Doctors Sitting on Time Bombs and Majority Might Lose Jobs to Hospital Reforms

Nona Suvariani,
Eka Kevanishvili

Journalistic Survey

Part III

Prior to the implementation of the reforms in medical sphere a serious campaign was launched against medical doctors. Everybody should recall the information that was constantly being delivered each and everyday Georgian TV Stations. Various doctors were being blamed for the death or mistreatment of their patients. Doctors claim that similar incidents are not rare but this information was announced publicly when it became convenient for the vested interests of some. 

Explains Davit Saganelidze, former MP, and former member of the Health Committee of the parliament. “The project aims to reduce the number of nurses, orderlies, watchmen, lift-attendants, etc. If doctors protested the reductions, then certain people would blame doctors for having done their utmost to mistreat people and patients. Thus, accidents in hospitals were announced on almost a daily basis. And those people who had no connection with medicine would think that every doctor is a very nasty person. While, there is no hospital which has not recorded instances of patients having died. Lado Chipashvili, former Health Minister, was responsible for such a concerted initiative and he told how he would not show any mercy towards any doctor, and that he would punish them for their malpractice. However, these loud statements proved false in the final analysis. I doubt there was some other initiative behind his statements and soon Kakha Bendukidze, former Minister of Economic Development, initiated a new hospital development project; this person is interested in the real estate business.”

Looted Cardiology Institute

144 employees of the Cardiology Institute have been on unpaid holiday for two years. In fact they have actually lost their jobs. Only two floors are still functioning in the looted and half-destroyed building that houses the institute. This institute was one among of the 100 hospitals of under the state program. “Bloc-Georgia” the winner of the tender, is now in charge what to do about the future activities of the Cardiology Institute. The company actively invests sums in medical field. This is the same “Bloc Georgia” which has already constructed hospitals with modern standards in Zugdidi and Kutaisi, two regional cities.

Lali Chavchanidze, one of the doctors of the Cardiology Institute, stated they were provided with a resolution from the institute when Giorgi Arveladze who was the Minister of Economic Development at this time. According to the resolution, a new hospital that was equipped with modern state of the art equipment was to be constructed in its place, and there would be at least 190 beds, and this was all to have been completed within 19 months, which would have the process finished by February of 2009.

Before the hospital was sold off, the Minister of Healthcare started renovation of the building and in August of 2006 gave unpaid holidays to the personnel of the institute. Doctors have not been able to fully understand what the investor really has in mind as relates to the hospital where they work, nor do they have any clue of what will the future of the Cardiology Institute. Dodo Bakhradze said they have not received any concrete answer to their questions from any governmental institutions as of yet. The Health Ministry sends them to the Ministry of Economic Development and in-turn this ministry then sends them to the investor. Many letters were submitted to various governmental agencies in seeking out answers to many questions.

“As far as we know, the “Bloc Georgia” satisfied the requirements of the tender and is to invest 13 million GEL. The Company promised us at the time when Lado Chipashvili was the health minister that the proposed renovation would finish in September 2007. Then Davit Tkeshelashvili was Health Minister who told us he was no longer responsible for our institute. However, by this time, the hospital had already been sold. We then opened correspondence directly with Bloc Georgia, as we did not know what to do or just how long was it possible for our furlough to last? In addition, the board of the building company “Libo +” (started to implement repair-works in the institute under the Health Ministry’s directions) and they had a financial disagreement with Bloc Georgia. The argument has not ended yet and we, the physicians are the victims of their quarrel.”

Doctors state that the repair-works started with tearing out and the rebuilding of the walls. The sanitary equipments were not changed; the water supply bill reached huge figures because the water was leaking. The electricity bills also reached enormous sums because, as doctors claim, the workers lived in the building of the institute all through the winter together with their families.

Besides Bloc Georgia, Cardiology Institute has one more interested investor-Pharmaceutical Company “Aversi”, and as doctors recalled, one year ago “Aversi” has requested information about the institute, especially about its management and asked questions about salaries in the proceeding three years.

