The Unhealthy Brass Neck Of Politics

Almost 1,000 million euros. This was the saving that the Spanish Government anticipated making by getting tough with so-called health tourism and by denying primary health-care assistance to those who were "sin papeles". The then health minister, Ana Mato, announced these measures in April 2012. They involved a reform not of health legislation but of the law on immigration. The target of the savings was the "tarjeta sanitaria", the health card. It would no longer be sufficient to be on the local register - "empadronamiento" - to get a card; fiscal residency had also be to confirmed. Those who were in "irregular" situations would lose the right to health care, except in the cases of emergencies, maternity and child care.

Twelve years earlier, the Aznar administration - also a Partido Popular one - had granted foreigners (and we are talking predominantly those from Africa) complete access to the national health system even if they were in situations of "irregularity". The immigration law established that being "empadronado" was sufficient. Aznar's government was responding at that time to the flood of immigrants coming into Spain, who were in fact being openly invited into Spain as they were needed for building and infrastructure development in order to fulfil the nation's economic miracle.

What a difference twelve years made. Economic crisis demanded that scapegoats were sought in order to relieve the state's debts, while immigrant workers were no longer making contributions of meaningful sorts, all the projects having been completed, mothballed or identified as monuments to colossal waste. Governments of different types had desired their vanity schemes. They implemented them and they welcomed foreign workers to realise them. And then, when the money ran out and the corruption became evident, they turned their backs on these workers and their families.

Of course, there are "illegals". We all know there are. But these fall into different categories, one of them being the workers who, quite legitimately (because the law said so), were perfectly entitled to full health care. This categorisation notwithstanding, when the government changed its rules, there was an outcry - from doctors and other professionals, from human-rights advocates, from Europe.

Come forward to the present time and the government has changed the rules again. The minister for health, Alfonso Alonso, will now allow those who are "sin papeles" rights to health care that his predecessor had taken away, albeit that the health card will not be given back. Critics have described the move as "vague", as it is unclear how health treatment can work without a patient having a card, but it is a move taken, nevertheless, with one eye on elections. The PP wants to appear more humane.

This loss of humaneness was no more evident than in the Balearics. It might be recalled that before he started falling out with Madrid over oil and financing, José Ramón Bauzá was hailed as the model PP regional president, his administration typifying all that Rajoy desired. The rules on health were followed with zeal. So much so that on 24 April 2013, Alpha Pam, a Senegalese immigrant, died in his apartment in Can Picafort. He had been denied treatment at Inca Hospital. He was "sin papeles". He would have to pay. He couldn't. He was, however, an emergency. Or should have been categorised as such and so covered by the provisions of the 2012 law. His death should not have happened. His condition, tuberculosis, was easily treatable had greater care and humanity been shown to him.

There are reckoned to be some 20,000 people in the Balearics who are "sin papeles". The adults won't have any influence on elections, and nor will those in other parts of Spain. It is not their vote which is being sought, though.

Last Wednesday, leading figures in the Partido Popular gathered in Madrid for a meeting at which the party's image was discussed. There will be a "relaunch" of a party which is aware that it could be facing obliteration at the regional elections and, worse still, at the national election at the end of the year. The health issue with immigrants is one strand of an attempt to appear more pleasant, but this has been made all the more difficult by the passing of the Citizens' Safety Law, a measure, like the attitude towards immigrants and health, that has been slammed by professionals (lawyers in this instance), the human-rights lobby, opposition parties and Europe.

It is a relaunch that is almost certainly too late for the regional elections and quite probably for the general election as well. But you have to admire the brass neck of a party that can perform U-turns on issues such as immigrants and health (not a manifesto pledge) and abortion, which was in the manifesto, in its desperation to come across as human and humane.

MALLORCA TODAY - Alcúdia rejects trilingualism and supports universal health

Alcúdia's council has rejected the imposition of trilingualism in schools and approved a motion to inform the national education ministry of its opposition. This was carried thanks to Carme Garcia, the former member of the PSM socialists who made a pact with the Partido Popular, going against the PP at the town hall. Her vote also helped to carry a motion condemning the death of Alpha Pam, the Senegalese man who died from TB as a consequence of not receiving medical treatment at Inca hospital.

