Hospitals, doctors under fire

The family of a Ventspils woman who died in hospital earlier this year have called for an investigation into the actions of her surgeon, who they say refused to operate unless the family paid him 500 lats (790 euros) for his services.

The woman, identified only as Inta, was rushed to Riga's Stradins University Hospital in May for what turned out to be a brain aneurysm.

Her step-sister, Inese Brence, said that before operating, the doctor handling her case said it would cost 500 lats, even though state health insurance is supposed to cover emergency medical procedures.

Before the money could be collected, Brence said her step-sister fell into a coma and died about a month later. She was 37.

A subsequent inquiry conducted by Latvia's medical and labor control board concluded that the delay could have played a part in Inta's death, Brence said.

Prosecutors have since said they have opened an investigation into the incident but have not pressed any charges or determined if laws were broken.

"At first, I didn't know this would become such a big story, I just wanted to find out what really happened," Brence told The Baltic Times. "But now I'm glad. Something has to happen. I cannot forgive this doctor. He cannot be allowed to continue working. This is a basic violation of his oath."

The doctor, Igors Aksiks, is known as one of Latvia's most gifted neurosurgeons. He could not be reached for comment, and hospital director Maris Plavins said he had temporarily taken a break from operations while the investigation is conducted.

Officials at the Welfare Ministry said the case highlighted a widespread practice in Latvian hospitals: doctors demanding bribes for payment.

Rita Naseniece of the ministry's health department said authorities were investigating three additional cases, all allegedly connected to the Stradins University Hospital in Riga where Inta died.

Maris Plavins, Stradins Hospital director, said in an interview on Latvian state TV that he "cannot rule out that in certain cases doctors have asked for money."

He also said it happened in all Latvian hospitals.

"Overall, I think the giving of envelopes or other gifts is widespread and, to a certain extent, keeps the medical system alive."

Arnolds Veinbergs, medical director at Stradins University Hospital, said the problem stemmed from the low salaries of doctors and nurses throughout Latvia.

"Of course, it's an ethical issue, and in no way can I say all doctors ask for this, but it is not possible for doctors and nurses to live on what they make," he said. "This must be addressed first."

Doctors make an average salary of 133 lats per month, nurses about 80 lats per month, according to figures from the Welfare Ministry.

Aksiks makes roughly 200 lats per month, Naseniece said.

After a one-day strike by doctors and nurses, the government agreed last month to raise medical salaries, earmarking 1.5 million lats from the country's sick funds that cover treatment and 1.7 million from the state health budget.

Officials said it would not wipe out the problem of bribes."We could increase their salaries by two, three times, it still wouldn't make up for the money they could make in bribes," said Silvestrs Savickis, a World Bank consultant working with the ministry on health reform.

A possible solution, Savickis said, might be to allow doctors to freelance on the side after putting in a required number of hours performing operations for citizens entitled to full insurance coverage from the state, thus removing the incentive for bribes.

Veinbergs, though, said too few Latvians would be able to afford operations done by a private doctor, which he said would run up to 3,000 lats each.

Sandra Garsvane, a lawyer with the non-profit Latvian Patients Rights Bureau, said the problem was widespread but that most people were too frightened to challenge it.

"They end up just gathering the money because the alternative is that their mother or brother or sister is in peril," she said.

Brence, too, said friends and colleagues told her that the "honorarium" for doctors is normal practice.

"We expected to pay some 75 lats or 100 lats, but 500 lats was just too much," she said. "Colleagues at Inta's office even said they would help, but these people also make low salaries - maybe 75 lats a month."

Naseniece said the problem reaches back to Soviet days, when hospitals were poorly managed but staffed by highly-qualified specialists who took advantage of patients.

"Bribery is an inheritance from the Soviet Union and all the bureaucracy that was so illogical and so unfair that it sometimes became necessary that if you wanted to get something done, you had to pay bribes," said President Vaira Vike-Freiberga last week.

Medical care in Latvia is highly subsidized by the state, with regional sick-funds paying up to nine-tenths of a citizen's hospital stay.

The formula is based on salary costs for doctors and nurses, electricity and maintenance costs, drug prices and other factors.

But sick-funds only receive enough funding for a fixed number of major operations per region, which leads to long waiting lists.

"The good thing is that joining NATO seems achieved, the government's priority will be on health care," Savicskis said.