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Magen David Adom's fleet of 750 ambulances and emergency care vehicles often reach their destination later than expected, according to a review of the Ayalon region conducted by MDA Comptroller Eli Arsalan.

Based on the organization's standards, the vehicles are supposed to depart within two minutes from the time a distress call is received, and they are expected to reach their destination within eight to 10 minutes in urban areas and within 10 to 20 minutes in rural locales.

At times, however, rescue teams arrive later than expected, leading to delays which can aggravate injuries or cause death for those needing treatment.

MDA runs 90 stations in 200 cities, towns and communities throughout the country.

The review, conducted between March-August 2000, covered the Ayalon region, which is the home to one million residents and comprises a number of cities including Bat Yam, Rehovot, Lod, Hod and Rishon Letzion. Magen David Adom receives 5,000 distress calls a month in the region.

In one case included in the review, an ambulance waited 45 minutes before heading off, "because the station refused to accept the call, saying it wasn't an urgent case." In another instance, seven minutes went by before the "urgency of the situation was made clear" and the ambulance left the station.

The standards governing Magen David Adom response times have no binding or legal character. They have never been formally adopted by the organization itself, or by the Health Ministry, which is responsible for all medical work in the country. In addition, procedures for transporting patients in emergency situations to hospitals are not anchored or delineated in the national health insurance law or in the patients' rights law. Claims pertaining to MDA's performance have been reviewed during the past year by the State Comptroller.

Senior physicians in the health care system, along with Magen David Adom workers, said that the Health Ministry fails to supervise MDA operations systematically, and has never issued sufficient standards to govern activities. Magen David Adom Director General Avi Zohar acknowledged that there is a basis to these claims. "Magen David Adom can decide to close a station, and the Health Ministry might simply follow along, wagging its tail," he said. "Much to my regret, the ministry isn't able to provide budgets which Magen David Adom needs."

During each shift, MDA employs 240 rescue team members (including drivers and paramedics) along with 22 physicians, most of them interns. Magen David Adom, not the Health Ministry, supervises its own work by means of in-house reviews. Paramedics, not physicians, carry out 20 monthly reviews of emergency medical transporting of patients to hospitals. Some top Magen David Adom officials suggest that these supervisory procedures are inadequate.

According to some senior MDA officials, the professional level of some physicians is low, something which Zohar acknowledged.

In a previous case, a 42-year-old Kiryat Haim resident sued Magen David Adom for inadequate care he claimed to have received after summoning an MDA team to his home in 1993 due to chest pains. The patient, represented by attorney Yoav Tzach, said the treatment he received aggravated his medical condition. His complaint was corroborated by an internal Magen David Adom panel, which submitted harsh critical findings about the doctor's actions during the emergency. The doctor, concluded the panel, failed to conduct heart tests that were clearly necessary.

The Be'er Sheva Distict Court is reviewing a claim submitted by a 16-year-old girl against Magen David Adom, the Health Ministry and the Kupat Holim Clalit health maintenance organization.

According to the claim, an MDA ambulance was summoned on July 20, 1998 by a Be'er Sheva dispatcher to attend to the girl who had collapsed. The claim alleges that the ambulance did not leave the station promptly despite pleas by a relative. When the medical team finally arrived, the lawsuit claims, the patient received sub-standard care - her father actually carried out resuscitation procedures. As a result, the girl lost consciousness and fell into a coma, which she has yet to come out of.

Magen David Adom denies the charges claiming that the ambulance arrived at the residence within a few minutes, and the girl "received the best possible care, under the circumstances."