Distressing trip to Madrid to give birth: the hospital in Lanzarote refused to assist a high-risk pregnant woman

She is a civil servant and affiliated with a mutual insurance company, but she claims that there is an agreement between her insurer and the public hospital that was not fulfilled, despite medical prescriptions that warned of the imminent risk to one of the babies.

May 3 2021 (13:19 WEST)
Updated in May 3 2021 (14:20 WEST)
Molina Orosa Hospital
Molina Orosa Hospital

In the 33rd week of a twin pregnancy and with a medical warning that one of the babies was running out of amniotic fluid, a high-risk pregnant woman had to take a plane last week to travel to Madrid in search of the medical attention she required, because the Molina Orosa Hospital refused to provide it. "I had no other healthcare alternative on the island," she explains in the complaint she has filed with the Hospital, in which she recounts the "distressing" situation she has had to face due to an inexplicable bureaucratic mess.

The patient is a civil servant and is affiliated with the Mutualidad General Judicial (General Judicial Mutual Society), so she is not within the Social Security System. However, although she receives healthcare through Mapfre, she claims that this insurer has an agreement in Lanzarote with the public hospital for cases that require it. But when that moment arrived, the medical prescriptions and Mapfre's commitment to cover all expenses were of no use.

"At Mapfre they told me they were overwhelmed, because it had never happened to them. It's as if, from one day to the next, they had unilaterally terminated the agreement between Mapfre and the general hospital, which is the only hospital that those of us at Mapfre can go to, and they didn't know what to do," she told La Voz.

At the Molina Orosa, they only offered her emergency care, but not the monitoring and scheduling of the cesarean section she required. She complains that she was given "no other alternative" than to leave the island in a hurry, with the risk involved in traveling with such an advanced pregnancy, and even more so in the midst of a pandemic and with risky circumstances.

In her complaint, she clarifies that it is not directed at the healthcare professionals at the center, but at the hospital's own administration and the Patient Care service. And she warns that she will take legal action, even through criminal proceedings, for the damages caused and for those that may occur.

For their part, after being consulted by La Voz, the hospital only pointed out that "everyone is treated in the emergency room, even if they have private insurance," but that "the follow-up of non-urgent cases has to be done by the mutual insurance companies and insurers," and they insist that this was not one. Regarding the agreement with Mapfre for care such as this, as of noon this Monday, they have not clarified whether it exists or not and why it was not fulfilled in this case. Meanwhile, the patient recounts an ordeal that began two months ago, but became critical last week.

 

A high-risk pregnancy

From the beginning of her pregnancy, the follow-up was done through the private practice of a gynecologist in Arrecife. But in addition to the fact that it is a "bichorial biamniotic twin" pregnancy, there were also other risk factors, since gestational diabetes was detected, as well as the mother's own age, who is 39 years old and a first-time mother. For this reason, since the end of last March, her gynecologist indicated that it would probably be necessary to schedule a cesarean section and recommended that she start the procedures, because that would have to be done at the Molina Orosa Hospital. And so she did. 

"I contacted my insurance company, who informed me that the agreement for this situation indicated the delivery and prior control if necessary at the General Hospital of Lanzarote," she states in her complaint. Mapfre then issued two authorization slips addressed to the Canarian Health Service: one for a prior review consultation and another in case the cesarean section was scheduled. In addition, the insurer informed her that they would take care of "any other health cost that may arise in the aforementioned hospital center, as the important thing was to bring the pregnancy to term with peace of mind." But from then on, the last thing she had was "peace of mind."

When she called the hospital to make an appointment in the gynecology area, she claims that the Patient Care service told her that, on the instructions of the head of the department, they could not give her an appointment because she does not belong to Social Security, and that the only care she could receive was through the emergency room. That is, neither the scheduling of a cesarean section, nor the prior control she required in the hospital.

In her complaint, she cites three other cases of colleagues who were treated in similar circumstances, "and even less urgent," so she does not understand the reason for the refusal she received. And while she was fighting that battle, the situation became critical last week.

