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Patients start gathering before 10 am outside the Baku Central Hospital of Oilmen office of Dr. Mirjalal Kazimi. Most seem to have been referred to him by TV.
“Are you coming because you saw Khoshghadam Bakhshaliyeva’s program?” they ask each other, referring to a popular talk show. “She is always praising Mirjalal, saying he is a really good liver doctor.”
Kazimi specializes in partial liver transplants using live donors, and he so dominates this field in Azerbaijan that when an iFact.ge reporter asked the Ministry of Health for transplant information, they gave Kazimi’s contact information and said: “Go ask him.”
Kazimi was happy to talk about his liver transplant operations — until the reporter asked him about the Lancet Medical Center in Tbilisi, capital of the neighboring country of Georgia. “I won’t talk about that!” he said with a rising voice, and soon ended the interview.
Kazimi performed two liver transplant operations in one week at the Lancet Clinic in March of 2016. Karlo Kekelidze, (64) and Giorgi Chubinidze (41), both died seven days after their operations.
Now Kazimi and three doctors from his Baku transplant team, Kamran Beydullayev, Gulam Rustam Zades, and Mail Sadiyev, face charges in Georgia for fraud and for operating without a license. According to the Georgia prosecutor, Kazimi received 35,000 lari (about $US14,000) that the Lancet Center had collected from one of the patients.
Kazimi spent 15 months becoming familiar with the Lancet Medical Center. The two men who died were his only Georgian liver transplant patients. They came to Kazimi after Lancet ran an advertising campaign saying “famous Turkish doctors” were in Tbilisi and ready to do transplants.
One of the patients was taken out of his hospital bed just hours before the surgery so he could sign a $US40,000 personal loan agreement with the clinic to pay for the procedure.The Georgia Ministry of Health said it did not approve either transplant and that one was performed without their knowledge. The founder of Lancet Clinic was recently sentenced to six years in prison for fraud.
Karlo Kekelidze had consulted with doctors at several other clinics before his family paid $US40,000 to Lancet. Kazimi told them the transplant needed to be done immediately.
The Georgia Ministry of Health wasn’t in as big a hurry. According to Nestan Londaridze, a Human Rights Center lawyer working with the families of both recipients, the Ministry board set up to evaluate transplants voted against this operation.
Kazimi went ahead with the operation. Kekelidze died seven days later. One board member said he did not know about this operation until two days after it happened.
Londaridze says that during the trial for Lancet founder Farman Jeiranli, several expert witnesses on transplants testified that there was no urgent reason to operate.
The donor was Leana Dolorenti, Kekelidze’s daughter. Dr. Gia Tomadze, president of the Georgian Association of Transplantologists, says donors should be family members because they are ideal donor matches.
But the Ministry says documents submitted by the family did not sufficiently prove their blood relationship. Natia Nogaideli, head of the State Regulation Agency for Medical Activities, says the Ministry requires a notarized document with proof of relationship between donor and patient, an informed consent document from both donor and patient, documents on their health, and a document on whether their blood tests suggest the patient’s body would accept or reject the new liver tissue.
The board looks at all these documents before approving an operation. Nogaideli says it’s an online process and the board has 48 hours to make a decision.
Before the family could provide more proof, Kazimi performed the 11-hour transplant. Based on the patient’s dark feces after the operation as observed by his family, testimony in Lancet director Pamran Jeiranli’s fraud trial suggested internal bleeding as a cause of death.
On March 7, 2016, four days after Kekelidze’s operation and three days before his death, the Georgian TV station GDS devoted a midday talk show to Lancet Clinic, Kazimi and liver transplants. The clinic promises many more successful liver transplants and even talks about starting a school for transplant operations.
Six minutes into the program, there is video of Kekelidze and his daughter side-by-side in beds. “After the operation, I feel like I’m born again,” Kekelidze says weakly into the camera.
Giorgi Chubinidze had been receiving liver treatment in Spain for several years, according to the lawyer Londaridze. (The families of both patients chose not to talk directly with iFact reporters).
“We have a report from Spanish doctors that he did not need a transplant,” Londaridze says. “Only monitoring every six months to check on his disease, which the report says was not getting worse.”
But three months after returning from a Spanish examination, Chubinidze’s family saw Lancet’s advertising for Turkish doctors in Tbilisi, and decided to get another consultation.
