• Italiano

Nine operating rooms and three lives to be saved. This reorganization in the health care system is at least illogical and forces doctors to choose between one patient and another. These are the key elements of a tragedy that could have been avoided, a health care emergency faced the wrong way, one of the many faces of mismanagement. This time, it concerns Naples. The victim is a 42-year-old woman who arrived to the San Paolo hospital nighttime, on March 8, with myocarditis with pericardial effusion in progress.

Francesca Napoletano’s story had begun with a complaint, which immediately alarmed her family. They take her to the nearest hospital, San Paolo, where she is registered with a code green and 3 hours later she is finally visited by a doctor. The latter realizes that the situation is complicated: the woman’s condition is serious and it gets worse and worse. Thus, they make the first choice: she needs special care and the doctor decides to transfer her to a better equipped facility.

Thus had begun her 8-hour-long ordeal, which culminated with Francesca’s death: dozens of calls were made from the San Paolo hospital and from the Emergency Room to public and private facilities. A flood of phone calls to find an available operating room. After having received several negative answers, the doctor from the San Paolo hospital decides to proceed according to the protocol: he sends the patient to the nearest hospital that is more suitable for her illness.

Thus she is transferred to the Monaldi Hospital, where the doctors were facing another emergency: there were only two operating rooms and in both of them were going on two extremely delicate operations – a heart transplant and an aortic aneurysm –, which exhausted the medical staff. It was no coincidence that the medical director had already refused to admit Francesca, explaining to the Emergency Room operators that his hospital was in a critical condition and was unable to accommodate another difficult case. Yet, the woman was already on her way there. Thus, the only thing they could do was accept her and try to offer her all the possible care.

The patient reached the Monaldi Hospital at 6am. Her condition was hopeless and the attending cardiologist performed an emergency pericardiocentesis, an operation that usually has a positive outcome, but the heart of the 42-year-old woman was too weak and after a few minutes, it stopped beating at all. Francesca died at 8.10am. Her parents and her husband are astonished: they immediately made a formal complaint to the police, which sequesters the medical records. Now, it is up to the judiciary to shed light on what happened and answer the many questions that arise spontaneously from this story. Why did the woman not undergo surgery straightaway at the San Paolo Hospital? And how is possible that out of the 9 operating rooms throughout the Campania region, none was available?

The Monaldi hospital, meanwhile, say they did everything in their power to save Francesca’s life. “We, doctors, are always dismayed when it is impossible to save a life – said the medical director -, but what happened proves once again the urgent need to reorganize the heart-surgery urgency/emergency network in our region.”

This emergency that could have been handled otherwise, that is why Minister of Health Lorenzin has sent inspectors there. The goal is to understand whether the woman could have been saved, whether the transfer to the Monaldi Hospital was a right decision, and whether the woman received all the possible care. In any case, Francesca is dead and no investigation will be able to hearten her loved ones and help them to give meaning to their loss. We hope her story will at least become a slap that will draw attention to the poor condition of the Italian health care system, not only in Campania, but on the whole territory of the country.

Data that highlight the situation of medical mismanagement in Italy the most are provided by a parliamentary commission of inquiry on errors in the health care system, which was established in 2009. Between 2009 and 2012, the Commission collected 571 complaints concerning cases of medical mismanagement. They gathered 400 reports on events that resulted in the patient’s death. Yet, it is worth pointing out that medical incidents are often not caused directly by an operator’s mistake, but are a result of inefficiency, deficiencies, inadequate facilities, inefficient ambulance service, long queues in Emergency Rooms, difficulties in transferring patients  from one hospital to another, and cases of hospital infections. The Commission’s data show that the most reports come from the south, where Sicily and Calabria lead the chart with 117 and 107 reported cases respectively.

This week more impressive statistics that concern squandering in the health care system were made available. Active Citizenship and the Tribunal for Patients’ Rights have presented the report titled “The Two Faces of Health Care”, created thanks to the reports of thousands of citizens who have identified, between 2014 and 2015, 104 cases of squandering in the Italian health care system. Grouping them into macro areas, in 46% of the cases, squandering can be attributed to facilities and tools that are scarcely used or not used at all; in 37% it is a matter of inefficient services and benefits; 17% of the cases are a consequence of poor human resource management. Among the reported cases, there is expensive machinery that was bought, but never used, operating rooms that were opened then locked for years, whole departments that were refurbished, but still cannot be used. These data give food for thought because they violate the rights of the patients, worsen the quality of the citizens’ life, do not allow fair access to health services. Little has changed over the years, however, and people continue to die because of a collapsing health care system.

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