CITIZENS' POWER COUNCILS MEDDLING IN HEALTH CARE

C O N F I D E N T I A L SECTION 01 OF 03 MANAGUA 000866 SIPDIS DEPT PLS PASS TO USAID LAC DEPT FOR WHA/CEN GREENE AND NYMAN DEPT FOR DRL G. MAGGIO DEPT FOR INR/IAA - EMERSON DEPT FOR USOAS NSC FOR V ALVARADO SOUTHCOM FOR FPA E.O. 12958: DECL: 07/07/2018 TAGS: PGOV PHUM ECON KDEM NU SUBJECT: CITIZENS' POWER COUNCILS MEDDLING IN HEALTH CARE Classified By: Ambassador Paul Trivelli for Reasons 1.4(b,d) ¶1. (C) SUMMARY: Representatives from health care unions reported that Citizens' Power Council (CPC) members have been installed in all 102 of Leon's public health centers. Although not healthcare professionals, these CPC stalwarts are making healthcare-related decisions. Over 40 qualified healthcare professionals have been fired, and many more "blacklisted," as the result of weekly reports these CPC members are submitting to a departmental committee led by the Sandinista National Liberation Front's (FSLN) political secretary in Leon. The CPC members are reportedly ordering doctors to write prescriptions for medicines often unavailable from public health centers to maintain the facade of free medical care, despite the risks to patients' health. Union representatives report that the installation of the CPCs in the health sector is now a nationwide phenomenon. END SUMMARY. Intimidation Whittles Ranks of Non-Sandinista Unions - - - - - - - - - - - - - - - - - - - - - - - - - - ¶2. On July 3 Mario Reyes, president of the Federation of Doctors and Dentists in the department of Leon, reported to Emboff that almost half of his union's 300-plus affiliates have bolted to join Fetsalud, the Sandinista-linked healthcare confederation controlled by FSLN National Assembly Deputy Gustavo Porras. Reyes complained that Fetsalud is coercing and threatening members of his federation; those who refuse to re-affiliate themselves with Porras' union are fired or transferred to other institutions and/or other parts of the country. He alleged, in addition, that those who resist are also blacklisted and are subsequently unable to work at any public health institution in the department. Other healthcare unions reported similar attrition to their membership ranks as a result of similar tactics. ¶3. (C) Beyond intimidation of union affiliates, at least 17 leaders from the various non-Sandinista unions have been summarily fired without justification from their public health sector jobs. Despite Ministry of Labor orders to re-instate these fired labor leaders -- who should receive special protection under Nicaraguan labor law -- Health Ministry entities have simply refused to comply. The Ministry of Labor has taken no further steps to rectify the situation. In addition to the labor leaders, Reyes and the others estimate that at least 40 other Leon healthcare professionals have been fired without cause, some with over 20 years of experience. To be re-instated, fired workers are forced to join Fetsalud and present a testimony or guarantee from a local CPC member. ¶4. (C) In several of the larger health centers, including the public hospital in Leon, the largest public hospital in the country, Reyes reported that union leaders have been kicked out of their on-premise offices and the offices turned-over to the CPC representative. CPCs Cover 100 Percent of Health Centers - - - - - - - - - - - - - - - - - - - - - ¶5. (C) Reyes, Juan Jose Altamirano, General Secretary of healthcare union FETRA, Jose Ines Lopez, General Secretary of the Federation of Independent Healthcare Workers of Leon, and Nuncio Antonio Silva, Labor Secretary for the Health Workers Syndicate in the Ministry of Health, Leon, all confirmed that CPC representatives have been installed in all 102 of Leon's public health facilities. (NOTE: In a subsequent conversation, Marcos Carmona, Executive Director of the Nicaraguan Permanent Commission for Human Rights, confirmed the installation of CPC representatives in public healthcare centers is taking place throughout the country. END NOTE) Although these representatives hold a variety of job titles, their primary marching orders are reportedly the same: oversee the operations of the facility, give preferential treatment to FSLN supporters, and report back to a CPC-directed departmental council on the health units' activities and the performance and attitudes of the staff. ¶6. (C) All four cited multiple instances in which CPC appointees have directly interfered in patient diagnosis and treatment recommendations, closely surveyed doctors doing their rounds, and actively intervened to win preferential treatment for known Sandinista supporters. Reyes