The changes that the Minister of Public Health, Karina Randoto the National Plan of ACV launched by the former Minister of Public Health Daniel Salinas They gave the hierarchy some headaches.
Wednesday was an example of this as a meeting with some health providers ended in a tense exchange. the director of the Brain Health Plan of the Ministry of Public Health (MSP), Claudio Berrutti and the director of Clínicas hospital, Álvaro Villar.
On Thursday morning, Rando called Berrutti to a meeting next Monday to discuss the director’s “dissatisfaction” with his role, MSP sources said.
Sources said The Observer which Berrutti considers a “lack of support” from MSP authorities the exchange he had in the meeting with director of the Hospital de Clínicaswho objected to the portfolio “close” or “merge” stroke centers from some providers.
As rebuilt The Observerthe first idea is that the General Director of Health (Digesa) of MSP, Adriana Alfonso y Berrutti is the announcement of Catholic Circle, the Hospital de Clínicas and the Spanish Association – which was absent from the meeting – that mechanical thrombectomies will be replaced by three centers.
However, due to Villar’s refusal, The director of Digesa asked the providers to present an alternative proposalsomething Berrutti is not good at.
In addition, in the meeting Villar accused Berrutti of having a “conflict of interest” between its position as a hierarchy of MSP Brain Health Plan and his private work on Uruguayan Medical Mutual Fund, where mechanical thrombectomies are also performed and MSP does not propose to close or change its operation.
“This man (by Berrutti) He began speaking out against Clínicas and Gaye (by Andrés Gaye, coordinator of the hospital’s Stroke Unit) cut him off and told him: ‘You can’t speak because you have a conflict of interest’. He (Berrutti) said that he had no conflict of interest,” said Villar and added: “Gaye told me, in front of him, that Berrutti is part of the Uruguayan Medical team and works with Roberto Crosa. So, it’s like Crosa sitting there.”
“Conflict of interest”
putter a neuro interventionist who specializes in performing mechanical thrombectomies. However, in addition to working with Berrutti on Doctor in Uruguayan advisor to MSP brain health plan and near the minister Rando after work also with the mutual fund when the hierarch worked as an anesthetist.
From MSP they say The Observer that the portfolio came to the meeting with the providers with a decision made to distribution of mechanical thrombectomies – a technique that can save the life of a patient suffering from an ischemic stroke and funded by the National Resources Fund– in Círculo Católico, the Hospital de Clínicas and the Spanish Association for 10 days of every month, instead of them working all the time as suggested in the original plan of the former minister. Salinas.
However, according to Villar, In fact, the MSP called the providers to inform them that “the minister intends to close the Clinic center.”
The director of that hospital assured that in the meeting the director of Digesa He informed them that within a month for the first ten days mechanical thrombectomies would be performed Uruguayan Medical, the next ten of the American Sanatorium and that the remaining days will be distributed by other providers –Círculo Católico, Spanish Association and Hospital de Clínicas–.
“Here it is not against him (by Berrutti), it is against the decision of the Minister of close the public sector and leave thrombectomy without academic training,” said Villar.
However, after the dissatisfaction of the director of the Brain Health Program, Rando met with Villar this Thursday and proposed working with the Hospital de Clínicas to “improve” the specialized stroke center.
Even at the end of August Rando raised directly reduce the number of centers that perform the techniquethe idea generated rejection among some of the eight neuro interventionists in Uruguay and in this new meeting the proposal of the MSP is to “merge” the service provided by Catholic Circle, the Hospital de Clínicas and the Spanish Associationas Berrutti says The Observer.
However, as Rando informed Villar, there is still no clear resolution from the MSP on what to do with the National Stroke Plan. The decision of closing, merging or changing the dynamics of centers that perform thrombectomies There is behind this a report from the FNR, asked by some specialists, which shows indicators of the number of interventions and mortality of each mutual fund 15 months after the start of the plan and which places Médica Uruguaya as one of the providers with the lowest rate of patient deaths.
The document serves as an argument for Rando, Berrutti and Crosa with initially consider reducing the number of centers performing mechanical thrombectomies. However, neurointerventionists have criticized the data as a limited time and not using the right methodology.
The amount of conflict
the minister Rando y Berrutti assured that some specialized centers that perform mechanical thrombectomies have poor results when looking at number of interventions and the mortality of patients. 15 months after the Salinas plan centers began, the FNR prepared a report concluding that in 78 mechanical thrombectomies carried out in that period of time, 25 were financed by the IMAE of Medical Uruguaya, 26 by the American Sanatorium and the rest were distributed to the various centers mentioned.
The report measures the death of the patient in 90 days and concluded that Médica Uruguaya had the best record: 25 thrombectomies and seven patients who died. At the Hospital de Clínicas, according to the FNR report, eight interventions were performed and six patients died.
However, Villar and Gaye brought another report to Wednesday’s meeting to refute these data and that thinking over a longer period of time. The document you are accessing The Observer the hospital took 16 months and not 15, that is, since the thrombectomy became under FNR funding.
the Mortality at 90 days is 50% according to data from Clínicas, and not 75% as shown in the FNR report. “Not true. The number of procedures actually performed is almost double that officially reported by the FNR,” said the director of the public hospital. According to Villar, in the meeting this Thursday, Rando validated the results presented by the Clinics and told him that he has no intention to close the center.
In the meeting, Berrutti criticized that Villar presented these data because he considered that the period of time taken by the Clinics was arbitrary and added patients who were not there before, according to the reconstruction of the meeting.
Villar answered that Clínicas hospital performed a total of 19 mechanical thrombectomies with a mortality of 50% and said that the closure of the center is “taking away elements from the public sector, ipover public offering, training and innovation”.
Interests and health
The medical specialty of those who perform mechanical thrombectomies is so specific that in Uruguay there are only eight people working to intervene in these patients suffering from ischemic stroke. And every intervention can be different US$ 9 mil and US$ 15 mil.
However, although the group of specialists is small, the accusations are alleged conflicts of interest and low productivity They always are.
Villar criticized Roberto Crosa as an advisor to Rando and Berrutti because “it is a person clearly associated with a company.” “Since this is not the Uruguayan Medical mutual fund, “This is the company of Dr. Crosa, who is a medical entrepreneur,” he said.
Berrutti also worked with Crosa, who explained that in addition to being andThe director of Brain Health at MSP works at Médica Uruguaya as a neurologist and is in charge of the stroke protocol. When in the meeting Villar and Gaye accused him of having a conflict of interest because of the activity, Berrutti replied that he “he has no problems,” that he is “honest” and that he has “no secrets.”
In August, Minister Rando himself made a clarification in a meeting with neuro interventionists, when he informed them that he would reform the National Stroke Plan: “First of all, I want to make it clear that I am not a friend no one else and that I do have no conflict of interest.”
Therefore, without an initial greeting, the minister began the meeting, as if it had been rebuilt The Observer at that time based on the six sources available.