Londaridze says that when Lancet doctors said Chubinidze needed a transplant urgently, his family wanted him to go back to Spain for treatment. But the Lancet doctors said he could suffer a blood clot and possibly die if he took an airplane flight.
According to the medical experts at Jeiranli’s trial, Chubinidze showed no signs indicating he might suffer a blood clot.
Londaridze says Lancet sent some tests to a German clinic to get advice. But Kazimi operated before the answers from Germany arrived. The donor was Chubinidze’s cousin, Iona Shengelia. Chubinidze died seven days later.
Chubinizde’s family did not have $US40,000 to pay for the transplant. They asked for a few days to find the money. Lancet told the family he needed the operation now and the clinic needed a quick answer.
The clinic then told the family it could loan the money. According to Londaridze, Chubinizde was taken from his clinic bed in the middle of the night before his operation to a notary to sign loan documents. His wife couldn’t sign because there was no property in her name.
The only people who signed the loan document were Chubinizde and Giorgi Archbadze, a lawyer for Lancet. The document does not mention Lancet or for what reason the loan money is needed. The entire $40,000 had to be repaid in one month, or else interest would be added at the rate of 1 percent daily.
After his death, the clinic called the family to ask for the loan payment. The family has refused.
Liver failure, internal bleeding, kidney failure and lung failure are listed as causes of Chubinidze’s death. According to Tomadze, the Ministry’s transplant board never was notified about this operation.
Kazimi claims the Georgia Ministry of Health approved both transplants.
“The procedure is very different in Azerbaijan,” he said. “The patient comes with the relative who would be the donor, and if it is a good match, the clinic decides whether or not the operation should be done.
“I am the only doctor transplanting livers in Azerbaijan. Turkish doctors came and did three; I’ve done all the rest. We let all patients know the the risks of the operation.
“In Georgia, the procedure is different. The donor and recipient go to the Ministry of Health, and a commission decides about the operation, whether it is a good match or not.
“There are many cases when they do not match. In Azerbaijan, we tell the recipient that your donor does not match. If they do match, we pick a date for the operation.”
According to Kazimi, he has done 114 out of the 117 liver transplants in Azerbaijan since 2008. He says 14 of those patients died.
Lancet’s only two liver transplant patients died. There have been 33 other liver transplants in Georgia since 2014. Hospitals doing the transplants include Aversi Clinic and Ingorovka Clinic in Tbilisi and Evex Hospital in Batumi. Five of their patients died.
Tomadze explained that foreign doctors need licenses to work in Georgia. Kazimi got a one-year license when he came to Georgia, but it expired before the two transplants. Six months after the two deaths, his license was renewed. The three Azerbaijan doctors on his team never got licenses in Georgia.
“For foreign doctors to get licenses, we check citizenship, education, resume, license in their home country, and operation activity,” Tomadze said. “We give a recommendation to the Ministry of Health, and they make a decision.”
Tomadze says Kazimi may have forgotten to renew his license. “I know him personally. He is really a nice person,” Tomadze said. “I personally gave him a recommendation to get that license. We wanted him to do transplants here.”
When asked why advertising for Kazimi said he was a Turkish doctor, Tomadze said: “About the advertisements, maybe it was a mistake. I do not know if it happened deliberately or accidentally.” Kazimi did some of his medical studies in Turkey.
The Georgian prosecutor has noted that Lancet Clinic used both television and social networks to say that a transplant surgeon had been invited from Turkey to Georgia and he would hold free consultations for people with liver problems.
Lancet Clinic director Jeiranli says he was being punished because of the political situation in Azerbaijan. Pro-government media has accused Jeiranli of supporting and raising money for political dissidents. The dissidents say they came to Lancet because they felt safer there than in Azerbaijan.
Lancet Clinic closed and has reopened as a Viva Medi clinic.
Kazimi told the Azeri Press Agency (APA) that Jeiranli is trying to blame him for the deaths. “I received information that the expert at Jeiranli’s trial testified that there were no medical errors,” Kazimi told APA. “It means accusations against Jeiranli are not connected to my operations.
“The main subject of that court case was financial compensation for families of patients. I declare that I received nothing from those patients.”
So far it appears Kazimi won’t come back to Georgia for any trial. He told the iFact.ge reporter: “we are going to get an acquittal”.