Patients at MBAL “Dr. Stoycho Christov” in Sevlievo were treated after they had already died, one patient was treated for a diagnosis that was not confirmed, and a concomitant illness of a pregnant woman was not addressed.
This information comes to light from a decision by the Administrative Court in Gabrovo dated July 15 of this year, initiated by the hospital’s appeal against sanctions imposed by the Regional Health Insurance Fund (RHIF) in Gabrovo.
Part of the sanctions relate to incorrectly submitted data regarding the date and time of death for three patients, while another involves inadequate medical care that contradicts what was agreed upon between the healthcare facility and the Health Insurance Fund, for which the NHIF pays.
The municipal hospital in Sevlievo argued before the court that “medical assistance was provided in full and with the necessary quality,” claiming that the identified violations are rebuttable and unproven, and they requested the annulment of the sanctions against the healthcare facility. However, the court determined that there was “insufficient medical care in its full scope and nature,” as well as incorrect reporting of data.
The penalty is minimal – 1,300 BGN – but the violations seem minor only at first glance. According to an inspector at the RHIF, submitting a later date and time for the occurrence of death implies that treatment for the patient continues, during which unauthorized medication or procedures may be prescribed.
The incorrectly submitted information is, in fact, false.
For three patients treated at MBAL “Dr. Stoycho Christov” who subsequently died, incorrect information regarding a later date and time of death was submitted to the RHIF. “The violation is not result-oriented; it does not point to and requires the occurrence of specific harm – an overpaid amount on a clinical pathway or prescribed medications for a patient who has already died,” the court notes. However, the magistrates indicate that “in this case, there is not completely unreported information, but rather incorrectly reported,” which renders it false.
This concerns three deceased patients from December 2023.
One patient was admitted with a brain stroke on December 2, 2023. They died on December 8, with the time of death recorded at 18:20, but the information about the death was submitted almost a day later – on December 9 at 17:35.
Another patient was admitted for treatment of bronchopneumonia on December 10, 2023. On December 15, they were transferred to the Therapeutic Department, where their treatment began under a different clinical pathway. They died on December 19 at 7:30, yet the information submitted to the Health Insurance Fund indicated that their treatment continued until 12:10, almost five hours after they had died.
The same situation applies to yet another patient treated for bronchopneumonia. She was admitted on December 27, transferred to the Therapeutic Department the same day, and died the next day at 18:00. The death notification was submitted a day later at 13:48.
Thus, the end of treatment for this patient is recorded as December 29, 2023, at 13:48, despite her dying on December 28 at 18:00.
The case is excluded from coverage.
While the aforementioned cases involve incorrectly submitted data that had no financial or other consequences for either the Health Insurance Fund or the hospital, the history of a patient admitted with an unproven diagnosis, discharged, and then immediately hospitalized again with a completely different illness, represents a different scenario.
The patient was admitted in November of this year for emergency surgical treatment under anesthesia due to ileus, which is a bowel obstruction. He underwent a surgical procedure, detailed in an operative report, and was discharged. However, the next day, he was readmitted to the hospital with a severe abscess, resulting in the removal of a pus-filled sac and four toenails from one foot, according to hospital documentation.
An abscess does not develop overnight.
The case file includes discharge summaries, surgical reports, and an ultrasound examination report. The latter indicates that the patient showed “no ultrasound findings of abdominal organ disease,” and a document titled “Consultation” notes that the patient almost always had diarrhea rather than constipation, with no recorded data indicating ileus.
The expert evaluation commissioned by the court further states that “no surgical procedure was performed” on this patient, raising questions about the validity of the reported protocol for such a procedure.
Regarding the abscess that led to the patient’s readmission to the same department the day after discharge, the expert clarified during an open court session that such an abscess does not develop in just one day. According to him, the patient likely had it during his first hospital stay, but it remains unclear why he was not treated for this condition at that time and instead remained hospitalized with a diagnosis that turned out to be questionable.
The inflammation was not acquired between the two hospitalizations; it must have been present before the first admission, as it takes between 3 to 7 days to form such a large pus-filled sac, according to the medical expertise. The standards for adhering to the rules of good medical practice and providing medical assistance of the appropriate type, volume, and quality, as contracted, have been violated, according to the RHIF in Gabrovo. As a result, the case is excluded from payment, and the hospital must reimburse the sums received for this treatment.
Co-existing conditions also pose risks to health and life.
Another case described in the court decision involves a pregnant woman being treated for bronchopneumonia, who also had anemia as a co-existing condition. The anemia was noted and identified when the woman was admitted, but it was not treated, leading to a deterioration in her condition, as detailed in the court ruling.
According to the conclusions of the forensic medical examination, “it would have been appropriate to arrange a consultation with a hematologist to clarify the other hematological indicators – serum iron, total iron-binding capacity, morphology of the red blood cells, etc., and to include the relevant medication therapy, including discussions regarding blood transfusion due to the very low values.”
Regarding this case, the court also shares the RHIF’s findings of a violation stemming from insufficient medical care provided in the necessary volume and quality. The court notes that “the patient’s condition was identified during the treatment of her primary illness, and the deviation in her blood parameters is significant, as noted by the expert. Nevertheless, no consultation with a specialist was conducted, and no measures were taken to initiate the necessary timely treatment, which is especially concerning in the case of a pregnant woman, as it puts the health and life of both the mother and her unborn child at risk.”
The court finds that the sanctions against the healthcare facility are adequately justified, thus rejecting the manager’s appeal against them.
The decision is not final and may be appealed.