recounted one particularly blatant incident in the Leon hospital in which a local CPC delegate tried to put a Sandinista supporter at the head of a two-year waitlist to receive treatment from the American-Nicaraguan Orthodontic Cooperative (COAN). Upon being refused, the local CPC delegate complained to the CPC representative installed at the hospital who, in turn, lobbied for the patient. The doctors again refused to budge. Following the second refusal, according to Reyes, the hospital CPC representative denounced the COAN doctor, accusing him of soliciting a USD 1,500 bribe from the would-be patient. Reyes concluded by noting that the situation had become so bad that senior FSLN official Lenin Cerna had to directly intercede and the CPC representative was transferred to a less-visible position. Firings and Black-listings by CPC-Controlled Committee - - - - - - - - - - - - - - - - - - - - - - - - - - - - ¶7. (C) According to Reyes, Altamirano, Ines, and Silvia, the FSLN political secretary for Leon, who also heads the department-level CPC, chairs a weekly meeting -- in which the local Ministry of Labor representative reportedly participates -- to evaluate reports sent in by the CPC representatives from each public health facility. Reyes and the others are convinced that this committee fires and blacklists doctors and healthcare workers based on these weekly field reports. Most fired workers have been unable to secure work in the healthcare profession anywhere in the department of Leon. Medical Residencies -- It's Not What You Know - - - - - - - - - - - - - - - - - - - - - - - ¶8. (C) In addition to establishing a strong direct presence in the department's health centers, the CPCs are also reportedly exerting pressure and influence within the University of Leon's medical residency program. Previously, stated Reyes, students had to pass a battery of exams to be accepted to the residency program for specialized medicine. However, according to Reyes and confirmed by the others, these exams have been scrapped, with students now needing only a political voucher or guarantee to gain a slot. Maintaining the Facade of Free Medicine - - - - - - - - - - - - - - - - - - - - ¶9. (C) Altamirano, Reyes, and Lopez categorized the government's campaign of free healthcare and medicine as a "lie," and insisted that the CPC representatives are pressuring doctors to write prescriptions only for the medicines included on the basic healthcare list -- no exceptions -- even if another drug might be more effective or the hospital does not have the medicines in stock and the patients would have to wait days or weeks. Altamirano recalled an event last April in which the CPC representative, in front of an assembled group of doctors, declared that a certain condition related to women's health could only be treated with the drug provided for in the basic list of medicines. When one doctor pointed out that the hospital didn't have the drug, the CPC representative reportedly responded, "That's okay. Make them come back tomorrow or until we have the medicine. We must maintain the image of free medicine." Doctors/Patients Fed-up - - - - - - - - - - - - ¶10. (C) At the Leon hospital and other centers, patients and doctors are apparently tiring of the heavy-handedness of the CPC representatives. At the Leon hospital, doctors and other healthcare personnel adopted a policy of immediately leaving the room every time the CPC representative (eventually deposed by Cerna) entered the room. In one particular instance, Reyes quipped, the patients, realizing what was going on, got so angry that they reportedly chased the CPC representative from the room. While this was, Reyes admitted, an isolated incident, all the unions, leaders were clear that patients are growing increasingly frustrated by the CPC-imposed changes. Comment - - - - ¶11. (C) While our discussion focused on the situation unfolding in Leon, the union representatives insisted that their colleagues are reporting the same phenomenon all over the country. Healthcare workers not affiliated with Sandinista unions -- specifically Porras' Fetsalud -- are being pressured, threatened, transferred, and fired. Those fired find it impossible to secure further employment in the healthcare sector. CPC representatives are forcibly imposed on hospitals and health clinics and those who protest are reported, fired, and blacklisted. CPDH's Carmona assured us that he has heard similar stories and that the problem is widespread. We will continue to track the issue, contacting healthcare unions throughout the country to assess the scope of the problem. TRIVELLI