Rafik Hariri Hospital: A Fatal Case of Corruption
By: Rouba Abou Ammo
Published Friday, August 10, 2012
Beirut’s main public hospital is running out of the most basic items, putting the lives of its patients at risk, despite repeated infusions of cash from the government.
A visitor to the Beirut Governmental University Hospital (BGUH) – also known as the Rafik Hariri University Hospital – will quickly realize that its crisis has not ended even after the 6 billion Lebanese Lira (LL) ($4 million) loan it received from the Ministry of Health about a month ago. But the crisis would not be resolved even if another loan of the same amount were granted. The hospital’s budget deficit has become so large that these loans would barely “cover employees’ salaries,” according to one of the nurses who works at the hospital.
General director of BGUH, Wissam al-Wazzan, insists that the administration managed to cover basic shortages. A tour of the hospital, however, reveals that patients’ health may be endangered.
When the hospital was established on 28 March 2005, it was meant to be a large public facility, a university hospital, and a destination for critical cases. It was considered to be one of the largest hospitals in the Middle East. Most of its patients come from deprived backgrounds and are treated at the expense of the Ministry of Health.
But former prime minister Rafik Hariri wanted it to become a destination for medical tourism, especially for Arabs from the Gulf, according to former MP Ismail Sukaria. Hariri’s wish, however, was not fulfilled due to the lack of monetary resources and the discovery that it is impossible to “combine patients in private and public healthcare,” according to Wazzan.
Only seven years since its establishment, the hospital seems run down. The smell of cleanliness usually discernible in large hospitals is absent from the BGUH. Everything here needs either servicing or replacement, from the floors to the beds and the equipment.
When employees are asked about problems at the hospital, they ask, “What’s there other than problems?”
The emergency section still suffers, even after the loan, from a lack of soap and napkins. The head of emergency, Fathallah Fattouh, says that sometimes he has to check the bathrooms himself. Employees speak of shortages in medications and medical supplies which sometimes compel patients themselves to provide them. Fattouh says that some patients are referred to other hospitals to undergo imaging procedures “because our machines break down.”
After salaries, air conditioning is the second most common complaint voiced by employees. It is one of the largest hospitals in the Middle East and it has no air conditioning. There are fans everywhere. Nurses warn of the dangerous repercussions in terms of patients developing infections. Three out of every four AC units do not work. Employees and patients are often forced to buy fans. While Wazzan says that the AC only stops when there is a power outage, the employees say that at certain times, operations are performed without having working AC.
Some patients bring blankets and pillows with them. Shortages in medication and supplies are ubiquitous. On 6 August 2012 only one kind of Intravenous therapy (IV) liquid was delivered to the hospital. It is being used by nurses with the approval of the supervising physician for all kinds of cases even though it could be harmful to some patients.
Minister of Health Ali Hassan Khalil, under whose guardianship the BGUH falls, spoke of practical steps to avert a new disaster such as programing a payment mechanism to guarantee the continuity of salaries and supplies, in addition to putting together a new administrative team.
If the crisis at the hospital now is the worst it has been through, it is definitely not the first. The difference is that in the past, loans were granted swiftly to save it. Today, the situation is different.
The hospital’s situation is becoming critical. No gauze, no sterile wipes, and no gloves. Basic supplies, that any family has at home, are lacking. Some nurses have had to use toilet paper to stop the bleeding after giving an injection.
The hospital’s budget deficit has now reached LL100 billion ($65 million). Additional loans from the Ministry of Health amount to little more than a sedative. What is the reason behind this runaway deficit?
The narratives vary but corruption seems to be at the heart of the matter. When Karim Pakradouni was minister of state for administrative reform in Hariri’s cabinet in 2004, he said: “Rafik Hariri created this hospital project for political and electoral reasons and for the benefit of the Sunni sect in Beirut. I asked in the cabinet for a report about the money spent on this project but until now my request has not be granted.” Suspicions were sown on that day, even before the hospital opened its doors.
