It was a note to terrify any family and has chilling implications for Brazil’s health system.
When relatives of a man in the south of Brazil went to visit him in an intensive care unit they were shocked when he handed them a scrap of paper.
“I need to get out of here because they tried to kill me today turning off the machine all night this is why I have to,” it said.
The hastily scribbled note reinforced suspicions that there was something seriously amiss in the Evangelical Hospital of Curitiba where the still-unnamed patient was being treated. Investigators were already monitoring the team running its intensive care after several members of the hospital's staff told government officials of their suspicions that patients were being killed there.
Last month the police finally acted, arresting Virgínia Soares de Souza, the 56-year-old doctor in charge of the unit, after she was secretly recorded discussing the fate of patients in her care. “I want to remove the debris from intensive care which is making me itch,” she can be heard saying at one point.
Her mission
In another recording obtained by local media she says: "There are some patients who are dead, so turn off the things [machines] as it makes no sense." In another, she described her mission as helping patients on to "the trampoline to the beyond".
Now Brazil’s health ministry says the doctor could be responsible for the murder of up to 300 patients and it has set up a team which is auditing 1,700 deaths during the last six years in the hospital.
“What was practised was the anticipation of death, a euphemism for crime,” said Dr Mário Lobato da Costa, head of the health ministry team in charge of the audit in an interview with Brazilian television.
Prosecutors have so far charged Dr de Souza with seven deaths, accusing her of limiting the supply of oxygen to patients on respirators after having administrated drugs to relax their diaphragms, leading to death by asphyxiation. Despite the gravity of the charges against her, Dr de Souza was released from prison while awaiting trial.
Team effort
But rather than a lone mass murderer, the investigation so far indicates that Dr de Souza ran a team that killed patients in its care in order to free up beds for the hospital. Seven staff who worked under her, including three doctors, have also been charged in the case and public prosecutors have started an investigation into the hospital's former directors, after recordings indicated at least one knew of her team's behaviour.
The health ministry’s auditor has hinted that the practices in the Evangelical Hospital of Curitiba might be widespread across Brazil, saying he has come under pressure to limit the scope of his investigation.
“There is a hidden pressure because this, in one form or another, impacts on all intensive care units, not only in Curitiba. Everyone will have to answer for what is happening in intensive care units,” said Dr Lobato da Costa.
Earlier this month, hospital authorities had to deny that Dr de Souza was responsible for the death of her husband, who was the former head of the same intensive care unit. Dr Nelson Mozachi died in his own unit in 2006 after a battle with colon cancer. A nurse claimed it was an open secret among the hospital’s staff that Dr de Souza killed her husband, whom she replaced as head of intensive care after his death. But hospital doctor Sergio Penteado said he had been responsible for Mozachi’s treatment and Dr de Souza “had no involvement in the case”.
Denying charges
All the accused deny the charges against them. In an interview recorded while she was still in police detention, Dr de Souza told a Brazilian television station: "I was never negligent, I was never imprudent, I never had an ethical infraction registered [against me] . . . I practised medicine conscientiously, correctly. I am not God, I am not perfect, errors might have occurred, never intentionally. I did nothing more than exercise with the greatest dignity possible, with respect for patients, intensive medicine."
In the interview Dr de Souza said hospital staff who contacted authorities with their suspicions are not doctors and do not understand the medical issues involved in intensive care. She also claimed several had been fired by the hospital and were seeking revenge.
Challenged about the recordings made by investigators she acknowledged that terms such as “debris . . . making me itch” were “unfortunate” but used by medical staff informally. “But it is maddening when you arrive on shift and see that of the 14 patients that for five, six there is nothing you can do for them,” she added.
The Regional Medical Council of Paraná state, where the hospital is located, warned against a “public condemnation” of those involved while the investigation continues.
