National tragedy - Romania’s closure of over 60 hospitals is a 'crime' staff say

Romania’s closure of over 60 hospitals between April and December this year is leading to confusion and tragedy for staff and patients. Report by Nicoleta Banila

In Baia de Aries, Alba county, the local hospital serves a remote rural community with a large psychiatric ward and 70 beds for inpatients, plus services for outpatients, paediatrics, a laboratory and radiology. The institution has run without debts and the next nearest hospital is over 25 kilometres away in the town of Campeni.
But Baia de Aries has shut its doors – one of 67 hospitals suddenly rushed in dissolution by a cost-cutting Government keeping to the terms of a multi-billion loan agreement with the International Monetary Fund (IMF).
“What they have done is a crime,” says Anca Ionela Nicoleta, manager of Baia de Aries Health Centre. “People will die because of lack of immediate attendance. The nearest hospital is 25 kilometres away and it will not be able to handle the extra flow of patients.”
Understood to be the result of IMF negotiations, Romania must reduce the number of hospital beds by 5,700 by the end of this 2011 to 129,500.
But this ‘bonfire of the beds’ is creating a backlash among staff and local councils.

No one from the Ministry came to investigate whether Baia de Aries was serving the community, while no successful assessment on whether these hospitals were providing for their patients took place.

The strategy of the Ministry is to order the closure without prior warning, then cut the financing for the hospital.

In Baia de Aries, the staff found out the hospital was closing from a report on television, which revealed that 67 hospitals are to be transformed into nursing homes for the elderly.

A few days later the hospital staff had to relocate severely mentally ill patients to another hospital in Campeni and send other psychologically disturbed patients back to their homes.

The Ministry is encouraging medical staff to relocate, but managers fear the nearest hospitals cannot absorb such a high labour force.
“Other hospitals’ budgets are too small and doctors would have to travel at least 50 kilometres to get to work on terrible roads,” says Nicoleta.

There is also a question over what will happen to the resources of the hospital. Baia de Aries has benefited from expensive medical equipment paid for by World Bank loans.

Its manager says that while the hospital was evacuated, all the medical equipment remained in place. “I never thought that one day, the Ministry would come here and evacuate our mentally ill patients,” says the manager. “We are a former mining town - the local council cannot afford to sustain us financially.”

The staff has received promises from the Ministry that “maybe” some of them can work in the new nursing home. But such a home will not need specialised doctors and none of the nursing staff are qualified to work in such an institution.

Nationwide cull

In its zeal to transform hospitals into nursing homes for the elderly, the Ministry is not informing citizens of the change in the status, leading to confusion and tragedy.

In Valcea county, a 42 year-old man died in font of the closed gates of the recently closed Balcesti Hospital, as the local community was not properly informed the hospital had shut down.

A 60 year-old man with chronic heart disease in Baneasa, Constanta county, was suffering chest pains and his family took him to the local hospital in Baneasa. Finding this was closed, they went to a local clinic for basic care. There they called for an ambulance to take him to the county hospital, which took 40 minutes to arrive. He died in the ambulance.

Romania is undergoing a massive transformation of its state healthcare system – but at a cut price. The Ministry of Health is shifting the responsibility for funding decisions and management of the majority of local hospitals onto local Government.
But while this decentralisation is taking place, Romania’s percentage of GDP spending on healthcare remains half the EU average of 8.8 per cent.
The Ministry’s decision to shut 67 hospitals, mostly in rural areas, increases the distance that a sick person must travel for care and puts pressure on regional emergency services, who cannot keep up with the rising demand.

Law-breaking managers

In this system overhaul, the Ministry is asking 670 doctors and 2,400 nurses to take new jobs in the old people’s homes, move to a new posting in a county hospital or move somewhere else in the country.

But many of the staff cannot find new positions. “The Ministry has created chaos in the medical system and people are left without work,” says Gheorghe Campanu, general manager of the recently shut Trusesti Hospital in Bacau county. “Our doctors had orders to receive a new job in an assigned hospital, but these hospitals’ managers refused to take them. Do hospitals now belong to the managers? Since when did public hospitals become privately-owned?”

