Romanian Health Care Is Terminally Ill

For expectant parents in most countries, a birth center stands for the joy of having a baby and the hope for a healthy new life.

In Romania, going to a maternity hospital resembles Russian roulette. While VIPs may be given the royal treatment, regular mothers are often confronted with indolence, rudeness and misery. Bribing the nurses and doctors is the rule, not an exception, and it doesn't even guarantee good treatment.

According to the UNICEF data, Romania has the highest child mortality rate in the developed world: 19 deaths per every 1000 newborn children. The chart shows many former Communist countries ranking close - such as Albania (18/1000), Russia (17/1000) or Serbia (15/1000). But some formerly Communist countries like Slovenia or the Czech Republic have fewer infant deaths even than the US (7/1000).

Another grim statistic where Romania holds the leading position is the one regarding mothers who die at birth.

Beyond the statistics, a recent case shocked the Romanian public: 40-year-old Natalia Ionescu died on October 11 in a prestigious birth center in Romania's capital Bucharest, after delivering a boy in a C-section. Her husband, journalist Mihai Ionescu, claims she was not given any transfusion after 12 hours of massive blood loss.

"It's not the first, nor the last case" was the implacable answer of Carmen Georgescu, the doctor on duty that night. Georgescu still claims the mother didn't need any transfusions, since the surgery went well. The head of the birth center, Bogdan Marinescu, famous for having overseen the pregnancy of Romania's oldest mother, Adriana Iliescu - 67 years old when she gave birth to her daughter - appointed the same Carmen Georgescu to lead an internal investigation regarding this case. The husband of the deceased woman filed a complaint to the Medical Council, the ethical body of the medical practitioners. Following the media coverage, the prosecutors and Association of Nurses also started their own investigations.

Over the past 10 years, over 1,100 complaints have been filed in Bucharest regarding the way the plaintiffs or their relatives have been treated in hospital. 485 of the complaints referred to patients who died because of medical errors. Yet, so far, only three surgeons have lost their right to practice.

It's not always about the doctors. According to Romanian law, doctors cannot be held responsible for the poor conditions in the hospital, the lack of medical equipment or supplies. In some hospitals, patients are required to bring their own cotton pads or needles, food is mostly provided by caring relatives, rooms are overcrowded, hygiene is poor. The daily bribe for a nurse is around $40, a surgeon might ask you for $500 or more to perform an intervention. Although employees pay 6.5% of their income and employers another 6% to the public health insurance, the Romanian health care system is grossly underfinanced. While other European countries spend 7-8% of their GDP for health care, Romania only dedicates 3.5% of a much lower GDP ($257 billion).

The low number of convicted doctors has also a financial explanation: insurance companies who cover malpractice cases usually don't cover moral damages - compensation for pain and suffering.

The insurance companies argue that it is hard to establish an insurance chart for such damages, because Romanian courts rule arbitrarily on their value. In January 2007, a Bucharest court ruled that Naum Ciomu, a surgeon who accidentally cut the penis of his patient, had to pay 125,000 euros ($183,867) in damages - it was not covered by his own insurance. The plaintiff demanded 800,000 euros ($1,176,789) and claims the court was far too lenient to the surgeon - possibly because the surgeon had to pay the sum from his own pocket.

In this grim picture, the only hope comes from the growing privatization of the medical sector. Although still chaotic and fragmented, the private market is growing faster than in neighboring Bulgaria or Hungary, where public services are better and thus the need for private alternatives less stringent.

According to The Diplomat, consolidation of the fragmented private market could be the next step. Instead of hundreds of existing small clinics, the "big players" might buy the smaller ones and consolidate the market, within the next 4-5 years, says Nachum Kroytoro, marketing and sales director at SOS Medical.

Still, as long as private clinics cannot offer the whole array of medical services, Romanians are bound to rely on the poor public system, risking their health and even their lives by doing so.

"The New European," a Romanian journalist, blogs at www.transatlanticpolitics.com.