Tuesday, 4 February 2014

Hadassah in Crisis

It’s been a long time since I wrote anything, and in truth that was because life has trundled on, at a pleasant enough pace, with nothing hugely eventful to describe.
But today some strange things have been going on at Hadassah Hospital, so here goes:

Last night it emerged that the Finance Ministry has applied to the courts to put Hadassah into some sort of administration.
All Hadassah’s debts ($200m of them) will be cancelled. That’s the good news.
The bad news for us is that those debts include the salary they owe us for our work in January. In other words, we won’t be paid for this past month.
They also will enforce a 10% pay cut on all doctors, nurses and non-clinical staff. The pay cuts are likely to be even higher for doctors who do private work in the hospital.

As a result, the doctors committee declared a strike: from today we will reduce to weekend skeleton staffing levels, with operating theatres only doing emergency, cancer and obstetric surgery. Even that work is likely to be unpaid, with no guarantee that the “weekend” on-call team will ever see any salary for their time.

The impact on Jerusalem could be bad. There are three hospitals in West Jerusalem – Hadassah Ein Karem (the big teaching centre to the west), Sha’arei Tzedek (towards the centre) and Hadassah Mt Scopus (near East Jerusalem). Two of those are Hadassah owned and affected by the strike. That means that the only hospitals providing neurosurgery (including neurological major trauma), plastics and burns, liver transplants and whole bunch of other services, for the 1.2m inhabitants of Jerusalem plus significant amounts of the West Bank, are going to be effectively closed.

That’s the objective facts.

The question is how did we got to this situation?
Over the last few decades Hadassah has been haemorrhaging money, especially after negotiating a very bad deal with the HMOs for reimbursement. We just about survived due to the generosity of the Hadassah Women’s Organisation in the US. But after Madoff the HWO said they could no longer support our running costs and we started running up debts.

Last spring our Chief Exec resigned and a new guy called Avigdor Kaplan arrived. As far as I could see he acted decisively, proposing voluntary 5% cuts in salary for all employees to save the hospital, plus the loss of 200 jobs. The doctors committee reluctantly agreed; the nurses agreed to 2.5%, the workers committee (non-clinical) refused and went on strike. During that strike the picketed the hospital and even physically assaulted doctors who crossed the line to treat their patients.

It was clear there would be repercussions, and since then we have had several months were we were paid 80%, 50% and 50% of our salary on time, with the rest arriving later. But it always arrived.

No we are in a position where even that may not be happening.

In addition, Hadassah doctors had various forms of grant money held in hospital bank accounts. That includes research grants, personal grants awarded to Junior Doctors from the government, and funds from private practice. All those grants have recently been simply taken by the hospital into the central pot.

What about the future?
My fear is that the government will consider the things that make Hadassah great, to be non-affordable luxuries. Things like support for research, both financial and in terms of flexible working hours; good salaries (many doctors earned better than they would in purely government hospitals) etc.
These (especially the research) were also the reasons that I chose Hadassah over other hospitals.

Hadassah used to be known to be the best hospital in Israel by a mile. The heads of every anaesthesia department in the country were trained at Hadassah. That reputation has been slipping for close to a decade, and we now have very stiff competition from a number of places, but we felt that with determination we could regain/retain the top position.  However there is a real risk Hadassah may be stripped bare now, and become little more than a DGH.

That would be a shame for everyone.

For the moment we have been asked to remain loyal to Hadassah, and I will respect that request. I’m in the fortunate position of not having a family to support, and not having to worry about where my next meal will come from. But having said all that, when I moved to Israel, I came to the best place I could find to learn anaesthesia at the highest level Israel could offer, and perhaps contribute to medical research at that centre. If Hadassah ceases to be that place, a lot of us will start to wonder if our dreams can be fulfilled elsewhere.

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