Sometime in mid-March the Community of Madrid cut the cable between their nursing homes and their hospitals. Families were stunned when caregivers told them they had asked for an ambulance for the elderly sick with covid-19, and on the other end of the line, they answered negatively. Later they learned what the rejection was due to. At least since March 18, the Ministry of Health prepared protocols, for use by public hospitals in the region, which excluded patients from residences with high dependency or disability. The truth about those official documents has been known in detail this week.
In practice, hospitals already performed this triage before the first protocol. On Saturday, March 14 at 5:00 p.m., the doctor at the Monte Hermoso residence in Madrid called Mari Cruz Sánchez to tell her that she was fighting to get the ambulance to pick up her brother Miguel and three more patients.
Miguel had been coughing up blood since Tuesday the 10th and Mari Cruz, a retired nursing assistant, knew that negligence was being committed. “You don’t have to have sanitary knowledge to intuit that coughing up blood is a symptom of a serious illness,” she says, narrating the days leading up to the death of her older brother.
Four hours later that Saturday, the doctor called him again to give him good news. The Hospital Cínico San Carlos was going to admit his brother. “They are only going to take Miguel,” he said. He explained that he was the only one authorized by the liaison geriatrician. Miguel, 77, was one of the youngest at the residence and his sister believes he was the only one selected due to his age. But it was of little use. Her condition had worsened so much throughout that week that she died the following morning in the ER, leaving her sister with a deep sense of injustice. Many others died helpless in their beds in Monte Hermoso, which on March 17 was the first Madrid residence to jump to the news due to a massive death outbreak.
The ambulances that evacuated several patients from Monte Hermoso that day in front of television cameras were a mirage. Between mid-March and mid-April, when Madrid’s hospitals brushed the collapse, seniors from multiple residences in the region were left without outside help. The abandonment has been denounced this week by the person who has the powers over the sector in Madrid, the director Alberto Reyero. He said that for weeks in March and April he unsuccessfully asked the Health Minister, Enrique Ruiz Escudero, that if the residents did not go to the hospital, the hospital should go to the residence. The proof of that communication has been published this Friday by this newspaper. In his emails and on Monday in the Madrid Assembly, Reyero questioned the exclusion as being immoral and possibly illegal. “There is one thing that we must never forget, that we, all of us, due to our condition as citizens, have the right to public health care, whether in the health center or in the hospital,” he said in the regional parliament.
Now these declarations give ammunition to the collective complaints that the relatives of deceased in residences have filed against the Community of Madrid. Around 200 families have already joined the accusation against President Isabel Díaz Ayuso, Escudero, the Minister of Justice, Enrique López, and directors of residences in the region. They are accused of reckless manslaughter, failure to help and prevarication. They believe that many of the more than 6,000 Madrid residents who have died with covid-19 or symptoms could have been saved. A judge in Madrid has referred the case to the Supreme Court so that it can decide on its admission since since Ayuso is appraised, that must be the body that understands the case.
One of the three lawyers who voluntarily represents families is Carlos Vila, who 40 years later finds himself again handling a complaint against the administration for his management of a health crisis. Then it was poisoning from the consumption of rapeseed oil, an epidemic outbreak that killed hundreds of people and left more than 20,000 affected.
Overcoming the distances, this 69-year-old lawyer sees some echoes of the rapeseed case in this new lawsuit. This time, he believes that public servants have more responsibility. “Then there were customs leaders who did not act diligently, monitoring the massive imports of the oil. But now it is more serious because the public administration is responsible for the homicide by its direct orders ”, he values.
One of those decisions questioned are the guidelines for hospitals and residences to decide which seniors were eligible for hospitalization, according to their levels of dependency. They are protocols that were signed by the director of socio-sanitary coordination, Carlos Mur. The known versions were signed between March 18 and 25. Another matter under examination are complaints about the lack of “medicalization” of the residences, some sanitary reinforcements that according to many sources in the sector were insufficient.
Escudero has defended that the transfers to hospitals they didn’t stop even on critical days and that your counseling improved medical resources of residences during the crisis. Escudero insisted this Saturday on Radio Nacional that dependents were not excluded, but only terminally ill patients. But this is not true according to the final protocol, which in practice involved the rejection of third-degree dependents according to a fragility scale from 1 to 9.
The plaintiffs, whose names are hidden in the document shared with the press, describe the helplessness suffered by their elders and the despair they experienced, lost in endless baffling calls to residences, 112 or hospitals.
“On Friday the 26th he tells him that it is wrong, but that she is not going to refer him to the hospital because even if he calls the ambulance, it will not come. That all she can do is put an antibiotic on him, ”narrates one plaintiff.
“The SUMMA doctor who treats him tells him that they are not going to send an ambulance and that the only thing that can be done is put him in palliation,” says another complainant who called on April 3 at 112 because at the residence they told her they were not getting help.
“She was insisted on the referral to the hospital, to which she said that they are prohibited and it is not included in the protocols. The external geriatrician also affirmed that she could not be referred, that the hospital was collapsed and that her mother’s age does not fit into the profile, ”says another relative.
“The geriatrician or gerontologist at the Jiménez Díaz hospital told her that she did not meet the criteria, because she was 83 years old, with cognitive deterioration and heart disease, adding that if she was a Christian she would pray, and that she also had to trust them,” says another.
One of the relatives who have joined the complaint is Elena Valero, daughter of two residents at the DomusVi Usera center in the capital. When the doctor surprised her on March 22 with the news that her 96-year-old father Alfonso had fallen ill and was dying, she thought they would send him to the 12 de Octubre hospital, which is just over 500 meters away.
“How sorry I am Elena. They have forbidden us to refer you to the hospital. They ask us to give him palliatives, ”he replied. She raised resistance but it was no use.
Alfonso endured four days alive at the residence, where they had no serum or medications, employees told him. It is common in these centers that are not endowed with resources to care for seriously ill patients. His father was a chatty man with a lucid mind, but he was in a wheelchair. Elena and her sister María Jesús believe that this limitation and her advanced age worked against her.
Her mother, Benita Pablos, fell ill on April 11. Then Elena tells how she got like a lioness to not allow the same thing to happen. She warned the doctor at the residence that if she was not taken to the hospital, she would immediately appear at the door with the police and report them for denial of relief. At dawn on April 13, his mother was admitted to Hospital 12 de Octubre. He could count it. By then the pressure on the hospitals had eased and the doors reopened for the sick from nursing homes. From the start of the crisis until Monday, the Community of Madrid had transferred 9,632 residents to hospitals.
For these daughters, the fact that their mother and many other residents have been saved after being hospitalized is proof of the injustice they believe the Community has committed. “They left him lying in the gutter,” says Elena. “They have decided that my father should die only because he was in wheelchairs.”
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