In July 2023, Sándor Farkas, a Fidesz Member of Parliament for the constituency of Szentes, published a Facebook post to reassure local voters. There was a lot of dissatisfaction with the closure of the maternity ward in the hospital in the town, and mothers in Szentes organised a protest action. Farkas, sensing the public mood, made a promise when he announced on his social media platform that „the maternity ward will be reopened from September at the latest”.

Had that happened, a family tragedy might have been avoided.

Piroska Varga-Dósa, 37, was in the 14th week of her pregnancy in September 2024 when she developed worrying symptoms. She experienced unusual, light bleeding and visited doctors, private clinics and the Obstetrics and Gynecology Clinic of the University of Szeged several times. According to her husband, József Varga, a self-employed contractor in the construction industry, his wife was very careful during the pregnancy and did everything to ensure the baby’s health.

However, the bleeding has not stopped. They finally decided to go to the hospital in Szentes too, to be on the safe side. Since the closure of the maternity ward in Szentes at the beginning of 2023, the hospital has provided outpatient care and one-day surgical procedures when patients can go home the same day. After the examination, the gynecologist wrote the following sentence on Piroska’s hospital paper: „inpatient observation is advisable”. In other words, the examination showed that Piroska should be admitted to hospital.

Direkt36 managed to reach the doctor, who confirmed that this was his recommendation.

„If there had been a ward operating, I would have sent her upstairs immediately,” he said.

(The building has a specialist ward on the ground floor, while the inpatient department of the maternity ward was upstairs when it was still open.) József, the husband, also said that if the department in Szentes had been in operation, “my wife would have agreed to stay there”.

Following the examination in Szentes, Piroska and her husband went back to their private doctor — but despite the previous recommendation, he didn’t send them to the hospital.“All he said was that nothing was wrong,” recalled József. The man added that they did not go to the hospital in Szeged because they felt that his wife’s complaints had not been taken seriously there before. We contacted the private doctor treating the woman, but he refused to comment on the case.

Three days later, at dawn on 29 September, they woke up to find blood all over the woman. József immediately went to the ambulance station in Szentes and the paramedics took Piroska to the Szeged clinic.

They were in constant contact on Messenger, and Piroska always wrote down what was happening to her in the hospital. “I was completely devastated,” she wrote to him when she found out they had lost their fetus. The woman was then taken to the operating room in a wheelchair. By that time, she was already quite unwell and had fainted. The medical report confirmed that her uterus had ruptured and she had suffered major blood loss. When the doctors came out in green clothes from the surgery room, József recalls that everything was “covered in blood”. It turned out that they had spent half an hour trying to resuscitate his wife, but had not told him at the time. József said that he was not allowed to see his wife until four hours after the operation had begun. During that time, he had not been informed whether the operation had been successful. When he finally got in to see her, he was horrified to see that his wife’s face and hands were greyish black. According to him, “by then, she had already bled out.” He spoke with two midwives who, he says, dismissed his concerns by saying, “Calm down, Daddy, everything’s fine.”

He refused to let it go, asking in a raised voice for help for his wife. Only then was an ultrasound scan performed. The scan raised the possibility of internal bleeding, so she was transferred to intensive care, where his wife was operated again. Piroska died on 4 October, five days after the first operation.

After the death of his wife and their unborn child, József turned to a lawyer. László Ábrahám, a specialist in medical malpractice cases, told Direkt36 that his client had suffered damages because the obstetrics department in Szentes was not working, because “the hospital did not ensure that the renovated maternity ward had an obstetrician to cover the whole region.”

In József’s opinion, the clinic did not adequately inform him of the risks and possibilities. He feels that waiting too long to have a caesarean section could have caused the problem.

“If they’d operated her back then, yes, the baby would’ve been lost, maybe she could never have another, but she might still be here.”

The University of Szeged finally settled with József out of court at the beginning of June this year: the family will receive a 42 million forint compensation – first reported by Délmagyar. The lawyer is currently negotiating a monthly allowance with the clinic, a process he says is still underway.

A complaint has also been lodged with the National Centre for Public Health and Pharmacy (NCPHP) for negligent endangerment causing death in the course of employment. The complaint states that the woman had repeatedly reported abdominal pains and light bleeding, but the doctors did not suspect the possibility of a ruptured uterus and did not perform a caesarean section earlier. This complaint remained unanswered for more than six months.

