Hospital Base San José de Osorno S.A

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Hace dos años la Contraloría General de la República realizó una exhaustiva investigación sobre numerosas licitaciones médicas en el principal centro de salud de Osorno. El informe, entre otras irregularidades, detectó 1.579‬ cirugías realizadas sin contar con el equipo médico completo en el pabellón quirúrgico, 152 cirugías realizadas por funcionarios del hospital en horario laboral, desde las ocho de la mañana a cinco de la tarde, que luego fueron cobradas por sociedades médicas al mismo hospital. Lo anterior perjudica gravemente la gestión de la salud pública y no soluciona la urgente necesidad de especialistas para cumplir con las metas del GES y el AUGE.

Desde el año 2015 el Servicio de Salud de Osorno ha gastado más de $6.000 millones de pesos en licitaciones públicas y tratos directos, que fueron adjudicados a oferentes con presuntos conflictos de interés, porque además de estar contratados por el Hospital prestaron servicios a las Sociedades Médicas locales que han ganado estas licitaciones. Irónicamente el monto total de la deuda que registra el Hospital Base San José de Osorno coincide con esta enorme cifra de dinero entregada a los privados.

Si usted considera que estas licitaciones se han realizado para solucionar las listas de espera, entonces comprenderá que la gravedad de estas irregularidades no se mide solamente en millones de pesos. Al día de hoy se han registrado  más de 230 fallecimientos asociados a listas de espera provinciales, entre enero y junio del 2018; 23.000 pacientes permanecen en lista de espera por nuevas consultas de especialidad y 5.127 pacientes en lista de espera de Intervenciones quirúrgicas. Todos estos problemas gozan de muy buena salud, han sobrevivido los tres últimos gobiernos y siguen creciendo.

Lo que leerá a continuación está contenido en los  informes realizados por la Comisión Investigadora Fonasa y por la Contraloría General de la República. Podrá observar que entre los involucrados figuran los nombres del actual Gobernador de Osorno, de un ex concejal PPD y de conocidos médicos osorninos que tienen acciones y trabajan para las sociedades médicas mencionadas en estos informes, que prestaron y prestan servicios en la red de hospitales del Servicio de Salud provincial, tanto en Osorno como en Purranque.

 

El doble juego, los protagonistas y el estado

Cuando comenzamos a publicar los primeros reportajes de investigación en abril del 2018, relacionados con el Servicio de Salud de Osorno, accedimos a documentos públicos que fueron la clave de entrada a una investigación periodística que se extendió por más de 12 meses. Aquí examinaremos el caso más grande registrado en la Región de los Lagos, en los últimos 10 años: el aparente conflicto de interés en el ámbito de las compras públicas y contratación de servicios médicos.

Repasamos el mecanismo utilizado por 9 sociedades médicas, entre los años 2015 y 2016, para  mantener a 63 médicos, funcionarios públicos de la red de salud, prestando servicios durante su  horario laboral establecido por contrato con el Estado. Esta práctica altamente cuestionable la hemos denominado como “doble función” que, de acuerdo a los señalado por los informes ya mencionados, vulneraría el principio de probidad que rige a todo funcionario público.

Toda la información que llevó a esta conclusión tan contundente  está contenida en los documentos presentados, a fines del 2017, para la elaboración del “Informe de la comisión investigadora de las adquisiciones de insumos y prestaciones de salud efectuadas por FONASA a prestadores privados, desde 2012 a la fecha, así como las pérdidas en ejercicios financieros a partir del 2010, y el eventual lucro de prestadores de la salud”

Este informe involucra a una nómina de 106 profesionales de la salud entre técnicos paramédicos, arsenaleros, enfermeros y principalmente médicos; todos ellos contratados por la red hospitalaria del Servicio de Salud de Osorno y simultáneamente por nueve sociedades médicas. Dicho documento fue firmado por el entonces Director del Servicio de Salud de Osorno (SSO), médico cirujano y militante del Partido Socialista, Nelson Bello Oyarce,  quien actualmente participa en la Fundación Territorio y Salud.

En el listado de profesionales involucrados destacan el actual Gobernador de la Provincia de Osorno, médico cirujano y ex concejal Daniel Lilayu (UDI), su hijo el oftalmólogo Rodrigo Lilayu Chávez y el ex concejal y candidato a diputado por el distrito 55, Alejandro Baeza Soto (PPD), entre otros. El listado de profesionales contratados por las nueve sociedades médicas investigadas, dan cuenta de una eventual maquinaria de “doble contratación” y situaciones tan insólitas como es el caso de funcionarios que aparecen realizando hasta cuatro prestaciones médicas “simultáneas”. 

