Friday, July 06, 2012
(BN) Spain Rescue Seen Worse Than Cure as Hospitals Make Cuts
Bloomberg News, sent from my Android phone
For some cancer patients, Spain's debt crisis means living on borrowed medicine.
Virgen de la Luz hospital in the rural province of Cuenca turned away two women with lung and breast cancer in May after Roche Holding AG (ROG) stopped supplying tumor fighter Herceptin, according to documents obtained by Bloomberg News. The women got the drug after a 24-hour wait thanks to a hastily-brokered deal to borrow it from another clinic.
To rescue Cuenca and the rest of Spain's health system, which sank into debt alongside the regional governments that operate it, the state arranged an infusion of guaranteed loans and demanded 7 billion euros ($8.8 billion) in cost cuts. Yet doctors and patients warn the prescription for cutbacks may cause more pain than the budgetary malaise it was meant to cure.
"The situation is not going to change," said Jose Andres Guijarro, a gynecologist at Virgen de la Luz who helped found a citizens group protesting cuts at the hospital. "If we didn't have money to pay before, we won't have it now."
Patients and hospitals across Spain are wrestling with the same dilemma. Even as old debts get paid off -- the country's 17 regions ran up some 12 billion euros in unpaid health bills through last year -- new ones are piling up. As a result, the need to break the cycle with spending cuts threatens to redefine the very notion of Europe's tradition of socialized medicine: how best to treat patients, not how to make ends meet.
"As long as it is state-funded, the health system will always run a deficit," said Miguel Llorens, financial director for Hospital Provincial de Castellon. Roche stopped taking his IOUs as well, and he says he pays the Swiss drug giant in cash.
Solar Panels
Tangled in a debt crisis that left him requesting a 100 billion-euro European Union bailout to help banks reeling from a real-estate collapse in its fifth year, Prime Minister Mariano Rajoy sliced 7 billion euros out of the health system as part of about 45 billion euros of cost cuts and tax hikes.
The spending cuts come in exchange for 35 billion euros in syndicated bank loans the central government arranged on behalf of town halls and regions, which pay for health care.
The hope is that the bailout will help get the flow of drugs moving again. Roche says its Spanish creditors paid their debts last week. That put medicine distribution "back to normal throughout the country," including in Castellon and Cuenca, the Basel, Switzerland-based company said in an e-mailed statement.
Still, Llorens says things aren't back to normal on the ground. When a patient needs Herceptin or another Roche medicine, he sends the company a pre-order. Roche bills him. Only after the bank transfer clears does he get the product.
One Solution
The square-bearded former nurse says he expects the credit agreement with Roche to resume in September. That will only solve one of his many worries, though: he must find about 3 million euros of cost cuts this year to meet his 85 million-euro budget. So he has mounted solar panels on the roof to save on electricity, endorsed salary reductions -- including a 20 percent pay cut for himself -- and left retired doctors' positions open to trim his payroll.
Llorens, who started working at Castellon as a nurse when he was 18, says while hospitals need more funds, they must learn to become more efficient. Before the loans, the average hospital was paying bills almost a year and a half late, industry group Farmaindustria estimates.
The spending cuts are the only way forward, or else unpaid bills will start to pile up again, according to Gloria Rodriguez, the regional government liaison for the Spanish Federation of Healthcare Technology Companies.
The debt crisis helped put one in 10 members of her organization out of business, she said in an interview. Spain's regions "were spending happily," according to Rodriguez. "Now they have seen they can't finance it."
Band-Aid
Rajoy's measures will mean longer hours and less pay for doctors and nurses, and higher costs for patients accustomed to spending little to nothing to visit a physician. It's fair to call the regional bailout a band-aid for bigger structural wounds in the health system, said Kaushal Shah, an analyst for Business Monitor International in London.
"The situation is far from over," she said.
