#Colectiv: Three years later, health system hopeless for heavily burnt victims

Romania has no real conditions to treat even a single heavily burnt patient three years after the fire disaster in the club Colectiv, said the doctors dealing with such cases. Health Minister, Sorina Pintea, however, recently said there were as many as 11 safety beds in Romania for serious cases of patients, namely six at the Floreasca Hospital and five at Spitalul de Arsi.

The doctors explained to HotNews.ro why the above-mentioned beds are not safe. The key to the problem is the lack of infrastructure providing for the perfect isolation of those injured.

The only realistic solution for the difficult cases remains, for this moment, their transfer to hospitals outside Romania. This is one of the few things that have changed after the Collective: the attitude towards them. In fact the minister herself has quickly approved earlier this year, in some very serious cases, the transfer abroad.

Doctor Elena Copaciu, who has been leading an 8-year Anesthesia-Intensive Care Unit of the University Emergency Hospital in Bucharest and adviser to Vlad Voiculescu in his office as Health Minister, told HotNews.ro that the units in the Floreasca Hospital and that at the Arseni Hospital in Bucharest ”are individual intensive care units at a standard very close to the compulsory ones, but there were no therapeutic bath available from the reserve, neither in Floreasca nor in the Arseni Hospitals.”

”The philosophy of organizing a true and modern center for burnt people is based on the principle that serious burns must be perfectly bacteriologically isolated from those aroun, and all the facilities must be dedicated to it. The burned bath should be located in the same room. The order 476/2017 clearly states that in order for a burnt people center to exist, it must have dedicated intensive therapy, dedicated surgery rooms, dedicated circuits and dedicated staff. That’s why a revamping of a burning facility is not just about purchasing new beds and getting them right. You need to have all the necessary infrastructure around them. If a bed occupies, say, only 15 square meters with the equipment around it, then it takes several tens of square meters for the facilities to serve it. What is currently not the case with the vast majority of locations, ” Dan Grigorescu, head of the Plastic and Reconstructive Surgery Section of the County Emergency Clinical Hospital in Braşov explained.

Copaciu also said that: ”The capacity for hospitalization in intensive care for large burns has not changed. For the moment there is no center in the country that fulfils all the conditions to be declared a care center for and then that patient’s pathway, which is provided by Order 476/2017. The medical services the patient with severe burns needs which are defined in the order cannot be offered in a coherent and structured way within the sanitary system in Romania.”

Only the attitude changed

Attitude towards burned patients to be transferred abroad changed, and they are quickly sent at other hospitals.

”In the cases that followed the Colectiv, there was no philosophy to handle it, but we have transferred the sick patients to specialized hospitals from abroad for the treatment of burns – this happened at least twice this year, ” said Bogdan Tanase, the President of the Physicians Alliance for HotNews.ro.

Otherwise, ”speaking of the development of a specialized unit for the treatment of the severe burns, this, as far as I know, has not yet happened. We do not have a functional unit at Western standards to care for the sever burns, ”said the doctor.

In Romanian hospitals patients with burns may be treated for up to 20 percent or 30 percent of the body surface covered with burns, but not 50 percent or 60 percent.

In turn, Doctor Elena Copaciu said that ”there have been more cases of patients who are seriously burned in intensive care units in county hospitals or university hospitals which are not prepared to care for such patients, obviously additional risks are added.”

”You can perfectly treat the patient while in the well-equipped bed, but if he is in that bed and you go to one or the other for various medical actions, you expose him to many aggravating factors. It supports the assertion, however tough it may be, that top endowments not supported by a proper functional structure can not provide this so-called ”great safety”. Therefore, in recent years, steps have been taken to build or organize some appropriate structures, initiated by the nomination of regional centers for severe burned, so Iasi and Timisoara are said to have been finalized but they are empty due to lack of funding for such facilities. If they comply with European standards, if the projects they were designed to meet the latest international standards in the field, I do not know, but it would be a tragedy not to respect them, ”explains Grigorescu.

On December 12, 2017, the Order no. 1419 (Emergency Priority Actions) which nominate 17 hospitals located in 9 localities (five in Bucharest, two in Brasov, Timisoara, Iasi and Cluj and one in Targu Mures, Craiova, Constanta and Oradea) considered to be able to provide a quality treatment for patients with different types of burns. The County Emergency Clinical Hospital in Brasov, where Dan Grigorescu is responsible for the implementation of the Arsuri Priority Actions Order, is on this list, which means he can treat burns not only from the districts of the hospital but also far from Brasov . The Order provides additional funding to treat patients burned by these hospitals, but funding is modest, says doctor Dan Grigorescu.

Building special burnt centers – a national priority that stands still, The Ministry of Health has signed or is in the process of signing ”in 2-3 days” the contracts for designing centers for patients with severe burns, funded by the World Bank, at Bagdasar Arseni Hospital in Bucharest, Grigore Alexandrescu Hospital in Bucharest, Timisoara and the County Hospital in Targu Mures, said Health Minister Pintea in early August, presenting the balance sheet after the first 6 months of the mandate.

Doctor Copaciu says that she does not understand why the Timisoara and Iasi centers, which were completed in December 2016, were not operational, and they were waiting for the equipment. For Timisoara, at least, it was at the purchasing line from the ministry, the entire file, complete, to be funded in early 2017 because in 2016 the builder finished on December 15 and could not fund an unfinished building, and there would be an increase in admission capacity, it is unacceptable to get by the end 2018, and not even these centers to be functional – to increase the capacity for internment for large burns and better distribution.

”Something, however, is too slow in the ministry, which is unacceptable. Something is too much in this story,”” says Copaciu.

Regarding the construction of these special centers for burned patients, Dan Grigorescu comes up with the idea that these centers are part of the future regional hospitals, an idea he says he did not hear from the Ministry of Health decision-makers: ”Speaking about the centers for severe burns as the equivalent of some small hospitals dedicated to this pathology, nor would it be difficult to build them as buildings adjacent to major hospitals or structures included in future regional hospitals. I have not heard yet that any of the top representatives of the Ministry of Health impose this idea in the public space: ”No regional hospital without a burning center!”

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