Tag Archives: Doctors

Insys founder ran bribe scheme to push opioid: U.S. prosecutor

John Kapoor, the billionaire founder of Insys Therapeutics Inc, arrives at the federal courthouse for the first day of the trial accusing Insys executives of a wide-ranging scheme to bribe doctors to prescribe an addictive opioid medication, in Boston, Massachusetts, U.S., January 28, 2019. REUTERS/Brian Snyder

By Nate Raymond

BOSTON (Reuters) – Insys Therapeutics Inc’s one-time billionaire founder directed a vast scheme to bribe doctors to prescribe an addictive fentanyl spray as opioid addiction was spiraling into a public health crisis, a U.S. prosecutor said on Monday.

John Kapoor, the company’s former chairman, and four colleagues are the first painkiller manufacturer executives to face trial over conduct authorities say contributed to the U.S. opioid epidemic, which officials said killed more than 47,000 people in 2017.

Kapoor, who was also Insys’ chief executive from 2015 to 2017, turned the company into a “criminal enterprise” that paid doctors millions of dollars to push its drug, Assistant U.S. Attorney David Lazarus told jurors in Boston federal court.

“John Kapoor and his co-defendants paid doctors to abandon their medical duties,” Lazarus said.

Kapoor, 75, and former Insys executives and managers Michael Gurry, Richard Simon, Sunrise Lee and Joseph Rowan have pleaded not guilty to racketeering conspiracy.

Defense lawyers will deliver their own opening statements later on Monday.

Kapoor’s 2017 arrest came the same day U.S. President Donald Trump declared the opioid crisis a public health emergency. In 2017, a record 47,600 people died of opioid-related overdoses, according to the U.S. Centers for Disease Control and Prevention.

Two top former executives – Michael Babich, Insys’ CEO from 2011 to 2015, and Alec Burlakoff, its ex-vice president of sales – have become government witnesses after pleading guilty to carrying out the scheme at Kapoor’s direction.

Lazarus told jurors that from 2012 to 2015, Kapoor and his co-defendants conspired to pay doctors bribes in exchange for prescribing Subsys, an under-the-tongue fentanyl spray approved only for use in managing severe pain in cancer patients.

Fentanyl is an opioid 100 times stronger than morphine.

Insys paid doctors as much as $275,000 in one case to participate in speaker programs ostensibly meant to educate medical professionals about Subsys but that were actually poorly attended sham events, Lazarus said.

The scheme led doctors to write medically unnecessary prescriptions for Subsys to patients, many of whom did not have cancer, Lazarus said.

He said Kapoor also participated in a scheme to defraud insurers into paying for the expensive drug.

Insys in August said it would pay at least $150 million to resolve a Justice Department probe related to its marketing of Subsys, and that it has taken steps to ensure it operates legally going forward.

(Reporting by Nate Raymond in Boston; Editing by Alexia Garamfalvi and Bill Berkrot)

Dentists, soldiers mix cocktails to leave crisis-hit Venezuela

Carlos Alzaibar takes documents as he packs his suitcase at his home in Caracas, Venezuela March 14, 2018. REUTERS/Marco Bello

By Andreina Aponte and Liamar Ramos

CARACAS (Reuters) – Like many young Venezuelans in recent years, dentist Carlos Alzaibar felt forced to leave the country when he could scrape together only a few dollars equivalent each month doing two jobs.

So on a recent day, just before flying to Madrid, he was sadly packing a red suitcase – while stacking diplomas from a half a dozen trades he picked up in the last year from bakery and bartending to photography and burger-flipping.

Those, he hoped, would help him find work in Spain and fund the medicines his mother needs for a kidney transplant.

“If not, she’s going to die,” Alzaibar, 28, said, folding socks and shirts in his family’s middle-class Caracas apartment.

Droves of Venezuelans, including professionals like Alzaibar and even retired soldiers and prosecutors, have been taking short courses to prepare for life abroad.

Suffering a severe economic crisis that has left many people short of food and basics, nearly a million Venezuelans have departed since 2015, according to the United Nations.

The U.N. refugee agency, UNHCR, calls it one of the biggest population flows in its nearly 70-year history.

