Revenge or measure due to waiting list

The Clinical Center of Montenegro has revoked the approval for additional work for nine orthopedists to work outside the institution for a period of six months. This was done after the doctors, dissatisfied with the appointment of Dr. Nikola Bulatović for the director of the Clinic for Orthopedics and Traumatology refused to work part-time at the parent institution - KCCG.

While doctors claim in a statement to "Vijesti" that they perceive the KCCG administration's move as a repressive measure, which will cause suffering to the population in the north and south of the country, the institution says that they are only following the regulations and that this measure will not endanger patients. Namely, they remind that the institution's director is legally obliged to revoke approvals for additional work, among other things because they have only implemented five to ten percent of the services planned to reduce waiting lists.

Orthopedists claim that due to what they consider to be revanchism, the functioning of the healthcare system will be seriously jeopardized. Protesting against the appointment of Bulatović as director, orthopedists Aleksandar Jušković, Vladan Ćipović, Marko Borovinić, Ivan Vlahovic, Mile Goločevac, Aleksandar Petricic, Oleg Lakovic, Miodrag Vujadinovic i Igor Mandic, they previously announced a possible suspension of work.

Doctors believe this is a repressive measure

Among the orthopedists whose consent for additional work was revoked are four who had a signed contract with the Kolašin Health Center. According to the decisions, which "Vijesti" had access to, the consent was revoked for a period of six months.

Some of them explained to "Vijesti" that nine out of 12 orthopedists oppose Bulatović's appointment, while three did not state their opinion.

"We have received a decision prohibiting us from working part-time, both in private and public healthcare institutions, and we perceive this as a repressive measure. Of particular concern is the fact that this ban also applies to the Kolašin Health Center, as well as the Clinical Hospital Center in Berane and the General Hospital in Bar. There is no doubt that such a decision will negatively affect the availability of health services to citizens, but also the ability to provide assistance to other general hospitals that are facing a shortage of staff. Such an approach represents a serious threat to the availability of health care and directly affects citizens for whom timely examinations, surgeries and faster treatment are of crucial importance," said one of the orthopedists whose consent for working part-time was revoked.

According to him, in Bar they assisted a doctor who was alone in orthopedics and went to help him solve trauma cases, in order to avoid sending patients to Podgorica, and in Berane they helped solve the waiting list.

Orthopedists who oppose Bulatović's appointment as head explain that they previously refused additional work at the KCCG, which, they claim, is on a voluntary basis. Refusing additional work, they believe, was one way to show their disagreement with Bulatović's appointment. They expect that the KCCG Board of Directors will address the situation at the Clinic for Orthopedics and Traumatology on Wednesday.

KCCG: Cancellation will not endanger patients

The KCCG claims that the consent for additional work was revoked because the refusal of certain doctors to work additional work at their home institution affected the organization of work and the implementation of the elective program (planned surgeries and interventions), and not because of their public statements.

They also claim that "the revocation of consent will not jeopardize patients or cooperation with other healthcare institutions, as they plan to provide services through a different work organization and engagement of the remaining staff."

As they said, in accordance with the Law on Health Care and the Regulation on Detailed Conditions for Performing Additional Work, a healthcare worker may perform additional work provided that, among other things, such work does not affect the organization of the work of the healthcare institution in which he or she is employed full-time.

"After analyzing the indicators prescribed by the Regulation, the legal obligation of the director of the institution arose to revoke the consents on the basis of which certain doctors of the Clinic for Orthopedics and Traumatology performed additional work in public and private healthcare institutions. The aforementioned action is in no way a consequence of their public statements or expressed position regarding the appointment of the acting director of the Clinic, but solely the result of the application of applicable legal regulations and the director's obligation to organize and manage the operations of the healthcare institution in a manner that ensures the smooth provision of healthcare," the KCCG said.

They claim that doctors whose approvals for additional work were revoked, and who opposed the appointment of the acting director of the Clinic, only provided five to ten percent of the services intended to reduce waiting lists in other public health institutions.

