Employees of the State Psychiatric Hospital have filed a complaint with the authorities against the director, Dr. Syuzan Sadakova, for the second time within six months.
They accuse her of psychological harassment and authoritarian management, which they believe is leading the hospital towards collapse. The director denies these claims, stating that “discipline is not harassment.”
The complaints against Dr. Sadakova include testimonies regarding the elimination of inconvenient employees, questionable appointments, and operating on the brink of regulatory compliance. The basis for all this comprises stories from daily hospital life shared with “For the Truth” by employees, including those who have left, been dismissed, or are still working there. The latter do not allow their names to be mentioned, fearing they may be the next to lose their jobs.
Without a Competition
Dr. Sadakova was appointed director of the State Psychiatric Hospital in Sevlievo on March 12, 2020, by then Minister of Health Kiril Ananiev. According to the Law on Healthcare Institutions, the position is filled after a competitive selection; however, the Ministry of Health has not scheduled such a process for the past three years. “The announcement of the competition is forthcoming,” they wrote in response to questions sent by “For the Truth,” but did not explain the reasons for not announcing it or clarify when it would be scheduled.
“During this time, the hospital is turning into a ‘nest of wasps,'” shares the dismissed orderly Detelin Vasilev with “For the Truth.”
“Employees loyal to the director are appointed, whose primary duty is to watch, photograph, and report on their colleagues who are not favored by the director,” says psychologist Miroslava Kasamakova.
“It’s pure envy and malice from people who don’t want to work,” argues director Dr. Sadakova.
No Communication, No Shopping
There are many prohibitions for those working at the hospital. Some are peculiar, while others are defined by those forced to comply as psychological harassment. In fact, the restrictions only apply to those employees who are not favored by the director. Those deemed “unsympathetic” are those who voice opinions about what is happening in the facility or, in other words, are not among the obedient. They are prohibited from communicating with each other, leaving their offices, and even purchasing water and food from a store located just twenty steps from the hospital during their break time. Cameras installed everywhere monitor who leaves and what they bring when entering the hospital.
“As director, I have the right to demand,” explains the director regarding these regulations. “I’ve implemented a strict way of working; discipline is not harassment.”
She calls us “stupid,” “incompetent,” “foolish,” “oligophrenics.” She uses expressions like: “It will be done as I say!”, “I am the director!”, “Democracy? Only dictatorship is what you need!”, “If you don’t comply, I will fire you!” share the employees deemed “unsympathetic,” who go to work with “fear of retaliation and subsequent unlawful actions against us.”
“You’re not the one; I am the one being harassed. This is a den of beasts, and everyone exhibits their character. These people want to destroy the hospital,” is Dr. Sadakova’s response.
The prohibitions do not apply to those employees who are favored by the director. For them, insults and threats are spared. One of those shielded from the director’s harassment is a physician, head of a department, who, despite being retired, is employed full-time but under special conditions – without having to take night shifts. It is known within the hospital that she behaves poorly towards patients, while nurses and orderlies are expected to provide her with food, carry her bags, and even order goods for her from various websites.
All of this may sound somewhat like a neighborhood story, but not to those forced to endure it.
Signal to the Authorities
At the end of February this year, Miroslava Kasamakova, a psychologist at the hospital for 21 years, alerted five institutions about the growing danger that the State Psychiatric Hospital in Sevlievo might disappear from the map of psychiatric care due to poor management.
In Bulgaria, there are twelve psychiatric hospitals, all state-owned. One specializes in the treatment of drug addiction and alcoholism, while the others cater to those suffering from mental illnesses. The hospital in Sevlievo is the only facility providing treatment for mentally ill patients in the Gabrovo region, serving four municipalities.
Kasamakova recently received an order for staffing reductions in her department. She views this as yet another “unlawful, unfounded, incorrect, and unmotivated” decision by the director, as following this move, the hospital, which has four departments in its inpatient unit and a day center, will be left with only one psychologist who has just one year of experience.
“We do not need two psychologists. After we stopped conducting psychiatric assessments for the court, the need for two psychologists was eliminated. This is the reason one of them was laid off,” Dr. Sadakova explains her decision. “I need this position. I will transform it into a medical one because there is a shortage of doctors,” the director clarifies and emphasizes that most doctors are currently retirees. This is a problem that affects not only psychiatric clinics but healthcare in hospitals across the country as a whole.
Convinced that Dr. Sadakova is exercising autocracy by disregarding the regulatory framework, Kasamakova reported the director’s actions to the Ministry of Health, the Ministry of Labour and Social Policy, the Chief Labor Inspectorate, the Ombudsman of Bulgaria, and the regional governor of Gabrovo. In her letter to them, a copy of which was also sent to “For the Truth,” she outlines in detail what is happening in the hospital and urges the institutions to conduct checks and take legal action.