The OPEC nation sits on the world’s largest oil supplies, but has seen annual production slump to a three-decade low, along with a four-year economic recession.

COCKTAILS AND COFFEE

Valentina Maggi, 22, studied graphic design and dreams of illustrating children’s stories, but has followed in friends’ footsteps to learn how to mix cocktails at the National Bartender Academy.

“I have many friends who have left the country and have told me to do this type of course because when you get there, you have more work options,” she said in a room with a long table where she had just completed her final test: a Gin Fizz made from gin, lemon, sugar and soda water.

At the academy, 6,000 students are expected to graduate this year – up from 4,500 a couple of years ago.

With Maggi were a 60-year-old retired military officer and a 52-year-old former Supreme Court prosecutor, both hoping to land work at bars in the United States and Argentina respectively.

Asking not to disclose his name for fear of reprisal, the former soldier said his monthly pension of some $5 at the black market exchange rate, left nothing for food after paying for his two sons’ schools.

Venezuela’s economic meltdown is one of the worst slumps in modern Latin American history.

Gross domestic product is shrinking on a scale akin to that of the United States during the Great Depression and inflation is the highest in the world, nearly 9,000 percent annually, according to National Assembly data.

A monthly minimum wage is worth less than a carton of eggs.

While critics lambaste President Nicolas Maduro for failed socialist economic policies and corruption, he says a U.S.-led “economic war” including financial sanctions are to blame.

“From six or eight months ago, everyone’s getting ready to go,” said Pietro Carbone, surrounded by the aroma of freshly crushed coffee beans at his barista training center where places are fully booked for the next three months.

(Reporting by Andreina Aponte and Liamar Ramos; Additional reporting by Efrain Otero; Writing by Girish Gupta; Editing by Andrew Cawthorne and Peter Cooney; Twitter: @ReutersVzla, @jammastergirish)

Turkey orders detention of top doctors over criticism of Syrian offensive

Demonstrators scuffle with riot police during a protest against detention of the head of the Turkish Medical Association (TTB) and 10 other leaders of theÊdoctors' union, in Ankara, Turkey January 30, 2018.

ANKARA (Reuters) – A Turkish prosecutor ordered the detention of 11 senior members of the Turkish Medical Association (TTB) on Tuesday, including its chairman, after the body criticized Turkey’s military operation in northern Syria.

The prosecutor said police in Ankara had started legal proceedings on Tuesday morning and search-and-detention operations were carried out in several provinces. Media reports said nine of the medics had been detained.

Turkish authorities have cracked down on any expression of dissent over the air and ground offensive against the Syrian Kurdish YPG militia in Syria’s Afrin region. More than 300 people have been detained for social media posts criticizing the campaign since it began 10 days ago.

The association’s lawyer Ziynet Ozcelik said that the doctors faced accusations of “propaganda in support of a terrorist organization, and provoking the public”. Ozcelik said it was the first time in the association’s history that all its executive members had been ordered detained.

The association had denounced the cross-border operation into Syria’s Afrin last week, saying: “No to war, peace immediately”. That prompted President Tayyip Erdogan to accuse the union of treason.

“Believe me, they are not intellectuals at all, they are a gang of slaves. They are the servants of imperialism,” he told AK Party members in the northern province of Amasya on Sunday.

“This ‘No to war’ cry by this mob … is nothing other than the outburst of the betrayal in their souls … This is real filth, this is the honorless stance that should be said ‘no’ to,” he said.

Turkey’s Health Minister Ahmet Demircan was quoted by Hurriyet newspaper as saying the union had no right to make such a statement and added that the health ministry had filed a lawsuit to have the union’s administration removed.

“It (TTB) has made a big mistake. The necessary actions will be taken in accordance with the law,” Demircan was quoted as saying.

CALL FOR IMMEDIATE RELEASE

The crackdown on top medics drew swift criticism from an international medical organization and rights group Amnesty International, who called for protection for the members and an immediate end to the legal proceedings.

The World Medical Association (WMA) said its President Yoshitake Yokokura condemned the detentions as well as threats of violence made against the doctors.