The medical personnel fear that if Aversi enters the institute and that means the company will introduce only their medicines for sale at the hospital. The same happened at the Tbilisi Hospital # 8 where representatives of the Aversi stated to the hospital personnel not to use any medicines that were distributed by the pharmaceutical company PSP. The employees of the Cardiology Institute have this information from their colleagues from other hospitals and consequently, they are sure the PSP will do the same at it own hospitals.

“It is a fact that such things are freely spoken about in public but it is factual. The pharmaceutical mafia is the biggest one that exists in the world and it is rather strong in Georgia,” said Lali Chavchanidze.

Tsira Kristesashvili, Keti Vakhtangadze, Diana Baghaturia and other doctors state that they intend to appeal before the court and will ask for monetary compensation for their lost wages and other perceived damages.

“Who will reimburse these two years? They have breached the rules of our labor contracts. We were forced to sit at home unemployed and nobody even thought to reimburse our wasted time.”

National Center for Ophthalmology and Neurology

The eighth lot included National Center for Ophthalmology and Neurology (NCON), Tbilisi Shalva Koridze Maternity House and Center for Plastic Surgery for Thermal Injuries. Nino Dugladze, doctor for the NCON, recalled that the employees of the ophthalmology learned about the competition on June 8 from the announcement published in the newspaper “24 Hours”. The competition was held on June 21. Thus, the announcement was published two weeks before while the Law on State Purchases states that the announcement on the tender shall be published twenty days before the fixed date of the competition. They have since made this and other violations known and hospitals and the provider of the tender information did not provide any responses to the addressed concerns.

Nino Dugladze: “If we had known about the competition a month earlier, we would have been more proactive and found reliable partners. By the way, Misha Omiadze, the former director general of the center attended the competition along with some of his companions and they were not allowed to participate in the tender.”

As a rule, New Hospital, Aversi and PSP took part in the tender on June 21. However, the tender finished with unexpected results and a completely unknown person, Kakha Gelashvili, and a firm “Unimshen” were successful in the competition (see part two of this series of articles).

Nino Dugladze recalled that after the tender Kakha Gelashvili rushed into the center and started shouting at personnel to leave the hospital because it was his property. The personnel of the hospital became nervous and decided to find out who was this person.

“We found out that his father, Komina Gelashvili, was undergoing medical treatment at Neurology Institute and this care was being covered by a medical policy, and that his mother was also being treated at the Hospital # 8 with the support of the same or similar kind of medical insurance policy.”

As for financial guarantee of 16 million GEL, later it turned out that this person had not provided any documents from any bank which was a requirement to take part in the tender. Each applicant had to provide a letter of guarantee in the amount of at least 2, 250 thousand GEL. Each applicant had similar letter but that person had the document issued by the People’s Bank and it expired within three months. If two applicants offered the same sum, the winner would be that who promised to complete the stipulated repairs in shorter period of time. Kakha Gelashvili had requested 23 months to carry out the renovation works but 16 million GEL was only verbally offered. According to the law, Gelashvili had to provide the letter of guarantee from any Georgian banks within the period of a month. However, in spite of such a requirement, he failed to provide any documents within the span of two months.”

In short, finally medical institutions with its garden on very prestigious place of the capital have been transferred to a person who is a complete stranger to the government.  Moreover, Kakha Gelashvili has not denied the fact that his parents had been receiving treatment at the hospital under the financial support of an insurance policy. “I did not have money for their treatment and what should I have done under the circumstances,” he explained.

Finally, on October 15 Kakha Gelashvili sold the hospital to the company “New Hospital” for one thousand USD.

Every document mentioned New Hospital, the branch of the PSP and later, PSP appeared in the official documents. However, Kakha Okriashvili, the founder of the PSP stated that the clinics actually belonged to him.

Kakha Okriashvili was a member of the Georgian parliament and he was very close to the authority when these tenders were organized to buy up various hospitals. His active participation in the process was in contradiction to acting legislation. Thus, he refused to comment… later, however, Nika Okriashvili, his brother became an official owner of the mentioned clinics.

Nino Dugladze: “Initially we could not make out anything as what was happening.  Initially they told us that the New Hospital and PSP are together as one. We did not see Mamatsashvili, the head of the New Hospital, and only the Okriashvili brothers were coming around.”

Since PSP was in procession of the Ophthalmology Center and this second company decided to implement some policies regarding hospital staff and this action was in complete contradiction to what was intended in the reform.”

