Hospitals throughout country pull vital services due to doctors’ overtime ban

Situation described as “desperate” and “unprecedented”

The break-down in negotiations between doctors’ syndicates and the government is now affecting State health service users in a way never before experienced. People are dying needlessly: every day there is another story of ‘a tragedy’ failed by the lack of response by emergency medical personnel, or by the fact that the necessary service was ‘closed for the day/ night/ weekend’.

If nothing is done to stop the doctors current ban on overtime beyond statutory limits (of 150 hours per year) around 25 hospitals will fail to ensure emergency care in the next few months, writes Expresso today.

Already 27 hospitals are struggling with what national media terms ‘constraints’. The situation in 11 of them is “desperate”, writes Correio da Manhã today.

When one refers to ‘ensuring emergency care’, this is not about having an orthopedic specialist available when someone falls out of a tree; it is about having cardiologists available when people have heart attacks; obstetricians when a pregnant woman goes into premature labour, or suffers some other complication; intensive care specialists when someone arrives in a critical condition.

President of the Order of Physicians Carlos Cortes has termed the current situation in Portugal as one of “imminent catastrophe”: the country’s SNS State health care is hanging by a thread, and in Cortes’ view, the government is showing “a great lack of sensibility and good sense”.

This morning things may change: Cortes is getting the ‘urgent meeting’ he requested over the weekend with health minister Manuel Pizarro, and it is generally understood that he will try and force the latter back into negotiations with syndicates.

Expresso explains the government “put an end to negotiations” last month, moving unilaterally with alterations to the functioning of the State health system (without doctors’ blessings).

In other words, having ‘presented’ a whole new tier of management only a year ago (involving legions of paid staff in no less than five ‘bodies’ see further details below), the ministry has actually moved into stark new territory where nothing is working as it should.

The reason doctors did not accept the ‘alterations to the State health system’s functioning’ is that, in the small print promising large increases in salary, came the reality that they would have to work “a brutal increase in statutory overtime” (Expresso’s description) – 250 hours per year, instead of the current 150 (which almost every doctor has already exceeded).

Claiming they are already exhausted and can’t do any more, this is the reason why doctors rejected what they call the ‘poisoned gift‘, and why they went ahead with a protest that is paralysing emergency rooms up and down the country. 

“Pizarro doesn’t hide his concern and recognises the “very painful” situation experienced by the doctors. But he has already confided that his hands are tied by the financial corset”, writes Expresso. 

Only António Costa will be able to force finance minister Fernando Medina to open the purse strings, allowing raises to the medical profession without forcing doctors to do extra work.

“And the right time is now, when the government is finalising the “most important budget of the mandate”, says Expresso. “Among priorities is debt reduction, an area in which the Finance Minister has reason to boast: Medina is one of Europe’s ‘savviest’, achieving the third lowest deficit in the eurozone this year. The problem is that “there is more to life than the deficit” – the famous phrase never uttered by Jorge Sampaio, which has become a slogan against austerity. 

“Faced with the closure of hospital emergency rooms, it is the health of the Portuguese people that is at stake”, the paper concludes.

Heart attack victim dies after INEM fails to attend emergency call… due to lack of doctor

Another citizen has died following ‘the lack of support’ by medical emergency services. This latest tragedy came in the district of Guarda on Monday and involved a 53-year-old man out walking with his wife in Serra da Estrela who suffered a heart attack. His wife made the emergency call at 1.45pm, writes Correio da Manhã, but the INEM life support vehicle requested “did not respond as it was inoperational between 2pm and 8pm due to the lack of a doctor”.

Local firefighters ended up attending the call, but what was needed, says the paper, was a “differentiated medical intervention that did not exist”.

“The man was unconscious. We started basic life support measures. In the face of the lack of availability of a VMER (the specialist INEM life support service) we were instructed to transport him to hospital Sousa Martins”, firefighter commander Paulo Sequeira told the paper. In spite of the crew’s best efforts, the man’s death was declared at the hospital.

The next day, Guarda district suffered another two hours without VMER support, this time due to a technical fault of the emergency vehicle.

The ‘crisis’ within INEM support is another aspect of the unravelling of services in Portugal’s beleaguered State health service. Almost exactly a month ago, entities providing emergency medical care stressed that it is not a question of the right to health being at stake, but the right to life.

Meantime, the crisis in the obstetrics department at Lisbon’s Santa Maria Hospital has seen seven obstetricians resign, with the “strong possibility” that more will follow.

Luísa Pinto, the former director of Obstetrics at the hospital, has been heard in the parliamentary Health Committee at the request of the Bloco de Esquerda party, and she has explained how this dismal situation seems to have come to pass.

Says Lusa, Luísa Pinto said that she had “no party affiliation or political ambition” and that she had conscientiously agreed to attend the hearing “in defence of truth and justice”, thanking Left Bloc MP Isabel Pires for the opportunity to present the reasons for the “difficult and painful decision that the doctors were actually pushed into” following a decision by the relatively new ‘second management tier’ of the SNS health service, the so called “health service executive board”.

“It’s somewhat comforting to realise that there are those who are concerned about understanding how, in a short space of time, in two months, what was a service of excellence among the largest obstetrics services in the country, not only in quantitative terms, but in terms of quality, whether clinical, scientific or teaching, and a service of national and international reference, has become a deserted service and, I would say, on the verge of extinction,” she stressed.

Luísa Pinto said that she had asked each of her six colleagues to send her the reasons for their resignations following the process of transition of health professionals from the Hospital de Santa Maria to the São Francisco Xavier “for what I would say were, to say the least, questionable reasons”, during which “the Board of Directors, the Executive Board and the minister of health failed to address the doctors’ concerns regarding the safety of professionals and users in this transition”.

The doctor, who is still working at Santa Maria, said that these organisations had “always been intransigent in the way they articulated and timed this process, without adequate planning and without taking into account consequences that could follow.

“From a voluntary departure, it became an imposition by ministerial order,” she said, adding that the first reason given by the doctors for their decision was the resignation of the directors of the Obstetrics department, Diogo Ayres de Campos and herself, which was considered “deeply unfair by the entire team” that was “fully functioning” and that “saw themselves in the leadership that they had”.

The second reason given by practically all the doctors who resigned, she said, “was the lack of organisation, the chaos that was installed in the service from the moment these resignations took place”, with emergency schedules going out two, three days in advance of the following month and “with holes”, which she said led to “a total impossibility of organising” personal, family and even professional life, “because it is impossible to schedule appointments, surgeries, whatever”.

“In view of this, the members who resigned felt that they could not go along with this lack of security, which not only means enormous anguish on a day-to-day basis for those on the ground, but which, above all, is a situation that involves extremely high risks of having dramatic consequences for our pregnant women and newborns. Therefore, we can’t go along with the idea that we need to keep delivery blocks open at all costs, but rather that we need to keep the delivery block open with due safety.”

Finally, Luísa Pinto asked who will remain when “the rest of the people who have resigned” leave – noting that there are three obstetrics specialists left. Who would be left to train the interns who “feel enormous anguish over this whole situation”, she queried.

“At the moment, there are interns without tutors,” she warned, not believing that “there will be enough training capacity in a few months to ensure quality training for the interns.”

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