Hard Look / What Would the Health Ministry Do Without Kolbotek?

Without popular consumer affairs show, the ministry could not have known about abuse of elderly at hospitals.

Shocking footage showing abuse of patients at the state-run psychiatric hospital in Tirat Hacarmel was aired this week on the popular consumer affairs TV show, Kolbotek. Candid cameras caught images of hospital staff bathing elderly patients, including Holocaust survivors suffering from mental illness, seated on toilets, using scalding or cold water. When residents cried that they were being scalded, their caretakers replied: "May you burn in the fires of hell."

One can't shrug off the images Kolbotek showed, or the admission of employees that the abuses have gone on for years. They add that all the institution's employees are well aware of it, but stay silent because a complaint could cost them their job. Nor can one remain unmoved by the hospital director's denial: she says she is unaware of any problem within the institution, and so does the Health Ministry.

If the filmed images raise suspicions of harm inflicted on dependents, under the law it is the duty of every citizen to file a police complaint, explained a ministry spokesman. The Health Ministry will support any measure that will assist in getting to the bottom of this matter.

Thus Kolbotek's cameramen will provide the help the ministry needs to learn about what is happening within its hospitals. It's an unfortunate state of affairs that the Health Ministry needs Kolbotek to learn about what is happening within its own quarters, but admittedly, it isn't exactly surprising. There is no way the Health Ministry could know that the elderly are being tormented at state hospitals (not, heaven forbid, at a private institution whose sole interest is to maximize profits at the expense of the welfare of its patients) if it does nothing to oversee, audit or learn about what is happening within the walls of its hospitals.

The Health Ministry runs 11 state hospitals, in addition to eight psychiatric hospitals and five geriatric hospitals. A total of 24 hospitals, with 12,000 beds, 24,000 employees and an annual budget of about NIS 6 billion. All of these are responsible to provide one of the most sensitive public services of all: the health, lives and mental welfare of the citizens of Israel.

This sensitive public role, which is also highly susceptible to bribery ('black market' medicine) within hospitals, is conducted far from the eyes of any inspector or auditor. There is only one single auditing office which provides for the entire state health system in Israel. This office includes the Health Ministry's internal auditor himself (Arieh Paz) and another four employees. These five persons are charged with supervising the entire vast state hospital system, in addition to many activities within the health ministry headquarters.

To drive home the point, the Clalit healthcare fund alone employees 30 internal auditors, and Clalit is, after all, a sort of private organization, not a government ministry.

The Kolbotek investigation demonstrates just how successful those five auditors are at supervising the activities of the state hospitals. If the Tirat Hacarmel hospital had an internal auditor, it is safe to assume the abuse would not exist, or at least, would have been discovered much sooner. It's safe to say that this would also have been the case in Shaare Menashe or Kfar Shaul psychiatric hospitals - two institutions where suspected abuse of patients has been reported in recent years. This is evidence, of course, that the Health Ministry has known for years about suspected patient abuse, in particular in psychiatric hospitals. But none of this has inspired the ministry to tighten supervision in these hospitals.

Just how closely five auditors are able to supervise the operations of all five state hospitals is reflected in the state comptroller report of two years ago: "The lack of internal auditing within the hospitals is inappropriate, since the Health Ministry's internal auditor's ability to audit all of the hospitals is limited." The state comptroller recommended that auditors be appointed to hospitals, and the civil service commission in turn promised to do so.

Two years have elapsed since the state comptroller report was published, and scandals have since been uncovered in two other state hospitals. The cost of an internal auditor in state hospitals remains unchanged as well: about NIS 170,000 per year. In other words, appointing 24 internal auditors for each hospital would have cost NIS 4 million a year, whichc ould have saved much money in uncovered inefficiency, corruption. Mainly it would have uncovered bad service.

The only problem is that the Health Ministry, with an annual budget of nearly NIS 6 million for its hospitals and another approximately NIS 1 billion for the ministry's headquarters, is unable to come up with NIS 4 million needed to act on the issue.