Professor Mikheil Omiadze, former director general of ophthalmology: “They did not show or provide us with any documents. They just came and showed the document of permission that covered the management of the property. Our lawyers claimed the document had no legal force. The Contract of Responsibility generally consists of 100 pages and its conditions provide the information about the activities of the company. After the document was drawn up, the countdown of the 23 completion date started. Mr. Okriashvili came to the hospital and told about holding a meeting and how it was necessary to start renovation work because the deadline to complete the work was approaching and the time clock had already been switched on.

He also said that their organization is a kind company, and if the personnel received only 40 % of the income during the previous board, now he promised to pay 90 %. However, later on we found out that after covering communal expenses each month that 90 % was just 2 GEL for each physician.

In addition, there is another problem that must be faced. The company has many debts and these total more than one million GEL. We are obligated to pay off those debts. This money must be reimbursed and consequently, the doctors will be effectively tied up to the radiator and made to work very hard.”

Mikheil Omiadze stated there are fields where private investor cannot profit from anything. Thus, the investor will resolve the problem by closing down the operation. The doctor added that if these processes continue in such a way, people will be forced to travel to Azerbaijan in order to have an appendix operation.

The controversy between the personnel of the Ophthalmology and company started in June. The personnel of the hospital sent letters to almost every minister who was directly or indirectly connected with a solution to their problem. However, they didn’t receive any adequate answers to their questions in spite of all their efforts. The only reply was an explanation of the Health Minister which stated they had no right to interfere in the disagreement. Thus, the ministry was able to get rid of all the possible responsibilities for protecting doctors and left them in the hands of the company to sort it out.

“They promised that nobody would lose their jobs; they even stated that the hospital would need additional new employees. However, according to the resolution signed by Nika Okriashvili, a total of six doctors were dismissed. Employees of the financial department were also oppressed and they were threatened with immediate dismissal if they refused to follow orders. The company was able to gain control of management tools without any agreement, which is a violation of the law. The entire administration was terminated and now the administration does not participate in any on-going process at the hospital. The owner also abolished the position of director general. Nika Okriashvili created his own position, public director,” employees of the centre have discussed these problems at meetings that were held in March.

The administration was very rude in its behavior towards the doctors. On March 8 (international women’s day) Nika Okriashvili even insulted women. At this time Kakha Okriashvili had visited the hospital. He and his brother appeared there as his brother was involved in some disagreement with the personnel.

There is an additional interesting fact to mention since PSP became the owner of the Ophthalmology Center; Okriashvili mortgaged the hospital. Evidently he decided to use the loan to carry out the repairs on the building.

Wolves on Doorstep of Maternity Hospital under Hospital Reform Project

PSP took control over the Maternity Home # 4 the same as it did the Ophthalmologic Center.  The staff of both medical institutions has since experienced serious problems with the new administration. The administration of New Hospitals decided to establish their office in the Maternity Home. Consequently some doctors lost their chambers as a direct result. The Maternity Home staff then went and spoke to the Human Rights Centre about their problems and this was during a meeting that was held several months ago. The medical staff had stated at the time that the so-called reforms were absurd and the problems should be solved through public demonstrations.

They evaluated the hospital layouts in negative light and considered that some private interests must have been involved in the process and how things turned out.    

Sasha Palavandishvili, doctor: “The government has not invested even a tetri for 20 years in this hospital. Everything was done with the money of the medical staff. Now they just turnaround and give the hospital to one person for a mere 1,000 USD. They could have sold the hospital to our staff and I ask you why did they choose to not do so?”

The doctors are convinced that the hospitals were given to these companies because government was indebted to them. The companies had funded National Movement’s pre election campaign and now is the time for political paybacks and that is how they were able to buy up the hospitals a rather cheaply and for a real bargain.

“It is clear that the investor did not have any respect for the doctors, as they proceeded to kick the doctors out of their chambers; they claimed that they needed these rooms for themselves. I have no cabinet to have some rest and some people are now repairing chambers for their own use.”

They are misanthropic cynics who show general dislike for everything and everybody.  If they do this once and get away with it, than they will never stop; they will come after everyone of use and that’s more the reason why we must stand beside each other.”