El lapidario informe de Contraloría al Hospital Base San José de Osorno

Luego de entregar esta información a la comisión investigadora de Fonasa se despacharon oficios a todas las contralorías, para realizar una serie de investigaciones en los hospitales de todo Chile. Como consecuencia el Informe de la Contraloría General de la República sobre la deuda pública Hospitalaria con fecha 19 de Diciembre del 2017, hizo notar varias irregularidades, presuntas faltas a la probidad y conflictos de interés de las sociedades médicas, antes cuestionadas, en especial Traumadent S.A. y Triviño y Ulloa Ltda, más conocida como Sur Visión (empresa oftalmológica), entre otras.

 

El gobernador Lilayu: “por Osorno y Purranque”

El currículum publicado en la página provincial de la Gobernación de Osorno señal, que el doctor Daniel Lilayu fue por más de 14 años el jefe del servicio de urgencia del Hospital Base Osorno y durante 10 años el jefe del servicio de cirugía de mismo hospital. El profesional de la salud quien actualmente ha diversificado sus intereses en negocios inmobiliarios, se ha adjudicado una gran cantidad de cirugías en la vecina ciudad de Purranque.

Durante su periodo como concejal por la UDI en la comuna de Osorno, desde el año 2015 a enero del 2018,  se adjudicó siete licitaciones públicas con una suma cercana a los $700 millones de pesos en el Hospital Base San José de Osorno y el Hospital de Purranque. Según información oficial, solicitada vía transparencia al Hospital Base San José de Osorno y a Mercado Público, el actual gobernador aparece como beneficiario de 79 contratos para proveer servicios médicos, atribuidos bajo la modalidad de “trato directo”, lo que significa que no es una licitación pública competitiva. Estas prestaciones, correspondientes a exámenes, fueron por un monto cercano a los $8 millones de pesos durante los años 2015 y 2016. 

En Enero del 2018, siendo Lilayu concejal en ejercicio y uno de los nombres que sonaba más fuerte para ocupar el puesto de Gobernador de la Provincia, se adjudicó la licitación 2144-2-LQ18 para realizar sobre 600 intervenciones quirúrgicas de varices para el  Hospital de Purranque, por un monto de $226 millones de pesos, que según las bases licitadas se extenderían hasta el mes de noviembre del mismo año y Lilayú aparece en el listado de Médicos Operantes. 

Para poder referirnos al Gobernador Lilayú y las Sociedades Médicas, hay que empezar por la Sociedad Angiomed Ltda. Rut: 78.486.930-K, la cual es conformada por Daniel Sergio Felipe Lilayu Vivanco, Ana María Chaves Salinas, Alvaro Daniel Lilayu Chaves, Gonzalo Ignacio Lilayu Chaves, Eliana Rosa Iturriaga Segovia y Rodrigo Andres Lilayu Chaves. Tal como se aprecia en este listado gran parte de los socios de Lilayu son sus familiares cercanos.

En el caso de Rodrigo Lilayu Chaves, médico oftalmólogo, se detectó claramente el caso de la “doble contratación” de servicios, pues formando parte del equipo de profesionales de Sur Visión era también funcionario del Hospital de Osorno durante los años 2015 y 2016.

También aparece en la nómina de dobles contrataciones el Gobernador Lilayu, funcionario del Estado quien se autocontrata como cirujano desde la sociedad médica antes mencionada, durante el año 2015, para la realización de cirugías.

Otro de los posibles conflictos de interés apunta a su pareja, Ana María Chaves Salinas, quien es oferente regular en mercado público a través de la empresa CASASANA, que mantiene sucursales en Osorno y Puerto Montt, que se adjudicó contratos por más de 20 millones de pesos en licitaciones públicas durante los últimos cinco años.

 

El mecanismo de precisión Quirúrgica

Todo mecanismo, para poder operar exitosamente y permanecer en el tiempo, necesita un engranaje que funcione a la perfección. Tanto las doble contrataciones, como las licitaciones adjudicadas con posibles conflictos de interés, se vienen realizando al menos desde el primer Gobierno de Sebastián Piñera, pasando por el segundo Gobierno de Michelle Bachelet y por la actual repetición en el cargo del economista de Harvard y empresario multimillonario. 

Pero ¿Qué autoridades han tenido conocimiento de estas irregularidades? La lista es transversal: Marcelo Larrondo, actual Director y Jorge Castilla, su segundo al mando, quien fue Director del Hospital Base de Osorno y actualmente ocupa simultáneamente los cargos de Subdirector Médico del Servicio de Salud Osorno y de concejal RN. Ellos conocían y conocen al detalle estas posibles irregularidades y según fuentes del área también estarían al tanto de estas irregularidades el ex Director Nelson Bello y la ex Directora subrogante Muriel Muñoz.