“We call on the Turkish authorities to immediately release the physician leaders and to end the campaign of intimidation,” the WMA, which represents 111 national medical associations across the world, said in a statement.

Amnesty said members of the TTB were “subjected to threats of violence”, and called on people to submit appeals to the Ankara governor’s office to provide additional security measures for the union and its members.

Separately, the Furkan Education and Service Foundation, a group that runs Islamic schools, said several of its members had been arrested. Those detained included the group’s Chairman Alparslan Kuytul, who had made remarks deemed to be criticizing Turkey’s military offensive.

(Reporting by Gulsen Solaker and Ezgi Erkoyun, Ece Toksabay and Tuvan Gumrukcu; Editing by Ece Toksabay and Peter Graff)

Counting the costs: U.S. hospitals feeling the pain of physician burnout

Counting the costs: U.S. hospitals feeling the pain of physician burnout

By Julie Steenhuysen

ANN ARBOR, Mich. (Reuters) – Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan.

His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients.

“You really have to find the balance to put it a little more in perspective,” he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected.

Some leading healthcare executives now say the way medicine is practiced in the United States is to blame, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

What’s more, burnout is not just bad for doctors; it’s bad for patients and bad for business, according to interviews with more than 20 healthcare executives, doctors and burnout experts.

“This really isn’t just about exercise and getting enough sleep and having a life outside the hospital,” said Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September.

“It has at least as much or more to do with the environment in which these folks are practicing,” he said.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors and leads doctors to leave a profession they once loved.

For a graphic, click http://tmsnrt.rs/2zMlmuy

Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

“Burnout decreases productivity and increases errors. It’s a big deal,” said Cleveland Clinic Chief Executive Dr. Toby Cosgrove, one of 10 U.S. healthcare CEOs who earlier this year declared physician burnout a public health crisis.

WHAT TO DO?

Hospitals are just beginning to recognize the toll of burnout on their operations.

Experts estimate, for example, that it can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

But no broad calculation of burnout costs exists, Shanafelt said. Stanford, Harvard Business School, Mayo and the American Medical Association are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

In July, the National Academy of Medicine (NAM) called on researchers to identify interventions that ease burnout. Meanwhile, some hospitals and health insurers are already trying to lighten the load.

Cleveland Clinic last year increased the number of nurse practitioners and other highly trained providers by 25 percent to 1,600 to handle more routine tasks for its 3,600 physicians. It hired eight pharmacists to help with prescription refills.

Atrius Health, Massachusetts’ largest independent physicians group, is diverting unnecessary email traffic away from doctors to other staffers and simplifying medical records, aiming to cut 1.5 million mouse “clicks” per year.

Insurer UnitedHealth Group, which operates physician practices for more than 20,000 doctors through its Optum subsidiary, launched a program to help doctors quickly determine whether drugs are covered by a patient’s insurance plan during the patient visit. It is also running a pilot program for Medicare plans in eight states to shrink the number of procedures that require prior authorization.

Similarly, Aetna Inc this year began a behavioral health program that eliminates prior authorization requirements for admission to some high-performing hospitals.

DOCTOR OVERLOAD

Experts define burnout as a syndrome marked by emotional exhaustion, cynicism and decreased effectiveness. Many burned out doctors cut back their hours to cope, and a disturbing number commit suicide.

A landmark 2015 Mayo Clinic study found that more than 7 percent of nearly 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers. About 400 a year go through with it.

Driving the burnout symptoms is the burden of data entry on clumsy electronic medical records systems that doctors must use to prove the quality of their care, said Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

Sinsky recently conducted an experiment in her own internal medicine practice in Dubuque, Iowa. She asked a staff member how many mouse clicks it takes to order and record a single patient’s flu shot in their electronic medical record. The answer: 32.

She has visited some practices where a doctor had to record flu shots for more than 1,000 patients because only the doctor was allowed to enter the order.

Such mandates reflect an overly strict interpretation of federal health reforms designed to encourage doctors to use electronic medical records, such as the 2009 Health Information Technology for Economic and Clinical Health Act that required doctors to demonstrate “meaningful use” of the systems.

