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INFO   :::  Human Rights > Alarming Neglect: the Elderly out in the Cold


Alarming Neglect: the Elderly out in the Cold

April 2015

No doubt that the mass salmonella poisoning outbreak in the privately-run nursing home “Dvoje” in Vranići nearby Čačak was among most serious “incidents” that ever happened in a social care home catering beneficiaries. The intestinal epidemic – that still rages – killed five people, had eight of them hospitalized (two in critical condition) and affected 41 others. In the meantime one of the hospitalized patients died.

Citizens at large learned the news on Thursday, April 16, when Dr. Aksentije Tošić of the Čačak Institute of Public Health went public with the outburst of the epidemic.

Given that as many as 30 beneficiaries were already infected at the time – and four already hospitalized – it is only logical that many of them had been affected much earlier. This very fact raises many questions about accountability.

First, how come that the news about the poisoning came so late and has someone, and who, failed to take necessary steps in due time that could have saved human lives?

There is a reason to assume that the staff wanted the sweep the whole affair under the carpet – primarily medical officers of the home and its owner, certain Pero Marić. His statement about beneficiaries’ poisoning probably being caused by Easter eggs their relatives had brought in was a lame attempt at veiling the truth and blaming someone from the outside but was also interesting for another reason. Namely, apart from the fact that it was quite impossible that all the infected consumed the same salmonella poisoned eggs (including members of the staff and families) his very statement reveals that the infection had been detected at least two or three days earlier considering that this year Easter was celebrated on April 12.

If that assumption is correct, then who was behind such scandalous, to put it mildly, attitude towards the health of elderly and helpless beneficiaries? Offhanded treatment of diarrhea, vomiting, high temperature and other more than evident symptoms of a serious disease is not only malpractice but a serious crime against people’s health. No doubt that all persons on the staff – and they are few - must have noticed the symptoms. And it goes without saying that the owner, once informed about it, should have immediately reported to the Čačak Institute of Public Health. Investigation into the case will show whether he did it or not. A thorough investigation, if properly conducted, will clearly reveal the level of responsibility of all those involved in this gross malpractice.

Another assumption – though less probable – is that the Čačak Institute of Public Health failed to properly react in the face of a deadly epidemic. The rules on announcing an epidemic are strict so as to ensure that a disease does not spread beyond control. To all appearances, the Institute reacted duly given that four patients had already been hospitalized at the time, which was a reason enough to announce an epidemic. The right question here is – has the nursing home immediately, after first two successive cases of poisoning, informed the Institute or it was the hospital that did it and when? The question is not a rhetoric one at all – and should also be investigated into.

And yet, latest developments raise other questions too and cannot but cause anxiety. Judging by statements by actors involved in the tragedy and medical reports, the intention to have the case closed is more than evident; all those statements and reports are meant to suggest that everyone did the right thing and did it by the law – hence, there is no one to blame. Mayor of Čačak Vojislav Ilić, for instance, said, “Most important of all is to investigate whether all relevant services intervened and reacted by the book.” In other words, six dead people should not be a problem if everything was done “by the book.” Following its summary inspection after the outburst of the epidemic the Inspectorate of Social Care released that it was just authorized to see into the legality of the work process and meeting of the standards of social care protection. Biljana Zekavica of the Ministry of Labor, Employment and Social Policy said that the nursing home had signed an agreement with the Čačak Institute of Public Health providing the latter’s regular control of the food served to beneficiaries.

On the other hand, Director of the Čačak Institute Ana Mišović claims that under a new law on food safety they are not obliged to supervise sanitary conditions for food preparation in the facility. According to her, the Institute’s control of this aspect is limited and excludes the test for salmonella.

Svetlana Tadić, the head of the district sanitary control department, confirms that the said law authorizes not the sanitary inspection to control the food prepared and served in the nursing home.

Zoran Ševarlić of the health inspection department in Užice said that in January the owner filed a request for deciding on the conditions for provision of medical services by general practitioners in the nursing home, and the inspection gave him a green light. The health inspection, he added, was not concerned with other aspects as it was not authorized to and, besides, saw “no reason whatsoever.”

And so the chapter was closed. Salubrious food in a social care home catering the elderly – whose age in itself exposes them to health risk – is nobody’s duty.

In several of its annual reports the Helsinki Committee has alerted of broken communication between various ministries and of the threat of non-existent or bad legislation on healthcare of persons accommodated in institutions under the jurisdiction of ministries of social policy and justice. Unfortunately, the “dead phones” are still there. This time, six dead people paid the cost.

