Mother, am I going to die - he asked me while he was lying in the hospital, a few days before his death. I was shocked. I said - you won't, son. I lied to him, he says for Center for Investigative Journalism of Montenegro (CIN-CG) Dragana Kankaras, mother Lazar Kankaraš, a boy who died in December 2024 at the Clinical Hospital Center of Montenegro (KCCG). He was only 11 years old.
The Higher State Prosecutor's Office (VDT) in Podgorica has opened a case regarding the deceased child, which is currently in the investigation phase, the VDT told CIN-CG.
Just a few months before his death, Lazar was a lively, cheerful child. He trained in judo, never having had any serious health problems, except for the occasional typical childhood injuries, “earned” in play. Falling from a bicycle in August 2024 and having to stitch up a wound on his knee seemed like another harmless injury that would heal easily and quickly.
However, after the wound was treated in the emergency room of the General Hospital (OH) in Nikšić, the first symptoms of a seemingly mysterious illness began to appear, the cause of which doctors were unable to determine. The entire spiral of various examinations and doctors, administration of medications that did not help, and repeated examinations lasted from the beginning of September, ending on December 11th - with Lazar's death.
CIN-CG obtained extensive medical documentation that raises suspicions that there were multiple failures in the boy's diagnosis and treatment. Lazar was a patient of several state and private health services: the Nikšić Health Center, the Nikšić General Hospital, the Children's Hospital in the KCCG, and two private clinics in Nikšić and Podgorica.
However, the cause of his persistent symptoms was only discovered five days before he died - infective endocarditis. Endocarditis is one of the infectious diseases with a high mortality rate of around 25 percent, despite all the advanced medical methods.
The clinical autopsy report, which CIN-CG had access to, states that "a congenital heart defect was found, with signs of infective endocarditis and spread of inflammation to all layers of the heart, with the development of sepsis and multiorgan failure, which led to death."
It is currently unclear how the boy, who was not even known to have a heart defect until a few days before his death, suddenly died of a serious illness, despite regular visits to a series of doctors for several months due to a chronic fever. The state institutions where the boy was treated have launched quality control commissions: KCCG, OB Nikšić and the Nikšić Health Center.
The Quality Control Commission of the Clinical Center of Montenegro also held a session regarding this case, the Ministry of Health (MoH) told CIN-CG.
"Due to the complexity of the case, they informed us that they will request the engagement of external members from the field of pediatric cardiology and pediatric cardiac surgery, and that the findings will then be submitted to the Ministry," said the department in charge. Vojislav Šimun"The ministry will then take all measures within its jurisdiction, towards further checks of all actors who participated in the provision of health services in the aforementioned case," the Ministry of Health told CIN-CG.
The Nikšić General Hospital's quality control commission determined that no improper treatment had occurred at the institution, the institution told CIN-CG. They have forwarded all documentation to the Ministry for further analysis.
The Nikšić Health Center, where the boy was also treated, told CIN-CG that the institution's Quality Control Commission had prepared a report on the case and submitted it to the Ministry of Health. They did not, however, specify the Commission's findings.
The Ministry explained that for now there is no initiative to control the work of the private institutions where the boy was treated, because they are not aware that he was treated there.
CIN-CG contacted two private institutions where the boy was treated. The Pediatric Clinic "Doctor Mica" told us that they were overwhelmed by the case and that they did not conduct quality control of the work of the immunologist colleague who worked with the boy, because the clinic is run by general pediatricians.
"We are general pediatricians and it would not be ethical and moral to give an opinion on an examination performed by a colleague who has more formal education, experience with such cases, and whose area of expertise is this," the administration said.
We have not received an answer from Milmedica regarding this case.
More than three months without a diagnosis
"One summer evening, Lazar took his bike, went for a ride, and fell not far from home. He injured his knee. From then on, everything started to change. It was the end of August," he explains in an interview with CIN-CG. Vladimir Kankaraš, the boy's father.
The boy was taken to the emergency room of the Nikšić General Hospital, where he was given four stitches. He was supposed to wear the stitches for seven days, but that was extended to two weeks because the wound had not healed, the boy's parents explain. He was then given antibiotics.
Shortly after the stitches were removed, in mid-September, the boy resumed normal activities. At the end of that month, he began to experience the first headaches and temperature spikes.
