Heart Ultrasound Wait Exceeds One Year

Patients at the Zenica Cantonal Hospital wait more than a year for a heart ultrasound. Due to a disorganised appointment system where they do not know when they will receive a term, they go to private clinics or seek connections for a faster examination at the Hospital, reports the Bosnian news agency Patria.

Sixty-three-year-old Ekrem Ramić from Visoko is one of 750 patients waiting for a heart ultrasound at the Zenica Cantonal Hospital (KBZ). He received a referral eight months ago but still has no information on when he will get an appointment. He has high blood pressure and difficulty breathing.

Although the Hospital claims that the wait for this service is up to eight months and that patients are informed of their appointment by phone or in person, research by the Center for Investigative Journalism (CIN) shows that this is not the case in practice. The wait for an ultrasound can exceed one year, and some patients are never called. The Hospital does not comply with the legal requirement and does not send written notification to patients about their position on the waiting list. However, no one monitors the implementation of the law.

In this disorganised situation, patients seek help in private clinics or through acquaintances at the Hospital to reduce waiting times.

One machine and 750 patients

Heart and blood vessel diseases are the most common cause of death among residents of the Zenica-Doboj Canton (ZDK). According to data from the Cantonal Institute of Public Health, 1,740 people died from these diseases in 2014, which is more than half of all deaths. Among these diseases, heart failure and acute heart attack are the most common.

Ultrasound examination is one of the most reliable methods for detecting heart and blood vessel diseases.

Cardiologist Adnan Delić from the Cardiology Centre "Sarajevo" says that waiting for a heart ultrasound can complicate the treatment process: - Some patients may have very serious, even fatal consequences because a serious problem that will greatly affect their condition was not diagnosed in time.

Patients from the ZDK area can have an ultrasound at the General Hospital in Tešanj and the Zenica Cantonal Hospital, where the largest number of patients are referred. If they have health insurance and are exempt from co-payment, such as pensioners, social welfare recipients, or children, they will not pay for this service. Other health insurance holders will pay a co-payment of 25 KM.

However, they will wait a long time for the examination because the Zenica hospital has only one ultrasound machine, which is 18 years old, almost double the average lifespan of such a machine. Deputy Director for Medical Affairs at KBZ, Harun Hodžić, says that 20 to 30 ultrasound examinations are performed daily. Priority is given to patients with heart attacks and those hospitalised, after which scheduled patients are seen.

The problem becomes greater if the machine breaks down, as happened last year when it was out of service for five months. By the end of that year, the number of people on the waiting list for a heart ultrasound reached 750.

According to the Law on the Rights, Obligations and Responsibilities of Patients of the Federation of Bosnia and Herzegovina (FBiH), hospitals are obliged to send patients notification of their position on the waiting list. Healthcare institutions that do not inform patients can be fined 10,000 to 15,000 KM under the law. However, in ZDK, there are no inspectors to monitor the implementation of this legal obligation. In this case, the Federal Administration for Inspection Affairs is responsible, but they say they have only two inspectors and cannot control everything.

From the Zenica Cantonal Hospital, they state that patients wait up to eight months for an ultrasound and receive information by phone or on-site. However, five patients, including Muharema Mahmutović from Zenica, told CIN journalists that this is not the case. Mahmutović says she came to the Internal Department of KB in December when her ECG revealed a "right bundle branch block." They sent her home without a scheduled appointment for an ultrasound. They said it was not an emergency and that they would call her. She has been waiting for a call for three months.

Hodžić says that the wait for this service is due to having only one machine for all patients. The hospital has procured another machine, but it has not yet started operating.

Ultrasound at the health centre

Residents of the municipalities of Tešanj, Doboj Jug, Olovo, Maglaj, Visoko, and Zavidovići can have a heart ultrasound at local health centres. However, they will pay between 30 and 80 KM for this service. Health centres can charge patients for services for which they do not receive funding from the health insurance fund. Heart ultrasound is not an examination typically performed at health centres. The director of the Health Centre "Visoko," Senad Karavdić, says they introduced this service due to patient demands and the long waiting list at the Zenica hospital.

- Waiting for an examination for half a year or a year is beyond any reason in medicine - says Karavdić, adding that a reasonable period would be up to a month.

He says they do not suggest to patients that they have the examination done there.

- A referral is written for the Zenica hospital, and we leave the choice to the patient - says Karavdić.

Bedra Vehabović had a heart ultrasound in Visoko because she was told in Zenica that she would wait more than a year. Due to chest pain and high blood pressure, she did not dare to wait.

- I paid 50 marks, even though I am, let's say, a social case - she says, adding that she is unemployed and lives with her brother on his pension.

A healthcare institution must be verified to provide services it offers freely on the market, state from the Ministry of Health of FBiH. In ZDK, no health centre is verified for heart ultrasound examinations, says Hajrudin Hedžić, secretary of the Cantonal Ministry of Health. He adds that the health inspection is obliged to control this.

Nijaz Uzunović, the chief federal health inspector, says they could conduct an inspection, but they have never done so before. Based on CIN's inquiry, Uzunović ordered inspectors to carry out a control.

Private connections or private clinics

Patients who do not know how long they will wait for an ultrasound or whether they will get an appointment at all have the option to go to private clinics. In five private clinics in ZDK contacted by CIN journalists, the price of a heart ultrasound is 50 KM. Asim Šabanović from Visoko also paid this price at the private clinic "Intermed" in Kakanj. He says he was told at the Zenica hospital that he would wait between one and one and a half years.

- That's a disgrace - it's the heart, not some trivial matter - says Šabanović.

Zijad Šut from Zenica has had two heart attacks and two heart surgeries. He says he has waited a long time for all the examinations he has had over the past 13 years of treatment, but he has not yet paid for an examination at a private clinic.

- If something is really urgent, then I call around, look for someone who can get it done a bit faster, so I don't have to wait so long. (...) That's how it works - he says.

Assistant Director Hodžić says that private connections have always existed and will continue to exist.

- None of us is immune to these private connections - he says.

Written by: Center for Investigative Journalism