“We have to recognize the exacting toll that the first generation of electronic health records have had on physicians,” Sinsky said. “I would identify it as one of the most important drivers of physician burnout.”

Pre-approval requirements from health insurers for many services and quality metrics built into Obamacare have added to doctors’ administrative duties.

“We’ve got this measurement mania. We’ve got to back off of that,” said Dr. Paul Harkaway, chief accountable care officer for Michigan’s St. Joseph Mercy Health System, a part of Trinity Health, a national not-for-profit Catholic healthcare system.

As a result of these requirements, primary care physicians spend more than half of their 11.4 hour workday performing data entry and other tasks, according to a September AMA/University of Wisconsin study published in the Annals of Family Medicine.

To manage, doctors often finish work at home in the evening, a part of the day known as “pajama time.”

COSTS TO THE HEALTHCARE SYSTEM

Doctors’ suffering can take a direct toll on patients. In a 2010 study, Shanafelt and colleagues found that the more burned out a surgeon was, the more likely he or she was to report a major medical error. Other studies have shown that burnout drives up rates of unnecessary testing, referrals to specialists and hospital admissions.

When doctors quit, it costs an estimated $800,000 to $1.3 million in recruitment, training and productivity costs, depending on the specialty.

Even when physicians don’t leave, they can contribute thousands of dollars in costs each year “just as a matter of inefficient functioning,” said Dr. Colin West of the Mayo Clinic.

The trend has medical malpractice experts concerned. CRICO, the malpractice carrier for Harvard University’s two dozen affiliated hospitals, recently had to settle a handful of cases because doctors were too burned out to fight, even though CRICO believed it could win.

“The clinician just wanted it to go away,” said Dr. Luke Sato, CRICO’s chief medical officer. Sato estimates that an average breast or colorectal cancer malpractice case might cost $750,000 to $1 million to settle.

The crisis has Harkaway worried for his colleagues in Michigan, and for his profession.

“Working with doctors every day, you see it,” he said. “They are just beat down.”

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Editing by Edward Tobin)

In Puerto Rico, lives depend on volunteer doctors and diesel generators

In Puerto Rico, lives depend on volunteer doctors and diesel generators

By Robin Respaut and Nick Brown

OROCOVIS, Puerto Rico (Reuters) – At a community center in Orocovis, an isolated agricultural town of 23,000 in the mountains of central Puerto Rico, six oxygen-dependent patients drew breath with the help of the diesel generator powering their equipment.

Then the generator sputtered as if it might die.

A dozen volunteer doctors and medical students from San Juan started assessing which patient should be transported first – in the town’s only ambulance – to a hospital an hour away, and which could survive without oxygen for a short time.

Javier Sevilla Rodriguez, a medical student, had only one way to make the agonizing decisions. He removed one woman’s oxygen tube, watching carefully to see how her blood-oxygen level responded.

“This is how we are doing triage right now,” he said.

Two weeks after hurricane Maria, many of Puerto Rico’s sick, frail and elderly are teetering on the edge, one faulty generator away from missing dialysis treatments or having critical medications go bad.

With nearly the entire island still lacking electricity, hospitals, clinics, and shelters are operating on aging generators not intended for long-term use and powered by scarce diesel fuel. Water is still not available for nearly half the population and supplies of medicines and oxygen are running low.

And residents still can’t call for help across vast swaths of the island because of widespread cellular network outages.

Many regions in the interior of the island, like this one, are only now seeing relief efforts, amid a plodding U.S. disaster response to this island of 3.4 million American citizens. The U.S. territory’s battered economy and infrastructure has magnified the humanitarian crisis wrought by the strongest hurricane to hit here in nine decades.

In Orocovis, even the sickest patients have gone largely without medical care since the storm. So the doctors worked quickly throughout the day, conferring with caregivers and writing prescriptions they would take back to San Juan to fill and then dispatch by messenger.

Now at the community center, their last stop before leaving town, time ran out.

With a loud clunk, the sounds of humming oxygen machines stopped and were replaced by a chorus of beeps and chirps warning that power had been cut.

The generator had failed.