According to József, the clinic hasn’t contacted him in any way since his wife passed away — not even to offer an apology. “I can’t get my wife back, I can’t get my child back, but I might be able to help others,” he said, explaining why he had gone public with their story.

Neither the Szent-Györgyi Albert Clinical Centre at the University of Szeged nor the National Centre for Public Health responded to Direkt36’s questions.

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We investigated the tragic case in Szentes in the framework of our project „Hemorrhaging Hospitals”. This is based on a database of official decisions on the closure of hospital wards, the first of its kind in the Hungarian press. It not only shows which hospitals were most affected by the closures, but also gives a general picture of the dire state of the Hungarian public health system.

This article focuses on small-town hospitals, using examples from the Southern Great Plain to illustrate the difficulties they face and how these affect patient safety.

No doctors, and no children at the renovated maternity ward in Szentes

There used to be three hospitals with maternity wards in Csongrád County, but with the closure of Dr István Bugyi Hospital in Szentes, expectant mothers can now only give birth in Hódmezővásárhely and Szeged.

Six years ago, the people of Szentes were delighted to hear that the maternity ward, located in the hospital’s pleasant park, would be renovated for 80 million forints. The infrastructure and equipment upgrades were completed two years later, and Deputy Minister Sándor Farkas, the region’s representative in the National Assembly, attended the handover ceremony. The mayor of Szentes, Zoltán Ferenc Szabó, said that many parents from rural areas choose the Szentes hospital because of the atmosphere of the maternity ward and the professional work carried out there.

Barely a year after the development, there were already rumours that the ward’s operation could be in jeopardy. At the end of 2022, mothers in Szentes started a movement on Facebook to save the maternity ward. They tried to attract doctors to the institution by sharing videos, photos, and their own birth experiences. They were unsuccessful: in early 2023, the NCPHP suspended the operation of the inpatient ward for an indefinite period.

In the summer of 2023, the University of Szeged took over the management of the hospital. Then, many hoped that the department would reopen. Sándor Farkas, the Fidesz MP for the region, repeatedly stated that the departments in difficulty, including the maternity ward, would return to Szentes. In July 2023, he made the specific promise quoted at the beginning of our article that the maternity ward at the Szentes hospital would reopen “by September at the latest.”

However, this has not happened to date, meaning that it has not been possible to give birth at the hospital for more than two years. A doctor who previously worked in the department told Direkt36 that even in 2021, there was a shortage of doctors in the maternity ward. Even before the closure, they could only cover the on-call shifts by bringing in external doctors.

The minimum personnel and equipment requirements for each department are defined by law. “These include, for example, the required number of doctors and other healthcare staff in each department, as well as the equipment that must be available.” The maternity ward in Szentes operated with 25 beds, and according to the minimum professional requirements, there should have been seven doctors in the department.

According to a source who previously worked there, the department operated with six doctors even before it closed, meaning that there were not enough to meet the requirements stipulated by law. In addition, most of the doctors were retired or approaching retirement, being professionals over the age of 60, he added.

According to the source, the hospital tried to find a solution to the shortage of specialists so that the department could reopen: they advertised positions and asked for help from the the clinic in Szeged, but were unable to replace the doctors. Another source with insight into the hospital’s operations confirmed that they tried to request doctors from Szeged, but they were told to “figure it out themselves.” He understands that the Szeged clinic is also struggling with a shortage of doctors, even though their job is to provide regional care for the most seriously ill patients.

“It’s like an untreated ulcer” that’s eating the hospital.

At the Dr. István Bugyi Hospital in Szentes, despite being affiliated with the clinics of the University of Szeged, it wasn’t just the maternity ward that was struggling. Last summer, it was reported in the press that the otolaryngology department was not accepting inpatients. The operator justified the reorganization by stating that comprehensive inpatient care was “not professionally or financially viable,” so more complex procedures were transferred to Szeged. Planned prosthetic surgeries were also transferred to the clinic. The press department of the University of Szeged told RTL Híradó that Szeged offers the most modern care and that patients have the best chance of recovery there.

According to another source working for the municipality, the reason behind all this is a severe shortage of doctors, which affects almost every department.

“Over the past 1-2 decades, a few doctors have been carrying the whole thing on their shoulders,” he said.

The biggest problem, in his opinion, is that the University of Szeged is not informing the public at all about the fate of the departments at the Szentes hospital. “It’s like an ulcer that isn’t being treated,” he said, referring to the hospital’s decline.

