added to this, he warns, are the poor scientific and technical conditions that rural and urban health centers provide for the training of doctors. In the case of the UMSA Faculty of Medicine, Pearanda points out that it is one of the few in the country that achieved its fourth international accreditation.
Note that this exaggerated offer of training for medical professionals should be planned and regulated by the corresponding authorities. There are public universities that do not meet the basic requirements of teaching, infrastructure, laboratory equipment and a hospital for healthcare teaching, among others, he says. Therefore, it concludes that in general the training of students ends up being poor.
But also, adds the orthopedic surgeon and health minister, Guillermo Cuenta, the training of Bolivian doctors, for the most part, is not according to the times and updating this implies, in principle, working on better education for professionals. That happens because the universities update their curriculum. It happens because the universities that offer a medical degree have a standardized curriculum, he explains.
If it is about training, for the person in charge of the Quality and Health Auditing area of the Ministry of Health, Ramiro Asturizaga, medical malpractice is also due to the weaknesses in this area. Often specialists show excessive self-confidence, have outdated knowledge, lack of surgical skills, or ignorance of the standards and protocols of medical care.
Data from the Executive Committee of the Bolivian University show that each year between 5,000 and 6,000 doctors graduate. According to the former Minister of Health, Anbal Cruz, 80% of the students of the private universities are foreigners, but almost 100% of those trained in the public sector are Bolivians. In addition, 90% of the professionals who graduate each year go abroad and only 10% stay due to the lack of opportunities … of these, only 7% of health professionals in Bolivia access a specialty, he asserts.
The doctor who operated on Richard Arias claims to be a dentist specializing in oral and maxillofacial surgery and traumatology and is accredited to perform this type of surgery. Despite having documents that support his training, the association led by Torrez received four other complaints against him and question his certifications.
When asked about these complaints, the doctor declares himself completely innocent. He affirms that this type of lawsuit is a social death and that it affects the family environment, in addition to creating susceptibilities in patients and colleagues. A whole system of antibodies is created, he regrets.
Also, he assured that he had successfully completed the surgery. The irreversible injury that the patient has at the brain level originates from intensive therapy. It has been well controlled in surgery, he says. Page Seven requested information on this case from the Los Angeles Clinic, from where they assured that it was not possible to give details since it is an ongoing criminal process and it was recommended to go for information to the Prosecutor of Cochabamba.
The truth is that a forensic medical certificate from June 4, 2018 indicates that Arias had hypoxic cerebral encephalopathy or a lack of oxygen in the brain, which caused the damage that he presents today. In addition, the external auditor of Sedes Cochabamba, to which this medium had access, establishes that Arias presented a cerebral ischemia “due to a deficit of continuous monitoring by the intensive care physician”, cardiorespiratory arrest due to “carelessness of surveillance of the area of nurse “and a second cardiorespiratory arrest by another” neglect of nurse “.
In telephone contact with this medium, one of the intensivists chose not to refer to the Arias case since he is in legal proceedings. The other intensivist doctor involved maintains, in the first instance, that the headquarters audit is totally deficient because it does not take into account important aspects, in his opinion, to determine what really happened.
On Tuesday (after the surgery), the (another intensivist) with the (surgeon) visit and decide to do a tracheostomy. It is also done by the (surgeon) without being a face and neck surgeon. An important event happens that night. The tracheostomy tube is pushed out of place by patient movement. Ah presents a cardiac arrest that is reflected in the nurse reports. (The other intensivist) reintubates the patient and there is irrecoverable damage. This event of the first cardiac stop is not registered in the headquarters audit, says the intensivist.
Two years have passed since the event and the Arias family demands to know where, how and why the hypoxia occurred and, more importantly for them, who is responsible for providing solutions to the patient’s current state of health.
Postgraduate training in the Medical Audit area
- Report The Ombudsman presented in March 2020 the report The medical audit is not an effective instrument to guarantee access to justice. In this document, he analyzes the postgraduate offer of two state universities in Bolivia, the Universidad Mayor Real and Pontificia de San Francisco Xavier de Chuquisaca and the Universidad Mayor de San Andrs.
- Chuquisaca The San Francisco Xavier University includes in its curriculum the specialty in medical auditing. Among the subjects that are taught are: Identification and intervention of quality barriers, Process management and development of quality indicators, Health quality, Ethical components and patient safety and Quality Processes.
- UMSA I offer the specialty in quality management and medical auditing. Among the subjects are Management and quality systems, Management by processes and quality instruments, as well as Biotics and Medical ethics.
- Beni The Autonomous University of Beni Jos Ballivin launched, in turn, a Master in medical auditing and quality management in health.
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