"The priority on waiting lists cannot be changed without a medical reason"

BarcelonaChanging the priority with which about sixty patients were to be operated on, without informing them or the doctors who had determined the maximum deadlines for entering the operating room, with the aim of doctoring the waiting lists. This is what, allegedly, has happened at the Ramón y Cajal Hospital in Madrid. Faced with these facts, the Minister of Health, Mónica García, asked the Community of Madrid to clarify the "apparent alteration of the waiting list data" and demanded guarantees in the control and veracity of the records. The news has set off alarm bells: Could there be more centers modifying the number of people pending an intervention, bearing in mind that for years they have been one of the great challenges of the health system? Could it happen in Catalonia?

"The priority is what it is and cannot be changed without medical reasoning, it is common sense. This does not happen in Catalonia, unless there is a consensus with the professional when the surgical activity is scheduled," assures the director of the healthcare area of the Catalan Health Service (CatSalut), Ignasi Carrasco, to ARA. The law sets maximum deadlines for performing operations that have been decided based on the severity of each disease and its repercussions on the patients' lives. Health centers must adhere to these deadlines to attend to patients within the indicated time and when someone waits longer than what the law determines, it is considered that they are past the deadline.

For example, a malignant tumor must be operated on within a maximum of 45 days; the obstruction of the blood vessels that supply blood to the heart, within a maximum of three months, and a knee or hip prosthesis must be placed within a maximum of six months. What allegedly happened in Madrid is that 57 patients waiting for orthopedic and traumatological surgeries at the Ramón y Cajal were changed from the preferred priority –which requires that they be operated on within 90 days– to the normal one, which extends the margin for performing the operation to 180 days.

Carrasco explains that access to patients' medical records to modify this priority "is highly regulated" in Catalonia. "You cannot enter if it is not for a legitimate reason; it is a control mechanism. A person's priority is not changed to achieve the ministry's objectives," he assures. The director of the CatSalut healthcare area explains that audits are also carried out and waiting lists and their compliance are reviewed, and that if they are modified, it is always done in accordance with a doctor's professional criteria after evaluating the patient in question.

Transparency in the lists

Following the scandal in Madrid, García has brought back to the table the project, which the autonomous communities rejected, to establish new criteria for transparency and traceability of waiting lists. The goal was to unify the way health data is collected and communicated by all autonomous governments, as they are responsible for health competencies and, until now, each one does it in a different way. In this sense, Carrasco asserts that there are autonomous communities that do not register patients on the waiting list until they are in the preoperative phase or that delete people from the waiting list when they are referred to the private circuit.

This causes territories like Madrid to have lower figures than those of Catalonia, despite having a similar volume of population. “We defend that one must be as exhaustive as possible because it is a right of the citizenry, one must be transparent,” defends Carrasco, who explains that Catalonia always has more patients and longer waiting times than other autonomous communities because a more intense exercise of transparency is carried out. “We declare everything,” he maintains.

The area of waiting lists is not the only one affected by the differences in the notification of health information between communities. The notification of infections and deaths related to covid also caused an uproar, especially on the part of Madrid, and from the Health leadership –then led by Junts– it was reproached that the ministry was not more demanding with all the autonomous governments so that they would report more complete data. A criticism also made by the Madrid health sector, for example, when it denounced a "data makeup" that minimized the impact of the pandemic in the territory by its administration and which, in contrast, penalized Catalonia informationally, since it notified many more.