The University of Szeged did not respond to Direkt36’s request for comment.

According to the decisions on department closures posted on the NNGYK website, there have been a total of 10 cases since 2020 in which a department at the Szentes hospital was unable to operate for a period of time and another hospital was designated to replace it. Half of these cases were due to a shortage of specialists. In other words, according to official data, there have not been many temporary ward closures in recent years. However, the above examples show that several wards are gradually shrinking, with certain procedures being transferred to the large county institution.

Several sources familiar with the operation of the hospital in Szentes have stated that the closure of the maternity ward was not based on professional considerations.

Mainly because Szentes had previously had the highest number of births among the small hospitals in the region: in 2022, there were 676 births in the hospital, compared to around 700-800 in previous years, and the maternity ward accounted for the majority of the hospital’s patients. In terms of the number of births, the hospital was surpassed by less than 30 births in 2022 and 2018 by the hospital in Hódmezővásárhely, which is also much closer to the clinical center in Szeged than Szentes, from where the route to Szeged is almost twice as long.

Hódmezővásárhely merged with the small town hospital in Makó in 2013, following a proposal by then-mayor Fidesz politician, János Lázár. Even then, there was a serious shortage of specialists at the Makó hospital, and the merger was expected to remedy the situation.

However, both the people of Szentes and Makó were disappointed. For example, the maternity ward has not been operating in Makó since 2020, nor have the pediatric ward and the psychiatric inpatient ward. Three years ago, the director general said that they were unable to reopen the departments due to a lack of human resources. He also reported that in 2023, 387 women from Makó gave birth in Hódmezővásárhely, which was almost two-thirds of all births. Based solely on the number of births, maintaining the maternity ward in Hódmezővásárhely is less justified than those in Makó or Szentes.

Neither the Hódmezővásárhely-Makó Health Care Center nor János Lázár responded to Direkt36’s questions.

The decline of small hospitals may also endanger patients

The entire southern Alföld region – Bács-Kiskun, Békés, and Csongrád counties – is full of small-town hospitals. Szentes, Orosháza, Hódmezővásárhely, and Makó are located 20-30 kilometers apart, and their residents are attached to their hospitals, which were built during the socialist era.

Most healthcare institutions suffer from severe staff shortages, but their closures and reorganizations do not reflect any logic; rather, they are completely random. All this not only makes care difficult and complicates matters for patients, but can also pose a real threat to their recovery.

A tragic example of this is the story of a woman in her 60s living in Békés County who found a lump in her breast in December 2022. She called the hospital in Orosháza to make an appointment for a mammogram. This is a screening test that reveals changes that are not visible to the naked eye, allowing breast cancer to be detected and treated.

The woman was unable to make an appointment because the machine at the hospital was out of order. She tried again in early January, but the machine was still not working. Her gynecologist grew tired of waiting and requested an X-ray and ultrasound, which showed a suspicious lesion. A sample was taken from the lump and sent from Orosháza to the clinic in Szeged for examination. After two weeks of waiting, the hospital’s response arrived: the sample could not be evaluated and a new one had to be taken. The second biopsy took place in Gyula at the end of January 2023.

The woman’s relative, Éva Sebők, a member of parliament for Momentum, reported on the events two years ago on her Facebook page.

“The shortcomings of the healthcare system have been keeping a family in fear for three months, as they are unsure whether the mother has cancer,” she wrote in her February 2023 post.

She told Direkt36 that her relative was diagnosed with a malignant tumor a few days later. She received chemotherapy, for which she had to go to Gyula. She traveled by public transport to her treatments until the summer of 2023, when her chemotherapy ended. They were unable to save her life, and she passed away in May 2024, 1.5 years after her diagnosis.

According to Éva Sebők’s experience, her relative’s story is not unique; equipment malfunctions are common in hospitals, and repairs can be lengthy, often taking weeks. When the woman tried to make an appointment for a mammogram, the machine had been out of order for a month. The hospital announced the malfunction on December 14, and examinations resumed in mid-January.  Last summer, there was also an 11-day shutdown, with the hospital stating that several services were suspended “due to vacation, further training, or illness.

Time is of the essence when it comes to malignant tumors: the earlier the disease is detected, the more effective the treatment can be, thus increasing the chances of recovery. It is difficult to say what role the delay in diagnosis played in the death of Sebők’s relative. According to Sebők, it is not certain that they could have saved her relative’s life even if the tumor had been diagnosed earlier. However, she believes that the hospital made a mistake by not referring the patient to another institution and not informing her of the dangers of a long wait.