"We took him to the doctor right away. That first rise in temperature was attributed to a stomach virus, which was prevalent in the neighborhood and at Lazar's school at the time. He was given antibiotics again," Vladimir explains.
However, after a short recovery, the fever starts again.
"The doctors say it's a minor inflammation, but it's nothing serious," says Vladimir.
"There are no other symptoms during the day. The child is healthy, plays, goes to school. However, in the evening he starts shivering and sweating. The temperature sometimes goes over 39 degrees. We don't understand what's going on," says the father.
For the Kankara people, a period of continuous Lazarus examinations, findings, and wanderings around diagnoses begins.
"They assure us it's nothing serious, but they don't know what it's all about."
After, as they claim, they underwent a series of tests at Nikšić's health institutions, the results of which did not indicate any significant problems, they are continuing their treatment privately at Nišić's "Milmedika".
"I think we've been on the trail a few times to find out what's wrong with Lazar. I asked the doctor at 'Milmedica' why the boy has clubbed fingers. Clubbed fingers are slightly swollen and bluish fingers that appear in lung and heart patients," Lazar's father tells CIN-CG.
Therefore, Lazar's saturation, the presence of oxygen in his blood, was measured, which was slightly low. However, the doctor did not continue the examination in that direction.
"I was told several times during Lazar's interrogations that 'I'm not playing Dr. House,' that 'I'm not playing doctor,' and the like. It would be better if I was," says the desperate father.
Who makes you take their temperature?
During October and November, Lazar was examined by a series of pediatricians at the Nikšić Health Center. He was then examined by specialists: a hematologist, an immunologist, a rheumatologist, an ophthalmologist, a surgeon, a pulmonologist, all of whom were performed at the Nikšić Health Center and the KCCG Children's Hospital, as well as in private institutions. Lazar underwent lung scans, an X-ray, an ultrasound, an echo of his kidneys, liver, pancreas... The doctor even asked for an ultrasound of his knee, the parents say.
Nothing alarmingly stood out in these analyses.
Several doctors expressed the opinion that the boy was healthy.
"Who makes you take his temperature every night?" one of the rheumatology specialists asked the parents, insisting that he was healthy, and that "sick children don't look like that," in other words, lively and energetic.
But Lazarus was only like that until he had a fever attack.
"The child gets weak every night, starts sweating and suddenly can't go anywhere," explains Vladimir.
The fever attacks would then go away on their own.
"We started giving him paracetamol to bring down his temperature," when the pediatrician approved.
Cautious and concerned, the Kankarašs carefully listened to every doctor's advice, and claim that they did not dare to take any "self-imposed" action in treating the boy's mysterious illness.
Lazar's later, November findings, which CIN-CG had access to, show that the boy is starting to have fevers more frequently, up to twice a day. Another pediatrician, a hematology specialist, is convinced that there is nothing wrong with the boy. Early puberty, she says.
"She assures us that occasionally children come who have a fever for two or three months, that it comes and goes. She also assures us that it's probably some kind of early puberty. He's really lively, he doesn't stop, he's never complained. It's just that he has that fever," Vladimir explains.
The report from that pediatrician-hematologist, which CIN-CG had access to, stated that the sedimentation rate and leukocytes were slightly increased (signs of infection), but as stated, there were "no indications for further hematological testing."
At that moment, hospital bacteria - streptococcus - were probably already rampant in Lazar's body, which would only be found in a bacteriological blood test in December, shortly before his death. The first one performed since the onset of symptoms. Streptococcus is a bacterium that usually develops and is transmitted in hospital settings.
Although Lazar's wound on his knee was examined several times, even ultrasound-scanned, doubts were removed that there was a possible wound infection that would have led to the boy's symptoms.
"The pediatric rheumatologist saw something darker on the scan of the wound. The surgeon at the KCCG examined the wound and pulled out the thread with a scalpel. He said that the temperature couldn't be the cause," explains Vladimir.
"After all the tests, they sent us home - the child is healthy," says Vladimir.
However, by the end of November, Lazarus' fever becomes completely chronic, the boy loses weight, becomes paler, and sweats intensely...
Nikšić General Hospital - they didn't know what to treat him for
At the end of November, Lazar finally received a referral for treatment at the Nikšić General Hospital. However, he was sent home the same day.
