The uproar was caused by the resignation of the former head of the surgical ward, Jan Ośko. Doctor Ośko resigned because for some time there had been talk at the hospital that Director Demarczyk was preparing someone to replace him. "No one required the doctor to submit his resignation," says Piotr Demarczyk. The SP ZOZ hired Tomasz Michalski, a specialist from Lwówek, to replace Doctor Ośko. According to the director, the Bolesławiec hospital will gain "a completely different profile of surgery than has been practised here so far. Broader, full-scope surgery, more major operations. Plus vascular surgery." Until now, residents of Bolesławiec used this type of service either in Wrocław, Jelenia Góra or Lwówek. Until now, the National Health Fund, as the director puts it, treated the Bolesławiec hospital's efforts to increase its surgical contracts with a smile on its face. This was because the range of procedures performed in our city was very limited. Thanks to Tomasz Michalski, this is expected to change.

The director is relying on people from outside Bolesławiec. But, as he stresses, this is not the only criterion. "If two people are substantively equal, I would prefer someone from outside who does not operate within a certain network of collegial and friendly dependencies in this city," explains Piotr Demarczyk. That is why he also hires new employees "under managerial contracts." He describes the resistance to his decisions as follows: "If someone has functioned within a certain personnel arrangement for 20 or 30 years, with only minor changes, it is difficult to expect everyone to be delighted that someone will come in with different requirements regarding the work system, work organisation and scope of duties." "I expected this kind of resistance," admits the director. He is pleased, however, that some people who had previously been rather sceptical about all changes are now speaking positively about them. As the director told us, there are increasingly more such people. He is not sure whether the staffing changes will make work easier. It will certainly be done "more efficiently and more intensively." By the end of the year, the indebted hospital, as the director announces, "will have a completely different image."

Many factors determine why its current image is not the best. These include society's attitude towards healthcare, especially towards the doctors at the Bolesławiec hospital, which Piotr Demarczyk considers "entitled." "Someone can make a huge fuss about having to wait here for half an hour," says the director. Yet they do not make such a fuss at their local doctor, where they had to wait six hours. According to Demarczyk, primary care physicians are also responsible for the SP ZOZ's debt. A primary care physician, "when referring a patient to hospital, is supposed to treat them and carry out all the necessary tests." In Bolesławiec, this happens "extremely rarely," the director explains. Most often, the patient is treated "out of thin air, without tests or diagnostics." When there is no result, a referral to hospital is issued, "most often with a diagnosis pulled out of thin air." In this way, according to the director's estimates, 75% of patients arrive at the Bolesławiec hospital. The hospital cannot refuse to provide assistance, as this would result in legal sanctions. Because patients are not diagnosed, the SP ZOZ loses tens of thousands of zlotys per month. The director has only indirect influence over primary care physicians. "I inform the National Health Fund about individual doctors' failure to fulfil their contracts," says Demarczyk. He has documented all such cases. He is prepared for a substantive dispute.

(GA/KG/MZ information)