I was disappointed by the “On Second Thought” column by Joel Rebibo, with regard to the resignation of the pediatric oncologists from Hadassah hospital. There were many inaccuracies in the piece.
He talks about “cuts to Hadassah” and that the hospital’s CEO, Ze’ev Rotstein, was only doing his job to save Hadassah. One has to be able to see the difference between painful financial cuts and endangering children. Rotstein united the bone marrow transplant department for adults with the children’s unit because he wanted to triple the number of transplants done to children coming from abroad, through medical tourism.
However, children being treated in the adult ward (which is in a completely different complex), by staff who are not trained to take care of children, have a 30 percent lower chance of surviving the transplant. A bone marrow transplant is an extremely complex procedure. Any slight compromise in the care given compromises the child’s chance of survival. These doctors were already working way over the accepted ratio of doctor to patient (it’s supposed to be one oncologist to every 15 patients; in Hadassah it was one oncologist to every 26 patients). But this was a red line they wouldn’t cross. The Labor Court backed the doctors completely and stated: “The doctors’ decision is a professional, fundamental and ethical one, as we would expect from senior doctors of their standing.”
Mr. Rebibo writes that Rotstein and the Health Ministry were willing to compromise and that President Rivlin offered to oversee the implementation of commitments drawn up in a contract. However, Hadassah did not put right the changes that the doctors found unacceptable. All it did was start building walls of plaster, in the adult bone marrow transplant department, between the beds, and put up a sign: Children’s bone marrow transplant department bed.
Mr. Rebibo writes: “If these doctors get away with breaking away, then other departments will do the same thing when faced with cuts.” It is common for doctors and even wards to move to other hospitals. Hospitals don’t collapse because of it but become better and improve their service.
Mr. Rebibo writes: “Hadassah … is still holding the door open to the breakaway group.” Not exactly true. Hadassah was only prepared to take back four of the six doctors. But how can they be expected to go back? Even if, let’s say, the situation is corrected and there is someone to oversee that it stays that way. Who’s to say Rotstein won’t make another decree in the future that is unacceptable to the doctors?
There are times when doctors are in situations where they know that the care being provided to patients is not as it should be. Few have the courage to take the high moral ground, as these doctors have done, and refuse to cooperate with a plan that endangers their patients.
Joel Rebibo responds:
Thank you for your thoughtful letter.
I purposely didn’t go into the specifics of the dispute between Prof. Rotstein and the doctors because at this stage it’s irrelevant. What is relevant is that the hospital offered to return the situation in the pediatric hemato-oncology unit to what it was before the dispute erupted, but the doctors refused to return. This was confirmed by an unbiased outside authority, Miri Ziv, the director general of the Israel Cancer Association.
The bottom line is this: Hadassah, an outstanding hospital, was brought to its knees by a NIS 1.3 billion debt which made it impossible to pay salaries and suppliers in a timely fashion. Rotstein was brought in to help save the hospital by cutting the budget — not with a scalpel, but with an ax.
Giving in to these doctors would have made it impossible to save the hospital. If they would have gotten away with it, neurosurgeons and cardiologists and psychiatrists and everyone else would try the same ploy anytime management wanted to cut them.
The public health system, not just in Israel but everywhere, has to live with economic realities. Doctors, with all due respect, have to do their best to save lives within the limits that exist. They can’t be allowed to dictate, because if they do, they destroy the entire system.