Directors-general of relatively small public Israeli medical centers don’t have it easy.
They must spend time and effort fund-raising abroad, as matching funds from their owners for development are usually dependent on collecting money from donors.
Competing for funds with well-oiled friends organizations of larger and world-renowned medical institutions is brutal, especially when people abroad have heard neither of their hospitals nor even the cities where they are located.
That’s the predicament of Dr. Carlos Gruzman, who runs Clalit Health Services’ Kaplan Medical Center in Rehovot as well as the Herzfeld Geriatric Hospital in Gedera south of Ashdod. In office since last fall, Gruzman replaced the retiring Prof. Jacob Yahav, a gastroenterologist and pediatrician who came to Kaplan – named for the country’s first finance minister, Eliezer Kaplan – in 2007.
The 63-year-old Gruzman, who was born in Buenos Aires and studied medicine in Argentina before his aliya to Israel in 1977, was most recently director-general of Hasharon (Golda) Medical Center in Petah Tikva.
Four years before he settled here, he came here as a doctor to help out during the Yom Kippur War.
Married with four children, the friendly immigrant doctor received a master’s degree in health systems administration from Ben-Gurion University of the Negev, interned at Meir Medical Center in Kfar Saba, specialized in intensive care and anesthesia and filled various administrative posts in Clalit.
He served in the Israel Defense Forces as head of the trauma sector of the Israel Defense Forces’ military medical school and was a member of aid delegations to help survivors of a massive earthquake in Turkey and the Jewish community building disaster in Buenos Aires, the volcano disaster in Cameroon. Gruzman also was an intensive care unit physician at Sheba Medical Center at Tel Hashomer and Emek Medical Center in Afula.
A longtime resident of Kfar Saba, Gruzman has just headed for Philadelphia for his first fund-raising trip to the US as hospital director. Kaplan’s sole friends organization, located in the Pennsylvania city, is holding an event to memorialize Yoni Netanyahu, who fell in the Entebbe rescue mission of hijacked Israeli airline passengers in Uganda four decades ago.
“I want American supporters to know more about my hospital and to get to know them,” Gruzman told The Jerusalem Post in an interview before his flight to the US.
Established in 1953 with 88 inpatient beds in hastily built barracks to absorb the growing immigrant and local population of 50,000 living in neighboring towns, cities and agricultural settlements, Kaplan has had to hurry to upgrade itself to today’s advanced state of medicine.
Today, the hospital serves a catchment area of some one million Israelis – more than 10 percent of the whole population – many of them from the lower socioeconomic strata.
They live not only in Rehovot but also Ashdod, Yavne, Ness Ziona, Kiryat Malachi, Rishon Lezion, Ramle, Lod and Gedera, as well as numerous kibbutzim and moshavim.
The diverse population includes the second- largest community of former Ethiopian immigrants (nearly two-fifths of all those who came from that country), as well as the country’s second-largest ultra-Orthodox (haredi) community, many immigrants from the former Soviet Union, a large Sephardi community, aging Holocaust survivors and minorities.
Although Kaplan is located in the center of the country, it was vulnerable to rockets and missiles from Gaza in Operation Protective Edge two years ago, and while it did not take any direct hits, several did explode nearby.
The hospital treated most of the wounded civilians from Ashdod and other places in the vicinity.
AFFILIATED WITH the Hebrew University- Hadassah Medical School, Kaplan is an academic and teaching hospital for medical students in their clinical years. There are 554 general, 75 day care, 17 dialysis and 54 newborn beds as well as 10 surgical theaters, four ambulatory operating rooms and 26 emergency room beds. Nearly 150,000 people were treated at its emergency rooms, 50,000 admitted, 7,000 babies born and 14,000 operations last year. It has a nursing school, a school for retraining immigrant doctors and a school for radiology technicians. Its scientists/ physicians conduct basic and applied research together with colleagues at the nearby Weizmann Institute of Science.
Gruzman noted that the hospital cares deeply about community outreach and educating the public about health promotion and disease prevention.
“We hold health promotion days in collaboration with local authorities and municipalities in the region; run a lecture series with a panel of our doctors for the general public; submit articles on health to local newspapers; offer activities for expectant couples and pregnant women; lead Internet forums; and run special events for Ethiopian immigrants,” he said.
As a hospital, Kaplan offers all inpatient and outpatient services except for organ transplants and neurosurgery, said Gruzman.
But he doesn’t want such advanced services, as “the number of procedures in the country is relatively small. There should be specialized centers so they accumulate experience and have high success rates,” said the director- general.
Kaplan does not have an in-patient psychiatry department, but it does boast a day hospital for both children and adults who need psychiatric care. There is also an outpatient facility for oncology patients, but not an inpatient cancer ward.
“And our AIDS center is veteran. We provide free dental treatment for HIV patients from all over the country.” Men who need prostate surgery appreciate Kalan’s minimally invasive “green laser” – purchased with donations – that removes tumors with no bleeding. It evaporates the malignant growth, said Gruzman.
Since 2010, Kaplan has carried out considerable construction of new facilities. These include a state-of-the-art day surgery center, intensive care units, a speech and hearing institute, a catheterization theater and an obstetrical emergency room. A cardiology center now being built on the campus will, said the director-general, be the largest of its kind in the Middle East.
