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Cablegate: Health Minister Under Fire, but Not (yet) Out

VZCZCXYZ0000
RR RUEHWEB

DE RUEHZP #2272/01 3281557
ZNR UUUUU ZZH
R 241557Z NOV 06
FM AMEMBASSY PANAMA
TO RUEHC/SECSTATE WASHDC 9390
INFO RUEAIIA/CIA WASHDC
RUEAUSA/DEPT OF HHS WASHDC
RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RUEHBO/AMEMBASSY BOGOTA 2464
RUEHMD/AMEMBASSY MADRID 0297
RUEHBJ/AMEMBASSY BEIJING 0153

UNCLAS PANAMA 002272

SIPDIS

SIPDIS

STATE FOR WHA/CEN - TELLO
STATE ALSO FOR OES/IHA - SINGER AND DALEY
HHS FOR OGHA - STEIGER, ABDOO, AND CORREA

E.O. 12958: N/A
TAGS: TBIO PGOV KSCA CDC PM
SUBJECT: HEALTH MINISTER UNDER FIRE, BUT NOT (YET) OUT

REF: PANAMA 2015 AND PREVIOUS

THIS MESSAGE IS SENSITIVE BUT UNCLASSIFIED. PLEASE HANDLE
ACCORDINGLY.

1. (SBU) Summary. The deaths of some 44 Panamanians from poisoned
medications produced and distributed by the GOP's Social Security
Fund (CSS) have prompted growing calls for the ouster of Minister of
Health Camilo Alleyne and CSS Director Rene Luciani. Although
several CSS employees and executives of the tainted substance's
local supplier have been arrested on criminal charges, Alleyne and
Luciani steadfastly deny any culpability in this tragedy that has
thus far affected at least 89 victims. The GOP's announced health
reforms, including closure of the CSS laboratory, have done little
to restore public confidence or to stem the pressure on President
Torrijos to fire Alleyne and Luciani. This, together with the lack
of GOP heads rolling over a tragic October 23 bus fire that killed
18 people, has prompted some to suggest that the Torrijos
Administration suffers its own type of "renal deficiency." End
summary.

Tainted CSS Medicines Kill 44, Another 45 Remain Ill
--------------------------------------------- -------

2. (U) As of Nov. 24, some 44 Panamanians have died from "Acute
Renal Deficiency Syndrome" ("SIRA"), i.e., kidney failure, caused by
the ingestion of CSS-produced medicines contaminated by diethylene
glycol (reftel). Another 20 victims remain hospitalized and 25 more
are recovering at home. Thanks to strong support from experts with
the U.S. Centers from Disease Control (CDC) and the U.S. Food and
Drug Administration (FDA), health authorities identified diethylene
glycol as the source of SIRA within about eleven days after being
alerted to a pattern of mysterious deaths at several public
hospitals in Panama City. The Ministry of Health (MINSA) and CSS
immediately pulled suspect medicines from government clinics and
pharmacies and mounted a broad PR campaign to recover potentially
contaminated medicines. As a result, no new cases have been
reported since late October. (The additional cases identified since
that time actually developed earlier, but were determined as SIRA
cases retroactively.)

3. (SBU) Visiting CDC experts and senior Gorgas Memorial Institute
(GMI) officials have told Econ Chief that, from a technical
standpoint, Alleyne has handled this episode in textbook fashion.
They credit him with mobilizing MINSA, GMI, and CSS immediately
after hearing on October 1 about several deaths from a "mystery
illness." He secured outside help from the CDC within 24 hours and
alerted the public to the problem at a time when the temptation to
suppress the matter would have been great (i.e., about three weeks
prior to a critical national referendum on the proposed $5.25
billion expansion of the Panama Canal). Throughout much of October,
Alleyne and Luciani held frequent press conferences to report on the
progress of joint GOP-CDC-Panamerican Health Organization (PAHO)
efforts to investigate and control the situation.