Qualities and Administrative Capacity
“Dr. Sadakova does not possess the necessary qualities for her position, lacks representative and management skills, does not have knowledge and experience in organizing and managing the hospital’s administrative activities, is unfamiliar with the laws and subordinate regulatory acts related to her role as hospital director, and is undoubtedly a person whose management will lead to the closure of the State Psychiatric Hospital,” states Kasamakova in her complaint.
She claims that “the director daily, rudely and shamelessly violates the Labor Code,” and that “the selection of personnel and hiring of staff is carried out arbitrarily, disregarding the rules established by the director herself,” with appointments following familial ties and friendships.
According to her, Dr. Sadakova manages the state hospital “unilaterally and dictatorially,” and harassment is a daily occurrence. Those whom the director disliked were called “Dr. Tzankov’s trash” (Dr. Tzankov was the director of the hospital until March 12, 2020, and stepped down due to retirement).
All of this is detailed in the complaint to the Ministry of Health, which turns out not to be the first against Dr. Syuzan Sadakova. In August 2022, an identical complaint was filed with the Ministry of Health, leading to an unplanned inspection. “For the Truth” learned this after requesting, under the Access to Public Information Act, a report on all inspections conducted in the healthcare facility over the past years and a copy of the reports upon their completion. This first (and, as it turned out, only) inspection was conducted remotely and based solely on documentation, which meant that the inspectors had no way of establishing or sensing the actual atmosphere in the facility.
Although it was a document-based inspection, the findings from nearly six months ago largely overlap with what is presented in Miroslava Kasamakova’s complaint now.
Without Assessment
In the three years since Dr. Sadakova was appointed director, she has not been assessed once, despite the fact that according to the Law on Healthcare Institutions, the assessment of directors of psychiatric care facilities is conducted annually. For these assessments, the Minister of Health appoints a committee to determine the level of competency of the respective director to manage the healthcare facility and how it has changed under their leadership. For the hospital managed by Dr. Sadakova, such an evaluation is missing, but the omission in this case lies with the Ministry of Health. Therefore, it is strange that during the ministry’s inspection, the inspectors noted that the ministry itself had not done its job. If the director had been evaluated two years ago, perhaps there would not have been any complaints or reports, and it could have been easily determined whether the accusations against her were true.
In addition to being the director of a state hospital, Dr. Sadakova works at two medical centers, is involved with the Medical Expertise and Labour Capacity Assessment (TELK), is a municipal councilor in Sevlievo (from GERB), and serves as an expert witness for forensic medical examinations in all courts in the Gabrovo region, as stated in the complaint against her. However, this information pertains to the date of the inspection in 2022, after which Dr. Sadakova reduced her commitments. In fact, according to her explanation given to “For the Truth,” she has only stopped preparing forensic psychiatric assessments for ongoing court cases. She made this decision after realizing that appearing in court required her to take unpaid leave. It is implied that she had not done so until then.
As of today, Dr. Sadakova is the director of the hospital, working as a psychiatrist under a civil contract at two medical centers – in Gabrovo and Sevlievo, and is a consultant at the Sevlievo TELK. All her outpatient commitments occur after working hours and do not interfere with her hospital duties, she tells “For the Truth,” emphasizing, “I work the most of all hospital directors in Bulgaria,” adding explicitly that she arrives much earlier than her staff in the morning, does not take a lunch break, and leaves later than her colleagues in other hospitals.
Despite having refused to conduct psychiatric assessments for the court, Dr. Syuzan Sadakova’s name has not been removed from the Unified Register of Expert Witnesses for the Gabrovo judicial district. During the period under review by the Ministry of Health – January to November 2022 – she prepared 19 psychiatric assessments: nine for the Sevlievo District Court, nine for the Gabrovo Regional Court, and one for the Gabrovo District Court.
Political Activity
Dr. Sadakova, besides being an obviously highly engaged physician, is also politically active. In the previous term (2015-2019), she was a municipal councilor from the Reformist Bloc, and currently, she is a councilor in the GERB-SDS group.
As a municipal councilor in Sevlievo from January to November 2022 (during the period of the Ministry of Health’s inspection), she participated in eight municipal council meetings and attended three meetings of standing committees. During this time, she was supposed to take unpaid leave, according to the provisions of the Law on Local Self-Government and Local Administration. However, Dr. Sadakova attended the municipal council meetings during working hours and failed to take unpaid leave for seven out of the eight meetings in which she participated.
This means that for seven full afternoons, which is the usual duration of meetings in Sevlievo, she received remuneration from two positions – as the director of the state hospital and as a municipal councilor. In both cases, taxpayers were disadvantaged, as the funds Dr. Sadakova receives come from them.
“I did not know that I had to take unpaid leave to participate in the municipal council meetings,” she told “For the Truth,” “I have accepted my punishment for this.”
