“I am not allowed to talk to you, I am not sure it’s even legal. But I had to speak to the media because children are being neglected.”
These were the words of a nurse in the pediatric hemato-oncology ward at Jerusalem’s Hadassah Medical Center on Wednesday, as she defied her hospital’s ban on speaking to the media to issue a desperate plea to the public.
On June 4, most of the ward’s senior doctors and residents left their jobs, leaving only the nurses and a handful of replacement doctors to staff Jerusalem’s only cancer ward for children. The nine physicians had quit in March over their objection to a plan by Hadassah hospital’s director, Zeev Rotstein, to let doctors operate on pediatric bone marrow transplant patients in the same department as the adult patients, a practice that the resigning doctors said was likely to increase the children’s mortality rate. The resignation took effect on June 4.
Amid reports that an atmosphere of chaos has reigned in the ward since the doctors’ departure, Rotstein has repeatedly reassured the public that everything is under control.
“The first three days were bumpy,” Rotstein told Israel’s 103FM radio station on Monday, following a Channel 2 News report Sunday evening in which a recording was leaked of nurses from the pediatric hemato-oncology meeting with Rotstein and expressing concerns that mistakes were being made in the children’s treatment.
“We met with the nurses and they raised some legitimate concerns which were addressed. The nurses’ claims were specific to those initial days,” he said. “The doctors currently working in the department are the very best.”
But according to a nurse working in the department, who says she speaks for many of her colleagues, things are not under control.
“He keeps saying everything is okay, everything is under control. It’s not, I can assure you, it’s not.”
According to the nurse, who asked that we not use her name, mistakes are being made in the ward frequently and she fears that sooner or later one of these mistakes could seriously harm a child.
“The new doctors don’t know the patients because they’re chronic patients. It’s not like someone who comes into the emergency room and you just have to figure out what is happening now. These are patients who have been in the ward for years and the doctors don’t know them and don’t know what is good and not good for them. A lot of mistakes are being made every day. The nurses are trying to make up for the mistakes but it’s hard. We’re very, very frustrated.”
If a parent asks her opinion, the nurse will tell them without hesitation to move their child somewhere she believes is safer, like Tel Hashomer or Schneider Children’s Hospital, both about an hour’s drive away. But she says she was told explicitly by the head nurse not to “volunteer information.”
“I think the parents understand by themselves what is going on. They don’t need us to tell them. They see that the nurses are frustrated. They see the chaos.”
On June 9, the nurse related, Rotstein sat down with the nurses from the ward as well as nurses from the Ministry of Health.
“We recorded the conversation in which we talked about how bad things are in the ward,” she said. “We let a few people hear the recording, probably a few people too many, because someone leaked it to Channel 2. The nurses did not give it to them. The hospital administration was very angry but none of us gave it to them.”
After Channel 2 aired the recording, both Rotstein and spokespeople for the Health Ministry went on air to reassure the public.
“But we’re not allowed to go to the press, that’s the problem. We can’t go and say no things are not okay. Rotstein just says whatever he wants and people believe it. He’s wrong, and he’s neglecting the children. I think it’s criminal, and that’s why I am talking to you.”
A dispute over medical tourism
The Hadassah Medical Organization, which has two campuses in Jerusalem, has been in financial trouble since at least 2008. Among the widely cited reasons are a history of bloated salaries and poor financial management as well as low reimbursements from Israel’s health funds, and to a lesser degree, the 2008 financial crisis and Madoff Ponzi scheme that caused the Hadassah Women’s Organization of America, which partially funds the hospital, to lose $90 million.
The crisis came to a head in February 2014 when the hospital, $370 million in debt, declared bankruptcy after two Israeli banks cut off credit lines to the institution. The government, the Hadassah Women’s Organization, the hospital’s creditors and five hospital labor unions agreed to a recovery program and a year later, Zeev Rotstein was appointed director-general of the hospital by Health Minister Yaakov Litzman in the hope that he would lead the hospital on its road to financial recovery.
Rotstein, who had previously headed the Sheba Medical Center near Petah Tikva for a decade, is widely credited with balancing that hospital’s books and making it run efficiently.
One of Rotstein’s plans to restore Hadassah to solvency was to increase the amount of medical tourism at the hospital. At the time of the doctors’ resignation, about 70 percent of the patients in the pediatric cancer ward were paying customers from the Palestinian Authority or Russia and the Ukraine. Palestinian patients pay about as much as Israelis, but Russian bone-marrow transplant patients pay about 500,000 shekels ($142,000) for the surgery, according to the nurse who spoke to The Times of Israel.
“Bone marrow transplants are a cash cow for the hospital,” Jerusalem resident Shraga Bar-On, the father of a young daughter with cancer, told The Times of Israel.
In the past year, Rotstein had actively sought to increase the numbers of Russian children receiving bone marrow transplants, according to the nurse. He sent one of the doctors on the ward, a talented surgeon by the name of Polina Stepensky, to Russia on several occasions to bring back new patients.
