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The serious omissions and paradoxes of Abruzzo health care

by Antonio Ciofani and Fiorella Cesaroni

09 NOVDear Director,
in 2015, Ministerial Decree 70 (Lorenzin Decree) was issued. The Region has several times drawn up and approved plans for the reorganization of the hospital network, but the Interministerial Table for Health / Economy and Finance, which validates the resolutions of the regions in the return plan, has not validated them 6 times in about 5 years; in fact, we insist on not providing any 2nd level hospital but “2nd level functions” scattered in several hospitals.

This is the history of the 6 failures
1) First rejection: session of 26.07.2017, the minutes on page 64 and on page 75 between the conclusions states: “.. we refer to the provisions of (DCA n. 79/2016) in relation to the commitment to identify the DEA of 2nd level in hospitals with the highest number of HUB functions in time dependent networks “-
2) Second rejection: session of the Table of 13 November 2017.
3) Third rejection: session of November 15, 2018, page 26 of the minutes “The functional integration envisaged does not meet the criteria for allocating the highly complex disciplines in a single structure, specific to the Level II DEA –

4) Fourth rejection: session of 19 and 26 May 2020, on pages 53/54 regarding the Hospital Network it is specified that it must be adopted in compliance with Ministerial Decree 70/2015, given that the document drawn up insists on spreading the disciplines with high intensity in various hospitals.
5) Fifth rejection: session of 4 October 2020, on page 3 of the minutes it is confirmed, given the evident arrogance found, that the Hospital Network must be resolved in compliance with Ministerial Decree 70/2015. Furthermore, on page 103, the Region is ordered to send the REVIEW of the Network itself by 30 October 2020 for the evaluation of the specific Table DM 70. Naturally disregarded deadline.
6) On 3 and 4 August 2021 the meeting of the representatives of the Abruzzo Region with representatives of the Table for a preliminary presentation of a new proposal for the Hospital Network, contained in the resolution of Giunta 462 / C, goes very badly. In fact, the minutes of the joint meeting of the Technical Committee Verification of Compliance and Verification Committee of the LEA with Abruzzo (20 July / 5 August) on p. 65 rejects (sixth rejection) the Region as defaulting on hospital care.

In the face of this shameful political / administrative stalemate, the Abruzzo region is still the only one not equipped with hospitals (therefore DEA) with a 2nd level qualification, the only one in which the prescribed hierarchical organization of hospitals for complexity in 3 levels , stops at 2, with the highly complex disciplines scattered here and there! But it has 2 faculties of Medicine and Surgery, one for every 650 thousand inhabitants (Italian average one every 1.6 million), who are silent on the subject instead of making a necessary technical-clinical contribution.

But there are other paradoxes: for example in the last Plan drawn up above: a hospital, by far the largest in the region (Pescara) with 650 beds, 97,000 admissions per year to the emergency room and 27,000 hospitalizations, has the same classification ( 1st level) of a hospital with 140 beds, 18,000 accesses to the emergency room and 4,200 hospitalizations (Sulmona). Clamorous case of technical-political programming illiteracy.

Again: no political force protests or proposes a serious Hospital Network, given that the ministerial rejections have affected both sides and therefore all parties: no one attacks anyone on these issues. But, what is even more serious, not even the general and medical unions and health professions do not protest, fearful of stepping on their feet but not realizing the serious damage to the rights of patients and citizens of Abruzzo, still lacking the life-saving service carried out by the DEA of 2nd level!

To make the situation even more serious, there is also the risk that the lack of a hospital network validated by the Interministerial Table, block the Abruzzo share (210 million) in the context of the distribution of the community funds of the PNRR being defined.

What solution? Apart from a possible involvement of the ordinary judiciary (omission ?, negligence ?, inexperience?), We have asked several times for a Commissioner to Acta to take care of the hospital network. We also did this recently, last August, through a remote meeting with the head of the technical secretariat of Minister Speranza, dr. Stefano Lorusso, (recently appointed DG of the PNRR Mission Unit for point 6-Health) with the participation of the president of the Senate Health and Hygiene Commission, Senator Annamaria Parente, some of us doctors of the Clinical Consultation and above all the delegates of 15 user associations.

PS It should be noted that those hoping for a revision and reformulation of a “new DM 70” will be strongly disappointed. The draft of the “new” DM 70, as exhaustively explained by Claudio Maria Maffei in this newspaper a few days ago, maintains the structure of the mother decree. And in particular as regards the classification of hospitals, absolutely faithful to the DM in force.

Antonio Ciofani
Spokesperson for the 2nd Level Clinic for the Goddess – Pescara

Fiorella Cesaroni
Coordination of User Associations

November 09, 2021
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