After a tour of ten clinics that provide dialysis services to PAMI affiliates in the Federal Capital and Morón, the General Audit Office (AGN, for its acronym in Spanish) concluded that some work without municipal authorization, have problems in the building and irregularities in their professional plant.
Among the health centers in Buenos Aires, the Control Agency stated that Cemic Fresenius Medical Care, in Rivadavia 6044, operates with a provisional authorization, as does the Stra, in Lautaro 333, which has its permit in process since 2002. This clinic in the neighborhood of Flores does not have an intensive care area "nor an agreement with any healthcare institution for the eventual referral of decompensated patients," the AGN adds. However, Stra does not have a current contract with an emergency service to make the possible transfers, nor does it have a room for own hemotherapy. For this benefit, PAMI affiliates must go to Sanatorio Santa Isabel, which is next to Stra. The clinic, moreover, presented failures in its physical plant: the hemodialysis room does not comply with the minimum surface of six square meters to operate normally and, as for the equipment against fire, "the evacuation routes lacked signaling (the same That the location of the fire extinguishers), the smoke detectors were insufficient and the certificate of the firemen's inspection was expired, "says the report of the Audit, approved this year on data of the period 2006-2007.
The space that PAMI has available to perform dialysis at the Favaloro Foundation (Belgrano 1782, seventh floor) also did not meet the requirement of six square meters per room. And, in the building, they did not exhibit the inspection of firemen.
In the service of Nephrology and Dialysis of the Hospital Español, the AGN discovered a "poor states of conservation of the walls, with lack of painting and, in some cases, plaster."
PAMI patients who have terminal chronic renal failure receive hemodialysis, continuous ambulatory peritoneal dialysis and continuous cyclic peritoneal dialysis as a substitute for renal function. The institute provides the services through contracted providers, just the clinics that visited the control body, corresponding in this case to the Local Management Unit (UGL) Capital, and Morón, in the Buenos Aires metropolitan area.
On the Morón side, the report notes that 53% of patients attending Haedo's Nefrodeha clinic received erythropoietin (EPO), a hormone that facilitates the increase of erythrocytes in the blood and stabilizes renal function. According to the AGN, this percentage is "well below the reference values" of the PAMI, ranging from 85% to 90%: "This situation justifies a specific investigation into the possibility of an under-representation" of the service, said the technicians , And concluded that, however, "there was no evidence of control of the Institute in this regard".
Something similar was observed in the Instituto Médico Constituyentes, where the percentage of patients with erythropoietin was 60%, and those who received transfusions climbed to 14%. As the PAMI parameter for transfusions is "<1%", that is, less than one percent, the Audit also warned about the "possibility of under-provisioning of the drug, supplying it for transfusions."
In this clinic it was verified that several nephrologist doctors "did not present record of registration in the Superintendence of Health Services", and that they worked technicians without specialization in infirmary. Likewise, the piletones where the dialyzers are processed were so small, that the spills were "facilitated," the report says.
At the time of the AGN's visit, Fresenius Medical Care de Merlo operated with a municipal permit that had been in process since 1999. In addition, the fire insurance was expired; There were walls with dampness and lack of paint; in the general room there was a disabled toilet, although the toilet "was not high enough", and in the area of isolated, infectious-contagious patients, there were no toilets for the disabled directly. On the other hand, in the Sanatorium Hurlingham, provide nursing services without a license.
However, the Audit Department concluded that the establishments visited, both in Capital and in Morón, "were never controlled by their respective LGUs"; rather, it is the Unit for the Audit of Lending, a unit that operates at a central level in PAMI. Control them "once a year."