PANAMA CITY.- When in 2006 thousands of Panamanians who had the flu or had a cough approached the Social Security Fund, they came out with a bottle of cough medicine prepared by the institution with raw material imported from Spain.
However, the syrup did not cure them, but took their health and even life.
One of the compounds used to prepare the syrup was diethylene glycol, an element used in automotive coolants, when in fact it should be prepared with USP pure glycerin.
It took 10 years, more than 200 people dead and more than 3,000 sequels, according to official data, to bring to trial those involved in the crime of poisoning, but the verdict little redeemed victims.
In September 2006, doctors of Neurosurgery of Hospital Complex Arnulfo Arias Madrid, of the Social Security Trust Fund (CSS, In Spanish) suspected the existence of a syndrome that killed 22 people. Each day more patients were brought with progressive neurological problems to the institution. They did not know the cause of this strange disease that was affecting more and more people, but they were sure it was something toxic rather than infectious.
On October of that year, the director of the Gorgas Memorial Institute, Jorge Motta, contacted the US Center for Disease Control and Prevention (CDC), who sent a toxicologist to support research. A few days later they found the cause: there was diethylene glycol in cough syrup prepared by the CSS.
In May 2008 it was estimated that some 6,000 Panamanians could have consumed the said syrup, and other medications such as ointments and creams, which were also contaminated with the same substance.
The case had global impact as the CSS had bought the product to a Spanish company, Rasfer International, which in turn had been produced by a plant in China, Taixing Glicerine Factory. In Spain legal proceedings were opened for crimes against humanity, while in China there were summary executions against those responsible.
Rasfer warned that the document delivered by Medicom, the company that imports the material to Panama, did not match the files that were on the sales. So two alleged facts were exposed: 1. That Medicom bought industrial glycerin and 2. That, when it was brought to Panama, documents and labels were altered to sell it as USP glycerin.
However, in Panama only preventive detentions had been made to some providers and managers of the CSS.
On March 31, 2007, a senior prosecutor ordered the preventive and investigatory arrest against Juan Jované, Rolando Villalaz and René Luciani, former directors of the CSS.
Prosecutors accused them of failing to prevent contamination of the syrup.
In the resolution of June 29, 2007, the full Court declared illegal the detention of Luiciani and ordered his reinstatement as head of the CSS.
The precautionary measures against Jované and Villalaz also were rendered ineffective.
In November 2012, the Court changed the preventive detention of Ángel de La Cruz, owner of the company that import the product, for an injunction of prevention from leaving the country. De La Cruz was the only one still detained in the case and he was held in the prison Tinajitas for the alleged crime of manslaughter after importing diethylene glycol.
Teófilo Gateño kept the ban on leaving the country and presentation in court every 15 days.
In January 2012, the Third Superior Court supersedes on a provisional basis Jované and Villalaz, while confirming the judgment of Luciani.
By that date, the State handled the figure of 6,000 bottles of syrups delivered, 22 people dead and thousands affected.
In 2014, the Public Ministry recorded 990 cases between survivors and deceased, but claimed it was difficult to determine the actual number of poisoned as each day new cases were brought. The Committee of Relatives and Patients for the Right to Health and Life claimed that there were more than 12,000 affected.
"It was on September 20, 2006. My nephew was cold and I was sick too, so I went to the CSS and I got a few bottles of guaiacolate. I had to be fine for an operation that I would undergo within a few days," Briseida de Trejo, one of the affected, told the newspaper La Prensa.
Trejo noted that when taking the syrup, she felt a strong burning in the throat and stomach. However, she should continue ingesting it to be healthy in the operation. The intervention was carried out as planned, but complications were just beginning.
They had to operate her again.
"When I was opened, pure dead tissue came out," she said.
Among the physical consequences presented are: high chronic renal failure, heart failure, diabetes, high blood pressure, neuropathy and cerebral ischemia. She has also suffered two heart attacks.
For Milagros Rey, the story is similar. After ingesting the syrup, dizziness, vomiting and diarrhea began.
She did not associate the syrup with discomfort until she saw the news in the local press.
"I issued the complaint. Then I was called a few months later to be told I was positive," she recalls.
