Sixty-three-year-old Ekrem Ramić is one of 750 patients waiting for cardiac ultrasounds at the Cantonal Hospital in Zenica. His specialist referred him eight months ago, but the Visoko man who suffers from high blood pressure and labored breathing, still hasn’t been scheduled for the procedure.
Hospital staff say it takes up to eight months to admit patients like him, and that the hospital gives appointment details via telephone or in person. An investigation by the Center for Investigative Reporting in Sarajevo (CIN) found that it can take more than a year to fit in patients. If they miss the phone call telling them it’s finally time, they are out of luck. The hospital does not send written notices of appointments, even though they are required by law. No one really monitors the hospital to check such things.
In this mess, patients who can afford it seek help from private clinics or try to curry favor with the hospital staff so they can jump ahead on the waiting list.
One Machine per 750 Patients
Heart and vascular diseases are the most frequent cause of death for Zenica-Doboj Canton residents. In 2014, 1,740 people died from heart-related diseases — more than half of all deaths, according to records from the Cantonal Public Health Care Fund. Stroke and heart weakness are among the most prevalent causes of death.
Ultrasounds are a nearly bullet-proof method for detecting heart and vascular diseases. Cardiologist Adnan Delić from a Sarajevo cardio center says that waiting for an ultrasound complicates medical treatment: “Some patients can suffer very serious, even life-threatening consequences, because that serious condition was not diagnosed on time, which will greatly affect their well-being.”
Patients from the canton can get ultrasounds at the General Hospital in Tešanj and the Cantonal Hospital Zenica, where most are sent. Retirees, welfare beneficiaries or children with health insurance who are exempted from co-payment, do not need to pay. Other insured patients pay a 25 KM co-payment.
They also will likely have to wait for a long time, because the Zenica hospital has just one 18-year-old ultrasound machine. That is nearly double the average lifespan of such a machine. Hospital Deputy Director for Medical Affairs Harun Hodžić said that between 20 and 30 ultrasounds are performed a day. Priority is given to patients suffering from a stroke or those who have been admitted into the hospital.
The problem is aggravated when the machine malfunctions. Last year it did not function for five months. At the end of that year, the number of patients wait-listed for cardiac ultrasound reached 750.
According to the Law on Rights, Obligations and Responsibilities of the Patients in the Federation of Bosnia and Herzegovina (FBiH), hospitals must inform patients about their status on waiting lists. Health institutions that fail to do can be fined between 10,000 and 15,000 KM. However, there are no inspectors monitoring to see if the law’s been followed in the canton. The Federation Bureau for Inspection Affairs should step in, but officials of that agency say that they only have two inspectors itself.
Zenica Cantonal Hospital officials say that patients are waiting up to eight months for ultrasound and that they are informed about appointments via telephone or at the hospital. However, five patients including Zenica resident Muharema Mahmutović told CIN this was not so. Mahmutović said that she was sent to a hearth clinic at the Cantonal Hospital in December after an EKG scan revealed a blockage on the right side of her heart. She was released without an appointment for an ultrasound and was told her case was not urgent and she would get a call in the future. That was three months ago. No call yet.
Hodžić said the hospital has purchased another machine, which should cut down the waiting, but it has yet to become operational.
Ultrasound in the Public Health Clinics
Inhabitants of Tešanj, Doboj Jug, Olovo, Maglaj, Visoko and Zavidovići municipalities can undergo ultrasounds in their public health clinics if they have between 30 KM and 80 KM. The clinics are allowed to charge patients for services not refunded by the Health Fund. A cardiac ultrasound is not a typical procedure for public health clinics, but Senad Karavdić, director of the Public Health Clinic in Visoko, says that they started offering them at the request of patients and because of the long waiting list in the Zenica hospital.
“To wait for a procedure for six months or a year is crazy, from a medical point of view,” said Karavdić. A month might be reasonable. He said that he does not insist that patients undergo the procedure at the clinic. “We write a referral for the Zenica hospital and leave the choice to the patients,” said Karavdić.
Bedra Vehabović got a cardiac ultrasound in Visoko after she was told in Zenica she would have to wait longer than a year. She did not dare wait because of chest pains and high blood pressure. “I paid 50 KM even though I’m a welfare beneficiary,” she said. Unemployed she lives with her brother on his pension.
A health institution needs to be certified before it can offer services on the market, wrote officials from the FBiH Ministry of Health. In Zenica-Doboj canton no health care clinic is certified to perform cardiac ultrasounds, said Hajrudin Hedžić, a secretary at the Cantonal Ministry of Health. He said that the health inspectors are obliged to oversee this.
Nijaz Uzunović, the chief FBiH health inspector, said they could do inspections but they never have. Following a CIN’s request for information about inspections, Uzunović ordered personnel to conduct an inspection.
Private Connections or Private Clinics
Patients unsure of how long they’ll be made to wait or whether they will get a spot on the waiting list at all sometimes choose to go to a private clinic. In the Canton’s five private clinics CIN reporters contacted, the price of cardiac ultrasounds was 50 KM. This is what Asim Šabanović from Visoko paid in a private clinic Intermed in Kakanj. He said that Zenica hospital staff told him that he would have to wait between a year and 18 months. “That’s shameful – the heart is in question, it’s not a trifle,” he said.
Zijad Šut from Zenica has had two heart arrests and two surgeries. He has a method for getting into check-up appointments without long waits or resorting to private clinics.
“If something is really pressing, than I phone around and look for someone who can speed up things for me, so that I don’t wait for that long…it works,” he said.
Deputy Director Hodžić said that private connections have always been effective shortcuts. “No one is immune to those private connections,” he said.