Despite its debt, Spain spent less per capita on health in 2010 than France, Italy, Germany, or the U.K., according to the World Health Organization. The budget demands may erode the fundamentals of the system, said Carmen Torralba, mayor of Sotorribas, a 900-resident cluster of villages outside the city of Cuenca.
"We're actually talking about something very basic, which is that someone who makes 1,000 euros a month can have free, quality care," she said.
Pregnant and Worried
The spending cuts, especially in this rural area at the eastern edge of Don Quixote's tilting ground on the Spanish high central plain, risk leaving some people in isolated areas without any access to health facilities and have sapped confidence in the system.
Nine months pregnant and waiting in the hot sun outside Virgen de la Luz hospital, Trini Romero says she's afraid doctors might put their finances ahead of her baby's health.
She and her husband, Manuel Rabadan, rushed the 100 kilometers from their village on the other side of the hills to the hospital in an ambulance, after her doctor had warned that her water might be slowly leaking out. When the same thing happened with her son four years ago, the hospital induced labor, she said.
This time, with no sign of leakage and a day to go before her due date, Romero said the hospital told her to find her way back to the village. Her husband lit cigarette after cigarette as the couple waited for a friend to take them home.
"They've gone too far," he said. "The situation is really bad."
Life-Saver
Guijarro, the gynecologist, says budget cuts have left him unable to get a drug used in cesarean sections to avoid haemorrhage and special vacuum pumps for difficult births.
Virgin de la Luz also ran out of Roche's cancer drug Herceptin for five patients scheduled to receive the treatment, according to an internal letter from the chief of oncology dated June 6 and obtained by Bloomberg News. With Roche refusing to deliver the drug, the hospital turned to other facilities for a loan, according to the letter. Two refused. A third agreed, resulting in a 24-hour delay because the medicine had to be transported a long distance, the letter said.
A lung cancer patient and a breast cancer patient made written complaints after being turned away by the hospital on May 29. Though the delays were not life threatening, both patients need the drug at regular intervals to stay alive, their doctor said.
700 Days Late
Roche stopped shipments because the hospital was more than 700 days late in its payments, according to an oncologist who treated some of the patients and declined to be named, citing fear of retaliation by local authorities. The hospital has also encouraged staff to use cheaper drugs for cancer patients or send them to other facilities, the oncologist said.
The Castille-La Mancha health services acknowledged "an isolated short delay" in cancer treatments at Virgen de La Luz in an emailed response to questions. The cost cutting measures "are only aimed at improving efficiency and don't affect health care quality," they said.
Roche may not have been the only drugmaker to clamp down on deliveries. AstraZeneca Plc (AZN) and Johnson & Johnson (JNJ)'s Janssen unit have also required cash payment from at least one hospital, according to an official who declined to be named. Spokespeople at both drugmakers said the companies don't have a policy of requiring cash payments in Spain.
Boom and Bust
About an hour's ride from Madrid by high-speed train, Virgen de la Luz is the only hospital in a province a little smaller than the state of New Jersey. At the peak of the Spanish real estate boom in 2007, the regional government of Castille-La Mancha promised to build a second hospital in Cuenca. Last year, as hospital drug debts spiked 89 percent to 408 million euros, regional President Maria Dolores Cospedal said the project would need private funds to proceed.
Now, not only is there no new hospital. The existing one has had to close one of its floors, cut staff and add beds to rooms. And services to patients in the province's far-flung villages are being curtailed, which may increase their reliance on Cuenca's sole facility.
The regional government wants to cut the traveling doctor and pharmacist who visit the eight villages that make up Sotorribas once a week to give checkups and prescriptions to the largely elderly population, mayor Torralba said. Only one of the villages has a pharmacy, and the sole bus connecting the hamlets to Cuenca runs three times a week.
'Cutting the Essential'
In Madrid, the latest round of cost cuts come on top of earlier efforts to pare services, said Jose Soto, general manager of Madrid's Hospital Clinico San Carlos. Soto's hospital employs more than 5,000 people and accounts for about a tenth of the region's health services.