See more: Diario de Mallorca

Indecent Haste: Alpha Pam

The Balearics health minister, Martí Sansaloni, considers the case of Alpha Pam, the Senegalese man who died of tuberculosis, to be closed. Closure has come, according to the minister, because the director of Inca Hospital, where Pam was not treated as an emergency (which by law he should have been, despite not having the right papers), has been dismissed and because disciplinary proceedings are being taken against three other members of the hospital's staff.

Sansaloni might consider the matter closed but this closure has come with unprecedented haste. Matters do not usually get closed quite so swiftly in Mallorca and they have not previously been closed quite so swiftly where Inca Hospital is concerned. There is the case of the alleged breaches of data protection law that were committed by personnel at the hospital and which involved Partido Popular representatives at Inca town hall. This came to light two years ago. As far as I am aware, its investigation and processing through the national agency for data protection and courts has yet to be fully resolved. But as no one died as a result of this apparent illegality, then things can be spun out. When someone does die, best to seek closure quickly and hope everyone forgets about it.

Unfortunately for Sansaloni not everyone is likely to forget about it. And those not doing the forgetting include Santa Margalida town hall (Pam lived in Can Picafort), the Senegalese community, the main PSOE opposition and the now ex-director of the hospital, Fernando Navarro.

The town hall is demanding that compensation be paid to Alpha Pam's family. This demand has been echoed by PSOE and other opposition parties, who are also demanding a full inquiry by a parliamentary commission into what happened and into what they claim was a situation whereby Sansaloni and President Bauzá knew but did nothing to prevent immigrants without papers and health cards being billed for emergency treatment (which they shouldn't have been). This charging is now being rectified, but it was indicative, so government opponents maintain, of the approach to dealing with illegal immigrants and those without a health card, an approach that allegedly contributed to Pam's death.

The government insist that two mistakes were made at Inca, one having been a  medical error in diagnosing bronchitis and not TB, the other having been a failure to apply the rules regarding the treatment of those without papers in cases of emergency. It was a failure to follow these rules that led to the removal of Fernando Navarro, a charge against him that he utterly refutes. Navarro seems determined to defend his honour. The matter will therefore surely not be closed.

PSOE and the opposition are right to press for a full inquiry. If nothing else, there is an inconsistency in the government's insistence that there were two mistakes. If Pam died as a result of the misdiagnosis, then he did not die as a result of a failure by the hospital to attend to him. Something doesn't quite stack up. Moreover, Sansaloni's willingness to so quickly consign the case to history leaves a nasty taste in the mouth. The expedition in investigating the circumstances surrounding Pam's death, the apparent expedience in sacking Navarro, the consequent exculpation of the health ministry and the exigency with which closure has been sought and gained all reinforce a feeling that the Pam case and its handling amount to a failure of decency. And one comes back to the alleged data-protection abuse affair to which none of this speed has applied. Investigations shouldn't have to drag on for months or years, but a death is a more serious issue than the leaking of patient information; it demands a decent period of reflection and not convenient rapidity. 

Members of the Senegalese community on Mallorca met the other day with Senegal's foreign minister, who was in Palma to discuss, among other things, the lack of health care for Senegalese citizens. The minister spoke about the "pain" that his government felt over Pam's death. One thing it may hasten, however, is the return of immigrants to Senegal; the minister was looking at ways to facilitate repatriation. Senegal would like its people to return in order to help with the development of its agricultural industry, so perhaps, in a respect, some good might come of the Pam affair. If they have limited employment opportunities in Mallorca and questionable access to health care, then they would probably be better off returning, but such an eventuality would not remove the need for there to be a full appreciation as to what happened in the case of Alpha Pam. Sansaloni's belief that the case is closed is wrong.


Any comments to andrew@thealcudiaguide.com please.

