TWO disgruntled former patients of the International SOS Clinic in Phnom Penh have

spoken out at what they described as a pattern of incompetence and unsympathetic

treatment from the clinic's staff.

Onesta Carpene, an NGO consultant and long term resident, complained that an SOS

doctor misdiagnosed her broken spine as osteoporosis and then prescribed physiotherapy

that caused "excruciating pain". Carpene was in fact suffering from a spinal

fracture caused by multiple melanoma and required urgent cancer treatment.

"The misdiagnoses and prescribing of harmful treatment caused me extreme and

prolonged pain and a delay in receiving essential treatment for a life-threatening

illness," she wrote from Italy where she is receiving radiotherapy and chemotherapy.

In her letter, Carpene said she felt obliged to contact the Post after her complaints

were brushed aside by the clinic's management. "I feel compelled to take further

action to raise public awareness, to avoid for further patients such shocking and

deleterious experience," she wrote.

Carpene received a home visit from one of the clinic's locally-hired Khmer doctors

on January 30 after she had suffered severe back pain and was unable to move. The

doctor prescribed morphine and physiotherapy, but that gave her only temporary relief.

On February 4 this year she went to the clinic for an X-ray.

But the clinic made no further diagnoses, nor did it conduct further tests. After

three further visits to the clinic, SOS advised Carpene to seek medical help in Bangkok.

"In Bumrungrad Hospital [on February 18] a spinal fracture was immediately identified

on the X-ray [that was] taken in the SOS clinic," she wrote.

Further investigations showed the cancer and Carpene was medevac-ed to Italy for

treatment. Italian doctors confirmed the fracture was clearly visible on the SOS

X-ray.

Carpene complained of "incompetence and an irresponsible attitude" at SOS

and said the clinic refused to assist in arranging her journey to Bangkok after it

became clear that her insurance status was uncertain. Nor, she said, did SOS provide

a referral letter or advise on an appropriate treatment facility in Bangkok.

Carpene outlined her complaint to the clinic's management but the reply she received,

after a delay of several months, she said, was "an insult to any person ...

of common sense".

SOS manager Brian Ritchie wrote in a reply to her that the clinic had reviewed the

case and "SOS physicians acted appropriately to treat your symptoms ... you

can be sure that SOS has measures in place to ensure that all patients receive a

diagnostic work up consistent with their presenting complaint, as well as full access

to further consultation for a second opinion".

But that was not the case when the wife of a US Embassy employee, who was at the

time six weeks pregnant, visited the clinic in April 2002. The woman, who asked not

to be named, was showing signs of a possible miscarriage and had blood taken by the

clinic's gynecologist.

The tests showed that she had a progesterone level of almost zero. Medical experts

- not with SOS - subsequently told her such a result was impossible and could only

indicate a faulty test.

But rather than order a second test, the clinic's gynecologist diagnosed her fetus

as dead in utero.

"The doctor was very insistent and told us not to hold any hope," the woman

said. She was then prescribed the abortofactive drug methergine to clear the uterus.

The drug causes the uterus to contract and slows blood flow to the placenta.

Two days later, when she was one-third of the way through the course of medication,

SOS rang to advise her that there had been a mistake and to discontinue the treatment.

"[The gynecologist] just kept saying: 'It's not my fault, it's not my fault',"

she said. "And when I asked to come and see her she said: 'It's Saturday we're

closed, come back on Monday'."

Instead the couple took their file and flew immediately to Bangkok where an ultrasound

showed a healthy pregnancy.

"My pregnancy was very stressful after that. It really ruined my pregnancy because

we didn't know what the effects on the fetus might be," she said.

Bangkok doctors told the couple that the drugs could induce a miscarriage and the

oxygen deprivation could cause birth defects. The couple also had to bear the expense

of a trip to Tokyo to see a specialist in high-risk pregnancies.

"They were reassuring, but there were no guarantees," said the woman who

has since had a healthy baby. Despite the mistake the couple's insurance company

was charged more than $400 for the SOS consultation.

As a result of the misdiagnosis, then-US Ambassador Kent Wiedemann stopped gynecological

visits to the clinic by embassy staff. The gynecologist has since left the employ

of the clinic.

SOS manager Ritchie said he was very familiar with both cases, but refused comment

stating that international medical ethics prevented SOS from publicly discussing

specific patients' cases.