Clinico San Carlos already suffered a 10 percent budget cut in the past two years, said Soto, who has seen the hospital shrink to about 1,000 beds from 1,650 during his 18-year tenure. In July, he'll be forced to scale back by as much as another 20 percent.
"So far we've managed to weather budget cuts with some adjustments," Soto said in an interview. "Now we are going to feel those austerity measures much more deeply."
Ghost Airport
Last year, almost 40 percent of patients in Spain waited more than 60 days to consult a specialist, according to data published on June 28 by the Health Ministry. The number of patients waiting for surgery increased 17 percent in December from a year ago and the average delay rose to 73 days from 65.
If Cuenca shows what balancing the budget may mean for patients, the train ride east to the coastal region of Valencia shows how the overspending came to be in the first place. A brand new airport that cost about 150 million euros to build in Castellon and was completed at the start of 2011 has yet to see a single passenger or airplane.
"They spent what they didn't have on what was superfluous," Spanish novelist Elvira Lindo wrote in Madrid's El Pais newspaper on June 20. "Now all they can think about is cutting what is essential."
To contact the reporters on this story: Naomi Kresge in Berlin at nkresge@bloomberg.net; Angeline Benoit in Madrid at abenoit4@bloomberg.net
To contact the editor responsible for this story: Phil Serafino at pserafino@bloomberg.net
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Monday, July 02, 2012
Saudi Arabia is angry that UN has removed the dissident Saad al-Faqih from UN'al Qaeda sanctions list
via Reuters/yahoo news
A U.N. Security Council committee is removing Saudi dissident Saad al-Faqih from the United Nations' al Qaeda sanctions list, despite strong objections from Saudi Arabia, a U.N. diplomat said on Sunday.
The London-based Faqih was added to the list in December 2004, days after the U.S. Treasury Department hit him with sanctions for suspected links to the late Osama bin Laden's militant network, which was responsible for the September 11 attacks on the United States in 2001.
The decision to de-list Faqih came after the 15-nation Security Council's sanctions committee failed to reach a consensus to override the U.N.'s al Qaeda-sanctions-list ombudsman, who had recommended removing Faqih from the U.N. blacklist, the diplomat told Reuters on condition of anonymity.
Reuters reported on Saturday that the removal of Faqih from the U.N. blacklist appeared imminent. One envoy said Faqih's de-listing was expected to take effect at midnight New York time (12.00 a.m. EDT).
Faqih told Reuters in London it had been "a laborious battle" to get him off the list.
"All that has happened in the last eight years is that an innocent, peaceful activist, acting within the law, has been a victim of a conspiracy by tyrants in the Gulf supported by superpowers," he said.
Formerly a professor of medicine at a Saudi university, the exiled dissident heads the Movement for Islamic Reform in Arabia and has insisted that he and his group are committed to peace. Faqih is an outspoken critic of the Saudi leadership.
Prior to Faqih's de-listing, there were 252 individuals and 69 entities or groups on the U.N.'s al Qaeda sanctions list, including Faqih. All individuals on the list are subject to asset freezes and an international travel ban.
SAUDI PRESSURE
Britain, Faqih's current host, was one of only four council members that supported the recommendation of the al Qaeda sanctions committee ombudsman, Kimberly Prost of Canada, that Faqih be taken off the blacklist, despite strong objections from Riyadh, diplomats said on condition of anonymity.
Council diplomats said The United States was among the 11 council members that supported the Saudis and opposed taking Faqih off the blacklist. A spokesman for Saudi Arabia's U.N. mission did not respond to a request for comment.
The other three countries supporting Prost's recommendation, the envoys said, were Germany, South Africa and Guatemala.
"The Saudis were pushing really hard against the idea of de-listing al-Faqih," a diplomat told Reuters. "I don't think the decision in London (to support de-listing) was an easy one."
