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Given that as many as 30 beneficiaries were
already infected at the time – and four already hospitalized – it is
only logical that many of them had been affected much earlier. This
very fact raises many questions about accountability.
First, how come that the news about the poisoning
came so late and has someone, and who, failed to take necessary
steps in due time that could have saved human lives?
There is a reason to assume that the staff wanted
the sweep the whole affair under the carpet – primarily medical
officers of the home and its owner, certain Pero Marić. His
statement about beneficiaries’ poisoning probably being caused by
Easter eggs their relatives had brought in was a lame attempt at
veiling the truth and blaming someone from the outside but was also
interesting for another reason. Namely, apart from the fact that it
was quite impossible that all the infected consumed the same
salmonella poisoned eggs (including members of the staff and
families) his very statement reveals that the infection had been
detected at least two or three days earlier considering that this
year Easter was celebrated on April 12.
If that assumption is correct, then who was behind
such scandalous, to put it mildly, attitude towards the health of
elderly and helpless beneficiaries? Offhanded treatment of diarrhea,
vomiting, high temperature and other more than evident symptoms of a
serious disease is not only malpractice but a serious crime against
people’s health. No doubt that all persons on the staff – and they
are few - must have noticed the symptoms. And it goes without saying
that the owner, once informed about it, should have immediately
reported to the Čačak Institute of Public Health. Investigation into
the case will show whether he did it or not. A thorough
investigation, if properly conducted, will clearly reveal the level
of responsibility of all those involved in this gross malpractice.
Another assumption – though less probable – is
that the Čačak Institute of Public Health failed to properly react
in the face of a deadly epidemic. The rules on announcing an
epidemic are strict so as to ensure that a disease does not spread
beyond control. To all appearances, the Institute reacted duly given
that four patients had already been hospitalized at the time, which
was a reason enough to announce an epidemic. The right question here
is – has the nursing home immediately, after first two successive
cases of poisoning, informed the Institute or it was the hospital
that did it and when? The question is not a rhetoric one at all –
and should also be investigated into.
And yet, latest developments raise other questions
too and cannot but cause anxiety. Judging by statements by actors
involved in the tragedy and medical reports, the intention to have
the case closed is more than evident; all those statements and
reports are meant to suggest that everyone did the right thing and
did it by the law – hence, there is no one to blame. Mayor of Čačak
Vojislav Ilić, for instance, said, “Most important of all is to
investigate whether all relevant services intervened and reacted by
the book.” In other words, six dead people should not be a problem
if everything was done “by the book.” Following its summary
inspection after the outburst of the epidemic the Inspectorate of
Social Care released that it was just authorized to see into the
legality of the work process and meeting of the standards of social
care protection. Biljana Zekavica of the Ministry of Labor,
Employment and Social Policy said that the nursing home had signed
an agreement with the Čačak Institute of Public Health providing the
latter’s regular control of the food served to beneficiaries.
On the other hand, Director of the Čačak Institute
Ana Mišović claims that under a new law on food safety they are not
obliged to supervise sanitary conditions for food preparation in the
facility. According to her, the Institute’s control of this aspect
is limited and excludes the test for salmonella.
Svetlana Tadić, the head of the district sanitary
control department, confirms that the said law authorizes not the
sanitary inspection to control the food prepared and served in the
nursing home.
Zoran Ševarlić of the health inspection department
in Užice said that in January the owner filed a request for deciding
on the conditions for provision of medical services by general
practitioners in the nursing home, and the inspection gave him a
green light. The health inspection, he added, was not concerned with
other aspects as it was not authorized to and, besides, saw “no
reason whatsoever.”
And so the chapter was closed. Salubrious food in
a social care home catering the elderly – whose age in itself
exposes them to health risk – is nobody’s duty.
In several of its annual reports the Helsinki
Committee has alerted of broken communication between various
ministries and of the threat of non-existent or bad legislation on
healthcare of persons accommodated in institutions under the
jurisdiction of ministries of social policy and justice.
Unfortunately, the “dead phones” are still there. This time, six
dead people paid the cost.
Minister of Labor and Social Issues Aleksandar
Vulin agrees that the legislation on inspections is inappropriate
considering that the latter are not obliged to exchange information
about malpractice. He also says that his Ministry has developed
rules on state-run nursing homes providing that these facilities
shall inform the Ministry about any incident. “And now we have
included privately-run nursing home in the rules,” he adds. He did
not explain what took him so long to initiate the amendment of the
law.
