How to get justice for medical malpractice

Tina Plemić (38) on the night between September 23 and 24, 2020, levitated between life and death. Two weeks earlier, she gave birth to her third baby at the Clinic for Gynecology and Obstetrics in Višegradska. In that same place, in Višegradska, on that terrible night for her, doctors tried to stop the massive bleeding in Tina's uterus, even though she was discharged from childbirth in the best order.

What happened and how did this happen?

"I was a patient of the private clinic '011 Medical Team Belgrade' for many years. I managed my second and third pregnancy in this clinic, and I gave birth in Višegradska. I had my third pregnancy, after which everything happened, in 2020," Tina Plemić begins her confession for "Vreme". She was born on September 9, 2020, by caesarean section. On September 19, she went to "011 Medical Team" to have the sutures removed.

Tina states that she was admitted by doctor Boris Vraneš, because her attending physician was on vacation. "When I came, doctor Vraneš noticed a small coagulum in the uterus, and scheduled a check-up for September 23rd. At that check-up, he told me that a vacuum uterus intervention should be performed immediately in order to remove an extremely small coagulum of 16 mm, presenting it as a trivial procedure, but necessary."

In an interview with "Vreme", Tina Plemić says that this was presented to her as a routine procedure that "is not even an intervention", and she came without fear at the scheduled appointment. The doctor, she says, met her in everyday clothes instead of a uniform and immediately transferred her to the intervention table, and performed the procedure: "Previously, he did not let me sign the consent to assume the risk, in which I should be informed about the potential complications of this operation , nor did he verbally advise me of the same potential complications. The intervention was terribly painful. My fingers went numb from the pain, I screamed, to which Dr. Boris Vraneš told me that I was made of silk, and then told my husband that I was spoiled. Later I found out that that moment of extreme pain was probably the moment when my uterus ruptured."

Rupture of the uterus, it will turn out that night, is what happened to Tina Plemić. However, this knowledge was preceded by a whole series of strange events, which, this woman believes, led to her being in danger of her life.

THE BEGINNING OF AGONY

Immediately after the intervention, Tina was sent home, but she soon realized that she was bleeding much more abundantly than normal, accompanied by pain. After all, she had already given birth three times and had two successful postpartum recovery. When she felt faint, she returned with her husband to the "011 Medical Team" clinic, where she was greeted by Dr. Vraneš, who was in a hurry because he had an appointment with the dentist. "He examined me, said that everything is fine, that the uterus is being cleaned like this, that I should stay there for a while with the sisters and left."

By the way, she paid for the intervention in cash and says that she has not received a single bill for any examination in seven years.

The doctor never came back, and Tina lay in the clinic for the next four hours, still bleeding profusely, without the presence of a single doctor. According to Plemić, the head nurse said that there was no need to go to Višegradska, claiming that they could do the same for her there as they did in the private clinic, and that everything was actually going "normally". At one point, the head nurse sent Tina's husband home to get the baby because "feeding can speed up contractions." When that didn't help either and when it became obvious that her condition was getting worse, as she lost consciousness several times, the head nurse still advised her husband to take her to Visegradska.

photo: gustavo fring / pexels

"She spread a sheet so that I wouldn't bleed out on the car seat, my husband was driving abnormally fast," says Tina. "Later we found out that the institution did not have the conditions for adequate resuscitation in such a condition, such as replacement of blood, coagulation factors, laboratory diagnostics, monitoring, operative treatment... They did not organize an ambulance, as required by the medical protocol in such situations, but that they let me go with my wife in a private car, with a brownie in my hand, while I'm bleeding profusely."

This is just one of the suspicious moves of this girl, which Tina Plemić describes, because she adds something else: "She put me on a chair with wheels, the one with a round seat and no backrest, and pushed me to my husband's car." After that, she independently completed, signed and stamped a new medical report in the name of Dr. Boris Vraneš, so that supposedly the doctors in Visegradska would know what it was about."