A CALL FOR DOCTORS

The medical convoy that visited Orocovis is an entirely volunteer operation, organized by physician Carlos Mellado. After Maria hit Puerto Rico on September 20, blocking roads and crippling power and communications networks, Mellado asked other doctors at his clinic to cover for him and threw himself into hurricane relief work.

On the first day, he headed to Canovanas, east of the capital, checking on people at shelters. He promised to fill many patients’ prescriptions and send back the medications.

The next day, he went to Vieques, an island off Puerto Rico’s eastern coast, and found diabetics without insulin, heart patients under extreme stress and crucial treatments interrupted by power outages.

When Mellado returned to San Juan, he stopped by the local radio station, which in the days after the storm, had become a trusted source of information for Puerto Ricans living without communications. Invited to speak to listeners, he called for other physicians willing to join him.

Now, Mellado has a core group of 18 physicians, who rotate between the trips and their own practices, and a growing list of more doctors who want to join. Each morning, he takes out a paper map of the island covered with notes about where he’s been. The doctors pick a town and go.

The convoys have no official ties, but Mellado reports each evening on what the doctors found to Puerto Rican and federal officials in San Juan. Sometimes Puerto Rico’s housing department coordinates deliveries of the drugs back to the towns, and a pharmacy chain donates medications for patients without insurance.

The government’s death count from the storm more than doubled this week to 36. But doctors across the island believe the total would be far higher if it included people with chronic conditions who died because they lacked access to medical care.

“For these critically ill patients, if everything fails, they don’t have too much time,” said Humberto Guzman, a pediatric orthopedic surgeon and member of the medical convoy. “People are dying.”

‘WE CANNOT WAIT’

In Orocovis, after the generator failed, the doctors looked for a quick fix. Guzman ran up the street to the town’s shuttered urgent care facility.

There, he found a half-dozen oxygen tanks that locals said had been delivered the day before. Each could provide about a day’s worth of oxygen to a patient.

The tanks were quickly moved to the community center, where the doctors taught family members to use them. But before that became necessary, the generator sprang back to life.

The doctors packed up to leave, assuring patients’ families that they could switch to the tanks if the generator failed again.

“In every town right now, there are moments like this happening,” Guzman said. “That’s why you need people like us to just go. We cannot wait.”

(This version of the story corrects to fix pronoun in paragraph 4 and change “country” to “island” in paragraph 7)

(Reporting by Robin Respaut and Nick Brown; Editing by Sue Horton and Brian Thevenot)

Doctors devise care plan for babies as Zika threat looms in U.S.

mosquito under microscope

By Julie Steenhuysen

CHICAGO (Reuters) – As U.S. public health officials try to determine whether Zika has arrived in the country, doctors are establishing guidelines on how to care for the rising number of babies whose mothers were infected with the virus during pregnancy.

Florida said it is investigating two possible cases of Zika not related to travel to an area where Zika is active, raising the possibility of the first incidence of local transmission of the mosquito-borne virus.

On Thursday, the Florida Department of Health said it was investigating a non travel-related case of Zika in Broward County, marking the second such case. Florida has asked the U.S. Centers for Disease Control and Prevention to assist in its investigation that must also rule out sexual transmission.

So far, 400 pregnant women in the continental United States have evidence of Zika infection, up from 346 from a week ago, the CDC reported on Thursday. All of those were related to travel or sex with an infected person who had traveled.

Three more babies have been born in the United States with birth defects linked to Zika infections in their mothers, bringing the total to 12, CDC said.

Zika has been proven to cause microcephaly, a severe birth defect marked by small head size and undersized brains that requires a complex network of care providers and social workers to treat and provide support to parents.

But microcephaly is just the tip of the iceberg, according to experts speaking at a CDC-sponsored workshop on Thursday. They said many babies exposed in utero who appear normal at birth may have developmental problems down the road, including hearing and vision problems.

For example, babies born without a functional sucking reflex may never develop the ability to swallow and will need to be fed through a feeding tube. These infants will have a higher risk of pneumonia, said Dr. Edwin Trevathan, a pediatrician and child neurologist at Vanderbilt University Medical Center.