Not being informed about the basics of the social
care system and its specificities – which are many and complex
indeed – cannot be an excuse for Minister Vulin. As a politician
appointed the Minister the least he should have done was to consult
those who knew more and had more expertise than he had. Had he done
it, it would occur to him that his Ministry was issuing licenses but
not controlling whether those obtaining them (be they state-run or
private) meet the standards for taking care of people. Besides, all
inspections need not be under the jurisdiction of a single ministry,
as Minister Vulin suggests with the wisdom in hindsight, but the
Ministry of Social Policy is duty-bound to make sure that
inspections are regular. The problem is that officials of the
Ministry itself rarely set themselves for inspections – and have
never set foot in this particular nursing home.
Though competent for social care legislation
Minister Vulin cannot explain how come that his Ministry is not
being informed about opening of a variety of privately-run homes for
the elderly that are mushrooming all over Serbia. In 2014 only
several such facilities were closed down once someone “clued in” the
Ministry about irregularities or that these facilities were
unlicensed. Had he been more concerned with social care than
politics Vulin would have initiated, say, that any legal person
intent to cater to social care beneficiaries should be licensed by
the Ministry in the first place – or at least that the Ministry
should be informed that this legal person was registered as service
provider in the Business Register Agency. As things stand now, the
Agency’s permit is good enough while the Ministry has not a
slightest idea about the very existence of all those enterprises;
and only gets into the picture once a tragedy, like that one in
Vranići happens. And yet, Vulin was aware of the existence of these
enterprises. For, on Friday, April 24, he said that his Ministry’s
goal was that all social care institutions were licensed by the end
of 2015.
Biljana Zekavica herself confirmed that the
Ministry was facing many problems when it came to licenses and
inspections alike. For instance, on January 24, 2014, it forbid
Petar Marić from Čačak to cater to adults and the elderly in “the
illegal nursing home” in Vranići. He obeyed. But as soon as April 14
his enterprise “Dvoje” obtained a five-year license as the Ministry
decided that “all standards for provision of services and
accommodation” had been met in the meantime. The Ministry argues
that “at the time the license was issued there were no doubts
whatsoever about the nursing home’s functioning and quality of
services provided to beneficiaries.” But is say nothing about how
many times, if ever, it had inspected the institution. In other
words, since the nursing home was opened back in 2012, the Ministry
was unaware of its operations for almost two years and, probably,
never inspected it at all.
The information that on March 20 a fire protection
inspector ordered Marić to close down his facility on the account of
unsafe accommodation of bedridden persons leaked in the meantime.
But nobody informed the Ministry about it – an extra excuse for it
to dodge its responsibility.
“Neither the owner nor the inspector informed us
about it, although they are duty-bound to. Only for the failure to
meet the standards for fire protection in the facility we would have
withdrawn the license and closed down the nursing home,” said the
Ministry officials.
Having subsequently inspected the nursing home the
Ministry realized that it was understaffed and that some employees
were moonlighting. Asked how possibly an institution as such could
operate, Zekavica replied, “To take the easy way out, one can just
close down a facility. But on should above all have in mind
beneficiaries’ state of health.” Her words only confirm the doubts
that the Ministry is aware of the existence of some illegal
facilities at least but “turns a blind eye” to the fact being at
loss what to do with so many old and sick people no one would take
care of. Unfortunately, that’s yet another bitter truth. At the same
time it testifies that neither the Ministry of Social Care nor the
Ministry of Healthcare function as they should.
Unlike Minister Vulin, his colleague, Minister of
Healthcare Zlatibor Lončar at least visited the hospitalized
patients, probably aware that his Ministry was also to blame for all
the failures. Minister Vulin does not even see himself as someone
morally responsible and it has never occurred to him to offer his
resignation, what any decent person would expect him to do. This is
also why he is among the worst Ministers of Labor and Social Policy
Serbia has had ever.
Impunity of high-ranking officials is far from
being an excuse for blaming this case, like many others, on “laws;”
because relevant institutions and authorized individuals are those
who pass the laws and take care of their implementation. And there
should be no excuse whatsoever for the Prosecution not to act since
the government refuses to. An unresponsive and dehumanized society
such as Serbia’s is hardly expected to press the authorities and
appeal to their conscience. Otherwise the old and helpless would not
have been in such situation – abandoned and unprotected.
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