Dumping medicine, faking patients: Cuban doctors describe a system that breeds fraud

Dumping medicine, faking patients: Cuban doctors describe a system that
breeds fraud
BY JIM WYSS
jwyss@miamiherald.com

BOGOTA, COLOMBIA
Since 2003, Cuba has been sending battalions of doctors to Venezuela in
exchange for cash and crude.

The program, known as Barrio Adentro, offers free medical care to some
of the nation's poorest. It's been credited with saving more than a
million lives and is one of the pillars of the socialist revolution.

But according to health workers who have defected from the program,
Barrio Adentro has been hollowed out by fraud. And they say they were
under such intense pressure to hit quotas that they've been faking
statistics for years.

As a dentist in the program, Thaymi Rodríguez said she was required to
see 18 patients a day, but often only a handful would make their way to
her clinic. Medical workers who didn't hit their daily quota were
threatened with having their pay docked, being transferred or, in
extreme cases, being sent back to Cuba.

To make up for the patient shortfall, Rodríguez said she and her
colleagues would routinely fake paperwork and reinforce the fiction by
throwing out anesthesia, dental molds and other supplies.

"I worked for three and a half years as a dentist in Venezuela, and it
was horrible dealing with the statistics," said Rodríguez, who defected
from the program late last year and is in Colombia awaiting a U.S. visa.
"I might see five patients a day, but I had to say I'd seen 18, and then
throw all that medicine away, because we simply had to."

Trashing medicine in a country where it's desperately needed was
painful, doctors said. But if they were caught giving it away — or even
worse, selling it — they would be kicked out of the mission and sent
back to Cuba. And regular audits of their supplies meant they needed
them to match their patient count.

The claims are difficult to verify, and calls to Venezuela's Ministry of
Health seeking comment went unanswered. But the Miami Herald spoke to
three different groups of health workers who had abandoned the program,
and all told similar stories.

Lucrative 'exports'
The quota pressure stems from Cuba's economics. Desperate for hard
currency, the government sends its legions of health workers abroad
under contracts that let the administration keep the lion's share of the
revenue.

According to an article published by the Wharton School at the
University of Pennsylvania, there were 37,000 Cuban health professionals
working in 77 countries during 2015. Citing unnamed Cuban officials, the
document claims the health workers generated about $8 billion in foreign
exchange revenue for the island that year.

Venezuela's state-run PDVSA oil company, which pays for the program,
says it pumped $28.8 billion into Barrio Adentro from 2003 through 2015.

There's no doubt the clinics (there were 7,287 of them in 2015) have
saved lives. The World Health Organization, among others, has praised
the program for helping reduce infant mortality, and President Nicolás
Maduro says the Cuban doctors have saved more than 1.4 million lives
since the program started.

But it's also clear the program is less effective than the
administration would like the world to believe.

Data breach
A Cuban IT expert who oversaw medical missions in four Venezuelan states
said it was his job to transmit patient logs and other statistics back
to Havana. The 34-year-old technician asked to remain anonymous because
he's been told he's facing arrest warrants in Venezuela and Cuba for
stealing data from the medical mission.

Venezuela pays Cuba based on the number of patients that are seen, or
educational workshops that are given, he said. And the island's
authorities simply don't want anemic patient turnout to get in the way
of the revenue.

"You have to understand that Venezuela pays Cuba based on statistics,
not based on what's really happening in the clinics," he explained.

In the four states under his purview — Aragua, Yaracuy, Guárico and
Carabobo — he said there were some 6,800 Cubans on different "missions,"
including 5,900 medical workers.

As he compiled his monthly reports, it was clear they were fabricated,
he said. Dentists were regularly logging 18 patients a day and doing
five educational workshops per week. In addition, they had to fill out
extensive paperwork on each patient. There simply weren't enough hours
in the day, he said.

"I'm an IT worker and a mathematician and like all my data to make
sense," he said. "And none of this made sense."

Patients needed
Dentists are particularly under the gun because Venezuela pays for their
services in cash, as opposed to crude, workers said. But nobody was
immune from the quotas.

Ibrahím Mustelier, an ophthalmologist, said he was required to deliver
six patients every Thursday for cataract surgery under a program known
as "Operation Miracle."

But the real miracle was finding that many people.

"What I would see in my practice were infections, conjunctivitis …
things that didn't need surgery," he explained.

When he didn't have enough cases, his bosses would send him out knocking
on doors to fill the beds.

"My supervisors would say 'Doctor, you know you're going to be punished
because we have to meet these quotas — and these orders are coming from
the highest levels,' " he recalls.

The pressure on doctors may be one of the reasons they've been defecting
in droves. Thousands of them received expedited visas to the United
States under the Cuban Medical Professional Parole program, which was
canceled Jan. 12.

The IT expert said that from January to October 2016, he had records of
90 doctors defecting from Aragua state alone.

But Barrio Adentro has also been a victim of Venezuela's economic
crisis, which features shortages of food and medicine. Doctors said that
even as they dumped some medicine others, particularly antibiotics, were
impossible to find.

In October, shortly before he abandoned his post, the technician said
Cuba recalled hundreds of doctors from the program because, he believed,
Venezuela was falling behind on payments. His IT department, for
example, was reduced from 22 to 12 workers.

But even as the program is struggling, both countries have a vested
interest in the program's success as it helps maintain the idea that
free healthcare is viable and thriving under Venezuela's socialism, he said.

"In the end," he said, "Venezuela and Cuba are just lying to each other."

FOLLOW JIM WYSS ON TWITTER: @JIMWYSS

Source: Cuban doctors defecting from Venezuela describe system of fraud
| Miami Herald -
http://www.miamiherald.com/news/nation-world/world/americas/cuba/article129125864.html