2023-07-20 09:30:30
The Ministry of Health today (Thursday) ordered the insemination unit in Asuta Ramat Hay’il to reduce the activity carried out in the in vitro fertilization unit at the hospital, this at the end of the hearing held by the ministry for the unit. It was also decided that the hospital should appoint a senior external escort from the field of treatment safety.
In May, it was announced that the in vitro fertilization unit at the hospital received information about a case in which there was concern that a child born after in vitro fertilization was not genetically compatible with the father, and that the hospital did not report the incident to the Ministry of Health.
Dr. Hagar Mizrahi, head of the medical division at the Ministry of Health, who conducted the hearings as well as the in-depth investigation on this issue, examined the entirety of the data, including a management deficiency in the area of treatment safety, including the management and investigation of unusual events at the Assuta Ramat Ha’ayel Medical Center, two identical significant events a few months apart and the treatment of these events by the hospital, as well as due to the way the information received regarding the third event was handled. Dr. Mizrahi is convinced that these failures are related to culture Poor organization in the area of treatment safety, as well as high workloads in the IVF unit, which undoubtedly contributed to harm to patients.
Accordingly, and according to the Public Health Ordinance, it was decided that:
The director of the hospital or the management of the Assuta network must appoint a senior external accompanying person from the field of treatment safety, with the aim of bringing about a change in the problematic organizational culture regarding treatment safety and assisting the hospital in updating procedures and implementing them, and inspiring a culture of safety and reporting and management of unusual events in the hospital. Reducing the activity carried out in the in vitro fertilization units at the hospital as follows: no more than 25 operations (egg extractions and embryo retrievals) should be performed in a working day. The reception of new patients in the in vitro fertilization unit at the hospital will be stopped immediately. The work in the IVF unit (including in the laboratory) must be finished by 11:00 p.m.
All this – until further notice, in order to make sure that the scope of activity corresponds to the required standard, and that the unit is run in a way that does not endanger public health or harm public health and patients’ rights.
In 2021 there were 60,962 IVF treatment cycles, a 46% increase from 2015. The percentage of live births in Israel that started with IVF treatments increased during this period from 3% to 6% of all births. More than 60% of the cycles were performed in private fertility units, even though in Israel there are 22 public fertility units (in most government and public hospitals) and only 4 private units: Assuta Ramat Hay’il, Assuta Rishon Lezion, Herzliya Medical Center, and Elisha Hospital. Last month, Dr. Mizrahi stated that about 14,000 treatment cycles are carried out in Assuta Ramat Hay’il, compared to about 2,000 cycles in Sheba
According to the inspection team of the Ministry of Health, most IVF services are concentrated in two private institutions in the central region, which creates an inequality in the availability of services in the rest of the country. The team found that the fertility treatment market conditions encourage female patients to choose the private units – especially the ability to choose a doctor who treats the private units. In the public fertility units, a patient sees a different doctor for each examination, from among the unit’s medical team. A patient in a private unit can consult by phone with her attending physician, while in the public unit there are consultation services with a nurse but not with an attending physician.
At the same time as the recommendations for the hospital in Ramat Hayyal, the Ministry of Health is working to change the manner of all private IVF units, in the recommendations published a month ago it was stated that: choosing a doctor for IVF treatments also in the public units without additional cost, operating the units in the afternoon, arranging the payment for the treatment of a third child, planning a budget to improve the public units – this is what the Ministry of Health team for examining the IVF system recommended, with the aim of encouraging female patients to choose in the public units. The team also recommended limiting the reimbursement of the Shaban programs for private treatments, obliging private doctors to work in the office part-time and not as “freelance” in IVF units, and refining safety procedures, in order to raise the standard of activity in the private units. Among other things, it was recommended to limit each unit to no more than 8,000 treatment cycles per year.
From Assuta Ramat Hay’il said: “This is a disproportionate and discriminatory decision, which will severely and unjustifiably harm the patient population. Assuta has carried out considerable improvement processes in the last year, while implementing new technologies and improving risk management processes and reporting procedures, so that today Assuta has an optimal laboratory on an international scale. Assuta demands that the Ministry of Health immediately carry out a repeat inspection of the unit to verify the improvements made and bring about a change in the decision, Because there is no sense in unnecessary and discriminatory harm to the patient population.”
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