Physicians Without Supervision

People who want to know which surgical ward and which surgeon have the lowest mortality rate, where the danger of infection is lowestand the like have no way of getting answers.

People who want to know which surgical ward and which surgeon have the lowest mortality rate, where the danger of infection is lowest, in which obstetrics department the rate of complications is low, which fertility institute has the highest rate of success, which hospital reports numerous accidents, which health maintenance organization offers the best service and the like have no way of getting answers - not even if they have a direct line to Health Minister Nissim Dahan, or to his ministry's director-general, Dr. Boaz Lev. They don't know, either.

Thus the Health Ministry is failing in its most important function - supervising the quality of medical care in the hospitals, the HMO clinics and the private medical centers.

The report published last week by the state comptroller notes that the Health Ministry, "which is in charge of public health and has the obligation to ensure that the health system provides the public with quality medical care," does not exercise systematic and comprehensive supervision and control over the quality of the medical services provided by the HMOs. The ministry, the report adds, has not set criteria of quality that will enable guidelines to be issued to the HMOs in regard to the service they give and for examining their behavior in retrospect. (The HMOs employ most of the physicians and nurses in Israel and also operate a large number of hospitals.)

The same situation exists in the hospitals, where the most risky medical procedures are performed take place, such as surgery and catheterization procedures: There, too, the Health Ministry does not maintain ongoing supervision - not even in the government hospitals, which are under the ownership of the ministry.

The first (and last) study in this field, conducted by the Health Ministry in 1994, found irregular mortality rates at Wolfson Medical Center in Holon and Soroka Medical Center in Be'er Sheva. In the wake of that report, the Israel Medical Association - the physicians' guild in Israel - instructed its members not to cooperate with similar surveys. The IMA also placed many obstacles in the way of attempts to investigate complaints against physicians, this following a decision in 1995 by the president of the Supreme Court, Justice Aharon Barak, to lift the secrecy clause from reports on investigations into medical accidents.

Instead of using its legal authority and fulfilling its public duty to maintain ongoing control of the work of the country's physicians, the Health Ministry yielded to the pressure it came under. Since then, no similar surveys have been conducted - neither in the cardiology departments where irregular levels of mortality have been found, nor in institutions such as Rambam Medical Center in Haifa, where high mortality rates were found in various departments during the period between 1990 and 1997.

The State Comptroller's Report noted that the ministry was not making use of the means of control at its disposal to examine the quality of medical care or to investigate complaints against physicians.

In 1997, the IMA and the Health Ministry signed a cooperation agreement as a result of which the former effectively became the supreme authority responsible for the level of medical treatment in Israel, as well as the organization that conducts surveys on medical care and investigates complaints regarding the ethical practices of physicians.

The State Comptroller's Report was sharply critical of the agreement, noting that in its wake, the ministry had lost its independence and exclusive discretion in the critical area of reviewing the health system. Thus, the report added, the IMA had delayed the publication of new procedures following the death of five patients during catheterization procedures and had opposed the publication of new guidelines in the wake of several cases involving lax supervision of women who suffered from serious postpartum bleeding.

In this way, the Health Ministry continues to bow to the wishes of the physicians' guild, at the expense of the public interest, while the unacceptable agreement continues to set the character of the ministry's work.

As was recently reported in this paper, pressure by the IMA brought about a temporary cessation of a survey being conducted by the Health Ministry to examine experiments on humans in hospitals. In the wake of this report, the chairman of the IMA, Dr. Yoram Blachar, informed Dr. Lev, the ministry's director-general, last week that the IMA agreed to have the survey conducted, but also demanded that all studies and examinations be suspended until the formulation of "understandings and working procedures."

Once again, Blachar showed who the real master is when it comes to medical treatment in Israel.