The officials at Ramón y Cajal Hospital admitted that they changed the waiting list behind the surgeons’ backs during a crisis meeting on Thursday, 48 hours after EL PAÍS reported the news about that controversial modification. The audio of that session, obtained by this newspaper, dismantles the accusation made by President Isabel Díaz Ayuso against surgeon Luis Alberto Martos, one of the four doctors who reported those alterations. “We agreed that the preferential priorities would become normal,” said one of the hospital managers, who defended that intervention as legitimate. The recording also exposes the poor state of public healthcare: few resources and unmet objectives.
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The case has caused concern over the possibility that waiting lists are altered to benefit hospital executives, who receive a salary bonus if they meet productivity targets. The changes affected 57 patients who had been classified by the surgeons as priority (to be operated on within 90 days) and who were downgraded by superiors to normal (with a longer deadline, 180 days).
The Madrid president has reduced the controversy to “a man manipulating medical appointments,” referring to Martos. For Ayuso, this issue that has caused public concern is “the bullshit of the week.” She made this statement on Thursday morning in the Assembly, despite emails and hospital documents contradicting her. Minutes before the president spoke, a crisis meeting of the service where the events occurred, the Orthopedic Surgery and Traumatology department, was held at Ramón y Cajal Hospital. Present were the two chiefs implicated in the changes, medical director Rafael Martínez, and the head of service, Basilio de la Torre, as well as a third who said he intervened, the hospital’s surgical deputy director, Enrique Aracil. Also attending was the doctor at the center of the storm, Martos, along with about fifty colleagues from that department.
The meeting took place before Ayuso’s words became known, but the day before the Health Minister, Fátima Matute, had made a similar attack against Martos. Additionally, both had tried to damage the surgeon’s image by recalling that he was accused of slashing the tires of his boss, de la Torre. The doctor had been legally acquitted of that accusation.
The audio makes clear that the three chiefs who addressed the group participated in changing the patients’ priority from preferential to normal. According to the evidence, they altered the severity of 57 patients. They claimed they had informed some doctors of the modifications, but not all, and defended that the changes were legitimate because, they said, some surgeons abuse the classification of patients as preferential. They also acknowledged that the team, which they compared to a machine, is “failing spectacularly” because it is unable to operate on those patients within 90 days, as established by the goal set by the Health Ministry. Furthermore, they denied that the reason for the changes was economic because they are far from meeting the target of timely operations.
Aracil explained that they made the changes because they had seen diagnoses of preferential patients that seemed incorrect. “After much consideration regarding fairness and such, and with the medical judgment of a traumatologist, who is the head of service, we agreed that the preferential priorities would become normal,” he explained to the team.
—You can’t change the surgeon’s criteria without consulting him— protested a specialist, Dr. Susana Alonso, Martos’s partner.
—It was changed because we couldn’t keep preferential patients with conventional diagnoses for 200 days, that’s a legal issue— replied the head of service, de la Torre.
—Did you inform the patient and the surgeon?— she insisted.
—I spoke with some of the surgeons, not all, with the head of the lower limb section and some others, some people told me, ‘look, I was setting it thinking it could be operated on sooner.’ The resources are what they are. The demand is very high and the resources I have are limited.
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“Kill the messenger”
A colleague of Martos intervened to request a denial of Matute’s accusations against the surgeon. “I don’t know if that deserves a public apology from management,” he said, “they accuse Dr. Martos of manipulating waiting lists to operate on easier patients, that’s not true, I believe it’s not true. And if the rest of my colleagues believe that’s not true, they should issue a note or a communication with the minister to refute that statement she made yesterday.”
Medical director Martínez rejected that proposal: “We are currently in a situation, as I told you, where this obviously has significance, which goes beyond the hospital, and from there there are political and media confrontations. I’m not going to enter into evaluating, denying, or affirming the minister’s statements, just as I don’t share what Dr. Martos tells me, calling me a liar several times, I don’t share it and I’m not going to discuss that issue.”
Instead, Martínez accused Martos of damaging the hospital’s reputation by reporting the situation to the press. “He crossed a red line” and added: “the step Dr. Martos took calls into question the hospital’s name.”
Outraged, Martos intervened to defend himself: “It’s a disgrace for you and for Dr. de la Torre who appear in the papers,” and added: “The culprit is you, don’t be mistaken. They are crushing me now because you have to kill the messenger.” He also recalled that he had been acquitted of the accusations of slashing the tires of the head of service’s car, de la Torre.
This chief acknowledged that Martos had been acquitted but added that he achieved that acquittal because he wanted to forgive him. He referred to not attending court on the day of the trial when he was supposed to ratify his complaint. “Returning to the waiting list issue, I am the main person responsible for whatever happens here and management knows that,” he said.
The officials also reported that an investigation is underway. Martos told them: “What are you going to investigate if you already have a culprit?”
Do you have something to tell? Write to the authors at s.castrogarciacomunicacion@gmail.com and fpeinado@elpais.es
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