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Nicoya Doctors Protest Against On Duty and Shift Cuts

By Oliver Pérez

Nicoya’s medical center is taking steps to reduce costs and the emergency department was the first to be affected. There, medical work-hours and calls have been cut back during weekends and holidays, as is confirmed in a statement sent by hospital director, Juan José Li Kam, and signed by 22 physicians.

Funds intended to cover on-call shifts and overtime for non-medical staff at La Anexión Hospital will last through September only.

Attending physician, Ricardo Guerrero Ureña, reported that as a result of this measure, on August 4th, after being on duty in the Emergency Department physician Hugo Delgado was called to work in the Internal Medicine Department from 7 a.m. to 11 a.m.

“He was assigned to make rounds after being the on-call internist. During that time, a year and a half old girl came to the Emergency Room with near-drowning syndrome while two urgent C-sections where also taking place. It is clearly wrong to remove an ER physician, increasing the burden on other doctors,” affirmed Guerrero.

On August 16th, 22 doctors gave Medical Director, Dr. Li Kam, an ultimatum, announcing that they would suspend on duty shifts, medical calls and overtime themselves, until the budget is guaranteed for the rest of the year.

In addition, they are demanding that the payment of overtime and on duty hours is not cut out of the 2013 budget.

In the statement presented by physicians, they are also demanding that five doctors should remain at all times in 24-hour duty.

Doctors are calling on the community to attend a forum that will be held on September 1st at the Coopealianza building, where they will explain the hospital’s current situation.

Meanwhile, Dr. Anner Angulo Leiva, Regional Health Services Director for the Chorotega area, explained that the Institution has been reviewing each hospital’s budget, as well as the outcomes and work results for each shift.


“When analyzing each doctor’s productivity per hour we’ve noticed that during the third shift at this hospital (La Anexion), which runs from 10 pm to 7 am, this indicator shows very low performance,” stated Angulo.  

According to the Regional Director, the Caja Costarricense de Seguro Social’s (CCSS – Costa Rican Social Security) Internal Audit Department is analyzing the hospital’s current situation and so far, technical studies indicate that a doctor should be removed from the third shift.

The VON tried to contact Medical Director, Juan José Li Kam, but was told at his office that he would not be at the hospital on Tuesday and Wednesday.

In April the Colegio de Médicos y Cirujanos (College of Physicians and Surgeons) reported that in 20 of the country’s hospitals budget cuts exceed ¢14,000 million colones, among them Nicoya’s Hospital.
Anner Angulo explained that the Caja has decided to cutback on extra hours for all hospital staff members.

“We are making sure that extra hours and overtime go in accordance with the required productivity and have a reason for being. Public interest should prevail personal interests, which is why we are calling on health professionals. The CCSS seeks to ensure services provided both in the present and future, which is why we are meticulously reviewing the services rendered to the population,” affirmed Angulo.


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