A spokesman for the British mission to the United Nations declined to comment because he said the committee's proceedings are confidential.
The al Qaeda sanctions list has been criticized by human rights advocates, who say it has proven virtually impossible to be removed from it.
Last year, the Security Council expanded the powers of the ombudsman, giving the office the authority to recommend removal of people from the blacklist. Council members must agree unanimously to override the recommendation or call for the council to take up the issue.
When the U.S. Treasury Department blacklisted Faqih in 2004, it said he had "maintained associations with the al Qaeda network since the mid-1990s, including an individual associated with the 1998 East Africa embassy bombings."
Earlier this year, Faqih criticized Saudi Arabia's rulers in an editorial in Britain's Guardian newspaper and predicted that the Arab Spring uprising, which began last year in the Middle East and North Africa, would reach Saudi Arabia.
(Additional reporting by William Maclean in London; editing by Christopher Wilson and David Brunnstrom)
Indonesia, Australia and Boatpeople
source: Yahoo News/AFP
Indonesian President Susilo Bambang Yudhoyono arrived in Australia on Monday as a political storm over people-smuggling raged, with the "evil trade" looming large in talks with Prime Minister Julia Gillard.
The Indonesian head of state was met by Gillard as he touched down in the northern city of Darwin for their second annual high-level meeting.
"I will be talking to the president of Indonesia over today and tomorrow about our economic links... about our people-to-people links, about our joint strategic interests in the region in which we live," Gillard told ABC Radio.
"Of course we will also be talking about the evil trade of people smuggling."
Canberra is facing a steady influx of asylum-seekers coming to Australia by boat, many of whom use Indonesia as a transit hub, boarding leaky wooden vessels there after fleeing states such as Afghanistan and Iran.
While the numbers are not large on a global scale, with 5,242 coming on 72 boats so far in 2012, boatpeople are a politically explosive issue in Australia, with the matter a key concern in the 2010 election.
More than 90 people have drowned in recent days after their boats sank en route.
Asked about whether whether Indonesia had the resources to conduct mass rescues at sea, Gillard said: "We will be talking about these questions as we talk through the full suite of our relationship."
Defence Minister Stephen Smith, also in Darwin, said the Australian navy had advised that it had sufficient resources to do its work, but added "there's no doubt that there was a high operational tempo".
Smith said the people-smuggling issue would be on the agenda when Yudhoyono and Gillard met for formal talks on Tuesday and said Canberra was already working closely with Indonesia on the issue.
"That general issue, given its importance, will be the subject of conversation between the prime minister and the president in the course of their meetings," he told reporters.
"But Australia works very closely with Indonesia to prevent people-smuggling operations. I think it's under-appreciated, the number of successful disruption events that occur through close cooperation."
Gillard wants to deter boatpeople by transferring them to Malaysia for processing, in exchange for accepting thousands of that nation's registered refugees for resettlement.
But her minority government has been unable to pass the required legislation through parliament because the left-leaning Greens and conservative opposition have refused to back it.
Conservative opposition leader Tony Abbott has pledged to "stop the boats" by turning back vessels where possible and otherwise processing asylum-seekers on the Pacific island nation of Nauru.
Yudhoyono's visit comes after the United States announced last November a plan to bring some 2,500 Marines to Darwin by 2016-17, a move which rankled some in Asia.
Indonesian Foreign Minister Marty Natalegawa has previously said the stationing of US Marines Down Under needed to be better explained to all countries in Asia to avoid "mistrust".
Abdul Razak Baginda, Mongolian Mistress and Najib Razak
source : Yahoo News/AFP
A scandal linking Malaysia's leader, a young woman's murder and alleged kickbacks in a French submarine deal has resurfaced as a potential danger for the government as elections loom.
Even by the corruption-prone standards of Malaysia's long-ruling coalition, which since 2009 has been headed by Prime Minister Najib Razak, the Scorpene case is explosive.
