“Neither heroes nor cowards!”, The scream of doctors Milanese arrived as far as Rome. The Deputy Minister Pierpaolo Sileri, according to what is learned, he is personally interested in the affair dell’implosion of emergency departments of the Santi Paolo e Carlo hospitals emerged a week ago, thanks to letter-complaint from 50 doctors and nurses revealed by Fatto.it. The deputy minister puts the stamp like this: also the Ministry of Health will monitor the case, not only the Lombardy Region. In the meantime, everything emerges. It turns out, for example, that while the emergency doctors, resuscitators and nurses of the two hospitals floundered behind 350 Covid patients (as many non-covid) and 150 accesses a day to the emergency room, the Region planned how hijack a part of the health personnel atFair Hospital, which has 64 patients. Meanwhile, the first, timid, acknowledgment of the problem comes from the councilor Gallera. The opposition attacks and asks with one voice to clarify and protect from possible retaliation the health personnel who had complained of having to make “intolerable choices on access to care”.
The fear of reprisals. The opposition is a shield
Following the disclosure of the letter, dated 17 November and registered three days later, Asst had issued a hard note against the signatories. By announcing an internal audit, them disavowed publicly accusing them of saying “false” things (download the document). He then proceeded to removal of their primary Francesca Cortellaro (download the revocation act), who although in a previous email had expressed critical issues to the director, even asking for the emergency room to be closed, had volunteered to defend the ASST. Maybe not enough to stay in place. Lastly, the health company promoted the initiative of one counter-collection signatures of dissociation of doctors and support to the management (download the document), transformed into a de facto public health problem in a kind of internal referendum on the general manager. At the bottom, the signatures of Stocco’s fiduciary department heads. In sixth place, that of Davide Chiumello, head of resuscitation of the San Paolo now appointed director ad interim of the urgency and critical area of San Carlo, in place of Cortellaro (download).
A reaction of contraposition total management to doctors who, instead of resolving the conflict, “risks flare up throughout the Region, with dire consequences for citizens “, write the opposition councilors who – given the gravity of the situation – have signed together a open letter, published today by Manifesto, in which they invite the management to mend the fracture with the doctors and the Gallera-Fontana duo to clarify. On Tuesday they will ask the Region a question (download), in question time on the story that promises sparks.
The moment of the great collapse
Within a month, the hospital had come to accommodate 350 positives in the Covid departments and as many in the other departments, with peaks of 150 accesses per day in the rescue area. On October 26 the primary Francesca Cortellaro had written a dramatic email to the director Stocco in which he asked to declare “the non-receptivity of the emergency room for at least 24 hours”, where the situation had now become “explosive”, with patients being brought there by ambulances “without any possibility of hospitalization for at least 24 hours“, And” the medical-nursing staff exhausted”, Until the admission that“ in that context, we are no longer able to ensure adequate patient care“. Which is, no more, no less, what the doctors wrote to the director himself twenty days later. The problem denied by ASST, however, only emerged when the internal letter came out of the drawer and became public domain. When the situation, reported in every way by those who were experiencing it inside the trench of urgency and resuscitation, was now got out of hand.
Ecumenical gallery (poised)
In the face of all this, Lombardy region remained silent. From the offices of Fontana e Gallera in a week there has not been a note, a position or even a signal of attention to the matter. Just last night, the general manager Matteo Stocco was summoned by the councilor and director of health Marco Trivelli to provide clarifications. “I asked for a report, tomorrow I will hear the primary removed and the primary, when we understand what happened we will make our choices, but always taking into account the autonomy of the company and management”, he limited himself to saying Gallera, taking note of the internal investigation announced by Asst. Not a word for doctors who risk being subjected to penalties for putting pen to paper as things were. Behind the silence there are also political motivations: to appoint Stocco director in 2018 it was just Gallera, given as a replacement after Christmas at the request of the League. The case of Santi Paolo e Carlo, so poorly managed by requiring the intervention of the deputy minister, could be the coup de grace.
