Twenty-four doctors and other employees at Kuressaare Hospital, the island of Saaremaa's only major hospital and epicenter of the most intense wave of coronavirus infections in the pandemic so far, have issued a petition calling for the removal of the hospital's medical manager, Dr. Edward Laane, citing incompetence.
Daily Õhtuleht (link in Estonian) reports that the petition's signatories want Laane out due to what they say is a lack of suitability for the role. Issues include interfering in the workings of the hospital, including committing violations of data privacy, a high degree of absenteeism, and providing patients with a controversial anti-malarial drug without following proper procedures.
The communication says that "[Laane's] work as a medical manager even before the crisis had been chaotic - rarely does his presence in Kuressaare exceed 10 working days a month. Now in a crisis situation, chaos and confusion have arisen in the hospital".
Kalle Laanet, chair of the hospital's council, told ERR Thursday evening that the Data Protection Inspectorate (AKI) had also been informed of possible violations, since the petition referred to Dr. Laane having had access to sensitive personal data and doctor and patient digital medical information, even without being the treating doctor in these cases.
Laanet also said the petition had come as no surprise, since some doctors had previously approached the Health Board's (Terviseamet) head of emergency medicine Dr. Arkadi Popov with their concerns.
"I know that there has been an e-mail exchange with Dr. Popov, where there have been complaints about certain issues," said Laanet, adding he did not know who the communications had come from.
Center Party member lone voice reported in support of Laane
Regional daily Saarte Hääl (link in Estonian) also says that dissatisfaction with Laane was apparent as early as March, but was only reaching official levels now.
Outgoing Saaremaa municipality mayor Madis Kallas told Õhtuleht that the municipality had received requests for Dr. Laane's removal, but could not give any further comment.
Saaremaa businessman and Center Party member Mihkel Undrest, who also sits on the hospital's council, said that he was also aware of the petition, but supports Dr. Laane's continuation in the post.
"It was also possible to report concerns to me every morning, as it really was throughout the day. Unfortunately, many did not take this opportunity," Laane said in a post on social media, ERR's online news in Estonian reports.
Details of petition's charges
In a letter dated May 5, which Kalle Laanet said he received on Thursday and forwarded to members of the hospital's supervisory board, the signatories state an increase in their lack of confidence in Dr. Edward Laane, head of treatment at Kuressaare Hospital Foundation, following the coronavirus outbreak, adding that their letter covers only some aspects of what they call his inadequate work.
- Providing inaccurate information to the media on the situation.
- Distributing a controversial anti-malarial drug, Plaquenil, to patients without authority to do so or a prescription ("literally out-of-pocket" the letter reads).
- Accessing sensitive personal information and digital medical histories without authority and in contravention of data protection laws. The data concerns doctors as well as patients.
- A desire to spend more time communicating with the press than on the main aspects of the role.
- General mismanagement of the hospital.
One example of the first point above which Õhtuleht reported was in the letter was a claim Laane made that preparations for the impending coronavirus crisis began at the hospital on January 29 2020, whereas in fact meetings were being held at that time expressly calling for avoiding sowing panic on the matter.
"Secondly, Dr. Laane 's medical work during the crisis has been starting after the end of the official working day. He gives oral instructions to nurses without the patient's doctor's knowledge, and without recording these instructions in medical documents," the statement also said.
"Crisis management has been characterized by the following [aphorism] - 'don't think, don't speak,'" the letter went on.
"The impression is that Laane has not perceived the seriousness of the problem," it adds, making him unsuitable for the role.
Kalle Laanet: We were focused on the crisis
As to why it has taken till the second week of May for the wide range of concerns to become public (the first cases of coronavirus date back to early March, and the island soon became the worst-hit region of Estonia-ed.) Kalle Laanet said that most of the attention had been focused on the growing pandemic, the work of the hospital and the setting up of a military field hospital, set up to accommodate overflow from the main hospital's coronavirus wards, but in the event not needed.
"We plan to meet with the council next Thursday and discuss this letter," Laanet said.
"First of all, we need to listen to both parties. Then we will decide what to do next. Today, the situation is too raw," he added.
Edward Laane's response: Most of the signatories were not even there during the crisis
Dr. Laane also provided a lengthier response later on Thursday evening. A message posted on Kuressaare Hospital's Facebook page, said, for one thing, many of the doctors who signed the petition had not even been present on the ground at the hospital during the pandemic.
"I understand that the coronavirus crisis has had a severe impact on many, including our hospital doctors. At the same time, it is surprising to see signatures from doctors who were either out of Estonia, at home, or working for a short time in a hospital, or [only] with COVID-negative patients throughout the crisis."
"The exchange of information went on all the time, but because the situation changed very quickly; not all doctors may be up to date with the latest news. For example, many of these were in Finland or at home."
Laane added the claim that he had been misleading about the hospital's preparations for the crisis on January 29 could be answered by the fact that he did not want to incite panic by making the call publicly.
Prevention rather than panic was key, he said, adding he had been working long hours, seven days per week, since the emergency situation was declared on March 12.
"At the same time, as a treatment manager, I took into account the information and requests received at the meeting, and additional protective equipment was ordered from the pharmacy. Panic and prevention are not the same thing. The request also raised the issue of short working days. During the week, my working days have started at 8 a.m., on weekends from 9-10 a.m. and lasted until late in the evening and at night. I have been at work every day as a treatment manager since the beginning of the crisis, ie on March 12.
"The truth is that every late night, when the doctors were already at home, I talked to the nurses in the [two COVID-19] wards through the [door] lock, without going to the black zone, asking how the patients were, whether their cases were severe, whether they were getting oxygen and how their condition had changed during the day, as well as what the treatment of patients is and how the nurses feel. The purpose of the visits was to motivate and support the nurses."
"The last conversation with the nurses took place in late evening of May 6. I have not given treatment orders to the nurses of the COVID departments, but have asked to call a doctor. I would also point out that I always wore protective clothing when entering the COVID zones."
As to the accusations of doling out Plaquenil without authority, Laane said that: "Indeed, I brought patients from Plaquenil from the pharmacy to the departments because it was urgently needed at the beginning of the crisis. It was recommended that Plaquenil be kept under strict control when communicating with the [medicines] agency."
As to testing the hospital's staff for COVID-19, Laane said the staff themselves pushed for this.
"The verification of the COVID samples of the staff was based on the demands of the staff themselves, as they were repeatedly asked in the morning meetings who were COVID positive."
On the claims of violating data protection regulations, Laane said that an audit had been required of all COVID samples.
"Due to a period of failure to transmit responses to our information system and based on physicians' requests, the hospital board decided to conduct an audit of COVID sample responses... We need to take into account the crisis situation here, where it was necessary to know whether the worker who provided the sample could continue to work in the hospital. The primary interest here was the protection of both the workers themselves and the patients.
"As a treatment manager, I would like to thank all the doctors, hospital staff and assistants who helped to successfully overcome the corona crisis in Saaremaa. Special thanks to the community for supporting and assisting the hospital," he concluded.
Editor: Andrew Whyte