The punishment is a “reprimand,” which was imposed on Dr. Sadakova this January by the Ministry of Health for “working” as a municipal councilor during working hours.
With the conclusion that Dr. Sadakova will be required to explain the findings in the inspection report, it has been submitted to the Minister of Health for approval, thereby bringing the ministry’s involvement in the case to an end, although the problems remain.
Paper Committees – More Inspections and Violations
At the end of August 2022, the Regional Health Inspectorate (RHI) in Gabrovo also conducted an inspection at the State Psychiatric Hospital in Sevlievo. This inspection was likewise prompted by the signal that had already been addressed by the Ministry of Health, which was forwarded to the relevant regional institutions.
During the inspection, it was found that the requirements for forming a medical council and the mandatory internal committees for psychiatric hospitals were only formally met. The composition of some committees was incomplete, and there was no record of when they met or what decisions were made. When the inspectors requested the minutes from the meetings, it turned out that “the chairman was absent from work,” and thus they did not receive any minutes. These findings are at odds with Dr. Sadakova’s explanation that “all decisions in the hospital are made by everyone,” because “there are committees that decide; I do not make any decisions alone.”
During this inspection, RHI also found that the director’s order for the dispensing of medicinal products was not current.
After the RHI inspection is completed, the signal is forwarded to the Labor Inspectorate in Gabrovo, which also conducts an inspection of the hospital. The findings from this inspection reveal “violations of labor legislation and health and safety regulations, for which the employer has been subjected to compulsory administrative measures to prevent and rectify.”
Appointments and Dismissals
The specific violations of labor legislation are not detailed in the response from the Labor Inspectorate. Affected employees provided more information.
In early February of this year, one of the orderlies, Detelin Vasilev, was dismissed from the State Psychiatric Hospital. The man had worked at the hospital for 12 years and had one year left until retirement. “During the COVID-19 pandemic, patients were prohibited from leaving the building. They relied solely on what was provided to them in terms of food or what their relatives brought, but not everyone had visitors. So I provided services – I bought them what they needed twice a week. I drove my personal car because sometimes the orders were substantial, and I went even on days when I wasn’t on duty,” the now former orderly recounts. This shopping continued for three years, but the director realized it was inappropriate after the third year and dismissed him disciplinarily.
According to the order terminating his employment contract, he was supposed to “carry out actions, propose and make decisions leading to the elimination of arbitrariness and strengthening trust in state institutions” and to “not participate in any transactions.”
“All appointments, as well as terminations, are made by a committee that includes two union representatives, a lawyer, and two representatives of the hospital. I do not appoint or dismiss anyone single-handedly,” explained Dr. Sadakova. Regarding the specific orderly, she added that she had grounds to dismiss him much earlier due to an inappropriate incident, but made a compromise.
While Detelin Vasilev was fired for providing services to isolated patients, Ibrahim Sopotliev has been reinstated at the hospital – he was dismissed by the previous director for systematically beating mentally ill patients.
Sopotliev has a criminal record and a suspended sentence for causing bodily harm. According to employees at the hospital, he continues to exercise violence against patients. Dr. Sadakova denies this: “No one is being harassed in this hospital.” Regarding the appointment of the criminally charged and convicted orderly, she states: “He has submitted documents for appointment according to the established procedure, and there is a committee that determined whether he should be hired.”
A woman has been appointed as a cleaner-librarian, whose official duties consist of cleaning the administrative department once a week, while the rest of her time is spent in the hospital’s archive, where she has access to patients’ medical histories. This information is strictly confidential, but not for the cleaner, who also serves as a librarian, as noted in the complaint against the director. It has also been added that the hospital’s electrician is Dr. Sadakova’s husband, who “fills his working hours by standing at the portal and taking photos of staff with his personal phone.”
“The Hospital is Me”
Despite denying the allegations against her, Dr. Sadakova cannot deny that she identifies with the hospital she manages. In addition to having her photo on the hospital’s Facebook profile, she makes political comments on behalf of the state institution, which cannot be said to correspond with the decorum expected from a physician. Just recently, under a post from the Municipality of Sevlievo directed against a member of parliament from “Continuing the Change,” the State Psychiatric Hospital in Sevlievo commented: “Advise him to visit us; we will not turn him away.”
Whether the involvement of a state hospital in the personal political biases of its director is acceptable is a question that should be addressed by her employer – the Minister of Health. The ministry is also expected to take action regarding the reports concerning the events at the Psychiatric Hospital in Sevlievo while there are still doctors, nurses, and orderlies remaining in it. Because if there is one thing that the administration and staff agree on, it is that everything happening there does not lead to stabilizing the hospital and increasing patient trust. It is likely time for the ministry to enter the facility once again to hear the staff, rather than making judgments based solely on documents.
