State Comptroller blasts Health Ministry for poor management under Litzman

In his report, Joseph Shapria said Deputy Minister Ya'acov Litzman and senior officials promote smoking, among other shortcomings.

Yaacov Litzman (photo credit: EMIL SALMAN/POOL)
Yaacov Litzman
(photo credit: EMIL SALMAN/POOL)
From helping the tobacco industry to increasing the number of smokers to failing to arrange hospital departments where medical students can learn, the State Comptroller shows that the Health Ministry under Deputy Minister Ya’acov Litzman and senior officials is badly run in very important ways.
In four sections covering nearly 300 incisive pages, the comptroller names and provides titles of ministry personnel who functioned badly.
Although 8,000 Israelis – including 800 non-smokers exposed to second-hand smoke – die from tobacco’s effects each year, the Health Ministry has failed to carry out many of the recommendations made by a public committee to prevent smoking damage – a committee that the ministry itself had established in 2011. The monetary cost of treating tobacco-related disease is NIS 3.7 billion a year.
Six years ago, wrote the comptroller, the United Torah Judaism deputy minister at the time allowed the international tobacco giant Philip Morris to market its cigarettes here in clear cellophane wrapping without the legally required “Smoking Kills!” warnings. “It would have been proper for the deputy minister to have decided [on such a policy] after checking with the relevant legal authorities,” the report says.
In May 2016, the tobacco company asked that its heated-tobacco product iQOS be exempted from the limitations of conventional tobacco products. Five days later, associate director-general Prof. Itamar Grotto – who had previously been in charge of the ministry’s public health division – sent a letter to the Tax Authority saying that Philip Morris did not have to post warnings on iQOS. Litzman’s senior adviser Motti Babchik – a fellow Gur hassid – also helped write the letter, the comptroller wrote.
None of the three had consulted with a professional expert or even with the legal adviser’s office before making this generous decision. Grotto, said the comptroller, thereby violated the Framework Tobacco Control Convention (FTCC) of the World Health Ministry that the Israeli government ratified in 2005. “This should be seen as very serious,” he continued.
Grotto and Babchik also took no action to prevent the sale of duty-free tobacco to domestic airline passengers – who don’t have duty-free privileges – at the new Ramon Airport in Timna.
LITZMAN DIDN’T consult with his legal adviser, either before or after a February 2017 meeting he headed that included ministry director-general Moshe Bar Siman Tov, Grotto and Babchik – where it was decided to continue to allow the sale of iQOS without limitations. Only after two lawsuits was the ministry forced to place limitations on the Philip Morris product, the comptroller wrote.
Litzman, Grotto and other senior officials met twice with Philip Morris lobbyists privately about iQOS without making the meetings public, in violation of the FTCC. “...exposure of these meetings makes it possible to prevent decisions from being taken that don’t jibe with the need to preserve public health... hiding such meetings with tobacco companies violates the vital needs for transparency.”
Litzman also failed to persuade the government and Finance Minister Moshe Kahlon to equalize taxes on cheap rolling tobacco – which now constitutes a major smoking product – to those on conventional cigarettes.
The Health Ministry was also negligent in demanding improvement in the enforcement of no-smoking laws in public places by municipalities. It also does no public service ads and has done little to persuade the health funds to get their members to kick the habit or the Education Ministry to vigorously fight smoking. 10% of the 409,000 pupils in 11th and 12th grade smoke.
But the comptroller did praise IDF Chief of Staff Gadi Eizenkot for issuing an order that tobacco not be allowed for sale in open bases where soldiers go home at night; he did, however, urge that tobacco not be allowed for sale in all IDF facilities, even closed bases.
The comptroller demanded that the Health Ministry set up an inter-ministerial coordinating team to seriously fight smoking, which has increased under Litzman’s leadership, unlike trends around the world.
INVESTIGATING THE clinical training of Israeli medical students, the comptroller faults the Health Ministry and the Council for Higher Education for doing a bad job of ensuring that they have enough hospital departments in which to learn under professorial tutelage. The ministry was uninformed about which hospitals had enough room, what future needs would be and how to meet those needs. An average of only eight medical students should accompany professors on their rounds from bed to bed, but the figure often reaches 12, so their learning is “ineffective.”
In addition, said the comptroller, too many foreign medical students are allowed to learn here, while the ministry has given medical licenses to students who studied abroad and don’t know basic Hebrew. The ministry has also “failed to take any action” to ensure that hospital interns and residents can study properly in the medical centers with adequate infrastructure and manpower.
In his examination of state-owned mental health services, the comptroller lambasted the Health Ministry for failing to ensure that enough experienced psychiatrists are available on district committees to decide regarding the forced hospitalization of mentally ill patients.
The ministry also did not make sure that enough beds were provided. At Abarbanel Mental Health Center, there was a department with just 34 beds for an average of 60 patients, forcing the remainder to wander from place to place. “This situation is insufferable, causes much discomfort to patients and violates their human rights.”