Italy's patients with AIDS revolt

BMJ 1995; 310 doi: (Published 08 April 1995) Cite this as: BMJ 1995;310:893

An unprecedented revolt by patients with AIDS at a hospital for infectious diseases in Naples has shown that the reforms of Italy's national health service have so far failed to improve conditions in its southern hospitals. Last month over 50 patients infected with HIV smashed windows and threatened to cut their wrists in a violent protest against the standard of their care.

According to both patients and nurses, the Cotugno Hospital is short of syringes and drugs and there are not enough staff to look after patients. The incident confirms that this year's partial privatisation of Italy's hospitals has done little to remove the inefficiency that plagues management in the southern half of the national health service. “We don't like to admit it, but there is no national health service in Italy,” said Gianni Nigro, health spokesman for Cgil, the doctor's largest trade union. Nigro said that while northern hospitals are comparable to those in any other country in the European Union, those in the south are like hospitals operating in war zones. According to Nigro, doctors at Naple's Cardarelli Hospital, the biggest hospital in southern Italy, frequently lack syringes, medicine, and equipment.

Carmine Cavalliere, a doctor at the Cardarelli Hospital who is responsible for looking after patients' rights, says that the most frequent complaint concerns the hospital's internal ambulance service: doctors can wait up to two hours for the ambulances to bring resuscitation equipment, often too late to save patients' lives.

It was in an effort to rid themselves of such accusations of poor care that regional health authorities stopped relying on general taxation to fund public hospitals. Instead, from last January private heath care managers were appointed to generate a fifth of hospitals' annual budget from savings and loans. The idea was to give hospitals an incentive to treat patients in the most cost effective ways. Instead, Cgil officials at the Cardarelli Hospital say that the reformed system is showing the same, familiar symptoms of inefficiency and corruption while at the same time hospitals are on much tighter budgets.

Magistrates are starting to investigate charges of corruption brought by Cgil officials, who drew magistrates' attention to Palermo's Ospedale Civico after reports showed that the hospital was working at a tenth of its capacity. According to Cgil, Sicily's regional administration blocked funding in the 1980s that was set aside for the purchase of computed tomography scanners, providing doctors with an excuse to recommend that patients should use private clinics and equipment.

“At the Cardarelli, the computed tomography machine is one of the oldest on the market and frequently breaks down,” said Cavalliere. “Of course, repairs are always held up and patients have to be sent to private doctors.” While the reform of Italy's hospitals limits doctors from working in both the private and public sectors, its emphasis on cutting costs still favours the private sector.

“The Campania government has set aside 17 billion lire to build special accommodation for patients in the early, non-debilitating stages of AIDS,” said Enzo Martone, a senior nurse at the Cotugno Hospital. “It's never been spent.” It is for this reason that a growing number of patients with AIDS, especially those rejected by their families, end up staying for long periods at the Cotugno Hospital.—CHRIS ENDEAN, Italian correspondent, European

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