Los integrantes de la Comisión Investigadora Fonasa estaba compuesta por los diputados Miguel Ángel Alvarado (Presidente Comisión), Leopoldo Perez, Karol Cariola, Juan Luis Castro, Fuad Chain, Juan Antonio Coloma, Jose Antonio Kast, Denise Pascal, José Perez, Yasna Provoste, Karla Rubilar, Jorge Rathgeb y Osvaldo Urrutia. Además mencionar que en ese entonces se encontraba como Presidente de la Cámara el Diputado Fidel Espinoza, el cual en 3 ocasiones solicitó la prórroga de la votación del informe final emanado por la herramienta de fiscalización parlamentaria.

Entre las conclusiones a las que llega el documento de la Comisión Investigadora a Fonasa, en relación a estas irregularidades y al mecanismo utilizado para estas dobles prestaciones, dice textualmente que  “Esa situación afecta a la fe pública pues, de acuerdo a la normativa chilena, un funcionario público no puede celebrar contratos con el mismo servicio del cual depende como funcionario. Entonces más paradojal, resulta aún, el hecho de que “vía glosa presupuestaria”, se establezca como requisito habilitante para prestar servicios por medio de una sociedad, el de ser funcionarios del sistema de salud pública”.

En el mismo sentido es contundente el informe de Contraloría, que también identifica uno de las maneras de operar, través del cual éstas sociedades triangulan el círculo de influencias para la posible adjudicación irregular de licitaciones médicas. Allí señala textualmente que “(…) se detectó que los mencionados jefes de servicio informan, de forma presencial o telefónicamente, la cantidad de intervenciones que se efectuarán de manera institucional, y la cifra de aquellas que no se pueden atender con recursos propios, lo que contravendría el principio de la probidad administrativa conforme lo estipulado en el artículo 62 N° 6, de la ley N° 18.575 “.

Las posibles redes de poder y nepotismo, son del todo conocidas al interior del Servicio de Salud Osorno. Un ejemplo: Irma Jofre la actual Jefa de Estadísticas de dicho servicio está casada con el Dr. Alejandro Baeza, propietario de Huapi Ltda. En caso de tener acceso a la información privilegiada correspondiente a las listas de espera, sería de vital importancia para las nóminas de futuras licitaciones. Es decir, correría con ventaja.

Otro de cargos claves, es la actual Jefa de Producción del Servicio Salud Osorno y hasta hace unos años ex Jefa del Subdepartamento de  Recursos Financieros S.S.O. María Eugenia Montero Pinochet, la cual tiene directa relación con el Programa de Prestaciones Valorada (PPV), estas prestaciones son las pagadas por FONASA, y que fueron investigadas tanto por Contraloría como por la Cámara de Diputados. La información sobre los PPV es entregada a los diferentes Jefes de Área del Hospital Base San José de Osorno,  directamente relacionados con Sociedades Médicas que se adjudicaron licitaciones, convenios y tratos directos, con el principal establecimiento hospitalario estatal de la Provincia de Osorno.

La prótesis financieras de Traumadent

Una de las sociedades médicas que lidera la lista por los abultados montos de estas licitaciones médicas, es Traumadent. Empresa que aparece realizando diversas intervenciones quirúrgicas traumatológicas y, pese a que en el informe de Contraloría se tachan los nombres de los involucrados en esta serie de irregularidades, el equipo de asambleapopular.cl pudo dar con ellos mediante un extenso trabajo investigativo.

A continuación podrá leer las irregularidades detectadas sin censura:

“Se advirtió que el señor Dr. Mauricio Guarda Marín , Jefe del Servicio de Traumatología,es cónyuge de doña Isabel Margarita Frohlich Mohr , y padre de doña María Javiera Guarda Frohlich ambas socias de la sociedad Traumadent Ltda., la cual se adjudicó la licitación pública ID N° 1545-660-lP16, denominada convenio suministro de 105 intervenciones Quirúrgicas de Artroscopia de Rodilla con Cirugía Endoscópica de Meniscos Simultánea, para pacientes beneficiarios del Hospital Base San José Osorno, por $ 71.814.750.” 

Otras de las observaciones realizadas por la Contraloría al Hospital Base San José de Osorno se refiere a posibles incumplimientos de contratos y ejecución de cirugías sin el equipo médico completo que solicitaba la licitación. En el caso de Traumadent S.A. el documento señala que “para 88 cirugías, éstas se efectuaron con pabelloneros que no se encuentran incluidos en la nómina presentada por el referido prestador de servicios; y finalmente, se constató que en 100 intervenciones quirúrgicas fueron desarrolladas sin contar con cirujano ayudante, 74 fueron realizadas sin enfermero (a), 18 sin contar con un auxiliar de anestesia, 17 fueron practicadas sin un pabellonero y 1 cirugía sin contar con arsenalero” .  Además de los anterior detalla que la sociedad traumatológica cuestionada, realizaba operaciones dentro del horario laboral, contraviniendo las bases de las licitaciones adjudicadas que, según “La resolución exenta N° 4.328, de 2016, previene que la empresa podrá realizar las prestaciones en los pabellones del referido centro hospitalario; siendo el Jefe de Pabellón del hospital quien asigne los horarios según su disponibilidad, siempre a contar de las 17 horas, en adelante.Establecido lo anterior, se evidenció que  70 intervenciones quirúrgicas fueron realizadas en un horario anterior a las 17:00 horas”.

Otro de los casos que atañe a Traumadent S.A. se relaciona con el actual jefe de Traumatología del Hospital Base San José de Osorno, Dr. Patricio Dietz. El supuesto conflicto de interés consistiría en que Dietz realizó doble prestación de servicios entre el Estado y la Sociedad Médica referida entre los años 2015 y 2016. Esta empresa, además de tener una estrecha relación con el ex jefe del área Mauricio Guarda Marín, en lo que va del presente año 2019 se ha adjudicado licitaciones públicas por casi $38 millones de pesos. Detrás de estos  conflictos de interés y las graves deficiencias de las prestaciones médicas entregadas, entre otras muchas más irregularidades, se acumulan cerca de $900 millones adjudicadas en licitaciones públicas durante los últimos 5 años y un total de 56 profesionales de la salud con doble contratación durante los años 2015 y 2016.

 

Las cataratas de Sur Visión 

La clínica oftalmológica vecina al recinto hospitalario, no sólo comparte los mismo profesionales médicos, también coinciden en sus salas de espera un sin fin de pacientes adultos mayores que son derivados desde las consultas públicas, para realizar cirugías tan comunes como son las cataratas. Según el anuario estadístico del SSO el año 2016 se realizaron 1.477 operaciones de cataratas  y el año 2017 se operó a 1.365 pacientes por la misma patología.

Como ya hemos señalado en párrafos anteriores Sur Visión es una sociedad perteneciente al destacado médico oftalmólogo Alejandro Triviño. En relación a esta empresa el informe de contraloría también detectó diferentes irregularidades señalando que  “se evidenció que 19 cirugías fueron realizadas sin contar con auxiliar de anestesia y en 150 prescindieron de un pabellonero, situación que incumple lo establecido en el citado artículo 12.2, de la resolución exenta N° 12.001, de 2016, del Hospital Base San José Osorno, y lo establecido en el artículo 10 de la ley N° 19.886.” También se detectó un grave conflicto de interés refiriéndose a que “A su vez, el señor Alfredo Triviño Lavanderos , Jefe del Servicio de Oftalmología, es socio de la Sociedad de Profesionales Triviño y Ulloa Ltda., la que a  su vez posee participación en la Sociedad Oftalmológica Sur Visión Ltda., siendo esta última, adjudicada en la licitación pública ID N° 1545-11 05-LP 16, denominada «Convenio Servicio de 150 Intervenciones Quirúrgicas de Catarata para Pacientes Beneficiarios del Hospital Base San José Osorno, por $ 75.000.000.

También se da cuenta en el informe que los médicos que forman parte de la sociedad Sur Visión, mantienen contrato vigente a esa fecha con el Hospital de Osorno, tanto así que casi la totalidad de los médicos que registran doble contratación son accionistas de las diferentes sociedades que conforman la prestigiosa marca oftalmológica. (Revisar listado de médicos en doble contratación). 

El informe detalla que “A su vez, es importante señalar, que la Sociedad Sur Visión Ltda., se encuentra conformada por cuatro sociedades con participación de un 10 % cada una, a saber: Sociedad Oftalmológica Doctor Felipe Marín Ltda., representada por don Felipe Marín González, Sociedad Oftalmológica Vesperinas y Gajardo Ltda., representada por don Rodrigo Vesperinas; Servicios Oftalmológicos Kriman y Asociados Ltda., representada por don Jaime Kriman y Sociedad Profesional Triviño y Ulloa Ltda., representada por además de una persona natural, doña Sonia Verónica Ulloa Vergara , quien de acuerdo a los antecedentes mantenidos en el Registro Civil e Identificación, es cónyuge de don Alfredo Triviño Lavandero, con la participación de 60% de ésta.”

Además de indicar los potenciales conflictos de interés, se investigaron faltas administrativas graves, como la operación de licitaciones en horario laboral del Hospital Base San José de Osorno, donde 4 accionistas con doble contratación, realizaron 32 operaciones en horario laboral, en el anexo N°7 del informe se detallan los horarios.

La historia no queda ahí, porque una gran parte de los médicos y accionistas de Sur Visión también licitaron y realizaron doble contratación mediante la Sociedad Terramedica Ltda. En esta sociedad participan los médicos  Jaime Kriman Nuñez, Felipe Marín González, Alfredo Triviño Lavanderos, Rodrigo Vesperinas Avilez y Paulina Ramos, cada uno de ellos con un 20% del total de acciones de esta sociedad que ha ganado, hasta la fecha, $26.397.001 producto de las licitaciones adjudicadas.

En los últimos 5 años Sur Visión ha obtenido más de $1.300 millones de pesos y durante el 2019 la sociedad de Marín, Vesperinas, Kriman, Ulloa y Triviño,  sigue adjudicando licitaciones por valores cercanos a los $177 millones de pesos. Esto sin contar los tratos directos, sin licitación pública, que le han reportado un poco más de $220 millones de pesos. Ganancias para nada despreciables  de estas sociedades ligadas al actual jefe de oftalmología del Hospital Base San José de Osorno y Coordinador Técnico del programa de Red de Atención Oftalmológica del Servicio de Salud Osorno (SSO), Alfredo Triviño, nombrado en dichos cargos públicos por el actual Director del SSO Marcelo Larrondo.

 

Huapi Ltda. el VIP de las licitaciones médicas

Si hay algo que es vox populi en los pabellones del Hospital Base de Osorno es la credencial VIP que posee el equipo que trabaja para Huapi Ltda, empresa del conocido médico, ex concejal y militante del Partido por la Democracia PPD, Alejandro Baeza Soto; sociedad que registra la mayor cantidad de médicos con doble contratación y severas irregularidades que habrían puesto en riesgo la integridad de los pacientes en las diferentes cirugías realizadas. Esto quedó claramente acreditado en el documento de Contraloría, donde se informó que “de las 499 cirugías practicadas, se constató que 448 (el 90%) fueron realizadas sin contar con un enfermero(a). Asimismo, se determinó que 275 intervenciones se ejecutaron sin disponer el equipo médico con un auxiliar de anestesia, 261 sin un funcionario que desempeñe las funciones de pabellonero, mientras que en 4 oportunidades no había un arsenalero”.

La empresa del ex candidato a diputado, Alejandro Baeza, también cometió graves faltas administrativas. Según el informe “se evidenció que para las cirugías de colecistectomía, que a continuación se indican, el proveedor Huapi Ltda., adjuntó los protocolos operatorios, no obstante estos no se encontraban con la firma de los médicos cirujanos que ejecutaron las intervenciones quirúrgicas en análisis, situación que contraviene lo precitado en el artículo 7°, del decreto N° 41, de 2012, del Ministerio de Salud, en consideración a lo dispuesto, entre otras, en la letra c), del artículo 6°, del mismo, cuerpo reglamentario”.

Por otro lado se detallan dos operaciones realizadas por funcionarios de doble contratación de HUAPI LTDA; operaciones licitadas que se realizaron en horario laboral del Hospital Base de Osorno, recordar que toda operación licitada se debe realizar después de las 17:00 hrs. Todo esto detallado en el anexo N°8.

Referente a los montos adjudicados por la empresa del médico Alejando Baeza, Huapi Litda. en licitaciones públicas, estas sobrepasan los $1.000 millones de pesos y cuenta a su haber con el mayor  número de profesionales de salud en doble contratación, siendo estos un total de 56 profesionales entre los años 2015 y 2016.

 

Volosky, el cirujano Mercedes clase “A”

El conocido cirujano vascular Tyndall Volosky del Hospital Base San José de Osorno, por haber ganado un Mercedes Clase A, en un sorteo realizado por la Óptica Alemana de la ciudad; también aparece en la nómina de dobles contrataciones y otras irregularidades sobre aspectos en la ejecución de licitaciones adjudicadas. Es así que el informe de Contraloría señala qué  “se evidenció que 94 intervenciones quirúrgicas se realizaron sin contar con enfermero(a), así como 23 cirugías fueron ejecutadas sin contar con cirujano ayudante, 14 prescindieron de un pabellonero y 11 se efectuaron sin disponer de un auxiliar de anestesia”.

Otras de las irregularidades tiene que ver con el aspecto de las dobles contrataciones y las operaciones licitadas, realizadas en horario laboral, el órgano fiscalizador del estado menciona en su informe que se evidenciaron “48 intervenciones quirúrgicas fueron realizadas entre las 8 y 17 horas, hecho que no se ajusta a lo dispuesto en el artículo 41 , de las bases administrativas que establece que las cirugías se realizarán a contar de Ias 17 horas, aprobadas mediante la resolución exenta N° 3.489, de 2016, del referido hospital, así tampoco se apega al principio de estricta sujeción a las bases, preceptuado en el artículo 10 de la ley 19.886.”

Pese a esta y otras irregularidades Volosky aún sigue adjudicando una serie de licitaciones en favor de su Sociedad Médica, entre los últimos 5 años, esta entidad comercial se ha adjudicado mediante el mecanismo de licitaciones públicas un total de $1.265 millones de pesos y de contar entre los años 2015 – 2016 con 24 profesionales de la salud con doble contratación. 

 

La historia que se sigue repitiendo


Nuevamente la posible falta de fiscalización a la gestión del Hospital Base San José de Osorno y de Purranque, entre otros,  por parte de los organismos del Estado, tales como FONASA, el Servicio de Salud de Osorno, el Ministerio de Salud y Contraloría, una vez más han dejado pasar el tiempo y permitido que las malas prácticas y eventuales hechos de corrupción se repitan una y otra vez.

Tal como lo detalla el informe de la Comisión Investigadora del año 2017, da cuenta de una débil legislación donde la clase política y sus representantes aún no se hacen cargo de regular el lucro en la Salud. El otrora Ex Ministro de Salud Emilio Santelices, prometió el término de las sociedades médicas en el sistema de salud para la resolución de las listas de espera, de eso hasta la fecha, sin éxito. Es conocido que los mismos médicos especialistas y funcionarios públicos de los recintos de salud, adquieren mejores pagas por las horas médicas realizadas vía licitación, lo cual debilita profundamente el espíritu de probidad que debe imperar en los pasillos de cualquier hospital.

En declaración pública emanada el 16 de marzo del 2018, El Colegio Médico señala desde su Departamento de Ética, que  “han sido categóricos en denunciar que  esta forma de contratación podría favorecer actos de corrupción y perpetuar los problemas de origen, al comprar estos servicios en forma directa y a precios que estimulan esta forma de vinculación por sobre la carrera regular. Además, han hecho un llamado reiterado a los médicos a evitar conflictos de interés al respecto”.

Cabe mencionar que el Ministerio de Salud, en varias ocasiones a intentado impulsar mejoras en las rentas de los médicos especialistas, para frenar esta mala práctica y así además contar con profesionales comprometidos con la salud pública.

Según el cuerpo colegiado, “El déficit de especialistas en nuestra red pública es histórico y fue a partir de la promulgación de la Ley AUGE el 2005, con las garantías de calidad y nuevos estándares de atención, que terminó de evidenciarse. Esta falencia, que generó la contratación externa de médicos para cumplir con los estándares, aún no está solucionada. Cuando para un síntoma existe una causa no resuelta, solo podemos esperar que este siga manifestando”

Según detalla el medio la Tercera, los esfuerzos por terminar con estas asociaciones no son nuevos. En el primer gobierno del Presidente Piñera, cuando se conoció su existencia, se hicieron los primeros intentos por normar dicha práctica. En la administración pasada de Bachelet, en tanto, se instruyó una auditoría a 64 establecimientos de salud, que identificó el funcionamiento de 440 asociaciones y que derivó en 41 sumarios, por incompatibilidad horaria y faltas a la probidad, entre otras materias. Además, se pusieron restricciones a los pagos de estas firmas en las glosas presupuestarias y se establecieron mecanismos de control, junto con un plan integral de mejoramiento y control de conductas inadecuadas, según explicó la ex subsecretaria de Redes Asistenciales, Gisela Alarcón.

En el mismo sentido, en declaraciones vertidas al mismo medio por Matías Goyenechea  presidente de la Fundación Creando Salud, explicó que “las prestaciones que se compran mediante sociedades, son entre tres a 20 veces más cara que una prestación institucional comprada. Sin embargo, la modalidad de pago a honorarios no resuelve el problema, hay que avanzar hacia una Ley Médica Única, hacia la carrera funcionaria y la retención de los profesionales, asegurando su permanencia en el sistema público”.

 

La deuda pública , las listas de espera y las indesmentibles cifras

La actual administración del Servicio de Salud Osorno liderada por Marcelo Larrondo y Jorge Castilla, conocen los antecedentes previamente mencionados al detalle, siendo aún más, que los actuales directivos se han “repetido el plato” en este segundo Gobierno de Sebastián Piñera. Lo cual levanta serios cuestionamientos, sobre si podrán poner coto o no, a estas irregularidades en licitaciones v/s la disminución de las listas de espera y la deuda pública.

