The death of a pregnant woman who could not receive treatment in Lisbon’s main hospital because of a lack of capacity has been met with outrage in Portugal, where a months-long health crisis has shut emergency services across the country and put maternity care under extreme pressure.
The 34-year-old woman was admitted to Lisbon’s Santa Maria hospital on 23 August with respiratory problems and high blood pressure. Owing to a lack of space in the neonatal service, she was transferred to another hospital, but she died after a heart attack in the ambulance.
Her baby, born at 30 weeks weighing 772g (1lb 11oz), survived.
The health minister, Marta Temido, in office since 2018 and throughout the Covid pandemic, resigned this week after the case came to light. She said in a short statement sent to the Guardian that she “no longer had conditions to stay in office”. The prime minister, António Costa, said the woman’s death was “the last straw” for Temido.
Santa Maria hospital said the patient had been stabilised, and it described transfers between regional hospitals as a “frequent procedure”. It told CNN that the woman’s death was “neither foreseeable nor expected in this situation”.
An investigation has been opened. The government’s general inspection of health activities (IGAS) is also examining the death of a baby on 9 June in Caldas da Rainha, north of Lisbon, after there were no obstetricians to assist the mother when she went into labour. On 22 August another pregnant woman had to be transferred twice between hospitals, travelling a total of 95 miles (150km) while in labour.
Newspaper front pages have called Portugal’s formerly highly rated national health service (SNS) the “national disease service” and the health ministry the “ministry of pretend” after shutdowns left thousands without access to care in the virtually free public health system.
The crisis is a result of decades-long structural problems including low wages, outdated equipment and inefficient bureaucracy, said Dr Gustavo Tato Borges, the president of the National Association of Public Health Doctors.
Salaries have not changed since 2009. A specialist physician has a monthly starting wage of €1,853 (£1,603) and a nurse €1,200. “There is no lack of doctors to fulfil the needs of the SNS, but rather a lack of doctors willing to subject themselves to working in the SNS,” Borges said. “The SNS does not have the capacity to attract doctors and ensure they stay for a long time.”
While the number of doctors in Portugal has almost doubled in the last 20 years, almost half work in the private sector. It is estimated that a third of the population have health insurance, an almost twofold increase in the last 16 years, as waiting times have increased in the public health system.
Child mortality is at its highest rate since 2018 and the third highest in the last decade. Portugal has an excess mortality rate of 23.9%, four times above the EU average.
The health ministry has announced a “deep” investigation into the death rate.
Before resigning, Temido had announced 1,600 vacancies for specialist doctors in areas including gynaecology, obstetrics and public health, and approved a new model for the SNS, with a different management structure, more decision-making autonomy for hospitals, and measures to increase productivity.
However, healthcare workers say the new model, as well as the minister’s resignation, fall short of fixing the structural issues chipping away at the public health system.
Costa has said there will be no change in health policies, saying Temido’s replacement would be purely a change in “personality, energy or style”.
“Those who want a change in policies will have to take down the government,” the prime minister said on Tuesday.