El fallecimiento del paciente Sedy Vera, de 63 años, el pasado 25 de septiembre en el Servicio de Urgencias del Hospital Universitario San Ignacio, tras negársele atención prioritaria en la Clínica Marly y en la Clínica Colsubsidio en Bogotá, reabre el debate sobre las múltiples fallas en la prestación de servicios de urgencias en salud en Colombia y evidencia los problemas del sistema para cumplir adecuadamente con los protocolos.
Dice la Superintendencia nacional de Salud-SuperSalud que las clínicas y el hospital serán investigados de acuerdo a lo que dicta la supervisión basada en riesgo en salud. En informe que se titula «Comportamiento y análisis de las peticiones, quejas y reclamos-PQR- presentados por los usuarios del sistema de salud colombiano de carácter prioritario, entre enero y septiembre de 2014», se encuentran como elementos prioritarios en la atención de urgencias la longevidad, la discapacidad, las enfermedades catastróficas y/o de alto costo, las coberturas, entre otros.
El Grupo de Soluciones Inmediatas en Salud de esta entidad ya había llamado la atención sobre este punto, al revelar que se encontró un crecimiento aritmético, en los PQRS, para un total de 8.545 casos reportados en el 2014. El macromotivo que generó más quejas fue La restricción en el acceso de los servicios de salud, con un 93%.
Agrega el informe que, según el tipo de entidad vigilada, los PQR están concentrados en el régimen contributivo, con un total de 6.964 reportes en el 2014.
Paradógicamente son estas entidades las que en el primer informe presentado por SuperSalud de los resultados financieros del Sector alcanzaron utilidades por 1.4 billones de pesos para el 2014, incluyendo a los actores del Sistema General de Seguridad Social en Salud y a las aseguradoras que participan en el sector (riesgos laborales, SOAT, pólizas de salud) y demás entidades que ofrecen planes voluntarios de salud.
La Secretaría de Salud de Bogotá recordó a los usuarios en su portal que «Ninguna persona debe dejar de ser atendida con oportunidad y calidad en los servicios de urgencias, sin importar su estado o tipo de afiliación al Sistema de Seguridad Social en Salud, o si existe o no relación contractual entre el asegurador y el prestador, según lo establece la Ley Estatutaria en su artículo 14.»
No están claras las razones por las cuales la familia del señor Vera no acudió inicialmente a la Red de Urgencias de Famisanar, EPS a la que estaba adscrito, según la Revista Semana. La cercanía a otros centros asistenciales y la información emanada del Ministerio de Salud que le expresa a todos los colombianos de la obligación que tiene todo prestador de servicios de salud de atender una urgencia sin barreras de ninguna índole les llevó inicialmente a las clínicas antes mencionadas.
Y allí el protocolo no se cumplió. Por esto, no hay credibilidad entre los colombianos sobre lo que reglamentan las leyes y lo que realmente implementan los prestadores de servicios de salud.
Julio César Castellanos, director del Hospital San Ignacio argumentó exceso de pacientes en el Servicio de Urgencias del centro asistencial, pero aclaró que se siguieron los protocolos del caso-triage- o valoración inicial del paciente para conocer el estado de sus signos vitales y grado de complejidad de la urgencia: El triage del señor Vera arrojó resultados de estabilidad en sus signos vitales.
Hoy días existen muchas guías científicas para la atención en un servicio de urgencias del dolor abdominal agudo. El mismo Ministerio de Salud en sus Guías para Manejos de Urgencias especifica que «En la evaluación de un paciente con dolor abdominal debe seguirse un método diagnóstico que incluya un interrogatorio preciso dirigido a establecer su forma de aparición, progresión, irradiación, migración, localización y las condiciones que lo alivian o exacerban; en segundo término, debe determinarse la presencia de síntomas asociados, su secuencia de aparición y relación con el dolor, especialmente aquellos pertinentes al tracto gastrointestinal y genitourinario. El examen físico detallado incluye evaluación del estado general, registro de los signos vitales, inspección, auscultación, percusión y palpación abdominal, búsqueda de signos específicos, y finalmente el examen genital y rectal.
El protocolo falló. En cinco minutos es imposible realizar todos los procesos anteriores.
Fallaron todos los protocolos que una sociedad digna implementa para los servicios en salud de sus ciudadanos: Los que no lo atendieron olvidando los alcances del nuevo Estatuto de la Salud, los que atendieron al señor Vera pero con negligencia, el gobierno por su poca efectividad y sanciones que se traducen en la impunidad ante casos tan graves como Saludcoop y Caprecom, pero sobre todo, nuestra cultura de corrupción.
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