 

Required "periodic hospital control"

On April 27, in the check-ups she continued with her usual gynecologist, he informed her that one of the babies "was falling behind in growth and had little amniotic fluid left, so periodic hospital control was necessary." Then he referred her to the emergency room of the Molina Orosa Hospital, where they did an ultrasound and monitoring through that route. There they confirmed that a decrease in amniotic fluid was indeed observed, informing her that they would give her an appointment in obstetrics in less than a week to do a gestational follow-up.

However, that same afternoon she received a call from the hospital's administration department, but not precisely to confirm the appointment, but to inform her that they were not going to give it to her, against the doctor's criteria. In this regard, the hospital has told La Voz that she was told this by mistake, because the doctor who treated her did not know that she belonged to a mutual insurance company, and that they realized this when they went to schedule the appointment.

"No matter how much I explain that I have the assistance authorization from Mapfre and that I would process any other that was necessary, they informed me that it is not a matter of payment for assistance, but that I am not within the Social Security system, so they invite me (not very politely, completely disregarding the problem and leaving me unprotected health-wise on the island) to look for another solution on my own, since the hospital is not going to attend to me, as they do not consider it an emergency," she says in her letter of complaint, in which she emphasizes that Mapfre has no agreement with any other hospital in Lanzarote for this type of assistance.

"The only option they offer me is to leave the island in search of the assistance they deny me, being left unprotected health-wise, in a situation that if it is not an imminent life-threatening emergency, it is one of immediate hospital assistance, to prevent the lack of such assistance from causing irreparable damage to one of the babies," she emphasizes in her complaint. 

 

"We have been able to remedy it, but it can happen to others who can't"

In the midst of that "distressing situation," she contacted her mutual insurance company and Mapfre again, who reiterated that they should attend to her at the Molina Orosa, and again she called the Hospital's Patient Care. And the person who answered the phone consulted again, but in the end the answer was repeated: "That the head of Patient Care indicates that it is not possible to make an appointment for me at the hospital."

When asking for written proof of that refusal, they invited her to file a complaint, attaching the Mapfre slips, telling her in advance that it would be "resolved in 48 hours, but in a negative sense." That same day she filed the complaint - which apparently had not even been resolved until this Monday - and also returned to her private gynecologist's office, who indicated that it was "imminent that the baby should have periodic hospital control," which "exceeded his office," since "he does not have the appropriate means for such control." If the amniotic fluid continued to drop, it would be necessary to schedule a cesarean section, which the hospital refused to do. The problem was not emergency care, because then it could be too late, but the prior monitoring required to act if necessary, before waiting for the problem to be triggered.

Thus, without time to wait for the response to her complaint, which they had also told her in advance would be negative, her husband and she bought two tickets to Madrid, "on the first available flight," booking accommodation and immediately making an appointment at a hospital. The next day, she was hospitalized in the capital, and has been admitted ever since, under permanent monitoring and monitored four times a day.

"Fortunately, we have been able to remedy it, but it can happen to people who can't," she explains from the Madrid hospital, where she has regained peace of mind, after two months of "fighting with the administration" and a last week of fear, impotence and tears. That is why she wanted to make her story public, "so that it doesn't happen to anyone else again," because she can't get out of her head what would have happened if this happened to a more vulnerable person, who could not have afforded that trip to Madrid.

In her complaint, she does emphasize that her claim is not directed against the gynecological service, "whose treatment was immediate and excellent," but "against the Hospital Administration itself." In addition, she warns that she reserves "the appropriate criminal, administrative or civil actions, with a claim for any damages or losses, personal or economic, that have been caused to me, or could be caused, by the refusal of health care." 

But that will be later. Now, she is focused on waiting for her babies, whose arrival is imminent. And although already admitted and monitored in a hospital, she has regained peace of mind, she still can't explain how they have had to get to this situation.

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