Italian hospitals crying out for emergency treatment

Health care/ a catalogue of errors

THE RECENT health reports from Naples have not been reassuring. A three-year-old boy with a malformed right hand had his left hand operated on by mistake. A middle-aged man with kidney problems died while two doctors bickered about how to use the dialysis machine. A six-year-old girl failed to wake up after a tonsillectomy .

Italy is not exactly famous for the quality of its health care. Indeed, some say that if you get ill you should go not to hospital, but to the airport. But these days the scare stories are proliferating. The low point came at the end of last month, when a group of Aids patients - again in Naples - revolted against the degrading conditions in which they were being kept by hurling their hospital meals and rusting beds and tables out of the ward windows.

Yet the health sector, like everything else in Italy, is supposed to be undergoing a revolution. Bled dry by a generation of politically appointed managers who handed out jobs to their friends like sandwiches and spent money freely, the Italian health service has now opted for a very British solution.

Since the beginning of the year, local health authorities and certain target hospitals have been run as trusts, meaning they can no longer rely on the state to mop up their deficits but have to become financially self- sufficient. As in Britain, the regional authority will pay for patients according to their condition, not the length of their stay in hospital, which gives hospitals a strong incentive to treat them quickly and efficiently.

Applying the logic of the free market to such a place as Naples is surreal to behold. Where, after all, do you start in a city whose largest hospital is so poorly run that a patient once died on the operating table because the stitching thread had run out? A city where bodies disappear from mortuaries, stretchers are stained with vomit and blood, many orderlies are ex-convicts on the payroll of the local Mafia, and where patients are left to rot in corridors because of lack of bed space or medical staff to attend to them?

Enter Domenico Pirozzi, a strange breed of Italian-style yuppie manager. He was recently appointed director-general of two specialised hospitals in Naples, including the Cotugno, where the Aids riot took place. Mr Pirozzi does not come from the private sector - no successful entrepreneurial manager would touch hospitals with a barge pole - but is a former official in the Interior Ministry.

He dresses sharply, chews gum, and has a sideline selling Lancias. Above all, he is image-conscious, and indeed, has a book called The Importance of Multi-Media Systems in Managerial Life lying prominently on his desk.

"All these reports of medical errors are highly exaggerated. These things happen in every country in the world," he said cheerfully. Mr Pirozzi happily accompanied journalists to the notorious Aids ward, where the rooms have been repainted, cleaned, and kitted out with new furniture, telephones and television sets. Patients are no longer isolated, but receive as many visitors as they want. "It's not exactly hell, is it?" Mr Pirozzi remarked.

Not exactly, no, but what about the rest of the hospital, where doctors say six people are crammed into each room and hygiene remains dire? And the food, which one Aids patient described as "inedible"? "It's fine. I had some myself the other day," Mr Pirozzi said. Even he conceded, though, that past mismanagement had created a fertile environment for medical horror stories. Previous administrators were more concerned with empire-building than health care, creating vastly overstaffed departments that did not correspond to patients' needs.

For example, Italy has as many heart transplant facilities as the United States. But because of hospital inefficiency, it can take weeks for a patient to gain access to basic medical services.

"The No 1 problem is that patients are staying too long in hospital," Mr Pirozzi said. "They have to wait five to ten days for a CAT scan."

Soon staff will be on a 12-hour day, with numbers cut from 3,200 to 2,700 to look after 1,200 patients. Each day doctors beg Mr Pirozzi for their departments, their jobs, and their equipment. So far, the reforms have raised little protest, or even public interest: anything that improves the Italian health system must, after all, be welcome.

Waste disposal experts recently grew angry enough to block the entrance to the hospital complex with their lorry for an hour. To British eyes, it doesn't look entirely unfamiliar.