Less obvious damage to structures on only one side of the brain may cause seizure disorders that do not appear until adolescence, Trevathan said.

Pediatric experts at the workshop are reviewing the potential consequences of Zika infection and plan to make recommendations on ways to treat Zika-exposed infants.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,600 cases of microcephaly that it considers related to Zika infections in the mothers.

FLORIDA PROBE

The recommendations come as Florida officials investigate what may be the first cases of Zika in the continental United States caused by the bite of a local mosquito.

Florida officials will not elaborate on how a resident of Miami was infected and whether the first case under investigation was related to mosquitoes.

“We continue to investigate and have not ruled out travel or sexual transmission at this time,” Florida spokeswoman Mara Gambineri said in an email on Thursday. However, she said the state still suspects the case is not related to travel to a Zika-infected area.

The White House on Wednesday released a statement saying President Barack Obama had spoken to Florida Governor Rick Scott regarding a suspected case of mosquito transmission of Zika and promised more money to fight the virus.

At the Zika workshop, Dr. Marc Fischer, chief of surveillance and epidemiology activity at the arboviral diseases branch of the CDC, said the agency has worked with state health departments to establish strategies to identify possible local transmission in the United States.

“When and if there is a case of local transmission, we work with local health departments to identify additional cases to define the geographic scope of the outbreak,” he said.

That includes surveying households and neighbors within a 150-yard radius around the residence of the person who has Zika.

“That’s basically the flying radius of the vector mosquitoes,” he said.

According to the U.S. Zika response plan, Zika local transmission is defined as two or more cases not due to travel or sex with an infected person that occur in a one-mile diameter over the course of a month.

CDC has given Florida $2 million for Zika preparedness, and on Thursday awarded another $5.6 million to assist the state with Zika as part of an additional $60 million in Zika funds to states announced on Thursday. U.S. lawmakers so far have not approved any of the White House’s $1.9 billion request for Zika.

CDC plans to award another $10 million to states and territories on Aug. 1 to speed identification of microcephaly and other birth defects linked to Zika.

(Additional reporting by Bill Berkrot in New York; Editing by Bernard Orr)

Doctors turn militant over Venezuela’s health crisis

Patients lie in hospital beds in the hallway of Venezuelan hospital

By Corina Pons

MERIDA, Venezuela Reuters) – A dozen doctors hold a hunger strike in the corridors of an Andean city hospital. In another provincial city, hundreds of protesting medics suspend appointments.

In the capital, staff from a pediatric hospital wave placards at the entrance to a hospital pleading for aid.

Not usually active in politics, many of the OPEC nation’s 40,000 doctors are becoming increasingly militant over drastic shortages of medicines, equipment and personnel amid a punishing economic crisis.

With eight out of 10 medicines now scarce, according to the main pharmacy group, protesting doctors are demanding that President Nicolas Maduro’s socialist government declare a national health crisis and allow foreign humanitarian aid.

“I started to see patients, both in the operating theater and in the emergency ward, dying for lack of medicines,” said David Macineiras, a 30-year-old orthopedic surgeon and one of 12 doctors who went on hunger strike at the main state hospital in the western highland city of Merida.

“They arrive in bad conditions and we can’t even get adrenaline to deal with a cardiac arrest,” he said, describing the case of a woman who died for lack of adrenaline. Macineiras himself was hospitalized for four days after his hunger strike.

The protests involve a small percentage of doctors, in part because medics – especially younger ones – depend on the state to complete their residencies and studies and so have good reason to avoid conflict.

Doctors who hold high-ranking positions in public health acknowledge there are problems, but insist that none are sufficiently severe as to put patient lives at risk.

Christian Pino, a surgeon at the Merida hospital who also joined the strike, insists the opposite is true.

He recently operated on an elderly woman who due to chronic hospital shortages had to bring her own supplies, including saline solution. It ran out before the operation finished.

“In post-op, we didn’t have any serum to hydrate her, so the patient died,” he said at the hospital where stretchers packed corridors and incubators stood abandoned with handwritten signs saying they were out of service.

