Spain’s Other Covid Casualties: Undetected Cancer Cases

MADRID — Last March, as the coronavirus was tearing across Spain, Lídia Bayona Gómez started to suffer bouts of vomiting and coughing.

A nursing home worker, she treated herself as a potential Covid-19 case, isolating and getting herself tested. The results came back negative, twice. With her weight dropping and her urine turning red, she made repeated attempts to see a doctor and in late April, on a phone consult, one told her to stay home and prescribed medicine for gastroenteritis and a urinary tract infection.

But the pain kept getting worse and in late June, her sister took her to an emergency hospital unit. In mid-July, she underwent a 12-hour surgery to remove two cancerous tumors, one from an ovary and the other from the bile ducts. She died in the hospital nine days later, at age 53.

It was not an isolated tragedy.

Hospitals and other health care centers have been forced to devote most of their resources to Covid-19 patients, and doctors are warning that a growing number of cases of cancer and other serious illnesses are going undetected, which could end up costing many more lives. That toll is beginning to be reflected in lawsuits.

The details of Ms. Bayona Gómez’s care are part of a lawsuit brought by her sister, Fátima Bayona, who wants Spain’s public prosecutors to charge the local health authorities in the northern city of Burgos with gross negligence. Last month, the prosecutors said they would investigate the death.

Several other suits have been filed just in Burgos, including one by a woman who learned she had terminal cancer after trying for seven months to get access to a hospital for testing.

Carmen Flores, the president of an association that helps patients or their relatives take legal action, said her association had helped file more than 50 lawsuits since September, when Spain and other countries were hit by a second wave of Covid-19. She said her workload was growing exponentially as a result of medical errors and oversights stemming from doctors’ focus on Covid-19 at the expense of other illnesses.

Unlike in some other countries, Spain’s government does not report how many medical lawsuits are filed each year. But Ms. Flores said that, judging by her monitoring of courtroom filings across the country, the number appears to have risen so far this year by at least 30 percent.

Some lawsuits accuse doctors of refusing to see patients in person. But others assert that doctors rushed to the wrong conclusions or did not want to touch patients as part of their examinations because of the risk of catching Covid-19.

For the most part, however, doctors say they are just overworked.

Credit...Samuel Aranda for The New York Times

Doctors in many countries have warned that the pandemic may have exacerbated other health problems, either through diversion of resources or because, especially in its initial stages, people were afraid to seek help for other conditions.

The main doctors’ body in Britain, the British Medical Association, said hospitals there received more than 250,000 fewer urgent cancer referrals than normal in April, May and June. A survey of U.S. cancer patients published in April found nearly one in four reporting delays to their care because of the pandemic.

But Spanish medics say the crisis there has exposed particular weaknesses in the country’s health care system.

“In Spain, we have long been proud of having become the best in the world in specialties like transplants, but this pandemic is now also making us realize how much we have neglected our primary health care,” said César Carballo, a doctor in the emergency unit of the Ramón y Cajal hospital in Madrid.

“We have had thousands of our professionals who have left to work overseas, and we really need to make it more attractive for them to work here again.”

The staff shortage has been particularly worrying in places like Madrid. The capital region’s leader, Isabel Díaz Ayuso, has been building a new hospital. But she is struggling to find health care professionals to work in it at a time when health labor unions are forcefully expressing discontent.

Last month, Spanish doctors staged a nationwide walkout to protest their working conditions and to warn the authorities against hiring additional doctors without adequate qualifications.

“It will cost us a lot of time, money and effort to rebuild the foundations of our health care system,” said Dr. Carballo. “You cannot find new doctors in just a couple of months.”

Ms. Flores, from the association that helps patients take legal action, echoed those concerns.

“This virus is at least, hopefully, making us understand that primary health care cannot keep functioning adequately when staff and investments have been steadily cut,” she said.

In another case of undetected cancer, Lydia Sainz-Maza Zorrilla, a radio journalist, has chronicled the final months of her sister, Sonia. She was 48 when she died in August of colon cancer after failing for three months to see a doctor in person. Instead, she received bad advice over the phone from her local health care center.

Credit...Emilio Morenatti/Associated Press

“Our public administration has used Covid as a perfect excuse to keep doctors on the phone and remove completely the possibility that they can diagnose patients properly,” Ms. Sainz-Maza Zorrilla said.

“If her doctor had actually seen her and touched her, I’m absolutely sure that my sister would be alive today, because colon cancer is terrible but you don’t need to die of it like she did,” she added.

Last month, Verónica Casado, the regional health minister, told a news conference that she was sorry “if there was something that had not been done well” in terms of treating Ms. Sainz-Maza Zorrilla. On Oct. 6, public prosecutors opened an investigation into her death from colon cancer.

While doctors and nurses are confronting the second wave of Covid-19 with better protective gear than in the spring, their morale appears to be lower.

“I simply cannot give a patient adequate attention when I have recently had to see 100 people in a single day,” said Patricia Estevan, a doctor in a public health care center in Madrid.

Manuel Franco, a professor and researcher in epidemiology at the University of Alcalá de Henares and an adjunct professor at Johns Hopkins University, said, “We have health care workers who are now not only exhausted but also angry because they have seen some improvement in the protocols since last spring, but not the hiring of more people that was promised.”

Still, a few of the recent lawsuits also underscore the danger for patients who end up receiving treatment in a hospital overstretched by the influx of Covid-19 patients.

Jesús Pinos is suing a hospital in the northern city of Santander after the death of his grandmother, María Delia Laguatasig Iza, who was mistakenly made to wait for her appendicitis surgery in a corridor filled with Covid-19 patients.

Although she had tested negative for the coronavirus before her surgery, she received a Covid-19 diagnosis a week later, eventually dying from it.

The hospital did not respond to a request for comment. Public prosecutors in Santander opened their own investigation on Oct. 26.

“She was the victim of some disastrous medical mistakes that you would never expect in a modern and functioning health care system,” Mr. Pinos said. “What is clear is that she entered hospital without Covid, was then sent home coughing and finally died from this virus.”

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