"The doctor who was in the ward didn't want to admit him because he didn't have a diagnosis. He said that Lazar was healthy, and that he couldn't lie with sick children," Dragana explains.
This doctor refers the boy to an immunologist.
"We are trying to find an immunologist privately as soon as possible. We are asking around about good ones. We understand that we would not be able to easily find them in state institutions, so we are looking privately to see who among the recommended ones can see us first," Vladimir explained, explaining the agony of finding a suitable doctor in Montenegro, where those who cannot afford private doctors wait for months to be examined by a specialist.
The Kankaraši go to the doctor at the “Doctor Mica” office. The report states that the boy has “been extensively (in detail) examined so far,” that his “rheumatological status is normal,” and that further “hematological examination is not indicated.” They give him a new therapy, which includes the drug “naproxen.”
“Naproxen” is a type of pain reliever that belongs to the group of “nonsteroidal anti-inflammatory drugs” (NSAIDs).
The Kankaraši say they asked numerous doctors and learned that NSAIDs are not recommended for patients with infective endocarditis.
"At that moment, the doctor didn't know that. All the doctors examined him in detail. But he was never referred to a cardiologist."
That evening, Lazar's temperature soars to 40,5.
"He was falling, he couldn't stay on his feet. We didn't know what to do, we didn't know if we could give him paracetamol. We called the ambulance, they said give him paracetamol, we showered him, he stayed up all night watching over him. In the morning his temperature dropped, we went to the doctor again right away," says the mother.
The doctor who prescribed "naproxen" said, after this development, that she should stop taking the medication.
His pediatrician again referred him to the hospital in Nikšić. However, Nikšić refused to admit him for the second time, insisting that it would be better for him to be placed in the Children's Hospital in Podgorica.
Delayed diagnosis
Lazar was treated at the KCCG in Podgorica from December 6 to 11, when he died.
"On Friday, December 6, doctors will begin examining him, all specialists in turn."
That day, Lazar finally received a diagnosis from a pediatric cardiologist. Draško Nikčević.
"After listening to Lazar, he shouted, 'Where have you been for a month?' When I explained to him that we haven't been to the doctor since September, Nikčević asked if it was possible that no one had heard the heart murmur," explains Dragana.
"Doctor Nikčević showed me a spot on Lazar's heart - a thrombus. He said it was definitely caused by bacteria, very possibly, the doctor claimed, from the stitching of a wound on his knee that spread throughout the body and attacked the heart," explains Dragana.
In addition, it turns out that Lazar has a heart defect - that he has two instead of three leaflets on the aortic valve. In such cases, infections that spread through the blood more easily reach the heart. The report states that the doctor made the diagnosis based on the medical history:
"Prolonged fever, weight loss of 2kg, intense sweating and new-onset heart murmur."
Parents are now wondering why other doctors, given the long-term presence of most of these symptoms, did not order an examination by a cardiologist.
"When we heard the diagnosis, we were shocked. I immediately said we should pack up and go to Belgrade. However, Dr. Nikčević reassured me and said that the child could be treated here. He told us that this was the first time he had encountered infective endocarditis, and that he was in contact with a doctor from Belgrade, who is an expert in heart disease in children," explains Dragana.
At that time, it was not yet clear what type of bacteria Lazar had, which was important for treatment, and they were told that they would wait a few days for the results of the bacteria and that as soon as they found out exactly what it was, they would apply targeted therapy.
"They also said not to worry because they had him 'covered' with antibiotics," says Dragana.
Cardiologist Nikćević did not want to comment on this case. When asked by CIN-CG, he said that he could not say anything until the work of the external commission that is supposed to evaluate the entire case is completed.
A weekend without a doctor's visit and findings
"That Friday we are admitted to the cardiology department, Lazar is put on 'longacef' for 12 hours. They convince me that the bacteria will not spread anymore, that it will stop or disappear. However, the temperature does not go down. They give him 'paracetamol', he sweats, eats, is in a good mood. And then it all starts over again," Dragana explains of the first agonizing hours in the hospital.
On Saturday and Sunday, during the weekend, there was no cardiologist in the ward at the KCCG Children's Hospital, she claims.
"There were doctors on duty, but not from cardiology. The doctor on duty asked from the door if we were okay."
He says that on Saturday the boy was fine, walking around. However, on Sunday the fever started again. No one comes, just one more question from the door - are you okay?
