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Fundação Americana ASHOKA (english)
Celia Marina Destri dos
Santos, a Rio de Janeiro Attorney, has created Brazil's
first legal and social advocacy group for medical malpractice
victims. She is moving to win a series of cases that will
open the courts and give victims new rights backed by real
remedies.
The New Idea
Brazil's inadequate public hospitals and poorly trained
doctors have created many malpractice victims with legitimate
claims to compensation and desperate needs for representation.
To fight for their legal and civil rights, Celia Founded
the Associacion for the Victims of Medical Malpractice (AVERMES)
and is digging in to win a series fo cases that will give
these victims real relief. Celia believes that winning a
number of malpractice suits will convince lawyers to take
an interest in these cases and develop expertise in the
field. In Brazil, lawyers can be paid through a contingent
fee, a key precondition to representing poor victims. Given
that this mechanism is available, Celia believes that a
few successes in court will open the field.
Medical malpractice often leaves people unable to work and
take care of their families. It is important that they know
they could be entitled to financial compensation . "No money
in the world can pay for the suffering of a victim," Celia
says. "However, people have to be aware of their rights."
She also that her efforts will indirectly improve Brazil's
health care system by making doctors and hospitals accountable
for their errors. "For too long, negligence plus imprudence
plus incompetence have equaled impunity," celia says. "AVERMES
wants to change the equation to equal justice."
The Problem
Poor educational standards and increasing numbers of medical
schools produce many unqualified physicians who now work
both in public hospitals and in private practice. These
"doctor factories" have no libraries and few facilities
to help medical students learn, even though the students
pay high monthly fees. Since this fee virtually guarantees
a passing grade, disinterest settles in between the professors
and students. The medical schools simply produce poor doctors
abundance.
The government's disinterest, economic chaos, and instability
only aggravate the problem. Government health staff are
poorly paid and are not provided with adequate materials.
Piece-rate compensation and overload invite carelessness.
Primary care referrals add to the overload and inability
to focus on the truly high-risk cases. Bribery and fraud
introduce further quality risks.
The victims suffer in many ways: disability, psychological
shock, economic bankruptcy. Everyone has stories. One man
is in a wheelchair due to an anesthetic error, another because
of a spinal tap mistake. They can no longer walk. Many now
go to a public hospital in fear. Celia says, "AVERMES" is
not against the medical profession. We are against poor
professionals."
Few people go to court because there are few lawyers who
will accept a case for which they will only be paid at the
end of the lawsuit. (A typical lawsuit takes an average
of five years.) Nor can the victim afford a five- year fight.
Thus, another problem is the general inefficiency of the
judicial system, which drags out the process.
The Strategy
Since Founding AVERMES in 1991, Celia has accepted 200 medical
malpractice cases. The victim plantiffs will only have to
pay the organization if and when they win the case - making
the decision to go ahead pratical.
To date, none of Celia's cases have gone to trial. She is
working through the legal system to find ways to speed up
the procedures. For example, she can use the simple complaint
of culpable bodily harm and culpable homicide, which translates
to punishment (but not prison) for the guilty doctor, but
no compensation for the plaintiff. Or she can use the civil
code to protect and defend the "consumer," here the victim
of malpractice. Almost all of the defendants in Celia's
malpractice cases are government hospitals and clinics.
She hopes that government will provide better health care
as the result of AVERMES's legal actions.
AVERMES now has about a 1,000 members. All are malpractice
victims or relatives of malpractice vitims. It has a staff
of seven voluntary lawyers who provide legal services, and
it provides leaflets, lectures, and interviews on malpractice
issues to hospitals, law schools, and patients.
Celia has also published manuals that describe methods of
protection against medical malpractice. Patients should,
for example, be certain of the procedure being, performed,
the potential risks, and the names of all doctors and assistants
involved.
The Person
The problems of medical malpractice can be illustraded by
Celia's own experiences. She has been a victim three times.
As a child, she contracted ab illness that doctors misdiagnosed.
As a result, it went untreated, and to this day she walks
with a limp. When she was fourteen, after dropping out of
school to go to work to help her family, one employer refused
to hire her because of this minor handicap.
When she was married and having her first child, she knew
that her hip problem would make natural childbirth difficult.
Tests showed that a caesarian was necessary. However, she
and her husband could not afford it, and the doctor forced
natural delivery. As a result of complications, the doctor
had to use forceps, injuring her newborn daughter.
Years later, after going back to school at night and erning
her law degree, Celia was again the victim of a doctor's
error. In 1990, she had an operation to remove a cyst from
her ovary, and during the procedure the doctor mistakenly
cut a wrong tube. Sisteen days later, she was rushed to
the hospital for emergency surgery. Doctors found two and
half liters of urine in her abdominal cavity and had to
remove one of her kidneys.
Celia grew up in a poor family in a poor town: Bangu, a
suburb of Rio de Janeiro. She dropped out of school as child
and went to work raising her two daughters. Eventually,
she went back to school and graduated from law school in
1988. She has experience in both civil and criminal law,
and has been associated with legal groups that advocate
ethical behavior for all professions.
| "Right there in the hospital bed,
the idea to do shomething came to me, because I was
revolted and indignant at having lost my left kidney
because of malpractice." |
Celia has always been an active member of her community,
yet after losing her kidney in 1990, she decided to devote
herself to malpractice cases. "Right there in the hospital
bed, the idea to do something came to me, because I was
revolted and indignant at having lost my left kidney because
of malpractice," she says.
Her dream is one day to start a foundation that provides
legal support, counseling, physical therapy, and other rehabilitation
programs to malpractice victims.
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