Back In PanamaBy John McCormick Print
Additional reporting by Berta Ramona Thayer in Panama
As software spreads from computers to the engines of automobiles to robots in factories to X-ray machines in hospitals, defects are no longer a problem to be managed. They have to be pred
Even though Multidata did send representatives down to Panama to deliver a patch for the hospital's software and provide its staff with additional operating instructions, the hospital had stopped using the software in June.
Patients were still being treated with the Cobalt-60 teletherapy machine, but the physicists calculated the patients' treatment times the old-fashioned way-by hand.
As a result, the hospital could only handle around 60 to 70 patients per day, instead of 100. That led to an even longer waiting list and forced the Panamanian government to start subsidizing private hospitals, where it sends those patients who are employed and therefore covered by social security. So far, says Dr. de la Rosa, the government has spent $10 million subsidizing private treatments.
Meanwhile, the three physicists are free on their own recognizance while they await trial. Two of them-Saldaña and Alvaro Mejia-continue to work at the National Cancer Institute. The physicists are funding their own defense, even though Saldaña, for instance, makes $585 a month.
Saldaña, who has worked at the institute since 1988, says it is difficult to continue after the overdoses, but "if we did not work, the patients would die." Ricardo Lajon, the chief physicist, calls Saldaña "one of the best physicists we have."
The Houston team also praises the physicists. "This was an unfortunate occurrence, which we believe was not foreseeable," its report said. "However once discovered the actions taken were appropriate and the cause was quickly found. The personnel involved are to be commended."
Prosecutor Cristobal Arboleda acknowledges the peculiarity of having hospital workers accused of second-degree murder continue to treat patients. But he says they must be presumed innocent until found guilty and cannot be fired before the trial.
Besides, he says, "administratively, the hospital needs them." Due to a dispute with the Ministry of Health, the entire radiotherapy department has been operating without a license to deliver radiation, a fact that Multidata is using as part of its legal defense. But if the department were shut down, Arboleda says, "90% of the cancer patients in Panama would die."
Saldaña today appears calm for someone who faces the possibility of two to four years in prison. Her mother takes care of her 13-year-old son in a town in the highlands, and that will continue if she goes to jail. The families of two of the dead patients have hired a private prosecutor to pressure the judicial system to convict the physicists, a common practice in Panama. Arboleda expects other civil suits to be filed in Panama depending on the outcome of the criminal trial.
Meanwhile, the families' lawsuits against Multidata and MDS have been dismissed in both countries-for lack of jurisdiction in Panama and for "forum non-conveniens" in the U.S. On Jan. 15, 2004, St. Louis County Circuit Court Judge Emmett M. O'Brien told the families to re-file their suit in Panama, where the overdoses occurred. Yet Judge Zoila Rosa Esquivel of the First Court of Justice of the Civil Circuit in Panama had dismissed the suit on April 30, 2003, saying that the case could not be pursued in two countries at the same time. In effect, by taking the companies to court in St. Louis County first, the families forfeited the right to take them to court in Panama, according to Esquivel's ruling.
Now the families are trying again in Panama. Judge O'Brien said the companies need to be given the chance to respond to the charges in Panamanian court, before the case can be reconsidered in the U.S.
Judge O'Brien's decision is a victory for Multidata and MDS, which fought to get the suit tried in Panama. Judgements awarded in Panama tend to be low, compensating victims just for actual damages, notes Edgardo Molino-Mola, a former Panama Supreme Court Justice. And since Panamanian judges permit both sides to engage in delaying tactics, such as filing motions with no substance, cases may not be resolved for 10 or 15 years.
Regardless of how the court cases end up, some good has come out of the tragedy. The Government of Taiwan donated two new linear accelerators to the National Cancer Institute, to replace its single, aging Cobalt-60 machine, and the Ministry of Health purchased a third linear accelerator that is expected to be installed soon. Training of hospital staff is greatly improved. A foundation led by a prominent Panamanian cancer survivor, Marta Estela C. de Vallarino, has raised hundreds of thousands of dollars that have helped the hospital buy new mammography and endoscopy machines.
Then there is the restorative power of family. Garcia survived because, after six treatments at the National Cancer Institute, he was so sick that his six children chipped in the $1,500 it cost to finish his treatments at a private hospital.
At that hospital he was treated by, among others, Saldaña, who moonlights there on a second shift.
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