Bogotá's San Carlos Hospital suspends emergency services: its director explains the reasons for the temporary closure.

In a statement released to the public, San Carlos Hospital in Bogotá announced that its board of directors had decided to temporarily close its emergency department.

Carlos Ocampo, the hospital's director, explained to this newspaper that the service will be open until July 31 and will be closed indefinitely starting July 1.

He also explained the reasons for the closure, which, in his words, are multiple. He noted that reopening the service is not ruled out, although this will depend on how the current situation evolves.

Before going into those reasons, I would like to give a brief overview of San Carlos Hospital. San Carlos Hospital is a non-profit organization created 77 years ago as a legacy left to the Bogotá community by Mr. Gustavo Restrepo. In other words, this hospital is for the Bogotá community; it has no owners. It is a board of directors that manages this entire legacy left by Mr. Gustavo so that we can provide safe, timely, efficient, and humane care, and our responsibility is to keep it running.

Our emergency department is relatively small among the large hospitals in Bogotá. We have 300 beds, 40 of which are for intensive care and intermediate care, but the emergency department only has three consulting rooms and 30 observation beds. So what's happening? In recent months, we've seen an exponential increase in the number of patients admitted daily, far exceeding our available capacity. And when capacity exceeds supply, this can jeopardize the availability of care and patient safety.

And what else are we seeing? Of the total number of consultations we handle, from triage 1, 2, and 3, around 70% are being hospitalized. But that's not just the problem with this volume, which is much greater than we can offer, but it's also associated with another difficulty: as the emergency room entrance, you can't put up barriers. There are specialties that San Carlos Hospital doesn't offer. For example, I don't have specialist capacity in oncology, I don't have cardiovascular surgery, I don't have pediatrics, obstetrics, and gynecology, or mental health. And when these patients are admitted, by regulation and ethical standards, I have to start treating them. And my responsibility is to begin a referral and counter-referral process with the insurance companies, but the insurance companies can go several weeks without managing to get these patients admitted to an institution that does offer those services. So, that's making it difficult for us as well.

So, analyzing the surrounding area, here in the south, within a radius of 10 kilometers, we have more than seven hospitals, both public and private, that have emergency services. The analysis that has been conducted over the past few months led the Board to make a decision: listen, let's instead concentrate these scarce resources we're receiving—human, technical, and financial—on services that are more relevant to the community and that we can expand. For example, the outpatient service, and outside of outpatient settings, offering priority consultations to resolve some low-complexity pathologies that don't require emergencies but that provide prompt care for users. Set up private consultations, but at a very low cost so they're affordable for the local population. Optimize the referral and counter-referral processes, such as rotation, transfer, and bed availability, which we're implementing.

And all of this, in light of this decision, as a responsible institution, is why we have been informing the Ministry of Health, with the Secretary and Undersecretary a few days ago, telling them about the difficulties we are facing and why we must make this decision, which has multiple causes. As you have said, it is a security issue, a problem of opportunity, a problem, in short, of a social responsibility that we have to have with this hospital, to keep it open, because it belongs to the population, as I said, it was the legacy that Don Gustavo Restrepo left us. It is for the patients of all the EPSs that are coming to us, so we have spoken with Nueva EPS, which has the largest volume, with Famisanar, with Compensar, with Salud Total, with Sanitas, with everyone to say: listen, let's all design some plans to mitigate this impact that the population could have, and what we hope is that we can reopen it soon when we manage to resolve all these difficulties that are occurring.

We will guarantee care for patients who are there at the time of closure. We will not neglect our patients because it is our responsibility and our institutional commitment to provide excellent quality care.

No, I'm saying it's multi-causal. There's a crisis that's been going on for years and has been growing, and in recent years it's become more noticeable, but this is also leading to some patients not getting priority consultations or not receiving their medications. So we're getting patients with severely decompensated chronic conditions, and since they're not being treated, the only way in is the emergency department. We're filling up with these consultations, with these needs, with decompensated chronic patients who require hospitalization, and the biggest problem is that I no longer have the capacity. We've set up contingency plans and expanded the emergency department, but I've reached the limit: I can't move the walls, nor do I have the means to double the number of doctors and nurses, therapists, physical therapists, respiratory therapists, and physiotherapists to handle these volumes, which the institution lacks the capacity for.

