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Trouble at the Heart of the Health Service

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When Dr. László Székely began preparations for a heart operation on a female patient last March, he recognized a potentially dangerous complication. His patient had breast implants, which were now old, meaning there was a risk that they would leak silicone during surgery.

Dr. László Székely

Szekely, then head of the Cardiac Surgery Department at the Gottsegen György Hungarian Institute of Cardiology, Budapest, discussed his concerns with the patient in advance. There was a risk, but with a track record of more than 800 heart operations on his CV, all using modern, minimal-invasive surgery techniques, he was not overly worried.

However, because of the vagaries of the Hungarian health system and circumstances beyond his control, the operation was to have life-changing consequences for more than just his patient.

During the surgery, Székely found the implant not merely leaking; the silicone was slowly making its way into the heart cavity. The situation was life threatening.

Not certified to deal with the implant, Székely requested the assistance of an experienced plastic surgeon from another state hospital, and the team set about tackling the emergency developing before them.

“She almost died, because of the silicone in her circulation, which was awful, [leading to] huge lung bleeding,” Székely says.

By using an artificial lung and circulation system to ensure proper respiration, the team solved the original heart issue, cleaned up the leaked silicone and performed a new breast implantation in one complex, 10-hour marathon session. The patient not only survived, but at least as of August, was “95% recovered”, bar some mild side-effects to her hearing.

Work Well Done?

For the oft-maligned Hungarian national health service, it was surely one job to be rightly proud of. Except, six months later, Dr. Székely was dismissed for this very operation. “I was fired for an administrative fault. I mixed public and private health [services],” he says.

The catch was that while the removal of the damaged breast implant via a national health-funded operation was acceptable under Hungarian regulations, the fitting of a new implant had to be a private operation.

The surgeons involved, fully aware of this rule, agreed to take responsibility upon themselves. “If the patient didn’t pay for the new implant, I promised to, from my own money: I saved the patient’s femininity,” says Dr. Székely.

Naturally, transgressing regulations cannot be condoned lightly in any profession, least of all medicine, where lives may be at stake. But, according to Székely, not only did the dismissal in this very complex case come without warning or any hearing, but leadership at the cardiological institute knew of at least one similar operation to which they had turned a blind eye in a gesture of understanding of the dilemma confronting the surgeons.

Moreover, the Hungarian national health service is faced with a dearth of qualified medical staff. Countless domestic media stories detail the miserably poor pay and conditions in hospitals, which has led to mass emigration by doctors and nurses for better-paying jobs in Western Europe and the USA.

Staff Aghast

In view of this, the dismissal of an experienced heart surgeon for a debatable “administrative fault” would seem to go against all reason. Certainly, his own staff at the institute were aghast at the move, with many rallying in support of their former boss.

“Over 70% of the colleagues working in the heart surgery department [signed] a petition of support,” Dr. Gábor Ender, a heart specialist formerly working under Székely tells the Budapest Business Journal.

“It declared that after the removal of Dr. Székely, the quality and level of medical procedures [at the institute] would decline. This drop definitely happened after a few weeks, according to information from insiders,” he adds.

The petition, sent to the Ministry of Human Resources, has recently been rejected, Ender says. “[The ministry] said that the director-general of the hospital had the legal right to sack Dr. Székely, and the ministry cannot modify the decision,” Ender explains. “Naturally, this is not the truth.”

Asked if there was any suspicion of professional malpractice in the affair by Székely, Dr. Ender responds: “Absolutely not, and [I] have not heard anybody as professional in his field who would [suggest that].”

Székely has turned to the courts for redress over his dismissal, a process that may take years and still yield a negative result. In his mind, the real reason behind the whole affair is a combination of personal revenge and power politics within the health service.

Obsolete Training

He argues that the rapid development of minimally invasive techniques for heart surgery in the past two decades has meant that the long and arduous training given to doctors in earlier eras is now largely obsolete.

“I had the chance to start doing this stuff earlier than others. Cardiac surgeons have to relearn everything. I have had so many fights against the older surgeons [about this]. It is very difficult for them,” Székely explains.

When those harboring resentment from such disputes combined with what he terms “medical barons” – powerful figures in the medical establishment who are able to bend the rules, in some cases for their own benefit – it seems Szekely’s fate was sealed.

The Budapest Business Journal requested comment on this story in good time from both the Hungarian Ministry of Human Resources and the Gottsegen György Hungarian Institute of Cardiology. Neither responded before press deadline.

However, the Institute, presumably through an oversight, was still proudly declaring Dr. Székely’s track record as a heart surgeon on its web site as this publication went to press.

Meanwhile, Székely is jobless, although he says he’s had offers, including one from abroad.

One of the patients scheduled for an operation that had to be put off after his dismissal has died. Asked if others are likely to die because of the shortage of specialized heart surgeons in Hungary, he replied: “Yes. But who cares? It’s only one vote.”

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