From Trusesti’s 22 medical staff, only two gained new jobs in nearby institutions. “This is changing lives,” says Gheorghe. “If they are not accepted in their own county, they will have to travel a great deal and not all of them have cars or can afford to pay for transport.”
Trusesti Hospital had 55 beds, no debts also and served an area of 50 kilometres up to the border with Iasi county and now those who need hospitalisation must travel up to 90 kilometres.  “No one came to tell us anything about the reorganisation of the hospital into a nursing centre,” says Campanu. “Patients still turn up at our doors - but what can we say to them? We do not have any legal status now, as they shut down our hospital without putting anything else in its place.”

City sees rationalisation

In the richest part of the country - Bucharest - only one hospital is being turned into a care centre for the elderly - Caritas Hospital, founded in 1880 on Strada Traian in Sector 3.

The hospital had the largest maternity ward in Bucharest, with 2,500 births per year and over 20,000 patients. Recently it became a trusted centre for maternity, following last August’s fire in a ward for premature babies in Bucharest hospital Giulesti, where five newborns died.
“After the fire, mothers and newborns came to us,” says a member of the Caritas admin staff, who did not want to be named. “The same happened with different hospitals which had problems with ward infections or accidents.”

Most of the Caritas hospital was reclaimed in 2005 by the Jewish ‘Caritatea Foundation’, with Bucharest’s Administration of Hospitals and Medical Services in Bucharest (ASSMB) paying 4,000 Euro per month rent to the foundation.
The space that belongs to the City is the ward where newborns and mothers stayed. This annex will transform into a nursing home for the elderly, while the foundation will take back the rest.  “We did not dissolve the hospital, we relocated it,” says Marius Savu, director of ASSMB . “We want to keep the social role of Caritas by transforming it into a care centre for the elderly, as we could not maintain a hospital in the only building at Caritas.”
Three other Bucharest hospitals - Carol Davila, Malaxa and Panduri – will take on the duties of Caritas.
Savu admits that the total number of beds will drop and many of the personnel may not find work at other hospitals. He says non-medical staff at Caritas will stay to work at the new centre for the elderly. “ASSMB has assigned our medical personnel to three hospitals, but we still do not have any confirmation that they will be received,” says an admin staff member.  Staff are also angry that the level of communication has been minimal.

“In all this madness, everything was made only by words, we did not have anything written regarding the transfers or the patients or doctors,” says a member of staff. “The nursing home is a big and complicated investment, which will not be completed, because of bureaucracy.”
To transform a hospital into an old people’s home will take the authorities only four months, according to Savu.

Local councils retain power

However many local authorities, sensitive to the public outcry, are taking back ownership of hospitals.
After the death in Balcesti Hospital in Valcea county, local authorities decided to ignore the Health Ministry’s order and reopened the hospital. Five doctors who did not transfer agreed to work voluntarily. In Balcesti, local city councillors also supported mayor Ion Curelaru to keep the hospital, but the city hall budget can only support medical facilities and is seeking further solutions to pay staff.
Volunteer doctors are currently treating emergency cases, as the hospital provides medical services under continuous hospitalisation for acute illness for around 44,000 inhabitants.

As we went to press, two hospitals have been reopened by local authorities and another in Sarmasu, Mures county, was about to open.
But the dissolution of the hospitals is set to continue. Once the transformation of 67 institutions into old people’s homes has ended, the Ministry of Health will close down further hospitals by ‘merging’ the services of two. What is further worrying is how the Ministry is undertaking its assessment of which hospitals it will target. This is not based on the quality of the institution, but the type of services they offer and where the hospitals appear on a map.

Switching powers

In 2010, Romania’s Ministry of Health began passing hospitals from Government to local authority control. Bucharest hospitals were the first to be decentralised, with 18 hospitals now in the city council’s responsibility.
Until last year hospital buildings belonged to the local administration, while the Health Ministry appointed the hospital managers, creating a mixture of decisions which was not coherent.
However, through the local prefectures, the Ministry has decided to shut down 67 hospitals that were passed to local authorities and transform them into care centres for the elderly. It can undertake this by cutting the budget the central authorities grant to hospitals through the National Health Insurance system.

Some local councils have made readjustments to their budgets to support local hospitals, but now their efforts and investments are being ignored, forcing large numbers of people to seek medical help far away from their homes.