Medical workers threaten strike action in emergency hospital

Since mid-May 2007, medical workers at the General Hospital for Active Treatment and Emergency Medicine in Sofia have been taking part in a series of protests, already lasting 40 days. The workers are demanding higher wages, improved working conditions and better quality equipment. The first warning strike was held on 18 May and consisted of a one-hour work stoppage; however, workers are threatening to go on effective strike if their demands are not satisfied. The duration of the strike action will depend on whether or not the workers’ demands are met.

Since 18 May 2007, medical workers at the General Hospital for Active Treatment and Emergency Medicine N.I. Pirogov (Pirogov) have been staging daily protests in demand of higher wages and better working conditions. Trade unions and doctors’ and nurses’ organisations have been involved in organising the protests.

Pirogov is the main emergency hospital in Bulgaria’s capital city of Sofia and the largest in the country. The hospital provides 24-hour continuous care for patients with critical conditions from around the country.

Strike organisation

On 4 June, consensus was reached between the protesters’ representatives, the hospital’s management and the Minister of Health, Radoslav Gajdarski. The minister announced the presentation of a draft law for a status change of the hospital to the Parliament Health Commission. On 7 June, the protesters’ representatives had a meeting with the Parliament Health Commission.

After the commission rejected the draft law, the trade unions declared that they would initiate the procedure for an ‘effective strike’, in accordance with the Law for Settlement of Collective Labour Disputes. The latter regulation stipulates the provision of a prior written agreement, three days before a strike, which will guarantee minimum health services for citizens. The chosen strike committee launched negotiations with the hospital management; however, an agreement on the minimum health services was not achieved. In this case, the law stipulates that the parties concerned should request arbitrage. Accordingly, the arbitration panel ruled on 27 June that doctors could go on effective strike if they continued to treat emergency cases that could not be taken by other hospitals, and as long as the departments treating children continued to operate as normal. However, planned surgeries would be put on hold, and all patients who did not need emergency medical help would be redirected to other hospitals.

The hospital workers’ protest has also involved the blockading of traffic on Sofia’s main streets for half an hour every morning. On 21 June, about 1,000 people gathered in Sofia’s centre to join the protest rally staged by the Pirogov hospital workers. Medical workers also handed a protest declaration to Bulgaria’s Prime Minister, Sergei Stanishev, along with the parliament, the Parliament Health Commission and the Minister of Health. In addition, a contact group between the strike committee and the health ministry was established.

Workers’ demands

The hospital workers’ demands centre around four main issues.

1. Changing the status of the Pirogov hospital to that of a National Institute for Emergency Medical Services – this would, in turn, allow the hospital to receive state subsidies (according to Article 5 of the Law on Medical Institutions). Many patients who need immediate medical help, for instance in the case of mass accidents or an emergency crisis, may not be covered by health insurance; their treatment is therefore provided at the expense of the hospital. The same issue arises with emergency aid, which is not fully financed by the state.

2. Higher salaries – the Pirogov hospital has a highly qualified workforce of some 2,100 specialists. According to trade union data, the average monthly wage of workers at the hospital is currently about BGN 500 (€256 as at 11 July 2007). Hospital attendants receive an average of BGN 180 (€92) a month, while nurses receive a monthly wage of BGN 250 (€128) and physicians a monthly wage of BGN 1,000 (€511). Given the cost of treatment in most emergency cases, which are not compensated by the Health Insurance Fund, the hospital cannot afford to increase the wages of its staff.

3. Better quality equipment – at the same time, due to the economic constraints, it is not possible to implement the rules for good medical practice with respect to outdated technical equipment.

4. A final demand concerns the request for the resignation of the hospital’s board of directors.

Support for protesters

Despite the hospital workers’ efforts to blockade the streets in Sofia, the city’s inhabitants and hospital patients supported the doctors’ protest. Moreover, affiliates of the Confederation of Independent Trade Unions in Bulgaria (CITUB) – namely, the Trade Union of Transport Workers in Bulgaria, the Union of Bulgarian Teachers (UBT) and the Federation of Trade Unions in the Forestry and Timber Industry – along with taxi drivers, fully supported the protest. CITUB’s leadership also supported the hospital workers’ protest and declared that the confederation would stand behind their just demands until they were satisfied.

Commentary

Although the government has agreed to change the hospital’s status as requested, the workers’ protest action will continue, as the reform still has to be agreed on by the parliament.

Tatiana Mihailova, Institute for Social and Trade Union Research