"On Monday, Lazar was in pain everywhere, he was crying, I was crying too. They were stabbing him again, they were taking a series of tests," says the mother.
Dragana explains her state of despair and panic, while she doesn't know what is happening to her child, and the day passes in the hospital in which, as she says, everyone around her is calm.
"A rheumatologist told me I was being too dramatic. Santa Claus is coming to visit, the holidays are coming up, and we're all feeling sick."
Finally, the results come back, the streptococcus bacteria are confirmed. They change the therapy. The medical records show that Lazar is then put on "vancomycin" every six hours.
"But he's been on 'longacef' for three days now, all of that worries me, why another medication now," says Dragana.
They also give him “gentamicin.” He says they learned from another cardiologist in the department that this was the right combination he should have received on the first day.
"We wonder if it was possible to get the test results faster, is it necessary to wait three, four days?"
Deterioration and death
After, as Dragana explains, Lazar received the new therapy for 12 hours, he began to have difficulty breathing, to suffocate.
"I saw his chest moving up and down, and he was telling me he couldn't calm his heart," says Dragana.
"The cardiologist on duty says they need to go to intensive care immediately. He's crying and asking what's going on, they won't let me in."
Early in the morning, Dr. Nikčević comes to do an ultrasound.
"He assures me that everything will be okay. I've been waiting for an hour, hoping that everything is okay, and that he will be brought back from intensive care," says Dragana.
However, Dr. Nikčević announces that the findings are worse than on Friday, the first day. He calls doctors from Belgrade, Dragana says not to tell her the details.
They are turning on oxygen in the intensive care unit.
"They convince me that everything is getting better. His pulse is 145, which doesn't seem right to me, but they tell me that's how it should be," says Dragana.
That evening, he says, his back hurt so much that he didn't sleep at all. They wouldn't let her in during the night, he points out. The next day, Lazar couldn't do without oxygen anymore.
"In the morning they still assured me that everything would be okay."
At 14 p.m. that day, the Dragans announced that the boy had to be taken to Belgrade after all:
"Then Nikčević tells me that there's nothing they can do about it. They say that Lazar is not getting any better."
However, the flight that was supposed to take place that day is postponed until tomorrow morning.
"When they told me that the transportation would only be in the morning because they lacked the resources to organize the flight efficiently, I started to complain," says the mother.
At that moment, Lazar starts coughing up something pink, says Vladimir. They start giving him blood.
"I look at the monitor - 170 heartbeats, blood pressure 40 over 90. No one explains to us what's happening, they just say - he's anemic. They give him something to make him urinate. The nurses are worried, we can see that something is happening," the father recalls.
After that, they ask for the parents' consent for intubation. They explain to them that he is exhausted and that this will make it easier for him to endure the journey to Belgrade.
"I explained to him - Lazo, you're going to sleep now, so you can breathe easier, so you can rest, so we can go to Belgrade more easily. He looked at me and said - okay, dad. He had a lot of trust in me," Vladimir recalls.
"I asked if I could be with him. They told us there was no point in staying, but to go and get ready for the trip. To be at the hospital at half past five the next day," says the mother.
While the parents were on their way to Nikšić, the phone rang. They were told by the Children's Hospital that Lazar's condition had worsened and that they had to return. When they arrived at the intensive care unit, they were told that they could not see their son, that he was being resuscitated at the moment.
"He was resuscitated by Dr. Nikčević and other doctors. After 20 minutes, they showed up to say that Lazar had died. 'Unfortunately, we were unable to revive him,' the doctors said," says Vladimir.
The parents recall that the doctors shrugged their shoulders at all their questions, explaining that the treatment had become complicated. One of the doctors stayed with them.
"He told us that he was already effectively dead on Monday, as indicated by the troponin test, which was high. In a severe heart attack, troponin is 40 to 50, and Lazarus had several thousand. Nobody told us that at the time."
And from the documentation that CIN-CG had access to, it is clear that the troponin finding was extremely high.
Ignorance killed Lazar, says Vladimir.
"I don't understand why, from the end of August to mid-December, after so many examinations, the doctors couldn't figure out what was going on."
Now it is the turn of the State Prosecutor's Office, which should shed light on all the facts regarding this tragedy and determine whether it could have been prevented.
Bonus video:
