The new director of the La Anexion Hospital of Nicoya, Dr. Jorge Fonseca Renault, conversed in depth with VON a month after taking the reins of the main medical campus of the peninsula, after the Costa Rican Social Security Fund (CCSS) intervened in December due to serious management deficiencies.  

Fonseca took the place of Dr. Juan Jose Li Kam and will be in charge for 6 months to a year since Dr. Anner Angulo, current Regional Director, will have to return to the role of medical director in a year and a half given that the post is his property, unless the CCSS indicates otherwise.

Fonseca was cautious when speaking of the plans of the intervention and the deficiencies found since in six months he will have to make a report to the Medical Management, but he didn’t hide that when he first walked into the hospital, he found it functioning at 60% compared to how it should be.

“There are many things that catch the attention.  The physical layout continues the same, but it should be bigger and with more staff since the population of this area has grown considerably,” the doctor explained. 

Weaknesses and Priorities

Fonseca pointed out that “a quick expansion and structural reinforcement is needed since the seismic code is different, principally the expansion of external consultation and hospitalization services since emergencies is new.”

In addition, the beds are insufficient.  Today we only have 105 and in surgery and internal medicine they are always full, more now with how dengue is,” added the chief.

Meanwhile, Fonseca mentioned that among the immediate priorities of the hospital is resolving the problem of garbage collection, because the Municipality of Nicoya hasn’t done it since December 24th. Elizabeth Fernandez Ramirez, coordinator of environmental management for the Municipality of Nicoya, explained that the hospital wasn’t properly separating hazardous waste such as bags of blood from normal waste. In addition, she said that most hospitals have private contracts for garbage disposal and by law the municipality is not obligated to collect the hospital’s waste.  Fonseca assured VON that the garbage is now being properly separated. 

In addition, the challenge with the operating rooms continues.  The rooms were shut down by the Ministry of Health on June 6, 2012.  Although they were reopened on November 27th, Fonseca indicated that “due to bad fortune a change in voltage in the electrical current damaged three air conditioners in the hospital, one of which is for one of the operating rooms; nonetheless we will repair it in the next days.” 

Due to this, the waiting list for surgeries continues to grow.  “As for those who are stuck [waiting], the idea is to get them out by November at the latest. I should explain that there is a wait of three months to get a case onto the waiting list; for everything to be normal there should be a maximum wait of one week. At the same time, we have to scientifically analyze the waiting lists for external consultation; there are many determining factors, but I can say that we would have to obtain more personnel to achieve the objective in two years minimum,” he cited.      

Budget, Overtime Hours and More Positions

As VON stated in the January issue, the CCSS will allocate $35 million between 2013 and 2017 to develop a hospitalization tower, the renovation of the entire old structure and the electromechanical systems.  The job bid closes on May 8th and minor works are expected to initiate in October.  

“The damages that the September earthquake caused will be done with separate money.  With this budget, we have to recover the archive clinic and the roof of the external consultation, which is being installed and will be ready in March,” said the director.  He also indicated that the budget from the CCSS for this year is 15 billion colones ($30 million), but he estimates that this won’t be enough so more will have to be requested.

“La Anexion has 595 employees, of which 40 are doctors and among them 23 are specialists.  For the resolution level we need more, but at this moment there wouldn’t be room for more to work.  Between February and August we will receive four specialists recently contracted by the CCSS, one of whom is a much-needed anesthesiologist,” he affirmed.

Finally, he referred to overtime hours, a theme that led some doctors to protest in August of 2012.  “We have an on-duty guard system on Sundays with specialists, and with general doctors on Saturdays, Sundays and holidays, but we want to eliminate as much as possible all types of on-duty guards.  I want them to work in shifts 24 hours a day, so the doctor is always resting.  It’s more efficient and the costs are less,” he assured.