Con respecto a las listas de espera y según se informa en documento presentado a la Cámara de Diputados con fecha 31 de Enero del 2019, llamado Glosa 06 Lista de espera no GES Y Garantías de oportunidad GES retrasadas”, da cuenta de las graves falencias de los recintos hospitalarios de la red del Servicio de Salud Osorno.

En tiempos de atención médica y número de pacientes, las cifras son alarmantes: 5.127 pacientes con 300 días de atención promedio en “lista de espera abierta de intervenciones quirúrgicas”, de los cuales 1.204 corresponde a adultos mayores. Además mencionar que existen 23.557, en lista de espera abierta de consultas nueva de especialidad, con una espera promedio de 215 días, de los cuales 4.322 son personas de las Tercera edad.

Mientras uno de los lemas de las autoridades de salud locales en este gobierno ha sido “Los niños primero”, en cuanto al sistema de salud, aún siguen siendo relegados, vulnerando así sus derechos fundamentales, 5.068 niños y niñas menores de 15 años; esperando una atención médica y 868 esperando una cirugía. Por otra parte las mujeres encabezan con un 60 por ciento la listas de espera en relación a los varones, en la comuna de Osorno.

Pero acá no queda todo, de acuerdo a la Glosa 06 mencionada anteriormente, sólo entre enero y junio del 2018 ,se evidenciaron 113 defunciones con garantías GES y 110 defunciones de “lista de espera no GES”, es decir, sólo en los primeros seis meses del 2018, fallecieron 223 personas esperando una cirugía.

Con respecto a la  deuda pública que maneja el Servicio de Salud Osorno, durante la administración de Marcelo Larrondo y Jorge Castilla, esta sigue subiendo año a año, para el Hospital Base San José de Osorno el año 2016 era de $3.905 millones, el 2017 fueron $4.046 millones, ya a fines del 2018 la cifra se incrementó en un 39% es decir $5.623 millones. Según fuentes del propio hospital, la cifra proyectada para fines del 2019 ascenderían montos cercanos a los $6mil millones de pesos.

El Hospital de Purranque, mantenía una deuda pública en el año 2017 de 156 millones de pesos, sin embargo en el año 2018, bajo la administración actual tuvo un incremento del 56%, es decir 88 millones de pesos más, haciendo un total de 244 millones de pesos.

Con respecto a los otros hospitales de la red, tanto Río Negro, Puerto Octay, San Juan de la Costa y Quilacahuín, en sus cuentas públicas de este año 2019 la información con respecto a la deuda pública es poco clara o bien no aparece señalada.

 

La vulneración sistemática del Derecho Humano al acceso a la salud


En el Informe Anual 2018: Situación de los Derechos Humanos en Chile del Instituto Nacional de Derechos Humanos (INDH), da cuenta de que las prolongadas demoras en atención de las listas de espera es una muestra de los padecimientos excesivos de los pacientes y una señal de corrosión del sistema público de salud que tiene como telón de fondo un escenario poco alentador: la denegación del derecho al acceso a la salud. Debido a los excesivos tiempos que demoran las atenciones, prolongando el sufrimiento de las personas y erosionando la legitimidad del mismo sistema de salud.

En su capítulo “Solución a las listas de espera en el sistema público de salud: Una promesa incumplida”, aborda de manera acuciosa y pormenorizada, reconociendo en esta situación de manera implícita, una denegación en el derecho al acceso a la salud.

El mismo informe señala un escenario aún más lamentable: el mayor número de retrasos se concentran en las personas del tramo FONASA B, correspondiente al grupo más vulnerable de la sociedad cuyo ingreso imponible mensual resulta menor o igual a $276 mil pesos. Cabe consignar que en la especialidad de traumatología existen personas que llevan esperando un tiempo mayor o igual a tres años y que en enfermedades cardiovasculares, una de las principales causas de muerte en el mundo y en Chile, el promedio de espera es superior a dos años.

Otra arista similar, el entonces fiscal Emiliano Arias detectó irregularidades en las listas de espera del Hospital de Rancagua en atenciones de salud GES y NO GES, situación que mantuvo en las cuerdas al ahora Ministro Jaime Mañalich,  encontrando que numerosos pacientes habían sido eliminados sin haber recibido la atención de salud solicitada y se encontraron más de dos mil fichas escondidas en el recinto asistencial. Una situación que, recalca el informe, es “gravísima” pues existió una acción intencionada de denegar una atención de salud que, según la propia investigación, constituyen delitos de prevaricación administrativa, cuasi delito de homicidio y fraude al fisco. Esto último debido a los bonos económicos por incentivos a directivos y funcionarios por el cumplimiento de metas determinadas por el Ministerio de Salud.

