EspañolOver the past year, Ecuador’s medical establishment, particularly its hospitals, has made it into the news several times. Some of the reporting has been about the deaths of patients in hospitals. At other times, it has been deaths due to a deliberate lack of access to medical care.

In one case, ambulance drivers took a patient to seven different hospitals before finding one that would admit him. By that time, it was too late to save him.

Many of the hospitals said that they didn’t have the necessary equipment or skills to deal with the patient’s injuries. That’s a plausible explanation, due to the way Ecuador’s doctors offer their health care services.

In all the cities and many of the larger towns, you’ll find at least one privately owned hospital, in addition to a public hospital. Many of these private ones are more like clinics. They’re owned by the small number of doctors who offer care in those facilities. Many have an emergency medicine department, but some don’t keep their emergency rooms open 24 hours a day.

At the other extreme are the large city hospitals, owned by corporations instead of by a group of doctors. Their emergency rooms are usually open 24 hours and are equipped to handle most emergencies — for a price.

Free versus Inexpensive

The people of Ecuador elected President Rafael Correa in part due to his promises to provide free health care to everyone. Unfortunately, in many parts of the country, “free doesn’t” include quality care. Ask any individual but the poorest Ecuadorian in Quito, Guayaquil, or Cuenca whether they visit a free hospital there. You’ll receive an emphatic no from everyone you ask.

They use private medical providers, even for emergency treatment. They’d rather pay for their care than risk what they believe to be substandard care at the free hospital.

Private medical care is very inexpensive here in Ecuador when you compare it to prices in the United States — but it’s by no means affordable to everyone.

Just a few days ago, my stepson returned from a visit to a private hospital’s emergency room and then a night in the hospital. The bill was $476 and change. That’s 1.5 times the monthly minimum wage here in Ecuador, and perhaps a month’s wage for an office worker or retail employee, for about 15 hours under the care of the doctors there.

Doctors and No Nurses

In North American hospitals, the doctors determine what’s wrong, fix it, and leave it to the nurses to do the rest, including ensuring that the doctors have prescribed the correct medicines and dosages.

In Ecuador, there are almost no trained nurses. Most health care workers you’ll see on the floor of a hospital here are what North Americans would call nurse’s aides. They’re not trained to do much more than change intravenous (IV) bags. Doctors do a lot of the tasks that a nurse in North America routinely does.

And since they do just about everything in terms of patient treatment, Correa has decided that they are the ones who need to be punished if patients die due to problems relating to their surgery or emergency treatment.

Ecuador versus Its Doctors

The president announced this month that the government will create a new law to criminalize malpractice. Doctors whose patients die will, if the situation warrants it, be charged and tried for medical manslaughter. There are currently no details as to how the government will determine if a doctor should be tried for manslaughter. However, the sentence will be 3-5 years in prison.

The doctors responded by stating that they will resign if the National Assembly passes that law and the government starts prosecuting doctors. One by one, hospital doctors are taking a stand against this potential new law. In some cases, hospitals have announced that all of their doctors will quit.

Correa, in response to the threat of mass resignations, told the doctors that it’s unfortunate that they feel they have to resort to quitting en masse. He also told them that if they do resign, he’ll be bringing in planeloads of doctors from other countries to replace them. This is in addition to the several hundred Cuban doctors that Correa recently said he was bringing in to help deal with the country’s unmet medical needs, especially in rural areas.

Professional Development, Not Prosecution

Many of Ecuador’s specialists did their professional training in the United States, Europe, and even Japan. So we can’t accuse them of being unskilled.

But perhaps what’s needed is more professional development or better-trained and more available nurses. If doctors are indeed causing unnecessary deaths, more skills and better skills on hand could help reduce that number.

In the meantime, doctors are having meetings with government ministers to see if civil and administrative penalties can be applied instead of criminal penalties.

Whether it’s development, more palatable penalties, or a combination of the two, it will certainly do much more for the health of the nation than jailing doctors or having them all resign.