To: Dr Kiril Nenov, Associate Professor
Head of Hemodialysis Unit
St. Marina University Hospital of Varna
24-Mar-2003
Re: Libels on me are recorded in the physicians’ report, and serious accidents are passed over in silence
Dear Dr Nenov,
I hope you remember the accident of 24-Jan-2003 which could have cost the life of a patient of ours. Allow me to remind you that three days later, on 27-Jan-2003, you summoned an improvised meeting at the secretary Ruska Nikolova’s office to which present were Dr Zorcheva, Head Nurse Boyka Demireva, Eng. Nenov and I. I call this meeting improvised because it was not recorded. Then Dr Zorcheva admitted that she had not been present at the accident herself, that the written by her in the report had not been true and that she had been misled by Eng. Nenov who neither denied nor confirmed but calmly waited for the next storm to pass by above his head.
In that meeting, or rather a collegiate conversation, you told us with a concerned tone to work jointly and in synchrony so that such critical situations would not happen in the future. If you believed that your words reached Eng. Nenov’s mind, you have bitterly deceived yourself, Dr Nenov! For that very day, 27-Jan-2003, only three days after the accident and some counted hours after the meeting, Eng. Nenov was about to repeat the same terrible mistake that nearly took away a human life. This time he did it before witnesses: Dr Zorcheva, nurse Ognyanova and me – incredible yet a fact! This is exactly how it happened. About 15:30 on 27-Jan-2003, Dr Zorcheva ordered me to terminate Katya Asenova’s dialysis an hour and a half in advance because Katya suffered violent cramps and vomited intensely. Katya was lying on her chair writhing with pains. We were standing around her discussing busily whether to restart her dialysis session in a while or not. At that same moment Eng. Nenov entered the room and silently made for Katya’s machine, blind and deaf to anything around, very much like a lunatic. He took his direction toward the temporarily idle machine never looking at us or never asking what had been going on. If there were a disconnected patient then he had to set the machine to disinfection: this is the mechanic logic which obviously governs all Eng. Nenov’s routine actions. No matter there were two nurses and a doctor around the patient, no matter that they were discussing aloud and gesticulating, no, Eng. Nenov advanced steadily toward his target, and as soon as he bent and attempted to put it into disinfection, three voices shouted “No!” at him at the same time. He startled like a walker in his sleep and slowly went out, his usual, engrossed in thoughts, air on face.
After that case I reckoned that Dr Zorcheva must have become convinced in the veracity and sincerity with which I had exposed the facts around the 24-Jan-2003 accident to which I had been the only witness, the more so that she had excused herself to me saying she had not realized how exactly it had happened before the next morning when she called me on my home phone, the report had been therefore written before she called me. Then I did not pay attention to the strange fact that the night of 24-Jan-2003, I had told both my colleagues and Dr Zorcheva what had just happened in details. They had understood, but not she!
I would not have taken up your time about this question if I had not been libeled again in the physicians’ report on 19-Mar-2003, and again by Dr Zorcheva. Without any fault on my part! Absolutely tendentiously!!! I have written evidence on both the cases as well as witnesses, and I am ready to submit them on request, or to send them to a higher instance, if need be. For the time being I shall only repeat that, with regard to the first case – that of 24-Jan-2003 – an incontrovertible proof of that the reflected in the physicians’ report does not comply with the truth is that the patients in the room of the accident never became aware of there being any accident, something entirely impossible if the events had developed the way Dr. Zorcheva had laid them out in her report, not being a witness herself at that. To the best of my knowledge, to lay out something overheard or not rightly understood in such a way as you have seen it with your own eyes is punishable by itself.
The second report which Dr Zorcheva wrote on 19-Mar-2003, reads: at 19:29 nurse Stoyanova told Dr Zorcheva that the patient Sherife form room 432 had been in pains since 18:00. Thus reflected in the report, the implication is that the patient had had complaints for an hour and a half, and nurse Stoyanova kept silent all the time instead of reporting to the doctor on duty!?? Everyone who has worked with me knows that I could be "accused" of caring too much for my patients and not of ignoring them.
The truth is as follows: first, after 19:00 I was not responsible for the stationary patients and yet about 19:30 it was me that the patient Rositsa from room 432 addressed telling me that Sherife was “short of breath” again. I did not waste time to explain Rositsa that I was no longer in charge nor redirected her to the new stationary nurse but let straight away Dr Zorcheva know by telling her that Sherife had complained of “short of breath” at 18:00 but there had not been such. Nurse Stamova was a witness of Sherife’s 18:00 complaint because we both went then to the patient [only to find her in good condition: her shortness of breath had gone, she had told us, and she had no cyanosis on examination, and yet we gave her oxygen and raised her bed. I have this event described in writing and signed by nurse Stamova and two patients: Sherife as directly concerned and Rositsa as a witness. I also have a written statement by Sherife’s daughter that her mother had not pains between 18:00 and 19:30, and that in case she had had any she would have called for the nurse and she would have come immediately. The text inside these square brackets is not included in the original, it’s only for you, Bill ]. Dr Zorcheva went to see the patient and soon returned and accused me of the abovementioned. I could not believe my ears! Immediately I suggested that we go together to Sherife’s room and listen to her complaints together but Dr Zorcheva angrily turned her back on me and started off in the reverse direction thus rudely ignoring my suggestion of going to the patient in question. I could not chase her, I had patients in dialysis my room to look after. Later, when a colleague came to substitute me for a short break, I visited Sherife in her room and asked her if she really had had pains and if so why she had not told me. Sherife said she had had no pains! Moreover, she told me that she had just started to praise the "little nurses": how good and attentive they were, when Dr Zorcheva left her room not listening to end of her story.
