Anyone forced to wait weeks or months for an operation at a public hospital should know the waiting list is likely to have been artificially padded - so patients are sometimes encouraged to bribe the senior doctors who determine the order of the list.

And, after receiving a date for your operation, it is worth remembering that residents who have already been on duty for more than 24 hours are likely to participate in the surgery. After the operation, you would be well advised to pray that no infection develops, which could even end in death.

Prayer is, in truth, likely to be essential because the Health Ministry ignores its responsibilities and does not conduct regular studies of infection rates in operating rooms and how such infections are treated - just as it does not perform any other regular inspections relating to the quality of medical care in Israel, and just as it does not operate any centralized system for drawing conclusions from cases of medical negligence. The ministry does not even have an updated list of all the operations performed in Israel, nor does it supervise waiting times for operations in any way.

Anyone hoping to find solace in private clinics is also likely to be disappointed. Some of the private clinics and medical institutes attract clients by means of false advertising. In some clinics, patients are diagnosed by workers who have no connection to the medical profession, doctors treat patients with hazardous materials that they are legally barred from using, and anesthesia is administered in a dangerous fashion. Some of the private institutes boast of being under Health Ministry supervision, but some - including some that perform operations - are not supervised at all. And even when supervision exists, it does not always prevent life-threatening malpractice.

The above are only some of the findings about the Health Ministry revealed in the 2002 state comptroller's report, which was published recently. The comptroller noted that, though the ministry is responsible for ensuring the health of the country's inhabitants, in practice, it fails to do so. In every field the comptroller examined in 2002 (and the same was true of previous reports), he found that the Health Ministry is defaulting on its obligations to the public.

For example, the comptroller discovered the ministry does not inform the public, as it should, of the dozens of doctors whose licenses have been revoked for malpractice or inappropriate behavior, such as raping a patient or taking bribes. The comptroller uncovered cases in which doctors with revoked licenses continued to work in clinics run by the state-funded health maintenance organizations; he also found the ministry neglects to inform private health facilities when doctors' licenses are revoked.

The Health Ministry's ongoing failure to fulfill its legal and public obligations must be called by its proper name: governmental anarchy. The ministry's senior officials, who are supposed to serve the public and act in the public's name, too often forget the public and serve the physicians' guild, instead. Thus, the ministry's current director-general, Dr. Boaz Lev, has continually caved in to the Israel Medical Association, which has been stalling the institution of systematic and transparent inspections of medical care and physician performance. And the ministry's legal adviser, attorney Mira Hibner-Harel, recently tried to reinstate the practice of keeping malpractice investigations confidential, as the IMA is demanding, even though the Supreme Court and the Knesset (through the Patient's Rights Law) have already ruled otherwise, on the theory that the medical profession should operate openly and transparently.

Another example of the ministry's lame functioning, which is not included in the comptroller's report, is the attempt by the ministry's regional office in Ashkelon to inspect a private medical facility in Ashdod, called Care, that performs many medical tests. In April 2002, the office sent a doctor and an inspector to the institute, both in the context of its regular inspections of medical facilities and in response to a specific complaint about that facility. But the two were unable to conduct their inspection because Care's management threw them out, in line with its policy of rejecting all supervision.

The regional office then complained to Dr. Yitzhak Berlowitz, the ministry's deputy director-general, demanding that the head office provide its inspectors with legal or even police backing for their visit, so that they could determine whether the facility's patients or employees face any health risks. The request was also sent to Dr. Lev, the director-general, to then-Health Minister Nissim Dahan, to legal adviser Hibner-Harel and to Dr. Alex Leventhal, director of the ministry's public health services division. As of this writing, the head office has still not responded to this request - and the Ashdod facility has still not been inspected. The ministry's top brass were apparently not bothered by the fact that, at the Ashdod facility and at other Care facilities in Tel Aviv and Jerusalem, ministry inspectors had previously uncovered serious problems, such as laser treatments performed by people who were not medical professionals without adequate professional supervision, or medicines whose expiration date had passed.