Tina openly expresses her suspicion that the head nurse, who, she later found out, is also the wife of the clinic's founder, forged the document by signing and stamping the medical report.

THE FIGHT FOR LIFE

Tina is urgently admitted to Višegradska, she is placed in the intensive care unit, it is determined that her hemoglobin is 67 (the lower acceptable limit is 110), she receives 9 units of blood (which is about 2,7 liters), two units of plasma and replacement of albumin in order to they could operate on her. They tried to stop the theft with the first operation, but were unsuccessful. "Later they told me that I was like a 'flow boiler' because they are replacing my blood with transfusions, and the bleeding continues profusely."

After the first operation, Tina falls into a state of hemorrhagic shock and the doctors decide that another surgical intervention is necessary for vital reasons: "They also assumed that they would most likely have to remove the uterus, for which I was frantic and signed the consent."

After opening with a large vertical incision, the doctors notice that Tina's uterus is torn in two places and assume that both ruptures are the result of an intervention in a private clinic. All this is in Tina's medical records. Since they were unable to take care of her even after several hours, the doctors on duty woke up the deputy director of GAK Višegradska prof. Dr. Saša Kadi, who comes from home and together with prof. Dr. Svetlana Spremović manages to stop the bleeding with a complex procedure of ligation of blood vessels: "I was 35 years old and they wanted to do everything to save my uterus, which they did and for which I am forever grateful."

From the moment when the uterus was torn in the private clinic, to the moment when Dr. Kadija completed Tina's second operation, 16 hours passed. For Tina, her husband and their three children, it was 16 hours during which they did not know if they would stay alive. At the very reception in Višegradska, Tina asked if her life was in danger, to which the doctors remained silent. During the night, while she is being operated on twice, Tina's husband only manages to find out that she is "levitating between life and death". "The anesthesiologist who was with me all night, at the invitation of my husband, said that a hair was missing and I would not survive."

After the operation, she was in the hospital for another ten days. It was only on the fifth day that the doctors told her that she could now "breathe a sigh of relief" and that the greatest danger had passed. Namely, Dr. Kadija performed a surgical procedure after which the uterus is supplied with blood in an alternative way, so it was crucial to see if the bleeding would stabilize. "All the time I was afraid that the condition would not stabilize and that I would have to survive an additional intervention and fight for my life, that there would be new complications," Tina told "Vreme".

CONTINUATION OF THE FIGHT

After being discharged from the hospital, Tina's fight was not over, on the contrary. The recovery took several more months, during which she went through more heavy bleeding, complications with breathing and two hospitalizations: "During all this time, every time I go even for an examination, my children remain frightened and in disbelief and ask if I will return.”

Tina also sought psychiatric help, so she was diagnosed with a severe form of post-traumatic stress disorder, accompanied by frequent nightmares, anxiety, fear for life, about which she also has medical documentation that "Vreme" had access to.

Everything that Tina Plemić says for "Vreme" is actually in the medical documentation, although all the agony, fear and dangers she went through are "coded" with Latin expressions, diagnostic codes and numbers.

From the legal side, we would naively think, the situation is clear: the cause of her condition is known and the consequences are documented. It should be simple. But... Now we get to the know-it-all commentators from the internet and their crazy questions "why have you been silent".

Tina Plemić was not silent. Her legal battle began in parallel with her recovery. And there, a whole new dimension opens before her, filled above all with silence, the silence of the judiciary. At first, she tried to mediate with the "011 Medical Team" clinic, during which, according to Tina, the clinic did not show the slightest goodwill, empathy or responsibility for everything that happened.

Her lawyer was told that she imagined everything because she panicked during the procedure: "They claimed that I was a woman in labor who was not in her right mind and that I imagined everything. Also, they made insulting and humiliating, ironic statements like that they didn't exactly escort me on the red carpet. Or: 'You can't prove anything, doctor after doctor won't because a crow doesn't take out its eyes...'"