We're seeing patients with cardiovascular pathology requiring catheterization or cardiovascular surgery. As I said, we've had patients here for several weeks waiting for someone to receive them and be treated in the appropriate departments. We've had patients with metabolic pathologies like diabetes; respiratory pathologies like COPD; patients with pneumonia, plus all the acute trauma, orthopedic, and appendicitis cases. Our surgeons here have made a commitment to have patients arrive, and we can operate on appendicitis in less than six hours. But I don't have any more rooms, I don't have any more surgeons to say: if 10 patients arrive at once, where am I going to operate on them and with what resources? I don't have that capacity right now, and that's why, in a very responsible manner, the Board, together with its administrative staff and medical team, have conducted multiple analyses to determine what we should do and how we can keep the hospital operating safely, with dignity, humanity, and in a timely manner.

For example, this week we set up a new process with Salud Total and Compensar that we've never had here, which is priority referral. What does this mean? We've chosen certain pathologies that require urgent care. For example, if a primary health care provider or a low-complexity emergency room—of which there are many here in the area—suspects a patient with appendicitis, they send them to me through referral and counter-referral. They don't come through the emergency room, but the way they send them to me, I count how many I can receive, how many I can receive with biliary pathology, how many with COPD or asthma, or with urinary tract infections, or fractures. So what we do is: listen, my capacity is to receive 20 patients from Salud Total for you, 20 patients from Compensar for you. That's the capacity I have available and offered, and I can safely provide that care. But don't send me 50, send me these 20. And we'll send them quickly.

One of the difficulties we sometimes face, Camilo, is that in our referral and counter-referral office, we can receive 300 to 600 emails requesting that we hospitalize, that we receive a patient. And each email is 20 or 30 pages long, reading which patients I have available for service, which specialties, so it takes me six hours to be able to say: I'm accepting this patient. And a patient with appendicitis who was diagnosed elsewhere, arrives six hours later when I say: yes, send him.

So, to avoid that and improve the quality and safety of care among patients being treated at our IPS, and we, the insurer says: man, I like this contingency plan you're putting together.

The other thing I was telling you is that we've already decided—it's coming out this week—what we're going to charge for a specialist consultation here at San Carlos. We're around 65,000 to 75,000 pesos per specialist consultation, whereas elsewhere you can find 250,000, 300,000, or 400,000 pesos. We're going to set a rate that the surrounding population can afford and get their problems resolved quickly.

Improving supply rotation processes with insurers, saying: "Give me a minimum stock of this so I can quickly resolve these patients' needs and not wait for authorizations." We need to seek efficiency in administrative and care processes to improve even further.

Last year, if my mind is correct, there were 1,300 patients per month. Last month we treated 2,500. What is this? Don't see it as a snapshot. See it as a dynamic process that increases month after month. This didn't increase overnight. No, this is what we're observing with the monthly analysis by the medical directorate, with its healthcare leaders. Look, today we're treating more. Today we need this more. Today we need these more supplies. Today we need more resources to be able to continue supplying us with this increase in hospital supplies. So, each month, I could say, it's increasing by approximately 10 to 20%.

As I told you, it's based on the actual capacity I have available and the capacity I can safely care for and receive these patients. But additionally, what's new is that we have the possibility of expanding by five ICU beds right now. So, we can accommodate five, not 10. We'll share the figures now. More or less, between August 15 and 20, we'll have these five additional beds.

Listen, we can increase capacity by 15% in the number of surgeries we can perform monthly. Listen, let's see how we can open 33 beds we have in the inpatient ward, which has been closed for a couple of years, but let's see how we can finance the opening and provide a greater increase in the number of patients.

Listen, what specialties do I have in outpatient care? Last night I spoke with two specialists who told us: "Doctor, we want to make a proposal to San Carlos Hospital. We support your proposal and will send you our resume so we can hire you." So, in this way, we're expanding our approach to addressing the healthcare needs of the population attending San Carlos Hospital, and to the various insurance companies with which we have agreements.

Yes, sir, the Board has decided that it's a temporary closure and requires us to begin making various analyses and proposals. During these pre-closure discussions, we had already spoken with several insurance companies, and some of them told us: "Listen, we're interested in working together to see what we can do with the emergency services." The Secretary of Health told us: "Listen, we don't like the closure of emergency services. We understand the situation, but we have to work responsibly, and we're going to have to sit down, Mr. San Carlos Hospital and the insurance companies, around a working table to see what we're going to do in the medium, short, and long term."

But as you rightly say, it's a closure that we hope will be temporary and that will make us think differently about the health system, not just emergencies, but also hospitals and general services, to see how we resolve it.

Camilo Peña Castaneda - Editor of Today's Life