Ichilov can't treat 3,000 new psychiatric patients, doctors say
By Ran Reznick
Ha'aretz, Thursday, August 31, 2006
Some 3,000 new patients with psychiatric problems, among them 300 children and adolescents, and adults under compulsory commitment orders, will not receive the treatment they need at the government-municipal Ichilov Hospital at the Tel Aviv Sourasky Medical Center, senior physicians believe.
Their concern comes in the wake of a directive issued last month by the Health Ministry, slashing by half the budget for psychiatric services at Ichilov Hospital, and a new directive by the hospital's deputy director, Dr. Ronni Gamzu, to greatly reduce mental treatment and not exceed the new quota set by the Health Ministry, "even if that entails stopping treatment immediately" and firing workers.
The ministry quota was part of its preparations for transfering responsibility for all psychiatric services to the four health management organizations (HMOs) in January 2007, in keeping with a government decision last February.
Staffers at Ichilov's psychiatric clinic posted an unusual notice on the door this past Sunday: "The Health Ministry has decided in a unilateral and arbitrary manner to limit the quota of patients at the clinic to half of the real treatment needs of the Tel Aviv public. Since in the first half of the year we have already far exceeded the new quota, we are regretfully compelled to close the clinic to new applicants until January 2007. Veteran patients will continue receiving treatment even though the existing service will also be limited."
The notice went on to state that people needing mental help, including urgent cases, can go to the HMOs, psychiatric hospitals and the offices of Health Minister Yaacov Ben Yizri and his director general, Prof. Avi Yisraeli.
A week ago, Prof. Gabriel Barbash, Ichilov's director general, wrote a sharp letter to Yisraeli, stating that the hospital management had tried to warn of the impending crisis and that responsibility for it resides with the ministry. Barbash added that "there is no suitable alternative framework in the Tel Aviv area," and asked: "Is it possible that nobody cares because in another three months the responsibility [for the psychiatric service] will perhaps move to another body?"
Two weeks ago, Dr. Shaul Schreiber, director of Ichilov's psychiatric service, warned Dr. Uzi Shai, the Health Ministry's district psychiatrist for Tel Aviv, but Shai responded yesterday with a particularly harsh letter, in which he warned Schreiber that Ichilov's moratorium on psychiatric services for new patients, "some of whom pose a danger to themselves and their environment, might exact a high price in human lives. The decision places some patients at risk and it is uncertain whether it would prove defensible in court in the event of disaster."
Shai expressed the hope that "the professional-ethical consideration will at least guide you to continue providing professional and responsible treatment to the residents as you have steadfastly done until now."
In a reply to Shai, Schreiber charged yesterday that some of his letter "lacks any substance, when the Health Ministry restricts the hospital to a treatment quota that does not cover even half the needs, and the hospital management issues dismissal letters for some of the workers. Had we acted out of a professional-ethical consideration, we would have shut down the system completely because we have far exceeded the patient quota for the entire year!"
The Health Ministry said yesterday that Ichilov's overflow patients can apply for now to other medical centers in Tel Aviv and the central region, and that Ichilov's concerns will be discussed by ministry officials in the coming days.
