UNDER THE MICROSCOPE OF THE AUDIT COMMITTEE THE REPORT OF THE AUDIT OFFICE ON A&E - Filenews 27/2
Non-compliance with the internal procedures of OKYPY and administrative weaknesses are noted by the Audit Office in its report on the Accident and Emergency Departments (TAEP) of the Nicosia General Hospitals, which was discussed on Thursday in the Audit Committee of the Parliament, with the discussion focusing on the remote diagnosis of X-rays, as well as the operation of CT scanners in public hospitals.
The Director of the Health Branch of the Audit Office, Michalis Vassiliou, stated that the object of the surprise audits of 2023 was to check the presence of doctors and the basis of admission of patients. He said that they spoke with shift workers and confirmed the physical presence of the doctors, while also reaffirming the "gaps in the patient admission process".
"We note that the picture in Limassol was better because the vast majority of the publications complied with the procedures. Legally, both doctors and the organization are exposed to risks for not filling out the forms correctly. What we systematically find is that many times the forms are signed only by resident doctors. This exposes the organisation to legal risks. To some extent, there may also be ignorance of the regulations by doctors. What we are saying is that the internal procedures of the organization are not faithfully followed," he said.
"We were informed that there was damage to the CT scanner of the Nicosia hospital. The organization has already purchased a new tomograph, received from June 26. It has not been operational yet but is expected to be operational soon", noted Mr. Vassiliou on the issue of the CT scanner at the Nicosia General Hospital.
Michalis Vassiliou added that services from a private hospital were needed within the GHS. "We noted that the radiologists on duty at the Nicosia hospital refused to diagnose themselves, which is why telediagnosis was chosen. We asked the legal framework for telediagnostic services. The national eHealth Authority replied that telediagnosis is carried out without a comprehensive legal framework. We also asked the Ministry of Health for views on this issue without receiving a response. As far as X-rays are concerned, we found a delay in the preparation of medical opinions. There has been an arrangement since 2021 for radiologists to be compensated overtime to prepare reports outside normal working hours. The administration intends to end this practice," he noted.
Regarding the time of stay of patients in the A&E department, Mr. Vassiliou stated that "part of the time is due to the fact that in the hours of 3-6 in the morning doctors provide services only in cases that need immediate handling. The other incidents are taken over by the next one who will come at 6 in the morning."
The General Executive Director of OKYPY, Kypros Stavrides, said that "the basic operation manual of the A&E needs to be updated. Our doctors are under pressure, there may not be time to deal with appropriately filled fields. It took a long time for the organization to enter its digital transition so that technology could help the doctor move quickly."
Regarding the delay in the operation of the CT scanner at the Nicosia General Hospital, Mr. Stavridis stated that there was a CT scanner and they ordered the second one, which came in June. "It became clear that the existing building infrastructure that the organization had was not suitable. It took us longer than we estimated to get the machine in. Now it has been introduced, we have also moved on with additional X-ray positions. It will operate either this week or early next week," he said.
On the issue of telediagnosis, Mr. Stavridis noted that "teleradiology is a practice that is done internationally. I'm not saying I'm 100% in favour of teleradiology. We have developed a system called PACS (Picture Archiving and Communication System). It is so good that anyone from another city can give an opinion. In case of error, the doctor who gives the opinion is responsible." On the issue of resident doctors, Mr. Stavridis clarified that residents always act under the supervision of specialist doctors.
The Vice President of the Pancyprian Medical Association (PIS) Dr. Chrysanthos Georgiou spoke of an original way of medical examination. "It is the first time I have experienced such control. This thing is schizophrenic to say the least. For quality control, there are quality committees in all hospitals, not in OKYPY, in the world. The prudent thing that the Audit Office should examine is whether the patient receives the care he needs during his stay in the A&E," he said.
"I would expect the Audit Office to come inside the hospital and check my living conditions 32 hours inside. It's not the doctors' fault. I have a requirement to have good working conditions. The conditions are unacceptable for 2026. What are we to blame for the systemic shortcomings? Look at the responsibilities of the state institutions," added Mr. Georgiou.
"It is not the doctors who are controlled by us but the body. We control the procedures. Everything we do is always with respect", replied the representative of the Audit Office to the Vice President of the PIS.
