The situation at Torrejon University Hospital has been unsustainable for years. Management by private healthcare giant Ribera Salud has degraded care at the center to the point of selecting patients for “reasons of business profitability”, with pressure on doctors to give priority to one patient or another. The administration imposed a model that reduced benefits with the sole goal of “reducing costs,” according to an internal statement prepared by hospital workers and seen by elDiario.es.
The text provides a detailed picture of the case of Hospital Torrejón, a public center with privatized management, and warns of the deterioration of service, the loss of high-level professionals and the implementation of a model that puts business results above patients. The document, prepared by a group of workers joined by more than 250 professionals, proposes a series of solutions to restore quality of care and points to some managers who have now been sacked for denouncing poor practices as being responsible for the current situation.
The controversy surrounding this hospital erupted on Wednesday after the publication of an audio recording, revealed by El Pais, in which the CEO of the Ribeira Salud group, Pablo Gallart, is heard demanding that medical officials reject unprofitable patients to the hospital, whose management has been committed for years to attracting patients from other health fields.
The Madrid Health Model, imposed by Esperanza Aguirre, allows patients to choose the hospital they want from among all the hospitals in the Community of Madrid. This, coupled with the process of privatization of health care that gives the management of public hospitals to private companies, has encouraged some centers to try to compete with each other to get as many patients as possible, because this means more income when these patients are profitable, that is, it means less medical expenses.
This is what happened for years at Torrejon Hospital, and was recorded in a 10-page statement prepared by workers of that center, which elDiario.es was able to access. Where is the germ of the current situation?
“Cost reduction”
The document notes that in the hospital’s early years, daily work was guided by “professional commitment, humanity and scientific rigor,” and that management knew how to combine “excellent staff selection” with “respectful, modern, collaborative and patient-centered leadership.” But this, they say, changed when new directors joined the administration, the Medical-Surgical Directorate and the Nursing Directorate.
Officials made decisions that contradicted the ethical framework: “Their extraordinary actions and often deplorable forms have led, if not authoritarian, to the continuous destruction of equipment, advantages and professional motives since their arrival.”
The document condemns the undermining of the independence of those responsible for the hospital areas, and the interference in their decisions, against a background of continued “questioning the commitment and work capacity” of the center’s employees.
Behind everything there is “management aimed at optimizing the budget without evaluating the true goal of our work: helping patients.” “The employees of the Torrejon Hospital bear witness with astonishment to an unstoppable loss of benefits, based exclusively on the alleged (and perhaps underestimated) reduction in the company’s costs,” they denounced. When contacted by elDiario.es, the hospital administration refused to make any statements.
The “stress” and money to care for other patients
Specifically, the document explains that ultrasounds are no longer performed by radiologists, or that radiological reports are prepared by “remote specialists without easy communication with the physician ordering the study,” and also that there are areas where there is no alternative to telemedicine or that in the emergency department there are no specialists with the MIR degree.
But what is most scandalous, the document points out, is that “some heads of services are under pressure to prioritize the scheduling of outpatient consultations and surgical waiting lists for patients from other health regions compared to Torrejón.”
Workers’ sources explain that the administration financially rewarded doctors who worked overtime to care for these patients from outside the health region. The latest available report from Cermas, from 2023, reveals how Torrejon Hospital increased the number of “incoming” appointments. Their number rose from 15,677 in 2022 to 24,377 the following year.
This has led to the Torrejón hospital receiving a very large number of patients, some of them with enormous clinical complexity, who, as the workers point out, have become “unprofitable” for the company. Hence the message that the CEO conveyed to the managers: “We certainly do a lot of non-capital activities that do not contribute to us, that is, they hurt us. I do not know whether there is a possibility of seizing the activity that interests us most or not.” What Gallart is calling for is an effort to exclude patients from outside Torrejon who would not benefit the hospital, which is a public centre.
The hospital has spent years trying to attract patients from around the region to increase its revenues and is now facing the consequences of that model. The workers denounced this in their internal document, in which they demanded an end to “discrimination between patients for reasons of business profitability, by abandoning, in any hospital service, the imposition of quotas for patients ‘from outside Torrejón’ and giving priority to patients ‘per person’, which is contrary to the codes of ethics of our profession.”
Hospital sources explain that what the administration did was to give priority to surgeries and consultations to people who come from outside Torrejón: with the same diseases, with the same severity, the patient enters from another health area first. The explanation for this practice is that the hospital receives additional funds from the government of Isabel Díaz Ayuso for each outpatient, in addition to the annual budgeted amount.
elDiario.es already exposed some of these practices a few months ago. The pressures in the internal report were expressed in letters to those in charge of the operating room: “We will have to schedule a non-personalized operating room procedure for next week.”
Protests in front of the administration
Hospital staff sent this report to management last June. The only response they received from Gallart was that he would “look into it.” Last September, district leaders conveyed their opposition to the new guidelines to the administration, without receiving any response either.
Hospital workers point out that they have always tried to ensure that patient care is guided by standards of fairness, although they recognize that some managers have “given in” to management demands. Naturally, they insist that their battle now is to fight the discredit after 14 years of excellent work that has turned them into a center of reference.
In addition, they decry that some of the now-fired managers who present themselves as opponents of patient selection practices are in fact the ones who imposed the model of attracting outsiders to fatten accounts. Specifically, they point to the director, Pilar Rodriguez, whose departure they requested in the document conveyed to management, but also to the directors of medicine and nursing, who are also outside the hospital.
Hospital sources also point out that the model shows its layers when there is no supervision by the Ministry of Health, because it causes situations of competition between hospitals and externally managed practices such as the one that occurred at Torrejon Hospital.
Following the information these days, the Ministry of Health announced that it was opening an investigation to find out what happened. “We will examine all avenues, of course, legal; I think there is this collusion here with the Ayuso government that ends up forming what is called institutional corruption,” Health Minister Monica Garcia said on Tuesday.