Gruzman is pleased to note that Gedera’s Herzfeld Geriatric Hospital, old but considered the best geriatric facility in the south, will in two years close down and move to a new building being constructed on the Kaplan campus. Herzfeld gives inpatient care to thousands of Israeli seniors, and it also services as a “half-house” before their return home after surgeries, strokes and other ailments.
Among them are elderly who were given acute care at Kaplan and need longterm treatment.
The new Herzfeld will include advanced rehabilitative technology, day clinics, diagnostic and treatment facilities and additional half-house facilities. As geriatric patients will be on the Rehovot campus, they will also be able to make use of all of Kaplan’s medical facilities that are not available at the current location in Gedera, explained Gruzman.
Together with Herzfeld’s 231 beds, the combined Kaplan campus will have over 700 beds, making it a large medical center. There will be only two patients per room in the new building. The integration of the two institutions was initiated by Clalit and the Finance and Health Ministries.
The old 1953 barracks are expected to be completely knocked down in eight years and replaced by additional modern facilities, said Gruzman. Although they are out of date, the shacks’ asbestos roofs that were considered dangerous to health (a risk of lung cancer) were removed many years ago.
As delivering babies is prestigious and financially rewarding to hospitals (they receive set payments from the National Insurance Institute), Kaplan is building a mini-hotel for women to recover for a few days after delivery.
“We will be the first medical center owned by Clalit to have one. We will also have a facility where families can spend Shabbat and holidays to be near their relatives who are hospitalized,” Gruzman said. “This will be sought after by the large sector of haredim who live in Ashdod and environs. And our in-vitro fertilization unit is very successful.”
WITH THE impending opening next year of Assuta Medical Center’s Ashdod Medical Center, Gruzman said he is “not worried” about losing patients to it. Assuta, which is a chain of private hospitals, was contracted by the Finance and Health Ministries to build a public hospital in the port city, with 25% of its activities involving Sharap (private medicine). Assuta received NIS 370 million from the government for the construction and equipment of the new facility (the state has not build a public hospital of its own for many decades).
“I am not concerned about patients who previously came to us going for treatment at Assuta,” said the Kaplan director-general.
“We have a very crowded emergency department and internal medicine department.
If Assuta’s opening in Ashdod leads to less crowding in Kaplan, it will be good for us, but it would not be good for us if all women living in Ashdod have their babies in Assuta.
Yet there are enough patients for all the hospitals. I want only public medicine in my hospital, not Sharap.
But he is worried about losing young doctors and nurses to Assuta. “Some of them already live in Ashdod. They have to understand that Kaplan is their home. Physicians who want to earn privately in a public hospital.
We want to preserve our high level of medicine. We have our own niches. The mini-hotel will attract the observant. We don’t oppose Assuta. I am for everything that promotes public medicine.”
Asked about the scourge of smoking, the director-general said he has not been able to wipe it out completely.
“I hate smoking – the dangers they pose and the smell. We have inspectors and use our own guards. We set up smoking corners as far as we could from the patients, but there are still patients, staffers and visitors who sneak a smoke. We don’t allow the sale of cigarettes inside the hospital, but there are kiosks outside that do sell them. Unfortunately, I doubt there are many medical institutions in the country that are completely free of tobacco smoke.”
As for the food served in the hospital, he learned from The Jerusalem Post that for the past three years, Nazareth (Scottish) Hospital has been serving only nutritious whole wheat bread and rolls – at higher cost, and not those made from white flour.
“I am ready to offer only whole wheat as soon as the government removes the subsidies and price controls from the white and transfers them to the whole wheat.”
Heavy charges for parking in hospitals are a widespread national problem.
“We set a limit to NIS 20 a day, but we have a shortage of parking spaces on and around the campus. We are going to build a structure with over 1,000 parking places.”
As for the high price of food for visitors in many Israeli medical centers, Gruzman said that the next public tender for kiosks and public cafeterias will invite companies that offer inexpensive sandwiches and beverages.
As for staff members undergo flu shots to protect their and their patients’ health, the director-general said 60% of them rolled up their sleeves last year. This is a high rate, but we want more, as the vaccination is effective and safe. I always make the rounds in departments every autumn to persuade the staff to get a shot.”
And even though almost 170 years have passed since Hungarian physician Ignaz Semmelweiss discovered that doctors and nurses who observe sanitary conditions by scrupulously washing their hands with soap and water effectively eliminate hospital infections, the rate is not 100% in Kaplan, as it isn’t in any medical center.
“We do observations of staff members to encourage them to always wash their hands, but sometimes they get lazy or forgetful.”
Asked about his hospital’s relationship with the country’s largest health fund, Gruzman said it is “very good. I have no reason to complain. They make great contributions to us. When we raise donations for development projects, they give us matching funds twice or three times the size of what we raise. For example, they will help us to buy a fusion machine to do better biopsies of the prostate. At present, when we remove tissue for examination, we can’t always find all cancerous tissue. The fusion machine integrates ultrasound of the whole gland so doctors can see exactly where to biopsy and do fewer removals of suspect tissue.
“We will need some $190 million, some from donors and some from Clalit, for our heart center. In a decade,” he continued, “if we get significant donations from abroad, the Kaplan campus will look completely different from the way it looks now.