True, some people really panic, even when they have to draw blood in the laboratory. But how exactly did Tina Plemić think that she bled for four hours, that she was admitted to GAK Višegradska in critical condition and that she was given almost three liters of blood so that she could even be operated on? Hadn't she thought of cutting the uterus in two places, intensive care and a vertical incision along the abdomen and operations that lasted more than seven hours? That he doesn't imagine the scars from the surgery even today? And does her husband, who was with her all the time, except in the operating room in Višegradska, and witnessed everything?

photo: m. jankovic

INSIGHT INTO THE SUBJECT

What happened next, Tina's lawyer Dimitrije Mladenović explains for "Vreme": "At the end of 2021, we submit a criminal complaint to the First Basic Public Prosecutor's Office. That application has been sitting in a drawer for some time, so the question of territorial jurisdiction is raised, because the consequence was established in Višegradska, where the First Prosecutor's Office is responsible, and the private clinic is located in New Belgrade, for which the Third is responsible. Finally, in June 2022, the case will be transferred to the Third Basic Public Prosecutor's Office because the First Public Prosecutor's Office declared itself incompetent".

Finally, Tina Plemić receives an invitation to report to the Police Department for the city of Belgrade, where she gives a statement, and to this day it is the only time that any of the institutions called and listened to what she had to say. However, during all that time, the Prosecutor's Office did not allow her lawyer to see the case. In September 2022, Tina's application was rejected, and the rejection decision refers to the expert report, although it does not say what the report says.

The deputy prosecutor who handled the case is dismissed in August 2023 and the new prosecutor who takes his place allows the lawyer to see the case. Attorney Mladenović remains completely taken aback by what he finds in the case: "There are only findings from the pre-investigation procedure: the statements that Tina and her husband gave to the police, as well as the police statements of the medical staff of the private clinic and its founder, who even formed some sort of internal alleged commission , which determined that there were no omissions".

Tina Plemić adds: "In her testimony to the police, the clinic claims that a certain Dr. Radulović was present all the time after the procedure, whom we did not see nor did she examine me. In the documentation, there is no evidence from her in the police, which gives us additional doubt".

There are a number of contradictions in the statements themselves, from the mention of Dr. Radulović, who was allegedly there, although neither Tina nor her husband saw her, like no other doctor, to other discrepancies: "Dr. Vraneš testified that before the intervention he persuaded me to go to hospital, and that I refused and that I insisted that the intervention be done in a private clinic", says Tina and adds: "The nurse says that she was on the phone with Vraneš all the time, he claims that no one contacted him, and so on…”

The case also contained the famous expert report, which, according to Tina Plemić, was essentially based on the report of the "internal commission" of the "011 Medical Team" clinic.

Then follows an appeal to the Court of Appeal, which was also rejected.

We know that a crow does not pry its eyes out. It seems we don't know how many crows there are and where all the nests are. Because Tina Plemić was not only let down by healthcare, but also by the judiciary. If this is so, it is confirmed by the findings of the independent expert whom she hired and who, based on her medical documentation, established that in her case there were a dozen omissions that can be considered criminal acts in connection with the performance of medical activities.

According to Tina Plemić, the doctor did not present the risk of the operation he performed, he did not ask for her consent, he assured her that the procedure was harmless... The independent expert's report says that this intervention is not even allowed to be performed on a newly born uterus, that the tissue is still always porous and prone to cracking, as well as that the appearance of coagulum after childbirth is a normal phenomenon, that they are expelled spontaneously. The most basic Google search of medical sites shows that coagulum is expelled up to 40 days after delivery. Instead, Tina Plemić received supervision without a doctor, a bed sheet with bleeding on it and a chair on wheels. And the doctor's report, which was stamped and signed by the head nurse in his place, in front of her and her husband.

The weekly "Vreme" sent an inquiry to the "011 Medical Team" clinic in order to find out what kind of internal commission it is and on the basis of which law and which article of that law complaints about negligent treatment can be resolved in this way. By the time this issue goes to press, the answer has not arrived, and if it happens in the meantime, it will be published on the vreme.com website.