MALLORCA TODAY - Santa Margalida looks for compensation for Alpha Pam

A change of mayor there has been in Santa Margalida but there is no let-up in the grievances between the town hall and the regional government. The latest issue has to do with the scandal surrounding the death from TB of the Senegalese resident of Can Picafort, Alpha Pam. The government accepts that his death should have been avoided as he wasn't diagnosed with having TB and so therefore treated as an emergency at Inca Hospital, whose director has been sacked. The town hall is to call on the government to compensate Pam's family.

See more: Ultima Hora

When Humanity Collapses

In September last year, a decree was issued that was designed, it was said, to ensure the sustainability of the Spanish national health service. This sustainability was to be guaranteed by removing rights to health care to immigrants without proper documentation and a health card. Illegals, in all likelihood. The implementation of this decree has claimed its first victim. A 28-year-old Senegalese man died last week of tuberculosis because he was refused treatment at Inca Hospital.

Let's not beat around the bush. This is a total disgrace and a savage indictment of the Spanish political class. I know there will be those, because I can already hear their voices, who will argue that illegals, those without papers, those who don't pay taxes, etc., etc. cannot expect to benefit from the health service if they don't contribute to it. This is a point of view with which I am not totally unsympathetic. But a man has died. This is the point. By any standards of humanity, this should not be allowed to happen.

The death of the man, Alpha Pam, has brought forth different versions of how he was dealt with by the local health service. The Balearics health service maintains that he did not take documentation from the centre of primary attention (which presumably means Can Picafort's health centre, where the health service says he had been attended to) when he went to Inca Hospital and so the necessary tests couldn't be carried out. There are other versions, such as a further one on behalf of the regional government which states that he was misdiagnosed in Can Picafort, and he had apparently been to the health centre there on several occasions over several months. The group Médicos del Mundo (MDM) insist that he wasn't attended to in Inca because of a lack of papers and health card. It also insists that he wasn't assigned to a family doctor and that when, on one of his various visits to try and get assistance, was told to go to emergencies in Inca when the health centre was informed that he had relatives who had been hospitalised with TB.

So, who's telling the truth? Not that this really matters to Alpha Pam any longer. For one reason or another, he is dead. If his death is, as MDM believe, the result of the "politics of austerity", then let us wonder at what it is going to cost to fly his body back to Senegal. Someone will have to pay, and it probably won't be his family.

Any number of organisations, in addition to MDM, have been weighing in with their views. They include the college of lawyers in the Balearics, which has said that his death is evidence of discrimination and that Pam's basic dignity, which should be assured under the Spanish Constitution, was not respected. The Catholic Church has also expressed its concern, the Bishop of Guadalajara having made a similar point about basic rights as the lawyers. The church's charity, Caritas, has accused the Spanish Government of failing to guarantee fundamental rights. Let it be noted that these criticisms are from an institution, the Catholic Church, which is normally a strong supporter of the Partido Popular. They are not criticisms of the rabid left.

Because of the national government's decree, Alpha Pam's death is a national matter, but it is also very much a Mallorcan matter. The Balearics health minister, Martí Sansaloni (you'll remember him, because he was the third appointment to a post that had been notable for its revolving door), has been attacked for his heartlessness over the matter. His resignation has been called for and there is a suggestion that legal proceedings should be initiated against the minister for failing to ensure emergency treatment regardless of circumstances.

It should be noted that the September decree did not exclude from medical care children, pregnant women and those whose conditions are emergencies, even if they have no health card or papers. Something, therefore, has gone wrong in the case of Alpha Pam, because he was an emergency. And it should be further noted that, regardless of Pam's status, tuberculosis is contagious. As such, therefore, a lack of treatment represented a health risk to others.

The generally held view is that the regional government is trying to squirm its way out of what is not a simple embarrassment; it is reprehensible. If it tries to avoid its responsibility, it, and by extension the national government, are revealed as more than just heartless. They are inhumane.


Any comments to andrew@thealcudiaguide.com please.