The doctors say that they are forced to sign 2-month employment contracts in order to be paid their salaries, which means that the employers will be able to easily dismiss them.

“When we turned to lawyers for help they told us that the Labor Code of Georgia effectively ties the hands of employees. They said the contract has no force and the labor code stands above the contract. However, in spite of this, there is no point in fighting.”

Maia Machavariani says she can’t make out why would a maternity home that functions normally and has stable income and patients need an outside investor.

The doctors emphasis that maternity homes are extremely important for the sake of the country, as there is a demographic problem; they consider there should be a state operated maternity home, which will only partially work on a profit motive, and that it should still be able to offer high quality service and be equipped with normal technology and staffed with professional human resources. 

The staff shares some of the instructions that they received from the hospital administration.

“Look at patients carefully, if you notice that they will not be able to pay, than do not accept them as patients. How can birth-rate in Georgia increase in this situation? They tell us that we must accept women in childbirth only if they are in a very critical situation. Those who need help, medical examination and therefore large hospital expenses, must not be accepted as patients. When a woman finds herself in such a terrible situation she won’t wish to have more children, especially when she is forced to visit several hospitals in search of normal conditions, and why should she have to be worried about administrative problems.

The same happens in Gudushauri Clinics. The intensive care department has been transferred from the clinics. Patients have to wait for days and even for weeks to be transported to the recovery department. The have created some kind of monster entity and now they have no beds to place patients.”

The medical staff states that PSP bought only an ultra sound apparatus for the maternity home. However, they say this does not serve any significant purpose. 

Doctors

The majority of doctors negatively evaluate the general plan for the reform and development of the hospital sector.

The medical staff of Maternity Home # 4 states that there is no need for the construction of 100 new hospitals. They say it would be better if the old ones were just managed better; they also note that it is impossible to build 100 hospitals in just two years.

Sasha Palavandishvili: “The program for the construction of 100 new hospitals is merely a bluff and they are simply making some minor repairs and pretend that they are doing something more.” 

It is unacceptable for the doctors that pharmaceutical companies have bought hospitals.

Sasha Palavandishvili: “There is no international precedent of pharmaceutical firms purchasing hospitals, which is a substantial violation. They will sell their own medicines in hospitals and make millions of dollars. I demand that someone eliminate this program.”

Misha Omiadze states that if the hospitals are to be transferred to pharmaceutical companies it would be on the same level of handing over a flock of sheep to the care and safekeeping of a pack of hungry wolves.

“We were unable to conduct surgical operations as some medicines and disposable materials, as well as equipment, came from another pharmaceutical company, which is a rival company to the PSP chain of drug stores. 

The problem of increased prices on drugs is rather pressing. Though the prices have increased only recently, the problem has already had an impact on the hospitals. It is forbidden to use the drugs of rival pharmaceutical company in these hospitals.

Misha Omiadze: “When an investor spends 102 Million GEL on a hospital and then it turns out that one department, for instance Neurological Department is non-profitable the investor tries to gain money by increasing prices on the sale of drugs. The investor will not have any other option to turn a profit. In short, there should be law forbidding pharmaceutical companies from buying hospitals.

Another important problem is dismissal of doctors. Here is the related statistics: there were 20,555 doctors in Georgia in 2006. Other medical staff equaled 20,169. If we assume that only 100 doctors-maximum will be employed in each hospital, only 10,000 doctors will be abke ti keep their positions in the final analysis, which means that the majority of doctors will be find themselves jobless.

The doctors highlight this problem. 

Nino Dugladze: “PSP bought 3 hospitals in fact: Burn Center, the National Centre for Ophthalmology and Neurology and Maternity Home # 4. In total 771 people work in these hospitals. The PSP administration now states that they will build multi-branch hospitals that will have only 150 beds. Everyone understands that there won’t be enough places for 771 staff members to continue working. Consequently, the mass dismissal will be inevitable. “PSP states that we will have to pass qualifying examinations. A private company has no right to that and how can I take an exam from a teacher? They have taken all functions from the Ministry of Healthcare and now they are able to everything that they want.”

The doctors have been waiting up to now. Some of them still want to continue court dispute.