Diethylene glycol has left in her body the following consequences: Axonal Symmetrical Polyneuropathy, lower limb neuropathic pain, severe bilateral carpal tunnel, irritable bowel syndrome, degenerative disease of the spine, disc herniations, hemorrhoidal disease in third grade, fibromyalgia syndrome, disorder anxiety and depression.
"I have been taken health, peace of mind, the ability to work ... I have been taken everything," she told the national newspaper.
Incomplete benefits and late trials
It was not until 2015 when the National Assembly passed the bill 93 which established improvements in health care for those affected by diethylene glycol and an annuity of $ 600 for the victims and relatives of the deceased.
The law also established the creation of a center of attention for those affected that provided expedited health care, timely and complete for victims of diethylene and other toxic.
Some of those affected expressed their disagreement with this measure as they considered, among other things, that $ 600 is too small for the number of tests and medicine to be taken for life and disability produced by poisoning.
Milagros Rey told La Prensa that poisoning left her disabled for life and she must spend between $ 200 and $ 300 a month on drugs.
In addition, some affected have reported that medical care and medicines arrive delayed, if at all, so treatments are difficult and the chances of living a life less painful decrease.
On March 14, 2016, 10 years after the tragedy that plunged Panama into mourning, the first hearing was held. The Second Court of Justice would investigate defendants for the alleged commission of crimes against public health, public faith and against life and personal integrity, to the detriment of policyholders of the CSS who took the syrup or contaminated products were applied.
The hearing was postponed until March 21.
"Evidence shows that there are guilty parties (...) the parties must understand and realize that this is an important and special process, and there are people with sequels of all ages, so that crimes must be corroborated and face justice," said Gabriel Pascual, president of the Committee of Relatives and Patients for the Right to Health and Life.
After the trial, in which all defendants pleaded not guilty, the Superior Court of the Supreme Court of Justice ruled 30 days to pass sentence.
However, hopes for justice quickly vanished.
The court ruled more in favor of the accused, rather than of the victims and freed of blame on former senior officials of the CSS.
The judgment acquitted René Luciani, Linda Thomas, Pablo Solís González, Teófilo Gateño and Josefa De La Cruz.
The court held criminally responsible for the crime against public health to Edward Enrique Taylor, Miguel Algandona, Nereida Quintero and Marta Cristelly Sánchez and sentenced them to 12 months in prison.
The longer sentence was granted to Ángel de La Cruz, owner of the company that gave the CSS the diethylene glycol instead of pure glycerine, who must serve 5 years in prison and pay $ 6 thousand in days of fines.
The claims of the victims and their families did not wait.
In August 2016, the affected went to the Palace of Justice Gil Ponce to express their rejection of the sentence.
"Justice is deaf, blind and dumb," said Blanca Domínguez, president of the Committee for the Right to Health and Life, to La Prensa.
Leosmar Tristán and Antonio Vargas, lawyers for the victims, reported that the decision would be appealed. So they did.
The terrible figures
Each year from 20 to 25 people die because of diethylene glycol.
To date, official figures indicate that 2,298 complaints of poisoning were issued, of which 670 were positive to the two criteria (having received the medication and having used it). 434 are still alive, while 236 have died since 2006.
There are 956 patients who tested positive for a criterion.
The Committee of Relatives of Victims for the Right to Health and Life says that in 2006, it was distributed 220,000 containers with syrup, a drug that reached 16,100 people, of which 3,500 are alive.
"We saw many people die and if a person developed kidney failure by diethylene, of course that this event will shorten life," said Néstor Sosa, director of the Gorgas Memorial Institute for Health Studies, to La Prensa.
The expert says that after this unfortunate fact, the CSS stopped producing drugs and now it is bought directly from the pharmaceutical industry.
The case is not yet closed.
The affected expect a ruling by the Supreme Court for issuing a lawsuit before the Inter-American Court of Human Rights.
Pascual said that they will complain in three areas: the violation of the rights of the victim by the failure that occurred and the damage from the point of physical and moral view nationwide against these patients affected with said syrup.
"If the Public Ministry and the Supreme Court insist on ridiculous sentences, we will await that outcome to proceed in the Inter-American Court of Human Rights, we will raise this internationally," he told to Panamá América.