Hereby I would like to inform you about a really serious accident which had to be reflected in the physicians’ report but it was not! This accident happened only a few days ago and was passed over in silence – in a flagrant contrast to my humiliation.. The question concerned is Eng. Nenov’s irresponsible attitude toward the disinfection of the dialysis machines– this proved before witnesses again! So, I should bear being libeled in the physicians’ report for a second time, while at the same time Eng. Nenov goes on demonstrating his criminal irresponsibility – totally unpunished and unpunishable??? You may say that an improper disinfection of the machines does not present a direct threat to human lives? A direct threat it may present not, but an indirect one –through spreading of hepatitis B and C – it does! Besides, would you be as kind as to remember, Dr. Nenov, that the Jan 24 accident did threaten a human life in a most direct way and yet Eng. Nenov’s name – the main culprit – was not mention in the physicians’ report, while I, who succeeded in preventing the fatal end, was libeled by Dr Zorcheva, and this without Dr Zorcheva having eye-witnessed the accident!!? I sometimes wonder whether Eng. Nenov would not get away with punishment even if a patient were killed through his fault?
The situation is more serious than it may look at first sight. You know very well, Dr Nenov, that the percentage of hepatitis C is too high among our patents, so high that we cannot afford a frivolous attitude toward the disinfection of the machines and toward the thorough disinfection of the ward as a whole (how many are the hepatitis C infected patients I cannot know since our patients have not been tested for a long time neither for hepatitis B nor for hepatitis C, let alone for HIV or Wassermann, but I remember that a year ago their number was well above the half of them all, and the situation could hardly have become any better.)
Apropos, this is the accident which shows most clearly at Eng. Nenov’s irresponsible attitude toward the work as a whole, and, particularly in this case, toward the disinfection of the machines. The night of 17-Mar-2003, after dialysis, at the time when the machines are set to disinfection, one of the machine just set to disinfection broke down – there was a RINSE FAILURE on its display, and the sound and light signaling gave out alarms within regular intervals. I personally told Eng. Nenov about the sign on the display but he replied he knew his job. He tried to set the machine to the proper 45 minute disinfection, and after he failed, he set it to 20 minutes. I asked him, “Is it going to stay on disinfection for 20 minutes only?”, and he replied, “When the 20 minutes have gone, I’ll prolong its time.” Then I went to Dr Staykova, the doctor on duty that night, and openly told her that I did not believe in Eng. Nenov’s words, so I asked her to come with me to the room when the end of those 20 minutes approaches, as an eye-witness. She agreed. Indeed, when the 20-minute pseudo-disinfection of the machine in question was near its end (the rest of the machines had 20 or 30 minutes more), Dr Staykova and I entered the room and we two observed the following: Eng. Nenov came, imperturbably switched off the machine without prolonging its time, and went out. Dr Staykova saw this all with her own eyes but she did not tell Eng. Nenov anything. Quite logically, I did not say anything to him, either: if a doctor cannot make it clear to Eng. Nenov, how ever will I? So, I kept quiet, I only told a few of my colleagues and also the senior nurse. The senior nurse said this accident should be recorded in the physicians’ report. But it was not! On 19-Mar-2003, I asked Dr Staykova why she had not reflected the incident in the report, and she said, "Reflect or not reflect it…" and waved her hand in an expressive gesture.
As you know, there was a petition against Eng. Nenov by the nurses in your ward, but it had been suspended. I would not repeat the rumors which spread about this petition (I have no evidence for them), I would only like to state herewith to you that I personally asked the senior nurse to suspend the petition for the following specific reasons:
the three meetings mentioned in the petition were not recorded, that is the same as if they had never taken place;
the physicians in your ward reserved their judgement: there was not a single doctor’s signature in the petition.
I am addressing you, Dr Nenov, in your capacity of Head of a ward where I have been working for 15 years as well as in your capacity of Leader of a collective among members of which I am reputed as an experienced nurse, with the insistent request for a definite stance on the questions laid out here, and more specificly on the following question:
Are you able to put an end to the libelous campaign against me initiated by Dr Zorcheva, or I had better address a higher instance?
Quite specific: I expect you to disprove in writing the two reports, of Jan 24/25 night duty and of 19-Mar-2003 day duty respectively. I can present, on request from you, detailed written statements and written evidence duly signed by witnesses.
As for Eng. Nenov, I rely on your competence and your powers in taking the right decision: for the further prospering of your ward, for high-quality caring of our patients and for guaranteeing of really collegiate relations among the staff – everything that you, being in the highest position, are the most responsible for.
Sincerely:
Reneta Stoyanova, R/N, Personal ID # [...]