Months-long queues to obtain a specialist visit, limited number of places at the hospitals, emergency rooms full of worries, operating theaters that were closed during the summer period due to staff shortages. The reason for it all is that “there are no more money”, the coffers are bare. And the organization of the Italian health system suffers: according to data of the Ministry of Health (collected via SIMES, the information system for monitoring the errors in Health Care) published in 2015 and referring to the previous years, in 26 cases surgical operations were performed on the wrong parts of the body. In 32 cases, the patient was the right one, but the procedures were incorrect. In 159 cases surgical material was forgotten inside the patient and a new intervention was necessary. There have been 471 fatal mistakes which have led to death or serious damage, 295 patients committed or attempted suicide, 135 cases of deaths or unexpected damages after surgical interventions.
Currently, the Jewish hospital of Rome is under heavy attack. It is charged with falsehood, and its executives and doctors are accused of fraud. According to police investigators, about 2,000 medical records were counterfeited between the years 2012 and 2013, so as to attest interventions which have been never performed. The estimated damage amounts to 7.5 million euros.
If we sum up to these kinds of episodes also the fact that managers of the local health authorities and hospitals are not controlled, administrative laxity, accounting errors, then the balance available for the improvement of the sector becomes “zero”.
And it is not a matter of minor instances of wasting. There are gigantic budget gaps which exist for decades without anyone noticing them. A symbolic case was highlighted by the Court of Auditors (sentence 912/2015, Sec. Judicial review of the Campania Region), in relation to the ten-year-long management of the local health authorities, which led to the creation of a 30-million-euros deficit due to double payments for the same interventions and other irregular accounting operations.
The reason for those mistakes is unbelievable: the judges refer to it as “serious disarray in the administration”. Nobody noticed the error, nobody controlled anything, nobody knew. And when some isolated directors tried to denounce the absurdities that were being perpetrated, the general response was indifference. This is how the health alderman Montemarano got into trouble, and 14 more people along with him: administrative directors, budget and final accounts managers from the economic and financial department, as well as the heads of the tax service, besides the various components of the local health authorities’ college of mayors.
To find out that millions of euros end up in illegal affairs is devastating enough – in a country where organized crime reached a point when it divides the territory into regions -, but to think that the same amount of money is being squandered due to inertia and unskillfulness is depressing. Those are not only journalistic considerations, but the words of the judges: “an extremely serious act of organizational and accounting disarray”. “It emerged – write the judges – that one of the main causes of the unutterable confusion found in the accounting, and the pathology represented by double payments, resides in the absence of a computer system capable of connecting directly all the cost centers of the structure, and in the abnormal confusion in the paper archive”.
Long story short, nobody bothered to fix anything, nor to consult other offices. Neither senior management nor the political interface had any interest in re-establishing order. Causing what in the sentence is called an “abnormal expenditure of public funds”. No “internal or external control of the lawfulness of the economic and financial management of the company”, with an inert attitude that has caused “a continuous worsening of the described state of serious inefficiency”. A slap in the face of the credibility of the Italian health care system.
Moreover, stress the judges, this ill-management developed “in a key sector, such as health care, with an immediate impact on the citizens’ fundamental right to health assistance”. The notorious financial difficulties which affected this welfare sector, seem to have imposed a higher degree of attention and commitment in order to prevent the squandering of resources that would have been inadequate even if nobody wasted them.
What now? It will be difficult to recover this money. In many cases everything lapsed. Thus, double income cannot be contested to organizations which have escheated them at least ten years ago; in other cases the objective inability to find the necessary administrative and accounting documentation was certified on record; still in other cases, the companies that had received double payment do not exist anymore. And it is highly unlikely that condemning 15 people involved to the payment of 30 million euros will actually lead to the retrieval of the entire vanished sum. Thus, the bad health care system writes yet another chapter of its saga, and, as usually, the citizens are the ones to pay for the book.