Head Physicians at Panama Institutions Submit Letters of Resignation

Following the 60-month prison sentence given to neonatologist Iván Sierra Robles for the death of several babies in the Neonatology Ward of the Dr. Arnulfo Arias Madrid Hospital Complex of the Social Security Fund (CSS) in June 2013, due to the use of heparin with benzyl alcohol, the head physicians of services at various institutions are submitting their letters of resignation.  The doctors state in their letters that the decision to make their positions available or to resign from their positions is due to the fact that it represents a risk to their integrity, honor and free exercise of the medical profession, due to the fact that the current management makes them responsible for situations that are beyond their control and responsibilities.

Among the doctors who have made their positions available is Ricardo Sandoval, head of the Internal Medicine Service of the Dr. Arnulfo Arias Madrid Hospital Complex, who sent a letter to the deputy medical director, Alberto Mattatal, informing him that he is making his position available.  In the letter, dated August 21, Sandoval expressed his solidarity with his colleague Sierra Robles “in the face of the disastrous precedent and his unjust conviction, which reveals the lack of coherent processes to exercise this leadership position in a safe and diligent manner.” Sandoval indicated that they do not have the legal support of the CSS to guarantee the exercise and effectively elucidate the scope of the responsibility that comes with being a head of service. 

The situation is not limited to the Hospital Complex, as the media had access to a letter in which the head of the Child Psychiatry Service of the Omar Torrijos Herrera Pediatric Specialty Hospital, Irina Caballero, resigned from the position she held for several years in solidarity with the case of colleague and teacher Sierra Robles.  The doctor said that, despite Sierra Robles’ years of dedication to patients; he has been affected and condemned by accusations of an act that is not his responsibility, without the support of the institution to which he owes his services. The Medical Association of Panama, together with the National Medical Association and various associations, expressed on Tuesday, August 20, its concern and solidarity with neonatologist Sierra Robles.  The medical associations stressed that, while they share the pain of the affected families, it is essential to guarantee a fair trial that takes into account all the circumstances and responsibilities of those involved. 

The country’s medical community has warned of the dangerous precedent that this conviction could set, affecting the confidence and performance of those who hold senior positions in the health system.  In addition, the doctors, through a statement, make an urgent call to the judicial authorities and society to reflect on the implications of this case, urging that measures be adopted that allow health professionals to carry out their work without fear of being unfairly penalized for systemic errors.  On social media, several doctors have shown their support for neonatologist Sierra Robles. For example, infectious disease specialist and pediatrician Xavier Sáez-Llorens said that “this condemnatory ruling is a legal aberration, no matter how you look at it. No one in the neonatology unit could have known or suspected that the parenteral nutrition had been poorly prepared.”  He added that the doctor himself was the first to think of this possibility and ordered its administration to be suspended for other premature babies. Cardiologist Daniel Pichel said that he has known Sierra since he was a pediatric resident at the CSS. He has always been a studious, responsible, hard-working and exemplary humane professional with his patients.  Pichel agreed with Sáez-Llorens that Sierra was the one who realized what could be happening, thus avoiding more deaths.

Meanwhile, Sandra López Vergès, a researcher at the Gorgas Memorial Institute for Health Studies (ICGES), said that the issue is not easy and that, therefore, a complete investigation with experts should be carried out. It is important to sanction when there is malpractice, but if there is not all the information from experts, one should not judge. In this case, the doctor could be the scapegoat for an entire system. The medical community is asking the court to review the case, as they believe there are inconsistencies in the investigation. In addition, the scientific reasons for the cause of the children’s deaths have not been explained and cannot be attributed to heparin, a drug commonly used in both public and private hospitals.  Sierra Robles, in a press conference held on August 20 at the Ateneo de Ciencias y Artes, explained to the media that it was not possible to confirm that heparin with benzyl alcohol was the toxin, since the literature indicates that in order to be the toxin, the dose should have been 10 times greater than that found in the analyses.