Local Supplier and CSS Workers Arrested
---------------------------------------

4. (U) By mid-October, health authorities determined that the CSS
lab had produced the tainted medicines using diethylene glycol
purchased in 2003 from "Grupo Comercial Medicom S.A.," a hitherto
obscure Panamanian firm created in 2000 that reportedly did business
only with MINSA and CSS. Panama's Attorney General has opened a
criminal investigation and police initially arrested three of
Medicom's corporate officers for questioning. Medicom's President
(at least on paper), Angel De la Cruz, eluded capture until November
17. Many Panamanians believe that the four were simply listed as
officers in Medicom's corporate papers and that they are simply
"fall guys" for more powerful players.

5. (U) Medicom has blamed its Spanish supplier, Rasfer
International, from which the firm claims to have ordered pure
glycerine in late 2003. Medicom's lawyers plan to sue Rasfer for
fraud, alleging that the Spanish firm shipped diethylene glycol
mislabled as 99.5% pure glycerine (propylene glycol, commonly used
in the mixing of medicines). Rasfer executives, in turn, deny any
wrongdoing, claiming that they obtained the product from a Chinese
firm (CNSC) that had certified the contents as pure glycerine.

6. (U) On November 14, law enforcement officials arrested four CSS
employees on criminal negligence charges, including the CSS
laboratory's chief. Each of them has denied culpability, pointing
fingers at each other or at higher-ups. Other ex-CSS employees
claim to have alerted current and former CSS directors to problems
with the laboratory's physical condition and management
deficiencies, to no avail.

Public Jeers GOP's Health Reforms, Want Heads to Roll
--------------------------------------------- --------

7. (U) With Panamanians' confidence in the public healthcare system
shattered by this episode, President Torrijos announced several
reforms on November 13 aimed at recovering public confidence. These
steps include permanent closure of the CSS laboratory, establishing
a fund to compensate SIRA victims, and various measures to cut
bureaucratic red tape to help make CSS facilities more accessible
and responsive to patients. Panamanians roundly criticized the
announced measures as cosmetic changes that are "too little, too
late" and continued to call for the ousters of Alleyne and Luciani.

8. (SBU) We have heard from a realiable source that President
Torrijos adamantly refuses to fire Alleyne. He said that Torrijos
told the source that it would be "unfair" to fire Alleyne, who
Torrijos maintained was "not part of the problem, but will be part
of the solution." This, despite polls suggesting that some 70% of
Panamanians believe that Alleyne and Luciani should step down or be
removed. Alleyne has consistently denied any blame, although on
November 21 he left open the possibility of departing on his own
terms and "with dignity" once investigators completed their inquiry
into the episode and the GOP's health reforms were on track.

Comment: GOP's Own "Renal Deficiency?"
--------------------------------------

9. (SBU) Combined with a tragic October 23 bus fire that killed 18
Panamanians, the deaths of 62 people due to alleged GOP negligence
has sparked outrage among average Panamanians. (Proportionately,
this would be equal to 6,200 deaths in the U.S.) These cases have
crystallized the public's sense that the government consistently
protects well-connected elites, even if it costs lives. It has also
ripped open the reality that Panama has two healthcare systems: a
decent one for the relatively few well-off elites and a fatal one
for the most low and middle-income Panamanians.

10. (SBU) Despite handling the episode professionally and, by most
accounts, responsibly, Alleyne has become the lightning rod for the
public's ire. Torrijos has also been heavily criticized for his
"stubborn" refusal to boot Alleyne and Luciani, as well as his
re-assignment (rather than firing) of the GOP's transportation chief
who was widely blamed for weak oversight of oft-reviled bus
operators. As one foreign observer told Econ Chief on November 16,
"The Torrijos Administration has lost the ability to eliminate its
own waste." Although Alleyne may well be unable to ultimately
withstand the steady barrage of criticism and editorial lampoons, it
is unclear who his successor would be. One prominent public health
official (and possible successor) told Econ Chief that, in light of
Alleyne's experience, anyone who wants the MINSA job "ought to have
his head examined."

EATON

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