They state that most of the work in other public institutions was performed by two doctors whose consents were not revoked, and that the Clinic with 13 specialists is not using its capacities optimally due to working in only one shift, which is why it was decided to change the organization of work.

As stated by the KCCG, the protesting doctors had limited contribution to the work outside the institution, within the elective program, "and the long-term goal is to strengthen institutional capacities and reduce the system's dependence on individual personnel solutions":

“KCCG will ensure the continuity and quality of orthopedic services using legally prescribed norms that allow for work in one, two or more shifts, double shifts, on-call or standby. The envisaged forms of work by the institution’s decision include: one-time full-time work, 12-hour shifts, eight or seven-hour shifts, on-call and standby. Based on these models, the new management of the Clinic will organize work in a way that ensures continuity of services.”

They pointed out that seven out of nine doctors who object to the current organization of work had previously expressed their opposition in writing to the cooperation plan with the Clinical Hospital Center of Berane and general hospitals in Bar and Nikšić, explaining that the project was not adequately designed, which they then clearly communicated to the director of the Clinical Hospital Center of Montenegro and the Minister of Health. Vojislav Šimun.

"Despite this, cooperation with the aforementioned institutions has been implemented, and of the total number of surgeries performed in these health institutions, one third were performed by the doctors who are protesting today," the administration claims.

Warning from Kolašin

The Kolašin Health Center says that four orthopedic specialists from the KCCG are permanently employed at the institution. These doctors, they explain, perform specialist examinations once a week, which include initial and follow-up examinations of patients with injuries and diseases of the bone and joint system. They claim that they have not yet received any official notification from the KCCG, nor from the Ministry of Health, regarding the decision to revoke the consent for additional work for the aforementioned specialists. They claim that they learned about this from the media.

"In addition to diagnostic examinations, our institution performs fracture reductions, immobilizations with various types of plaster and other orthopedic immobilizations (circular plaster, splints, etc.), controls and replaces existing immobilizations, as well as detailed monitoring of the entire course of treatment after injuries occur. Also, within the mini-room, minor surgical and orthopedic interventions are performed under local anesthesia, treatment and care of minor injuries, dressings, removal of stitches, as well as other outpatient procedures that do not require hospital treatment," the DZ reminds, explaining that orthopedists treat between 90 and 100 patients per month.

The possible revocation of the approval for additional work for orthopedic doctors, according to the DZ, would have an extremely negative impact on both patients from the territory of the municipality of Kolašin and the entire healthcare system of Montenegro.

"The engagement of these experts in our Health Center has achieved significant financial and logistical savings for patients and the system, primarily through reducing the need for patients to travel to other health institutions. The abolition of this practice directly undermines the availability of secondary health care at the local level, which inevitably leads to a burden on central institutions and a consequent extension of waiting lists for examinations, consultations and further treatment," the Health Center warns.

Ministry: Waiting lists and greater scope of services are priorities

Šimun's department says that the issue of staffing and the way of organizing the provision of health services and issuing approvals for additional work is the responsibility of the KCCG management. They claim that they monitor "the functioning of the health system and take measures to improve the availability and quality of health care for all citizens."

They emphasize that they have undertaken a series of concrete activities aimed at improving orthopedic healthcare, thus "providing a greater number of prostheses, increasing the amount of necessary medical and consumable materials, and involving other healthcare institutions in the process of providing orthopedic services in order to further strengthen the system's capacities and improve the availability of healthcare to patients."

The Ministry's priority, they conclude, is to reduce waiting lists, increase the scope of services, and better organize the healthcare system in cooperation with institutions.

KCCG will ensure the continuity and quality of orthopedic services by using legally prescribed norms that allow for work in one, two or more shifts, double shifts, on-call or standby. The forms of work envisaged by the institution's decision include: one-time full-time work, 12-hour shifts, eight or seven-hour shifts, on-call and standby. Based on these models, the new management of the Clinic will organize work in a way that ensures continuity of services," the KCCG said.