Mauricio Negrão’s last memory of his father was his two hopeful thumbs-up from a hospital bed.
His 73-year-old dad, Manrique Negrão, expected to leave intensive care within days after recovering from an operation to remove tumors from his large intestine, his son said.
But on the day he was hoping to be transferred from ICU at the Evangelical Hospital in Curitiba, in southern Brazil, Mauricio received a midnight phone call.
“I went into a state that I cannot describe,” Mauricio said. “Something like fully anesthetized—confused—and I was silent, so that the pastor called me again to ask if I had understood the message.”
His father, a fit and active lawyer, was dead.
A year later in February 2013, the head of the hospital’s ICU, Dr. Virginia Soares de Souza, was arrested along with her team on suspicion of killing patients to free up hospital beds. What emerged were allegations that—if proven—would make the 58-year-old doctor one of the most prolific serial killers of all time.
De Souza has pleaded not guilty to charges that she and her staff prescribed muscle relaxants and cut patients’ oxygen supply so they would die of asphyxia to increase patient turnover.
The scandal briefly gripped Brazil, uniting two of the country’s most serious injustices: a deeply flawed healthcare system and a legal apparatus that is “tilted towards those with deep pockets,” according to the International Bar Association. But while prosecutors claim there could be as many as 300 suspicious deaths attributable to De Souza and her underlings, almost all are still awaiting investigation, leaving hundreds of people in a painful limbo more than two years after the first arrests and headlines.
Meanwhile, De Souza and the other arrestees remain on bail until the initial seven test-charges of aggravated first-degree murder reach court, which may still be months away.
In Brazil, private hospitals treat a high percentage of low-income patients through the public health service, the Unified Health System (SUS). But the overlap between private and public hospitals is said to hurt those who can’t afford private healthcare plans.
“Because there are too few public hospitals to treat low-income people, private hospitals, which prioritize maximizing profit, tend to choose what SUS patients they will take in based on how much the government will remunerate them for their services, not based on how critical or urgent their medical condition is,” José Sestelo, a professor of collective health at the Bahia State Federal University, told The Lancet last year. (The Evangelical Hospital director told me last year that they attend mostly to the needy.)
A report by the Regional Medical Council for the State of Paraná obtained by VICE said the Council Board “confirmed the reduction of ventilation parameters for lack of clinical response and the use of drugs administered intravenously as a comfort measure.” But the report added that the Board “could not prove the benefit” of the measures and recommended a professional ethics case be launched against De Souza and two others.
De Souza, a widow, is staying with her daughter while counting on the support of her former employers at the hospital. A spokesman for the hospital said they were awaiting the judge’s decision.
“The difficulty in the progress of the case is due to the fact that there is really no evidence of criminal acts,” Elias Mattar Assad, De Souza’s lawyer, told VICE. “My client, in that ICU, only practiced critical care medicine, observing all protocols.”
Assad said the case, along with all medical records, was in the hands of judicial experts for a re-reading. He said this stage of the process was expected to take another eight months before it would reach a first hearing.
“The delay is not good for anyone, but if it’s a choice between an injustice or a delay, of course, she prefers a delay,” he added. “There are more than 2,000 questions from the prosecution and defense for the experts to answer, all technical, medical matters.
“The prosecution only proved that people died in ICU. Dying is not a crime,” he added.
The state prosecutor in Curitiba warned last year that the case could take up to five years to resolve and said it was unprecedented in Brazil.
“Each investigation is very complex and there are more than 300 cases being investigated,” Fernanda Nagl Garcez told me in February 2014. “Unfortunately, it can’t proceed as quickly as the families deserve.”
State Prosecutor Fernanda Nagl Garcez
She said experts would examine the seven cases before passing them to a judge to decide whether or not the defendants would face a jury trial.
“The delay is due to the quantity of queries presented by the parties, as well as their complexity,” she told VICE last month. “The other hundreds of cases are still at the stage of police inquiry.”
Such delays are not uncommon in the Brazilian justice system; human rights organizations say the country’s law enforcement apparatus is unprepared and negligent. (Less than 8 percent of almost 50,000 homicides a year are successfully investigated and prosecuted, according to NGO Global Justice.)
Last year, Transparency International called for a reform of the judiciary system, which it said was “underperforming” and allowing cases to be prolonged excessively because of the multiple appeal routes.
“We loved my father and we miss him. Our police do not have the capacity to lead on a crime like this.” —Inima Lemos
Idarli Lemos is among those who has filed a case with police after her father, 78-year-old Florencio Odilon Pereira, also died in De Souza’s ICU. She claims he received unnecessary treatment and surgery that was not authorized by his family.
“He was lucid until the last day of his life,” Idarli said. “My father looked after himself. He could have lived until he was more than 100 years old. The Public Ministry [prosecutor’s office] has separated hundreds of suspicious cases, and the investigation is still going on only with the first seven cases and very slowly.”
September marked three years since Pereira entered the hospital. “On these dates, we relive a deep nightmare,” Idarli said.
She said he would take milk and breakfast to neighboring disadvantaged families, and went back to school to study accounting and agriculture at the age of 50.
Inima Lemos, Idarli’s sister, added, “We loved my father and we miss him. Our police do not have the capacity to lead on a crime like this.”
Inima, Idarli and Ivanilda Lemos, who believe their father Florencio Odilon Pereira died at the hands of his doctor
Sheila dos Santos’s mother, Roseli da Luz dos Santos, was 56 when she suffered heart problems and died in the ICU of the Evangelical Hospital. She said the family received no explanation for her mother’s treatment in the hospital and claimed she was only informed of her death six hours after it happened.
“She was a friend to everyone,” dos Santos said. “It destroyed the family because she was the pillar of the house.”
But when we spoke last year, she remained hopeful that the investigation would eventually bring the family closure.
“We are poor but justice will serve us,” she said, speaking from her modest home in São Braz, on the outskirts of Curitiba. “It’s not going to bring my mother back, but it’s something.”
Originally published by VICE