The hospital of Orosháza and the University of Szeged did not respond to Direkt36’s request for comment.

Unofficial ward closures in Orosháza

The Dr. László Elek Hospital and Clinic in Orosháza is located in Békés County, a little over half an hour’s drive from the county capital, Békéscsaba. According to the hospital’s website, it is “a key institution in the city,” operating with more than 400 beds.

According to the NCPHP’s website, based on decisions regarding temporary hospital ward closures, the trauma and emergency departments have been struggling in recent years. But it is not only these departments that have found themselves in a difficult situation. Inpatient care in the otolaryngology and urology departments is also suspended on weekends. At the beginning of this year, weekend care for patients requiring traumatology care was also suspended due to “temporary human resource management difficulties,” according to a hospital statement.

The city’s mayor, János Raffai, recently posted on his Facebook page that the cardiology inpatient department would be temporarily suspended until the end of the year, but the hospital called this “fake news.”

According to them, this is not a matter of closure, but of reorganization: care is more efficient at the county hospital, so the inpatient department will be transferred there, while cardiology care in Orosháza will be merged into internal medicine.

According to a source familiar with the hospital’s operations, the institution’s problems are caused by a shortage of doctors and nurses. To his knowledge, in 10 years, the institution has lost about 90 doctors and more than 300 nurses and other staff. According to his information, the reorganization of cardiology care was also justified by the fact that there were only four doctors in the department, two of whom left.

The hospital of Orosháza did not respond to Direkt36’s questions.

In February, an online petition was launched to resolve the hospital’s situation. Péter Takács, the State Secretary for Health visited Orosháza in early April, where he said that the changes were in the best interests of patients because those requiring more complex care would be admitted to the county hospital more quickly and receive treatment sooner.

Éva Sebők, a member of parliament representing Momentum, organized a protest in front of the hospital during the state secretary’s visit, which was attended by hundreds of people, according to a report by Magyar Narancs.

Sebők told Direkt36 that it is rare for an entire department to shut down in Orosháza; more often, care is reduced and certain departments are merged. It also happens that more complex procedures are not performed in the institutions, but only in the county hospital. The latter was also the case with cardiology.

“Practically speaking, if I say that a department was closed, I am telling the truth, but State Secretary Péter Takács is also telling the truth when he says that there was no closure,” said the Momentum politician.

These reorganizations do not appear in the NCPHP’s designation orders, meaning they are not included in our database compiled on the basis of those decisions (which we described in detail in the first part of our series). Another institution only needs to be designated if a hospital announces that its department is unable to perform its duties for a certain period, so patients must be temporarily referred elsewhere. This is not only a phenomenon in Orosháza; care is being reduced similarly in many smaller hospitals.

The healthcare experts interviewed by Direkt36 agreed that certain services do not need to be available in every hospital. They said that rationalization would not be a problem in itself if it were done in a planned manner, after assessing what the real needs are and which departments have so few patients that it is not worth maintaining them. However, according to the experts, this is not what is happening now, as most of the closures are sudden and random. “This could only be done in an organized manner, but at the moment, chaos is the organizer,” said Zsombor Kunetz, a doctor and health analyst. He added that it is not the departments where care is not needed that are being closed or suspended, but those where doctors are running out.

Yet small hospitals play an important role in healthcare. If they can perform simpler procedures locally, then clinics and county hospitals can focus on more complex surgeries that require more equipment. “In contrast, county hospitals now perform minor surgeries such as cataract surgery or medical curettage,” said Gabriella Lantos, healthcare manager.

An example of this is the hospital in Orosháza, where, according to a source familiar with the hospital’s operations, the county hospital is sometimes unnecessarily burdened. If an elderly patient sprains their ankle on the weekend, they are immediately taken to Békéscsaba, as the hospital in Orosháza does not have a traumatology department. The situation is similar with otolaryngology, “they don’t even perform simple tonsil surgery at the hospital anymore.”

In the first part of our series of articles, we presented a picture of the daily struggles of hospitals based on more than a thousand official documents, and in the next part, we will reveal why the government is not addressing hospital reform.

Editor of the series: Zsuzsanna Wirth.

Illustration: Virág Török / Telex