“Medical tourism is good for us, It’s a good thing,” the nurse told The Times of Israel..”But you have to know how many tourists to bring and make sure they’re not there at the expense of the Israeli kids. If you go searching around Russia you’ll always find another mother, but doctors can’t take endless numbers of patients and give them all good treatment.”
According to the Israel Union of Medical Tourism, in 2014 the Israeli medical tourism industry treated 60,000 patients and brought in 1.5 billion shekels.
Many parents of children from the ward interviewed by The Times of Israel agreed that medical tourism can be a win-win for Israel in general and Hadassah in particular, but critics contend that in the pediatric hemato-oncology ward, they felt it was being done without forethought and haphazardly.
Indeed, according to Channel 10’s Hamakor television magazine, the pediatric hematology-oncology ward at Hadassah took in 160 new patients last year, as opposed to 120 new patients four years prior to that. But the number of doctors — six senior doctors and 2-3 residents — remained the same. The same departments in other Israeli hospitals like Sheba and Schneider have at least twice the number of doctors per patient.
“The doctors did not have a problem with medical tourism,” said Shraga Bar-On. “But they wanted to first expand the facilities and staff. It seemed as though Rotstein wanted money quickly.”
The nurse told The Times of Israel that Rotstein was generally disliked in her department and seen as a bully. She recalls in particular that he called Mickey Weintraub, a doctor widely liked and admired by parents and nurses, an “evil Haman.” He also said menacingly on Channel 10’s Hamakor program that if someone threatens him he will “shoot them,” a comment that no one took literally but that critics say is reflective of his management style.
According to the nurse, the doctors in the pediatric hemato-oncology ward put up with their new boss until late last year, when they learned of a plan to operate on child bone marrow patients in the adult ward.
“It doesn’t exist anywhere in the world that children and adults are operated on in the same unit,” the nurse exclaimed.
“Sending a child to the Sharett Institute [of Oncology] is like sending them to the cemetery,” a parent of a child from the Hadassah cancer ward told The Times of Israel, citing an unverified statistic whereby bone marrow transplant patients in the pediatric hemato-oncology unit at Hadassah had a 73% survival rate while patients at the Sharett Institute, where they do the adult bone marrow transplants, have a 50% chance of survival.
On March 5, the ward’s six senior doctors resigned their posts, claiming that Rotstein was endangering the children in their ward. On June 4, despite efforts by Hadassah Hospital to obtain a court injunction to keep them in their jobs, their resignation went into effect and the six doctors, joined by three residents, stopped coming to work.
Pediatric hemato-oncology is a specialty that takes years of training to master and it has been challenging for Hadassah to restaff the ward, said the nurse.
“Rotstein has hired two new doctors for the ward. Professor Goldstein is the director. He did rotations with our doctors for a month. Then there is another doctor who came from the United States. They appointed him as a director as well. So now we have two directors and no physicians to work in the ward… It’s crazy.”
Rotstein, for his part, claims that the children are in good hands and that the resignations occurred because director of the pediatric hemato-oncology ward Weintraub was envious that his protegé Stepansky was promoted to a more senior position than him. Weintraub’s bruised ego, according to Rotstein’s version of events, led him to persuade his entire senior staff to move to Shaarei Tzedek, a competing Jerusalem hospital, which is not recovering from bankruptcy and can offer the doctors better conditions.
Health Minister Litzman has sided with Rotstein and forbidden any other Israeli public hospital, including Shaarei Tzedek, to hire the resigning doctors, leaving these highly trained specialists with no choice but to return to Hadassah or to stay at home and twiddle their thumbs. A public outcry has ensued, with many parents of children who were treated in the ward taking the side of the resigning doctors and urging Litzman to let the doctors re-open their ward at Shaarei Tzedek.
But Litzman has refused, for reasons that remain unclear.
When asked, Litzman did not explain his reasoning to The Times of Israel, beyond issuing a statement that “Minister Litzman fully backs the professional judgement of senior staff in the Health Ministry that it would not be appropriate to establish a second pediatric hemato-oncology ward at Shaarei Tzedek hospital. The minister supports the parents and is working to ensure that Hadassah will continue to operate a professional department at the highest level.”
Asked if the fact that nine doctors quit the department leads him to question Rotstein’s job performance, Litzman did not respond.
Rotstein initially agreed to speak with The Times of Israel but did not respond in time for publication. In an interview with the NRG Hebrew news site this week he defended his actions as those of someone who “has come to heal Hadassah, which was bankrupt. I have taken some painful measures. It’s obvious that my belt-tightening decisions don’t make me popular, but you can’t say my purpose is greed. Today the staff and patients at Hadassah have light in their eyes again.”
But the nurse in the pediatric hemato-oncology ward does not have light in her eyes. She believes her department is in crisis, and resigning was the only way that the doctors could alert the public to the fact that something is deeply wrong.
“After our doctors left, people said, How could the doctors leave, don’t they care about their patients? I think they felt the situation with the bone marrow transplants was too dangerous to face. And it’s continuing. They’ve been doing eight transplants a month in the adult unit since then. Kids are already being endangered. The Health Ministry is saying, Don’t worry we’re watching. But they’re not watching. They’re not doing anything.”