West Tallinn Central Hospital (LTKH) terminated Veerus's employment with immediate effect on Thursday; at a press conference on Friday, LTKH board member and chief medical officer Vallo Volke said the reason was a loss of trust.

"Without going into detail, situations can arise during hospital treatment where there is suspicion that the outcome could have been better. We call these potential adverse events. The law, ministerial regulations, and the hospital's internal procedures require us to handle all cases like these—we register them, analyze them, and ultimately determine whether we could have performed better as a hospital or whether everything proceeded as could be expected from a European hospital," Volke said at the press conference.

The hospital had said earlier its reason for Veerus' dismissal was the death of a patient which occurred in the anesthesiology clinic earlier this year.

Volke added that if a case involves potentially preventable harm, or even suspicion of such harm, the hospital is required to notify its insurance company.

"The accusation against our clinic was a serious violation of patient safety rules. We discovered a case that, in our assessment, was a potential harm incident that should have been reported to the insurer. None of these processes had been carried out by the clinic," the LTKH board member continued.

Volke said he had previously asked Veerus for explanations on the case and whether the concerns were real, but he was given false information in response, he said. "I was told that everything had proceeded as usual. We are talking about a case with very serious consequences," Volke said. "In summary, this means we cannot continue the employment relationship in such circumstances."

Volke added there had been disagreements with Veerus before on what constitutes a preventable harm incident and what does not, but the most recent case was of such a severity level that trust could not be restored once the issue had come to light.

A clinic director is responsible for quality within the clinic, including ensuring that all suspected incidents are registered and properly investigated, Volke added, noting that the incidents will be investigated "thoroughly from beginning to end, and ultimately determine how much of it involves areas where the hospital could have performed better."

Veerus denied any wrongdoing and told ERR honesty and patient safety are of utmost importance to her. LTKH's quality indicators rank among the best not only in Estonia but also in Europe and globally, she added.

"For years, I have worked to ensure that treatment guidelines are updated, that our quality indicators are continuously analyzed, that adverse events are reviewed, that simulation training is conducted, and that staff are properly trained. We report adverse events in accordance with the applicable ministerial regulation and hospital procedures, and we adhere to those requirements," Veerus said.

The deceased patient's treatment continued in another clinic after their initial surgical treatment at LTKH, and if an adverse event occurred there and was not reported, she could not be held responsible, Veerus added.

"I provided explanations regarding this patient to the medical director in February, and no additional questions were asked of me after that," she continued, adding that since the investigation process is still ongoing, there is currently no ruling on whether a medical error actually occurred.

Veerus was also emphatic in her denial of the implication Volke had made that she had misled him as management board chair.

"It seems to me that the real reason for the extraordinary termination of my employment is that for a long time I tried to find compromises with the management board regarding the major problems that my colleagues have also highlighted in their public appeal," Veerus said.

A situation has emerged in which nursing activities and physicians' work have been hived off from each other, Veerus added; previously staff were accustomed to working as a unified treatment team focused on the patient's well-being.

She also called LTKH's management board's work culture "toxic," adding it "does not reflect the values of a modern healthcare system." "In this situation, we have tried to find compromises with the management board, and I have not been a convenient partner for them."

On Thursday, a public appeal signed by 36 employees of LTKH appeared on the Ministry of Social Affairs' register. It stated that only 44 of 74 physician positions at LTKH are currently filled after a wave of departures; staff are overworked, exhausted, and anxious, the address said.

These issues could jeopardize the quality of care and patient safety for women and newborns, the appeal went on.

Volke said he met with colleagues from the women's clinic on Friday and declared it "currently functioning very well," adding it "employs 51 doctors who fill 41 physician positions, plus we also have 10 resident doctors in training."

That there are currently no physician job advertisements for the women's clinic indicates it does not need to make any new hires at present.

Minister seeks explanations

Minister of Social Affairs Karmen Joller (Reform) wrote to Tallinn Mayor Peeter Raudsepp and Deputy Mayor Riina Solman (Isamaa), stating that in her view this is not merely an ordinary workplace dispute within a large organization, given LTKH's women's clinic is one of Estonia's most important centers for obstetrics and gynecology. One in four Estonian children is born there, she noted.

For this reason, Joller, a medical doctor by training, said she wants the City of Tallinn, as the hospital's owner, to explain as soon as possible how it intends to mitigate risks to women's health and children's treatment at the women's clinic and how it will ensure that maternity care and hospital operations remain adequately staffed with the necessary specialists.

"When concerns are being raised simultaneously by clinical leaders, anesthesiologists, midwives, and key specialists in the field, this cannot be dismissed as mere internal organizational dissatisfaction," the minister said.

However, Karl-Sander Kase, who heads LTKH's supervisory board, said the management board had provided sufficient explanations about Veerus' firing.

"The supervisory board took note of this information, and the management board is responsible for the hospital's quality and healthcare organization," Kase said. "We trust the board's proposal and decision; it was justified and well argued."

An additional issue concerns funding from the Health Insurance Fund, as the clinic reportedly submitted invoices that were lower than the actual sums. According to Kase, he instructed the LTKH management board to establish a working group to determine both the extent of the financial discrepancy and the period during which the billing issue persisted.

Kase, an Isamaa Tallinn councilor, also criticized Joller's comments, saying matters like these should not be resolved via the media. If necessary, the Health Insurance Fund can investigate the matter, he said, and the hospital has its own procedures, but political actors should not intervene.

Under current plans, LTKH and its East Tallinn counterpart, ITKH, are to be merged as one under the Tallinn Hospital umbrella by the beginning of 2028.

Background:

Long-serving senior gynecologist Veerus, who was chief physician and head of the hospital's Women's Clinic, was dismissed from LTKH Thursday.

In a public appeal sent to health officials, city leaders, hospital supervisory boards, and several Estonian medical organizations, staff warned that management problems, staffing shortages, and specialist departures could threaten patient safety and quality of care for women and newborns.

The hospital had said Veerus was fired following the death of a terminally ill cancer patient in intensive care after major surgery earlier this year.

The head of the pregnancy and perinatal center, Konstantin Ridnõi, has also resigned after helping uncover what he described as a systemic billing error that may have caused the hospital to miss eligible reimbursements from the Health Insurance Fund (Tervisekassa).

Staff had also identified a shortage of anesthesiologists as the most urgent problem.

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