“Corruption” gnaws at the hospital as the stories related from the patients and the staff – some of which are documented – indicate. But Wazzan rejects such talk. His conviction, which he repeats without hesitation, is that there is absolutely no corruption at the hospital. At times, he does concede to realism and supposes that there is a little bit of corruption that some people might be responsible for, but this “little bit” does not have an impact.
“Since the hospital was established, those in charge of it and entrusted with it have treated it as the perfect place to make commissions and engage in corrupt behavior, take my word,” Sukaria counters.
The current situation, according to Sukaria, is one where “patients in the emergency room go through a lot of trouble to receive care.” He points out that “when the classification committee came to inspect the hospital last year, management rented ACs for $75,000 for the day, only to return to fans later on.”
Add to that “the lack of medication and charging patients for them, not to mention the theft of expensive medications by some doctors...and giving patients half the prescribed dosage in order to sell the other half, with the excuse that the patient is going to die either way.”
Sukaria explains that the deficit consists of debt to the Ministry of Health, companies, and institutions. He says that one of the problems “lies in the ministry’s mistaken estimate of $300 as the daily cost of caring for one patient when in reality it is double that, in addition to the corruption and being late with payments all the time.”
He explains that the law “organized governmental hospitals” work in such a way as to have the Ministry of Finance cover the costs for the first year, while in the following years they rely on the 5 percent they receive from the patients and other sources.”
The Ministry of Finance often complained about the hospital’s delays in preparing its budget. On 23 March 2012, the ministry sent a letter to the hospital management saying that it has to show the hospital’s budget project for that year to the ministers of finance and health before the last day of July for approval, pointing out that “the hospital does not comply with the deadlines set for presenting its budget, knowing that the last budget that was approved by the Ministry of Finance was back in 2007.”
On 13 August 2010, the ministry returned the hospital’s unaudited budget for 2009 and the budget project for 2010, noting that “it became clear that there is a discrepancy between revenues and expenditures for 2010 by LL5,709,300,776 ($3,800,000), which violates the principle of balancing between revenues and expenditures.”
Corruption has many faces. It has become normal for someone who is influential at the hospital to bring in a patient at his own expense without subtracting from his account the supposed costs at the time of preparing the payroll.
An employee who heads one of the departments received compensation for overtime in June 2009 that exceeded LL2 million ($1,300) without working one additional hour, according to her colleagues. That same employee got her husband a job in a company charged with providing dialysis and the solution for patients with kidney failure.
Employees tell of more incidents of corruption at the hospital. They say that “one influential person discharges patients without having to pay anything, while the head of another department charges patients for the medical supplies they need to undergo operations!” They add that some employees in the administration “are paid by the company that brings Iraqi patients sent by the Iraqi Ministry of Health to the hospital for treatment in order to find them beds and complete the treatment.”
All of this and there is no room for corruption at the Rafik Hariri University Hospital, Wazzan insists. He denies that AC equipment was rented for the inspection committee “but we had to rent some equipment due to a malfunction in our own equipment last summer.”
As for the waiting time in the emergency department, he puts the blame on Lebanese people not being used to waiting. As to the delays in presenting budgets, he says the problem is that “it is not possible to present the budget before knowing the amount of the loan that the Ministry of Finance will give, which is always late.”
According to Wazzan, there is another reason for the. He says it is because most patients are treated at the expense of the Ministry of Health and pay 5 percent of the cost of their treatment while the ministry covers 85 percent (some of it is discounted). The hospital must absorb the remaining 10 percent, in addition to the ministry’s discount, which has created a deficit over the years.
Wazzan says that “work is ongoing to address the issue – the 5 percent has been increased to 10 and the ministry decreased its discount.” Demand has therefore exceeded capacity, but Sukaria points out that “the hospital should have worked within its capacity to maintain financial equilibrium and control corruption.”
The outcome remains the same. The deficit is huge and Wazzan stresses that “university hospitals of this size need annual support to cover any deficit that might occur through decreasing discounts, raising the financial ceiling, and the allocation of an annual operating budget ranging between LL10 and LL15 billion ($7-10 million). The hospital has suffered financially since its creation, because no budget has been approved since 2005.”
This article is an edited translation from the Arabic Edition.