The Vice President of the Board of Directors of OKYPY, Andreas Theodoridis, said that the findings and suggestions are a tool for self-improvement. "We recognise that some of the findings highlight real challenges. The A&E departments of the public hospitals of Limassol and Nicosia operate under constant pressure. An internal evaluation of the procedures is already underway."
The General Financial Director of OKYPY, Robertos Karahannas, noted that in public hospitals, the cost is not flexible. "It must be determined what our role is in the GHS. We want to become autonomous, but on the other hand, the Cypriot people want us to provide everything, everything, whether it comes out financially or not," he said.
"It seems that some people had reasons for the CT scanner not to work. We sat him in the room and waited to fix the space. Mr. Vassiliou, a detailed report should be made on the issue of the CT scan. From what I understood, it has various kingdoms in our region", noted the Chairman of the Audit Committee and DIKO MP, Zacharias Koulias.
Referring to the issue of remote diagnosis of X-rays by radiologists abroad, Mr. Koulias said that "it was found that there is no legal responsibility of the one who will give the medical opinion abroad if something goes wrong. Nor is there a legal framework."
"We do not ignore in any way the efforts that have already been made to date by OKYPY to improve the services provided to patients in the A&E and especially through the rapid circulation clinics, but also with the recent purchase and the immediate operation of the CT scanner. We believe that much more needs to be done to reduce the time patients stay in the A&E and to reduce the inconvenience suffered by patients," said DISY MP Savia Orfanidou.
"We call on OKYPY to proceed with the updating of the Basic Operation Manual of the A&E and towards the re-evaluation of the needs of various specialties, such as radiologists," he added.
AKEL MP Marina Nikolaou stated that "during the discussion, the operational readiness of the doctors on duty was confirmed" which, as she said, also concerns the core of patient safety".
"It became clear that most of the issues identified concern procedural and administrative weaknesses. Congestion and delays in A&E are not a one-factor phenomenon, nor can they be simplistic in medical practice," he added.
Nicosia MP Irene Charalambidou said that "by making the GHS we put the cart before the horse. We caught the public hospitals, threw them into competition and told them to float. And every year we see an increase being requested, a strengthening of the budget and an extension of autonomy. Let me also remind you that public hospitals have obligations that private ones do not."
"I am very concerned about the issue of CT scans because in order for the diagnosis to be made correctly, the CT recording must be read correctly. It is necessary when such diagnoses are made that often the patient's own life is at stake to have responsibility", noted Ms. Charalambidou about telediagnosis.
The General Director of the Health Insurance Organization (HIO), Ifigenia Kammitsi, said that "we have no particular say in this audit that took place. We have a relationship with OKYPY because they are contracted with us. As far as the A&E is concerned, what we do is to compensate for the services provided. We certainly know that the A&E of Nicosia gets the largest volume."
"The autonomy of hospitals is not our business. We have a close cooperation with OKYPY. We cannot take a position on the CT scanner," he added.
On the issue of transplants, Ms. Kammitsi said that there was another case where the patient successfully managed to reach Greece and have the transplant performed. "Unfortunately, we do not have direct access to air ambulance," she added.
The representative of the eHealth Authority, Minas Kyriakides, confirmed that there is no legal framework for telediagnosis. "The legal framework is ongoing. The agreement on cross-border health provision is awaited. What we are sending now is out of context. They are agreements between hospitals," she noted.
"The Ministry of Health is closely monitoring. We are here for supervision and monitoring," said the Director of Health Services of the Ministry of Health, Anastasia Christodoulidou.
The President of the Pancyprian Union of Government Doctors (PASYKI), Sotiris Koumas, raised the issue of the credibility of the investigation. "We cannot consider that the Audit Office is infallible. We question the way the investigation was conducted. The methodology had to be recorded. Who has written this manual? When did OKYPY give it to us to check it and see if it is applicable? I hope they will call us next time," he noted.
"The problems are too many and OKYPY cannot handle them alone. The wait at the A&E is increasing, the waiting time for sorting outside the A&E is also increasing. We had to have more beds so that the department would not be pressured, noted a representative of PASYNO.
"Most of the findings concern procedural issues and we call on the organization to proceed with a solution, in cooperation with the employees," said the representative of PASYDY, Konstantinos Zachariadis.
A representative of PEO noted that OKYPY must continue the work it does. "It is always good for the problems that exist to come to the surface. The Federation together with the management of OKYPY are in a good cooperation", said the President of the Cyprus Federation of Patients' Associations (OSAK), Charalambos Papadopoulos.
CNA