The Region asks for 13 doctors for the Fair
Perhaps however – the conditional is a must – the gravity of the situation had not been well represented by Stocco on the upper floors of Palazzo Lombardia, where the echo of the newspapers, trade union announcements and opposition reactions reached just right. This is demonstrated by the fact that, just as the emergency departments of the Santi e Paolo hospitals collapsed due to a lack of staff and saturation of intensive care, the Region was even planning to take away doctors and nurses to be allocated to the one at the Fair, currently occupied by 65 patients. In the most dramatic days for the two Milanese hospitals, the health management of Ats Lombardia prepared a note (download), signed by the director Marco Trivelli, to divert to the Portello 3 medici e 9 nurses drawing them from Saints Carlo and Paolo, in view of the activation of a further module (the seventh) at the Portello. As if really no one in the Region had any idea of the real conditions in which the health personnel of the two hospitals, overwhelmed by the second wave, were forced to operate.
Everyone knew. The unheard complaints
However, the shortages of staff in the emergency area of the two hospitals had been known for some time, even before the arrival of the Coronavirus. From year to year they have been (unnecessarily) reported to the top of the Asst. The November 12, 2018, the nursing coordination had asked the management (at the time in the hands of Marco Salmoiraghi, now Deputy Director of Lombard Health) to fill the criticalities in the emergency room under staff of 23 nurses. Request reiterated a year later, on October 18, 2019. One year later, on 30 December 2019, the RSUs arrive to deposit a exposed in the Prosecutor’s Office and to the Inspectorate of the work to signal the shortage of nursing staff, together with the unsuitability of spaces and internal organization. It is in this context that Covid-19 arrives.
Chronicle of an emergency within an emergency
The first wave brings up the problem. The June 26 under the Pirellone the flags of the Basic Unitary Confederation. But it is not resolved at the turn of the summer, in anticipation of the second wave. So much so that on 12 October 2020 – that is to say eight days before the famous “letter” from the doctors – the Fp CGIL of Milan sends Stocco (and for information to the managing director of the Trivelli Region) a note on the management of the “Critical Area” – Asst San Paolo e Carlo where he reported reports of “increasing difficulties of PS operators” due to the influx of patients and the lack of organic “for the failure to replace colleagues who left for retirement, mobility and maternity”, including the “maybe early reopening of all departments in the summertime” (download).
The October 26 we try the primary then defenestrated by the director to whom he had reported the situation. It is not heard, so much so that a month later, more and more desperate, 50 doctors take the initiative of the internal letter, complete with signatures and freshmen, which causes the case to explode. The inertia of management leads to the state of sector agitation November 10 with strike announced for December 14 (USI health promoter, USB and Nursing Up join), complete with nurse rising on the roof of the San Carlo with a banner “Neither heroes nor cowards! Staff in a state of agitation“. The November 22, once the story has blown up in the newspapers, the Public Health Defense Committee asks for the resignation by Stocco, Trivelli, Gallera and Fontana.
“Zero sum” assumptions. Calls for staff at the end of October
The note with which Asst Santi Paolo e Carlo disavowed the signatories of the letter refers to the assumption, from February to today, of 97 doctors and 94 nurses. But without providing the real balance, that is, the additional staff net of terminations and retirements. Fatto.it posed this and other questions to the director Stocco and the institution. The answer was: “at the moment it is not possible to fulfill your request“. In the letter the doctors – with the emergency departments now close to collapse – denounced theinsufficient “staff doctor, nurse and auxiliary, especially in the critical area, not even remotely filled by personnel hired ad hoc, introduced in highly specialized departments with an increasingly hasty and summary training “. And it was, according to the complaint, a “very serious and known shortage well before the pandemic”. Such by now that “in the absence of these critical resources, we are forced to operate choices relating to the possibility of access to care, which are neither clinically nor ethically tolerable. Against our will and, above all, against our human and professional conscience ”. The Asst site, however, is now full of notices and alerts. The one for the “rextraordinary eclutment of health personnel in the sector forepidemiological emergency from covid-19“. Issue date: 2nd October 2020. The collapse of the emergency departments had now occurred.
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