Monday, August 3, 2009

Favaloro teaches Lessons in Health Care Policy

Wedding in St. Louis was amazing, DJ rocked Boom Boom Pow as the bride and groom entered the reception for their first dance, lots of cupcakes and great to see old friends again. I’ll post the pictures as soon as they arrive via their respective photographic channels.

I’m putting off Cash and Bart chapter 2 till next Monday to reprint Dr. Favaloro’s parting letter and message. This Argentine doctor that was famous for creating the coronary bypass technique, a procedure that’s saved innumerable lives. He returned to Argentina from a comfortable position at the Cleveland Clinic to help medicine in our country grow (sure the meat and delicious Malbec might have also contributed to the decision). The increasing privatization of health care and dwindling government money for the funding of institutes like his Fundacion Favaloro made it impossible for him to continue his benevolent work. In the public sector, the corruption surrounding a large social welfare system with corrupt incentives drove his foundation out of money. His hospital benefited thousands of uninsured Argentines, prepared hundreds of doctors throughout the country and Latin America and is a great example to guide the ‘public option’ discussions we’re having in Congress this week.

Dr. Favaloro’s Suicide Note (English Translation and summary courtesy of Fer)

If my letter of resignation from the Cleveland Clinic is read, it’s obvious that my return to Argentina (after noted achievements in the cardiovascular surgery field) was guided by my love of this country. I came back to work as a teacher, as a researcher, and a doctor.

We immediately requested a number of beds for the uninsured. So we were able to operate on hundreds of patients without any cost at all. The majority of our patients came from national social programs, and we had contracts with the largest among them

With the money we earned, we paid the residents, the secretaries, the nurses and our costs, and split the rest among the doctors. I never allowed anyone to touch a single peso that did not belong to us.

In the mid-70’s we began to organize the Foundation. We built the Institute of Cardiology and Cardiovascular Surgery. When it opened, I wrote 10 basic rules to uphold a rigid ethical standard.

The quality of our work, driven through technology and the professionals we incorporated into the project made it so that we never lacked for work. But we had to fight constantly against the corruption in medicine in our country. We’ve systematically refused to break our standards and haven’t paid a single peso to get the ‘advantages’ available buying in to this corrupt system. So the social programs stopped sending their patients to the Institute.

The stories I could tell about meetings with the heads of their unions! Bunch of corrupt men that live easily at the cost of the workers and pay-off with the monies that are intended for their members’ medical coverage.

For example, the PAMI has an old debt with us (from 94 or 95) of 1.9 million pesos. We would have gotten paid within 48 hours if we had accepted the returns that were asked of us (of course not asked of me directly).

The same happens with patients in the private field (including the insured) which are sent to specific surgeons by their insurers knowing that they will get a juicy cut in return.

For so long, I’ve had to hear this “Favaloro doesn’t operate anymore!” Where does this myth come from? The patients that need to go under the knife and request to be operated here are told, “Didn’t you know that he hasn’t operated anyone for a while now? I’ll recommend someone fantastic from our network, don’t you worry.” This fantastic surgeon will return up to 50% to the recommending agent. I of course, continue to operate with the same enthusiasm and commitment as always.

The surgeons that participate in this network of corruption are internationally renowned doctors that attend these Congresses at American College or American Heart and congratulate me so emotionally there. At the Paul D. White lecture in Dallas dozens of Argentine cardiologists hugged me with tears in their eyes. But when they return here, they return to the ‘system’ and money is what is most interesting for them.

The level of corruption has reached an alarming level. Even at our foundation our doctors have shown me letters they get from these organizations that explain the system of corruption very carefully.

Our situation here at the foundation is of desperation now, millions of pesos are owed to us from work we’ve done, including high-risk patients that we cannot refuse. It would be too easy to say ‘there are no beds available’

Our medical oath does not allow us to do this.

These patients bring with them a high cost that is rarely recognized by our social welfare programs. To this cost, we compound the dozens of other overhead and supply costs that are putting our projects at such risk.

In the United States the big institutions like this, can realize their medical work, their research and education because of private donations they receive. The 5 biggest medical colleges there receive more than 100 million dollars each! We don’t even dream of that here.

At first, I contacted the BID, which helped us initially. They published our relationship in several publications as their highest accomplishments! I sent four letters to Enrique Iglesisias, who throws around lots of money in this Latin America. I’m still waiting for his reply.

Without a doubt, being honest in this corrupt society has its price. One way or another, you have to pay for that honesty

I feel very alone. I knew that it would be an uphill battle from the Cleveland Clinic and that I would have to battle for the foundation. The project of the foundation is wavering and begins to collapse.

We’ve had meetings with my closest collaborators, and some of my closest allies in this fight recommend that to save the Foundation we must become part of this ‘system’.

“We’ll have people organize it all, there are specialists that know how to do this.” “You should step aside, we’ll make it clear that you don’t know any of what’s happening. You have to understand it’s the only way to save the foundation.”

Who’ll believe that I didn’t know anything!

I can’t resign my ethics at this age, it would be extremely difficult for me. I would rather disappear. I can’t say that nobody has defeated me. I’ve been defeated by this corrupt society that controls it all. I’m tired of receiving awards and honor abroad. I was recently included in the millennium Surgeon Legends. I participated in this conference where I had to listen to the same thing over and over.

“The legend, the legend!”

Maybe my greatest sin, here in my country, has been to always loudly convey my feelings, my critique, my complaints at this society of privilege where very few enjoy it all, while most live in misery and desperation. Expressing all of this here, gets punished severely.

I’m consoled by the fact that I treated my patients equally. My colleagues know of my inclination for the poor, that comes from my young days working in Jacinto Arauz.
I’m tired of fighting and fighting, galloping against the wind, like Don Ata used to say. I cannot change. It has not been an easy decision, but it has been a thought out one. Please don’t talk of weakness or bravery.

The surgeon lives with death, it is his inseparable companion, I leave hand-in-hand with her.

At some point, at an academic event in the US someone introduced me as a good man that continues to be a rural doctor. I hope I’ll be remembered as such.

In the last weeks I’ve written desperate letters to national entities, state entities, businesses, without receiving a single answer. An outside committee has begun to work at the foundation. Yesterday they began to lay off people that have worked with us for a long time. Some faithful and dedicated collaborators. I could not show my face there on Monday.

I repeat the obligation of cremating me immediately, and spreading my ashes in the hills close to Jacinto Arauz, there in the Pampa. It is strictly forbidden to realize religious or civil ceremonies.

A strong embrace to you all,
Rene Favaloro

Spanish long (actual) version at a friendly blog

1 comment:

  1. Very moving and how sad it had to come to that end. God bless him.