In June, Pino read a list of doctors’ demands in Venezuela’s National Assembly before the opposition-led legislature declared a state of medical emergency and approved channels for foreign humanitarian aid.

“I prefer to raise my voice with my colleagues than be an accomplice to this,” Pino said.

But the government-leaning Supreme Court shot down the assembly’s proposal. Government officials deny Venezuela is facing a humanitarian crisis and say there is no need for humanitarian assistance.

Maduro is fiercely proud of health advances under the 1999-2013 rule of socialist leader Hugo Chavez, and he says adversaries are exaggerating the problems now.

“There is no humanitarian crisis, I say it with absolute responsibility,” Foreign Minister Delcy Rodriguez recently told an Organization of American States meeting on Venezuela.

DEPRESSING DATA

Up-to-date data is hard to find, but what little is available points to a severe deterioration.

Health ministry statistics show that in 2015 for every 100 people discharged from state hospitals, 31 died – a rate six times higher than the previous year. Infant mortality was 2 percent of births last year, 100 times worse than 2014.

It is a huge challenge for the ruling Socialist Party which, under Chavez, ran enormously popular free health projects such as Cuban-staffed clinics in the slums but is now finding its welfare programs stretched.

According to the World Health Organization (WHO), Venezuela and Guyana were the only countries in South America to see maternal death rates worsen last year.

Health Minister Luisana Melo recently recognized health sector problems but said authorities are working to reduce the rates of infant mortality and death during childbirth.

She said shortages only affect around 15 percent of medicines and that Venezuelans tend to consume more medicine than they need to.

The government says a U.S.-backed “economic war” by political opponents and hostile business groups has caused the crisis, exacerbated by a plunge in the price of oil, which accounts for 95 percent of export revenues.

Huge lines snake around most pharmacies from before dawn, with some people staying all night to stake a place. Rowdy scenes are common, and soldiers guard the crowds.

In Merida, orthopedic surgeon Carlos Hidalgo said he joined the hunger strike after a patient arrived with an open fracture of the tibia and femur and there was no saline solution to clean the wound.

“They went to a kiosk and bought water to wash him with that,” he said. An infection set in and the patient’s leg was amputated.

“That’s why we protested, not because of our working conditions,” said Hidalgo, who makes 16,000 bolivars a month, equivalent to about $25 at the weaker of two official exchange rates and just $16 on the black market.

Some doctors are also worried about their legal liability. Medics in the city of Barquisimeto decided to ask patients’ relatives to sign a permission slip acknowledging the poor conditions they were working under.

At hospitals there, medics have held two strikes this year. Surgeries were halted on a recent day due to lack of gloves.

Idabelias Arias, the head of the emergency ward at a pediatric hospital in Barquisimeto, has had to use basic CPR (Cardiopulmonary resuscitation) to revive children for lack of adrenaline. “Doctors are doing war medicine here.”

(Writing by Andrew Cawthorne; Editing by Kieran Murray)

Doctors Head To Africa For International Volunteer Day

On World Volunteer Day, December 5th, two doctors with international missions group SIM are heading to Africa to serve in hospitals treating patients with Ebola.

International Volunteer Day was established by the United Nations in 1985 as a way to encourage volunteerism around the globe.  SIM International focuses on helping people around the world and Dr. Dan Crawford of SIM said he’s excited to help those in need in Africa.

“We feel like we are well prepared,” Dr. Crawford told USA Headline News.  “You can’t be completely prepared until you are there, but we don’t really feel any great anxiety about the disease itself.  We know we are in God’s hands wherever we are and there are dangers wherever you work.  There is, however, anxiety about going to a new place.”

Dr. Crawford has spent 15 years volunteering monthly at a low-cost clinic in Portland, Oregon.

Dr. John Fankhauser will also be volunteering with SIM’s Ebola mission.  Dr. Fankhauser had been practicing family medicine at the SIM ELWA Hospital in Monrovia, Liberia when the Ebola outbreak started.

He has personally been quarantined twice because of possible exposure to Ebola.  He said it’s God’s call on our lives to help those in need and so he has no problem going back after his second quarantine.  He trusts the Lord will plan his days and he trusts in Him.