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Cablegate: Citizens' Power Councils Meddling in Health Care

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P 082303Z JUL 08
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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
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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
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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
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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
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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

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