Minister of Labor and Social Issues Aleksandar Vulin agrees that the legislation on inspections is inappropriate considering that the latter are not obliged to exchange information about malpractice. He also says that his Ministry has developed rules on state-run nursing homes providing that these facilities shall inform the Ministry about any incident. “And now we have included privately-run nursing home in the rules,” he adds. He did not explain what took him so long to initiate the amendment of the law.

Not being informed about the basics of the social care system and its specificities – which are many and complex indeed – cannot be an excuse for Minister Vulin. As a politician appointed the Minister the least he should have done was to consult those who knew more and had more expertise than he had. Had he done it, it would occur to him that his Ministry was issuing licenses but not controlling whether those obtaining them (be they state-run or private) meet the standards for taking care of people. Besides, all inspections need not be under the jurisdiction of a single ministry, as Minister Vulin suggests with the wisdom in hindsight, but the Ministry of Social Policy is duty-bound to make sure that inspections are regular. The problem is that officials of the Ministry itself rarely set themselves for inspections – and have never set foot in this particular nursing home.

Though competent for social care legislation Minister Vulin cannot explain how come that his Ministry is not being informed about opening of a variety of privately-run homes for the elderly that are mushrooming all over Serbia. In 2014 only several such facilities were closed down once someone “clued in” the Ministry about irregularities or that these facilities were unlicensed. Had he been more concerned with social care than politics Vulin would have initiated, say, that any legal person intent to cater to social care beneficiaries should be licensed by the Ministry in the first place – or at least that the Ministry should be informed that this legal person was registered as service provider in the Business Register Agency. As things stand now, the Agency’s permit is good enough while the Ministry has not a slightest idea about the very existence of all those enterprises; and only gets into the picture once a tragedy, like that one in Vranići happens. And yet, Vulin was aware of the existence of these enterprises. For, on Friday, April 24, he said that his Ministry’s goal was that all social care institutions were licensed by the end of 2015.

Biljana Zekavica herself confirmed that the Ministry was facing many problems when it came to licenses and inspections alike. For instance, on January 24, 2014, it forbid Petar Marić from Čačak to cater to adults and the elderly in “the illegal nursing home” in Vranići. He obeyed. But as soon as April 14 his enterprise “Dvoje” obtained a five-year license as the Ministry decided that “all standards for provision of services and accommodation” had been met in the meantime. The Ministry argues that “at the time the license was issued there were no doubts whatsoever about the nursing home’s functioning and quality of services provided to beneficiaries.” But is say nothing about how many times, if ever, it had inspected the institution. In other words, since the nursing home was opened back in 2012, the Ministry was unaware of its operations for almost two years and, probably, never inspected it at all.

The information that on March 20 a fire protection inspector ordered Marić to close down his facility on the account of unsafe accommodation of bedridden persons leaked in the meantime. But nobody informed the Ministry about it – an extra excuse for it to dodge its responsibility.

“Neither the owner nor the inspector informed us about it, although they are duty-bound to. Only for the failure to meet the standards for fire protection in the facility we would have withdrawn the license and closed down the nursing home,” said the Ministry officials.

Having subsequently inspected the nursing home the Ministry realized that it was understaffed and that some employees were moonlighting. Asked how possibly an institution as such could operate, Zekavica replied, “To take the easy way out, one can just close down a facility. But on should above all have in mind beneficiaries’ state of health.” Her words only confirm the doubts that the Ministry is aware of the existence of some illegal facilities at least but “turns a blind eye” to the fact being at loss what to do with so many old and sick people no one would take care of. Unfortunately, that’s yet another bitter truth. At the same time it testifies that neither the Ministry of Social Care nor the Ministry of Healthcare function as they should.

Unlike Minister Vulin, his colleague, Minister of Healthcare Zlatibor Lončar at least visited the hospitalized patients, probably aware that his Ministry was also to blame for all the failures. Minister Vulin does not even see himself as someone morally responsible and it has never occurred to him to offer his resignation, what any decent person would expect him to do. This is also why he is among the worst Ministers of Labor and Social Policy Serbia has had ever.

Impunity of high-ranking officials is far from being an excuse for blaming this case, like many others, on “laws;” because relevant institutions and authorized individuals are those who pass the laws and take care of their implementation. And there should be no excuse whatsoever for the Prosecution not to act since the government refuses to. An unresponsive and dehumanized society such as Serbia’s is hardly expected to press the authorities and appeal to their conscience. Otherwise the old and helpless would not have been in such situation – abandoned and unprotected.











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