The “Dr. Stoycho Hristov” Hospital in Sevlievo reported a surgical procedure that did not actually take place, and a patient claims that she gave 4,000 levs in cash to the orthopedist treating her for a hip joint operation.
After the patient filed a complaint with the Regional Health Insurance Fund (RZOK) in Gabrovo, an investigation was launched and the case was reviewed by an arbitration commission. During an examination in the presence of an inspector from the RZOK, it was found that there was no scar from hip replacement surgery, and the arbitration commission found omissions and inconsistencies in the surgical report, which did not even specify which hip had been operated on—the left or the right.
As a result of the findings, the Regional Health Insurance Fund partially terminated the hospital’s contract for the clinical pathway, which concerns a large-scale and complex procedure on the lower limb and pelvis – a sanction that the hospital appealed, but on November 10 this year the Administrative Court in Gabrovo upheld it, although the decision is not final and is subject to appeal before a higher court.
One night in the hospital, one “operation” in the documents
The patient was admitted to the hospital on September 4, 2024, and left the next day of her own accord. No therapy was performed, she did not receive a medical report, and no outpatient therapy was prescribed. However, her medical records show a surgical intervention marked as “other hip joint replacement.”
In her complaint, she claims that she never had hip surgery, which is why on April 26, 2024, the director of the Regional Health Insurance Fund in Gabrovo ordered an unscheduled inspection at the Dr. Stoycho Hristov Multiprofile Hospital for Active Treatment in Sevlievo.
The inspection found that the patient had not received the treatment and surgery that the hospital had reported. There was no sign of any surgical intervention, even though the hospital had registered the surgery and received BGN 3,304 from the National Health Insurance Fund (NHIF).
The inspection concluded that the hospital had reported medical services that had not been performed, for which reason the amount was deducted from the payment, and the medical facility’s contract for the clinical pathway in question will be partially terminated.
Dr. G. – advertisements, videos, and many years of practice with stem cells
The inspectors found that the orthopedist who performed the “operation,” who appears in the court decision as Dr. G., actively advertises stem cell treatment on social media, where there are numerous videos of “grateful patients.” He has been applying similar methods in various hospitals across the country for years and also has a private practice working under contract with the National Health Insurance Fund. The patient found him on the internet.
“I paid everything in cash”
In court, the woman testified that she paid the orthopedist BGN 70 for examinations prior to hospitalization, BGN 350 for two blood plasma injections, and BGN 3,500 on the day of admission to the hospital. She did not receive any receipts for any of these payments, according to her testimony. The doctor denies having received any money from her.
She admits that she did not know what clinical pathway she would be admitted to, and only later, when reviewing her medical records, did she see that a serious hip joint operation was listed. She then filed a complaint.
Not an operation, but a medical procedure
A court-appointed expert is adamant that no surgery was performed. According to his testimony in court, there is no postoperative scar as described in the surgical report, and the injection of stem cells into the hip joint does not constitute surgery, but rather a procedure. The extraction of fat from the abdomen is a minor operation, but it is not related to hip surgery and does not cover the clinical pathway that the hospital has reported. The expert concludes: “The diagnostic algorithm has been followed, but the treatment algorithm has not.”
No urgency
The arbitration commission also found that the reported clinical pathway, according to which the patient was “operated on,” is performed by third-level hospitals. The Sevlievo hospital is a second-level hospital, which allows such interventions to be performed only in emergencies. However, nothing in this particular case indicates urgency.
The patient had been using a cane for a long time, had visited orthopedists multiple times, and her condition was chronic but not life-threatening, according to the arbitrators’ conclusions.
No surgery, but expensive clinical pathway activity reported
The documentation submitted by the hospital is full of unexplained omissions, the arbitration commission further states. There is no start and end time for the surgery; it is not specified whether it was the left or right joint; an incision of the hip joint is described, which is missing.
The arbitration’s conclusion is categorical: no operation was performed under the specified clinical pathway. Instead, Dr. G.’s routine stem cell manipulation was performed in a hospital setting and was improperly reported as a highly specialized operation.
“Za Istinata” also spoke with a doctor who left the orthopedics and traumatology department after a little over 10 years of working there. He hinted that such cases may not be isolated, but without official reports, this cannot be proven – and filing such reports depends entirely on the patients.