El INDH recomienda en este informe de finales del 2018 al Estado, a adoptar medidas económicas, técnicas y legislativas, hasta el máximo de los recursos de que disponga, para lograr una progresiva efectividad, sin discriminación, al derecho a la salud. Recomienda, además, al Ministerio de Salud, generar un sistema de alerta en relación a pacientes con prolongados tiempos de espera, desarrollar un mecanismo de fiscalización respecto del cumplimiento de la gestión GES, diseñar nuevas herramientas que permitan evitar incentivos inadecuados para el cumplimiento de la atención en los plazos estipulados, elaborar un marco normativo y de gestión que permita a la Atención Primaria en Salud fortalecer los planes preventivos en la población y elaborar programas de formación permanente a los profesionales que trabajan en Atención Primaria de Salud.

De estas recomendaciones y la solución no sólo referente a las listas de espera, las sociedades médicas, nuevas leyes de control, el rol fiscalizador y finalmente evitar la muerte de pacientes. No han sido tomadas en cuenta, ni este Gobierno ni en los anteriores. 

Es de vital importancia que las comisiones de salud del parlamento, pongan fin a estas prácticas para así acortar además la desigualdad que se genera, entre prestadores del servicio y usuarios, que en este caso es la ciudadanía común y corriente, sobre todo con bajos ingresos económicos.

De seguir estas prácticas, nunca se cerrará el círculo vicioso de la pobreza utilitaria, que llena de garantías económicas a un cúmulo de élite privilegiada en el mundo de la salud.


Yessica Nuñez Paredes, Periodista. Licenciada en Comunicación Social. Editora Periodística.
Equipo asambleapopular.cl

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  22. Juicio civil a toda esta Lacra..deben devolver los miles y miles de millones ROBADOS si!!!! Robados al usuario…al paciente..con esa danza millonaria..cuanto se ayudaría a la gente necesitada de salud.. Y TODAVÍA SALEN A LA CALLE? cero verguenza..

  23. Que denigración existe no sólo en Chile. El aprovechamiento político y económico al parecer a tocado todos los ámbitos de la sociedad, no sólo Chilena, si no, además la incorporación de entes foráneos que mitigan el impacto en la sociedad, con disfraces de idoneidad. Lo que estamos viendo en Osorno, debiera castigarse con todo el peso de la Ley, incluyendo la impasividad del Gobierno, para enfrentar severamente la lacra que se ha incorporado en todos los ámbitos de nuestra sociedad… La pregunta es ¿existirá realmente una persona que se atreva a desenmascarar a todos, sin importar credos, personas e instituciones? … Hagámos la encuesta e incribámonos con un criterio altruista y transparente para mostrar un nuevo Chile renovado en verdad, aprovecharemos de tocar ésta nueva sociedad que nace con maldad y que, dado el actual sistema jurídico, no hay forma de frenar, al parecer… «Por un Chile Renovado y Transparente», comencemos YA !!!

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  25. Que terrible como se hacen millonarios y los pobres usuarios se mueren esperando ,con su famosa lista de espera .quien le pondrá el cascabel al gato.

  26. Felicitaciones al equipo investigador. Acciones como esas son las que permitirán limpiar el servicio público de gente inescrupulosa, sinverguenza y con poca vocación de servicio, como la que denuncia esta auditoría

  27. Esta situacion en el mundo de la salud en Osorno es conocida desde hace muchos años,no se resuelve porque los mismos que cometen estas irregularidades y empobrecen al hospital son los directores de servicios..jefes de especialidades..etc. y si les prohiben esas conductas amenazan con renunciar al hospital. Un circulo vicioso ideal para enriquecerse a costa de la salud y vida de la población.Aun les falta averiguar el negocio de las dialisis y otros.

  28. La ex Directora del Hospital Río Negro, 2010-2018, (ochos largos años ) aumento el recurso humano en dicho Hospital, habiendo dejado este establecimiento de hacer atención primaria debido a la inauguración de un Cesfam local. Hasta la fecha existen dos profesionales en una misma funcion, no se hicieron selección de antecedentes como corresponde o simplemente se fueron quedando a través del tiempo. Estás malas prácticas se denunciaron ante el director, sr. Bello el cual jamás resolvió lo denunciado, también se denunció al Diputado Espinoza el cual también lo soslayo debido a la amistad con Bello.

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