It centres on allegations that French submarine maker DCNS paid commission of more than 114 million euros ($142 million) to a purported shell company linked to Abdul Razak Baginda, a former close associate of Najib.
Malaysia's opposition claims the payments were kickbacks to top officials involved in a $1.1 billion deal for Kuala Lumpur to buy two Scorpene-class attack submarines.
Abdul Razak's Mongolian mistress, who was said to have demanded a payoff for working as a language translator in the deal, was shot dead and her body blown up with plastic explosives near the capital in 2006.
But the extraordinary affair sank off the radar in 2008 when a Malaysian court cleared Abdul Razak of abetting the murder, sparking an outcry and opposition allegations of a huge cover-up.
Calls for further investigation were not pursued at the time.
Now, though, the affair is back in the headlines with a vengeance after French judges, acting on a complaint by opposition-leaning Malaysian rights group Suaram, launched a new probe in April.
Since then Malaysia's online media has been aflutter with talk of new "evidence" that Suaram and its lawyers say has been turned up by the judges.
They include an allegation that a classified Malaysian defence ministry report on the country's naval needs was sold to French defence giant Thales, which part-owns DCNS, possibly to help land the contract, according to Suaram's lawyer Joseph Breham.
Najib was defence minister in 2002 when the Scorpenes were ordered.
Malaysia's current defence minister, Ahmad Zahid Hamidi, told parliament on Tuesday that no confidential information was leaked or corruption involved in the submarine deal.
Breham has told AFP that as parties to the case, Suaram are allowed to view evidence in the ongoing investigation and quote from it, but not distribute hard copies. AFP is not able to verify the claims.
"We are quite overwhelmed at the developments in the case," said Suaram official Cynthia Gabriel. "If the French investigation had not opened, we would never have known about these things."
On Monday, news portal Asia Sentinel published 133 documents, which it said were obtained from the French inquiry and showed the deal "has resulted in a long tangle of blackmail, bribery, influence peddling, misuse of corporate assets and concealment, among other allegations".
AFP has no way of verifying the authenticity of the documents.
A DCNS spokesman said the company could not comment on the case, citing the ongoing judicial investigation.
The defence minister told parliament the deal was done through "direct negotiations in accordance with procurement procedures", without any commission being paid.
Najib himself has not commented publicly on Suaram's latest claims but has previously denied any link to the graft allegations, rejecting them in 2008 as a politically-motivated smear by the opposition.
Malaysian authorities have long refused calls for a wide-ranging inquiry.
Nurul Izzah Anwar, who is the daughter of opposition leader Anwar Ibrahim and who raised the issue in parliament, told AFP: "This concerns national security and is very serious.
"At the very least, Najib must explain to the electorate what happened."
The prime minister must call fresh elections by early next year, and will be seeking to reverse strong opposition gains in parliament at the last polls in 2008.
But he already faces corruption cases involving top officials, slowing economic growth, and questions over his pledges of change after police clashed with protesters at a rally for election reform attended by tens of thousands.
Suaram's allegations give the opposition a fresh weapon, said top Malaysian pollster Ibrahim Suffian.
"The case has new legs now. At minimum, it could embarrass Najib if it points to involvement by those close to him, and of course worse if we see direct involvement by Najib," he said.
Also looming is a late August court appeal by the two police officers convicted and sentenced to hang for the murder of Abdul Razak's mistress, Altantuya Shaariibuu.
Both of them are former police bodyguards of Najib and one, Sirul Azhar Umar, has previously said he was a scapegoat for higher-level culprits.
The French inquiry is likely to take years, and focus more on French politicians and business people than Malaysian officials.
But Breham told AFP that other new evidence seen by the plaintiffs points to a previously unknown company in Hong Kong called Terasasi receiving 36 million euros ($45 million) from Thales.
Records indicate Abdul Razak was listed as heading the company, said Breham, citing information he said was provided by the judges.
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