In the semiannual state comptroller’s report released on Tuesday, May 1, 2012, the report questions the managerial end of Magen David Adom, an organization responsible for Israel’s emergency medical service, blood bank services, and an annual operational budget of 573 million NIS. The report adds that as a public organization, the laws governing its operational activities are quite explicit and a probe into MDA revealed alarming shortcomings and mismanagement.

The report explains MDA has taken the luxury of permitting senior officials to become involved in aspects of the daily operation that are prohibited by law, citing Dr. Noam Yifrach, who heads the executive board also involved himself in donations to the tune of 120 million NIS annually in direct violation of the guidelines set by the law. There are numerous examples, all pointing to the lack of division of authority and responsibility between the executive board and operational officials.

Equally alarming is what appears to be favoritism pointing to former Minister of Health Danny Naveh, who was instrumental in getting Yifrach his post. The minister was actually involved in the meeting during which Yifrach was elected to the top executive slot.

The report includes criticism of the organization’s internal audit system, particularly the committee responsible for meeting regularly to continue monitoring and assuring quality control. The committee does not meet frequently enough and when a meeting is held too many members simply do not bother attending. Some meetings were held with too few participants, once again in contradiction to guidelines which demands a minimum number of people be in attendance.

The executive board is blamed for not ensuring the audit committee convened while the latter simply failed to minimally carry out its duties. Actually, four of seven MDA committees failed to convene at all from 2007-2010.

The same holds true about the MDA board. Members are selected without determining suitability and this body follows the examples of other levels of leadership, simply failing to maintain a basic level of operational acceptability.

The state comptroller recommends that the Ministry of Health addresses the current MDA law that empowers the organization – to amend it to better suit today’s standard for other quasi-governmental bodies. The law is antiquated and ill suited to meet today’s realities. The comptroller states the corporate makeup of MDA is proof that widespread reform is in order. The comptroller’s recommendation includes bringing the justice ministry on board to work together with the ministry of health towards revamping the MDA Law.

The law places the minister of health at the top of the ladder, responsible for overseeing MDA operations but in actuality, it is difficult to accurately define the minister’s role in MDA operations.

The issue of payment has been one that appears in the media from time-to-time, with a growing number of people who received service by MDA staff and vehicles insisting they are overcharged as well as speaking of unjustifiable charges. The comptroller confirms this, stating MDA has overcharged tens of thousands of people, violating the price ceiling set in place by the government. MDA responded that thousands of refunds have already been issued. MDA states 1.8 million NIS in overcharges have been returned to date.

Amazingly, 280 pages of the 800 page Hebrew report addresses problems pertaining to the health ministry.

The report simply cites the alarming lack of proper management, questioning the length of the term of the director-general, who in essence is the chief of operations. This post is held by Eli Bin since 2005, and the report strongly recommends setting a limit to the term in office which does not exist today. In his case, he was set in place as the operational chief of the national EMS but lacks any training or degrees in pre-hospital emergency medicine and management.

State Comptroller Lindenstrauss adds that while today there are numerous volunteer organizations which do not charge for their service, there are ongoing disputes regarding territorial rights, disputes that should be addressed by Deputy Health Minister Yaakov Litzman in his capacity as acting minister, but this too has not occurred.

End of comptroller’s report.

Regarding the last paragraph, Litzman is working to revamp the MDA law and to establish “Rachel – Rishut Cheirim Leumit” (a national emergency authority) that is in line with the reality that today, United Hatzalah and Zaka play a major role in the nation’s EMS system and what was once a MDA monopoly is no longer the case.

MDA is an organization that enjoys the best of every situation. On the one hand it has successfully built a state-of-the-art “friends of MDA” organization in many countries and cities around the globe, today operating a major fundraising operation. On the other hand, it receives government funding and charges for its services despite the fact that it operates on the backs of thousands of volunteers nationwide. To make things increasingly frustrating, the EMS organization habitually cries that it is broke.

The shortcomings of the organization date back long before this report, to the tenure of then medical director Dr. Nancy Caroline, an internationally renowned physician who left her prestigious post in the United States to serve her people here in Israel, seeking to bring MDA into the 20th century regarding pre-hospital medicine. She left Pittsburgh in 1976 to move to Israel and become an Israeli citizen, then assuming the top medical post at MDA. Despite her tenacious efforts, widespread corruption led to her resignation.

Most alarming regarding the semiannual report is the fact that it does not carry any weight under the law and despite the damaging findings the report can be used by lawmakers as a guide as to where change is required, but more often than not, it is placed on the bookshelf along with previous editions of the comprehensive report – taking its place in the State Comptroller’s archives.

(YWN – Israel Desk, Jerusalem)