According to a review by the Health Ministry, "there is a distinct and strong link between a donation made by a patient and the treatment received," in the cardiac and neurosurgery wards of state-run Ichilov Hospital in Tel Aviv. The report also raises questions as to whether the gift was given "as a direct consequence of the donor's free will to make a donation to the ward in which he was hospitalized."

Numerous anomalies in the manner in which donations were made by patients were also recorded at state-run Sheba Medical Center in Tel Hashomer, with a sample review showing that some 75 percent of the donations, particularly to the cardiac surgery department, were made at the time of, or close to the time of, the patient's hospitalization - contrary to regulations.

A sample review conducted at Assaf Harofeh Hospital in Tsrifin and Wolfson Medical Center in Holon shows that 75-92 percent of the donations were made contrary to instructions.

The Health Ministry's probe ran into difficulties and footdragging on the part of the hospital directors, and no review was conducted at Haifa's Bnei Zion Medical Center due to opposition on the part of the hospital's friends' association.

On reading some of these findings on contributions to the hospitals' charity associations, one could think that they were revealed just recently. But these are findings from a Health Ministry probe conducted in 1981-84 by ministry officials Ruth Keren, Aryeh Paz and Hava Wohlberg.

Backing for the findings came in a 1983 letter from Prof. Dani Gur, then director of Sheba's cardiac surgery department, to the Health Ministry's management: "It's no secret that I encourage patients to make donations; and recently, I am being hounded by the hospital's director, who is accusing me of trying to deceive him and the Health Ministry by circumventing directives," Gur wrote. "And indeed, he is correct! I am trying in every way to skip over the obstacles that are threatening the existence of the fund. ... I haven't drawn a single shekel from the fund for my needs, but I know that in certain wards, the fund is exploited as a means to improper objectives."

This was the one and only probe that has been conducted by the Health Ministry into the friends associations at the hospitals it owns - despite the fact that the probe aroused suspicions that the friends associations, as well as the research funds at the hospitals, serve sometimes as a means to launder illicit money donated by patients in return for being able to choose a doctor at the hospitals or get bumped up in line.

Such payments, made directly to the friends association or hospital fund, and not directly into the doctor's private pocket, have already been defined by the courts, including the Supreme Court, as bribery. The Supreme Court ruled that such payments are not donations, even if they are termed so, but are in fact bribes a patient is forced to pay in his most dire hour - and that the action can be considered a criminal offense that carries a seven-year jail term.

The friends societies have been operating as independent associations at the government hospitals for some 30 years, and they collect and manage most of the donations made to the hospitals. They do not come under the supervision of the Health Ministry or State Comptroller's Office, but only of the Registrar of Societies - supervision that is not always very meaningful. Indeed, according to an initial review conducted in recent months by the Health Ministry's comptroller with regard to the claims and documents pertaining to the friends associations, it appears that since the probe in the 1980s, not much has changed.

The Tel Aviv district prosecutor's announcement a month ago about the filing of criminal charges against Dr. Gideon Uretzky, the director of the cardiac surgery department at Ichilov, for conditioning operations on making a donation to the friends association provides additional cause for conducting an urgent investigation into the goings-on in these associations. The decision is now being reviewed by State Prosecutor Eran Shendar, following an approach by the doctor.

At the start of last year, in the wake of the Uretzky affair and others, the State Comptroller's Office approached Paz and requested an investigation into the matter. In June 2004, Health Ministry director general Avi Yisraeli instructed the ministry's comptroller to conduct an inquiry into the donations received by the associations - after the Health Ministry had disregarded this obligation for more than 20 years.

Not surprisingly, just like 20 years ago, some of the hospital managements and associations are impeding the probe. Dr. Benjamin Davidson, director of Assaf Harofeh, for example, wrote to the Health Ministry that he "was astounded by the offensive initiative with regard to the charity association," and that "it's not a good idea to bite the hand that feeds you."

For his part, Ichilov director Prof. Gabi Barabash warned that the probe was likely to deter donors and cause "the baby to be thrown out with the bath water," while the chairman of the friends association at the state-run hospital in Nahariya informed the Health Ministry that "in any event, the donors' particulars will not be revealed to the Health Ministry comptroller."

Until now, the Health Ministry has failed in most instances in which it is supposed to represent the good of the public and has backed off in deference to the interests of the hospital managements. The test now facing Health Minister Dan Naveh and his director general, Yisraeli, is not to fail again in their duty to investigate the friends associations.