Tina Plemić continues her legal fight through civil litigation, but she also believes in the power of the public. "I didn't do anything out of anger. I thought carefully and decided to speak publicly because I had previously taken all legal actions, but the prosecutor's office and the courts completely failed me. Without any reason, my life was threatened and I came out of it barely alive, with great consequences. The fact that the prosecution completely failed me as a citizen does not mean that I will give up on my goal of getting justice in this matter. That is why I continue the institutional struggle, because I still want to believe that the struggle for law and justice through institutions can produce results. The decision to go public is my choice as the last way to appeal to the institutions and to get that justice."

Tina notes that, despite everything, she still has faith in the professionalism and dedication of the people in the institutions, and she particularly emphasizes the entire staff of GAK Višegradska, especially the two doctors, professors Saša Kadija and Svetlana Spremović, who gave their best both personally and professionally to saved both life and womb.

photo: marija janković

CITIZENS DO NOT REPORT MEDICAL ERRORS

She encourages others not to remain silent, and that the silence of patients is increasing, according to a research by the newspaper "Danas" from November last year, which says that the number of reports submitted by citizens for negligent treatment has dropped drastically in the period from 2012 to 2022, and before that it was small. Namely, in 2012, citizens of Serbia submitted 18 applications for negligent treatment, and in 2022, only one was submitted, and in numbers - 1.

According to the interlocutor of "Danas", the key reason for this decline is the amendment of the Code of Criminal Procedure, which stipulates that citizens can no longer file a private lawsuit against health workers for negligent provision of medical care, but the prosecution does it. The new provisions of the Law apply from October 2013. A patient who is damaged or dissatisfied with treatment can only file a criminal complaint with the prosecutor's office, after which his hands are tied. The Prosecutor's Office processes the application and decides whether to reject it or file an indictment before the court. Judging by past practice, in most cases applications are rejected. Because - a crow does not take out its eyes. And those eyes pretend not to see what is on the other side: pain, lifelong consequences or the worst possible outcome - death.

From 2012 to 2022, only 15 percent of cases that reached court ended in a conviction.

Trouble with experts

Similar to Tina Plemić, many women come forward these days and mention problems with the expertise of their own cases. This is also the case with Maja Simić Simeunović, who is leading a court case against the doctor at GAK Narodni Front because she suspects that her baby died due to a negligent delivery. Maja said in the media these days that there are only three gynecology court experts in Belgrade (one of them was an expert in the case of Tina Plemić and only "copied" the statement of a private clinic) and that one of them told her that he would rather write a novel than to artificially give birth. That's why she hired an independent expert from London and is now in the process of waiting for an officially certified translation of his findings.

"Crows" and in the prosecution

When the case of Tina Plemić was transferred from the First Basic Prosecutor's Office to the Third, it was taken over by Deputy Prosecutor Goran Svilar, who was dismissed on July 26, 2023. The decision on his dismissal is publicly available on the website of the High Prosecution Council. In its decision, the Council refers to Article 104 of the Law on Public Prosecutions, which states that the prosecutor can be dismissed if he is convicted of a criminal offense punishable by a prison sentence of at least six months. In addition, the decision on dismissal also mentions a part of the Code of Ethics for prosecutors and deputy prosecutors, which says: "A public prosecutor and deputy public prosecutor is obliged to refrain from any behavior that could damage the honor and reputation of the public prosecutor's office in the performance of his duties and in his private life. as well as public trust in the work of the public prosecution." It is clear from this that Svilar was convicted of a criminal offense that provides for a longer prison sentence and that for some reason, in his private life, he damaged the honor and reputation of the prosecutor's office.

Prosecutor Svilar was prosecuted for domestic violence, abduction of a child, attack on neighbors and destruction of their property, insulting police officers, and during one of the proceedings, he avoided receiving court summons and did not appear at the hearings.