From: Reneta Todorova Stoyanova
[Personal ID # and address]
To: Mr Minister of Internal Affairs
Cc: Mr Premier
Re: Unsatisfactory reply from the Regional Police Department regarding undocumented treatment of foreign citizens in a Bulgarian hospital
Dear Mr Minister and Mr Premier,
Herewith I inform you that the reply from RPD-Varna, reg.# 19258 of 15-Sep-2003 (enclosed herein), does not satisfy me, viz.:
On item 1. Described is only the procedure of registration of patients, and this is made incorrectly. The registration books are two, not only the one kept by the head nurse. My questions are:
Was the registration procedure observed in the particular case?
Why should copies from the medical files of the foreign citizens be kept not in the archive but in the "Occupational Medicine Department of the hospital"?
On item 2. The cited article 7 form the Act of the Medical Establishments is irrelevant to this case. I have not questioned the type of the procedure: whether it was urgent or not. The availability of a contract clearly proves that it was not urgent.
Regardless of whether admitted urgently or not, however, all the patients have to be registered in the two register books available in the unit they are serviced. In this particular case, they were not. I assert that up to my last working day, 29 May, 2003, the foreign citizens had not been registered in the two register books. I think that as early as I submitted my alerting letter, the police should have reacted in due time. More than three months have passed since then and it would be difficult to prove anything now. The register books were not bound sealed or their pages enumerated; therefore, they might have been written anew.
As to the supplies and medicines which, according to the inspection of RPD-Varna were “a component of the total value of the dialysis performed”, art. 13 in the contract for dialyzing the Belgian patients explicitly reads: “ The CONTRACTOR shall be obliged while performing the subject of this contract not to use supplies and medicines which have been delivered from the Ministry of Health along a centralized delivery.” Such supplies were used for the foreign citizens (this is documented by the two inspections made on the part of the health authorities by the end of May) in detriment to our Bulgarian patients who not only have to tolerate, cite, “shortage of the state delivery”, according to the inspection of the RPD but they also have to tolerate that their available delivery of supplies be taken away. Why the inspection made by the RPD-Varna has not noticed any disorder here?
To the question of payment fir the services: it is known that the final sum of any service is accounted not through a contract but through a payment document. What payment document is there to account for the dialysis procedures performed to the foreign patients, in this connection to account for the overtime work of the staff? It is not clear from the contract what can be accepted as a realized contract: from what to what date should the foreign patients be dialyzed; by the force of this contract more procedures could be performed without being accounted for.
On item 3. For the first time, after over three months, officially are mentioned the citizens of Israel who were dialyzed one time “by the force of a concluded contract”. Where is this contract so that it could be seen whether it is consistent? Why has a copy of it not been enclosed as a proof just as a copy of the contract for the Belgian citizens was enclosed before (although the most important inseparable part of it was missing)? Is there a payment document for the service performed to the Israeli citizens?
On item 4. Again, a procedure is described and it does not become clear whether the foreign patients had presented documents of serologic tests for hepatitis and AIDS. This is a very serious question and before it is answered, some doubts will remain that the guest patients might have been infected while they were treated on the clearest possible dialysis machines.
I shall be very grateful to you if you help me get an exhaustive reply to the questions posed by me. I believe that if a more serious inspection had been performed still while I the foreign patients were on treatment in St Marina Hospital, and not three months later, I might not have lost my job.
Yours faithfully
Reneta Stoyanova, a former medical nurse with over 15 years of work in the St Marina Hospital HD unit, Varna