ANKARA, Turkey (AP) — The mother thought her baby looked healthy when he was born 1.5 months early, but staff swiftly whisked him to the neonatal intensive care unit.
It was the last time Burcu Gokdeniz would see her baby alive. The doctor in charge told her that Umut Ali's heart stopped after his health deteriorated unexpectedly.
Seeing her son wrapped in a shroud 10 days after he was born was the “worst moment” of her life, the 32-year-old e-commerce specialist told The Associated Press.
Gokdeniz is among hundreds of parents who have come forward seeking an investigation into the deaths of their children or other loved ones since Turkish prosecutors accused 47 doctors, nurses and ambulance drivers and other medical workers of neglect or malpractice in the deaths of 10 newborns since last year.
Turkey guarantees all citizens health care through a system that includes both private and state institutions: The government reimburses private hospitals that treat eligible patients when the public system is overwhelmed.
President Recep Tayyip Erdogan’s ruling party, in power since 2002, has promoted the expansion of private health care facilities to improve access in the country of 85 million people. The case of the newborn deaths has put for-profit health care for the country’s most vulnerable — newborns — into the most horrifying light imaginable.
The medical workers say they made the best possible decisions while caring for the most delicate patients imaginable, and now face criminal penalties for unavoidable unwanted outcomes.
Shattered parents say they have lost trust in the system and the cases have prompted so much outrage that demonstrators staged protests in October outside hospitals where some of the deaths occurred, hurling stones at the buildings.
After the scandal emerged, at least 350 families petitioned prosecutors, the Health Ministry or the president’s office seeking an investigation into the deaths of their loved ones, the state-run Anadolu Agency reported.
The prosecution's case
Prosecutors are demanding up to 583 years in prison for the main defendant, Dr. Firat Sari, who operated the neonatal intensive care units of several hospitals in Istanbul. Sari is charged with “establishing an organization with the aim of committing a crime,” “defrauding public institutions,” “forgery of official documents” and “homicide by negligence.”
Prosecutors say that the evidence clearly shows medical fraud for profit, although they haven’t said how much the defendants allegedly earned. An indictment issued this month accused the defendants of falsifying records, and placing patients in the neonatal care units of some private hospitals for prolonged and sometimes unnecessary treatments in facilities unprepared to treat them.
The indictment and the testimonies of nurses who have come forward suggest that the newborns were sometimes transferred to hospitals that were understaffed and had outdated equipment or insufficient medicine.
The indictment and testimonies also claim that the defendants withheld treatment and gave false reports to parents in order to keep hospital stays long as possible and to embezzle the social security system out of more money. The indictment alleges that the long-term stays coupled with patient mistreatment resulted in babies' deaths.
The prosecutor's office included hundreds of pages of transcripts of audio recordings in the indictment but the recordings themselves were not made available to the public.
In one of the transcripts, a nurse and a doctor talk about how they mishandled the treatement of a baby and agree to fake the the hospital record. The transcript describes the nurse as saying: “Let me write in the file the situation worsened, and the baby was intubated.”
Suspect Hakan Dogukan Tasci — a male nurse — is described as accusing Sari of compromising patient care by leaving just him in charge at the hospital instead of having a doctor present in the intensive care unit.
Tasci is also described as accusing an ambulance driver, who is among the 47 who have been charged in the scandal, of transferring babies to some hospitals for “profit.”
"He does not check whether the hospital is suitable for these newborn babies or not, he risks the lives of the babies and sends them to hospitals just to make money,” the indictment quotes the male nurse as saying.
In an interview with the Turkish newspaper BirGun, Dr. Esin Koc, president of the Turkey Neonatology Association, said that the private hospitals in the indictment most likely had “insufficient staff.”
“They made it seem like there were doctors who didn’t exist,” she told BirGun.
She said that her association conducted inspections of the neonatal intensive care units of private, state and university hospitals in about 40 hospitals in 2017 and while university and state hospitals were good, "there were problems in private hospitals at that time.”
Years without a family, then a death
After years of fertility treatment, Ozan Eskici and his wife welcomed twins — a boy and a girl — to one of Sari's hospitals in 2019. Although the babies initially appeared to be healthy, both were admitted to intensive care. The girl was discharged after 11 days, but the boy died 24 days later.
During questioning by prosecutors, Sari denied accusations that the babies were not given the proper care, that the neonatal units were understaffed or that his employees were not appropriately qualified, according to a 1,400-page indictment.
He told prosecutors: “Everything is in accordance with procedures."
This week, a court in Istanbul approved the indictment and scheduled the trial date for Nov. 18 in a case that whose defendants are increasingly isolated.
Lawyer Ali Karaoglan said he and two other attorneys who represented Sari during the investigation have recently withdrawn from the case. And authorities have since revoked the licenses and closed nine of the 19 hospitals implicated in the scandal, including one owned by a former health minister.
The scandal has led main opposition party leader Ozgur Ozel to call for all hospitals involved to be seized by the state and nationalized. Erdogan said those responsible for the deaths would be severely punished but warned against placing all blame on the country’s health care system.
“We will not allow our health care community to be battered because of a few rotten apples," Erdogan said, calling the alleged culprits “a gang of people devoid of humanity.”
“This gang ... committed such despicable atrocities by exploiting the facilities provided by our state to ensure citizens with higher quality and more accessible, affordable healthcare,” Erdogan said.
No more trust in the system
Gokdeniz, who gave birth in 2020, said she trusted Sari and accepted her son’s death as natural until she watched the scandal unfold in TV news and on social media.
“It all started to fall into place like dominoes,” she said.
Eskici, too, had placed complete trust in Sari, whose assurances he now views as cruel deceptions.
“The sentences he told me are in front of my eyes like it was yesterday,” he said.
Sibel Kosal, who lost her baby daughter Zeynep at a private hospital in 2017, is also seeking answers. She says the scandal has shattered her trust in the health care system and left her in constant fear for her surviving children.
“They have ruined a dad and a mom,” she said.
Kosal pleaded to the authorities to take immediate action.
“Don’t let babies die, don’t let mothers cry," she said. "We want a livable world, one where our children are safe.”
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Badendieck reported from Hamburg, Germany.
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This story has been amended to correct that Dr. Esin Koc is a woman.
Suzan Fraser And Robert Badendieck, The Associated Press
