Immediately after he took office as health minister last Sunday, Danny Naveh was briefed by the ministry's top officials on the manifold problems requiring his attention in the ailing health system. There is, however, one significant problem he is unlikely to hear about from his senior officials, namely that the Health Ministry hardly carries out ongoing supervision and control over the country's health institutions, so that the quality of medical care received by patients is constantly deteriorating, in some cases even leading to death.
All of Israel's health ministers and all the director-generals of the Health Ministry to date have failed in this cardinal task, despite the trenchant criticism leveled on the subject by the State Comptroller, the courts and the commissions of inquiry appointed by the Health Ministry itself. Some of the ministers and senior officials in the ministry did not grasp the importance of the subject, while others came to the Health Ministry with the sole purpose of getting through their tenure safely before going back to direct hospitals or health maintenance organizations, and not in order to defy the dictates of the Israel Medical Association (IMA), which is preventing essential supervisory action.
Instead of listening to a lengthy talk on the problem, Naveh could get all the information he needs about the subject by studying just one case, which shows how Health Ministry supervision of the hospitals could have prevented severe and indeed irreversible harm to a patient. The episode in question concerns the negligent treatment received by Ziv Shariki, a girl with cancer, at Bnai Zion Medical Center in Haifa. Her story was reported on Channel Two's "Fact" program.
The case was investigated extensively by a Health Ministry commission, which found the following: In June 2001, Shariki received chemotherapy, within the framework of which she was given magnesium sulfate intravenously for eight hours on the evening of June 26. However, the dose she received was 100 times higher than what she should have been given.
The probe turned up a series of blunders, negligence and extremely serious mistakes on the part of the senior medical and nursing team in the children's oncology department, and in the hospital's pharmacy. For example, the resuscitation cart in the department was not checked for half an hour, and despite the exceptional gravity of the case "no in depth process of drawing conclusions was conducted by the hospital's management."
Beyond the gross negligence in the treatment Shariki received that evening, the investigation turned up a broader problem relating to the supervision of the country's hospitals. It turned out that some of the nurses in the department had very little experience in administering medicine of the type Shariki received, due to the fact that the children's oncology department at Bnai Zion Medical Center has few patients. The director of the hospital, Dr. Amnon Rofeh, told the commission of inquiry that oncology for children in the Haifa area is usually provided by Rambam Medical Center. The commission concluded that it is "very doubtful" that there is any justification for the existence of this unit at Bnai Zion "in the light of the low volume [of patients], which has a direct effect on the proficiency of the staff."
In this case the functioning of the department was examined after irreversible damage was done to a patient. The question is why the Health Ministry does not carry out examinations of this kind on a routine basis. If such checks were conducted regularly, it would emerge that in some of the departments in the country's hospitals the medical and nursing personnel lack sufficient experience and there is no economic justification for maintaining these departments, they pose a mortal danger to patients.
On Tuesday of last week, Dr. Gabi Barabash, the director of Ichilov Hospital in Tel Aviv, warned about the phenomenon at a conference organized by the IMA. Barabash described a study conducted in the United States, which found that the rate of complications in complex surgery performed in departments of large hospitals is significantly lower than the rate in departments in small hospitals where the scope of activity is not as great. Whereas insurance companies in the U.S. oblige patients to undergo surgery in large hospitals, the situation in Israel is the opposite: the health maintenance organizations refer patients to small institutions that agree to charge a lower price, without always taking into consideration the medical risk such patients thus face.
Attempts to exercise control over the quality of the medical treatment and the functioning of hospitals in Israel have so far failed. One of the major reasons for this is that the IMA has successfully blocked such supervision, in part for fear that the findings will be made public. So powerful is the influence wielded by the physicians' guild that until six years ago the management of the Health Ministry - the minister at the time was Yehoshua Matza and the director-general was Barabash - signed an agreement that transferred to the physicians' guild some of the ministry's governing powers with respect to supervision and control over physicians. The agreement did not give rise to a significant improvement in the supervision of the physicians' work, and, despite recommendations to annul the agreement, the current Director-General, Dr. Boaz Lev, continues to abide by it.
The new health minister would do well to cancel the agreement, which was born in sin. If so, he will send a signal that he intends to be the first minister in years who is going to make a serious effort to improve the quality of medical treatment.
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