Obstetricians from Barreiro refuse emergency services at Garcia de Orta

The obstetricians from the Gynecology/Obstetrics department at Barreiro Hospital—whom the Minister of Health is reportedly preparing to forcibly summon to reinforce the Garcia de Orta emergency room staff—do not want to be mobilized to Almada, a source familiar with the matter told Observador. Most of the specialists are over 55 and are therefore exempt from working in the obstetric emergency room. Only two of the seven doctors are under that age, and one of them has already announced that he will terminate his contract if the forced mobilization goes ahead. The solution found by the Ministry of Health to reinforce the Garcia de Orta emergency room staff may ultimately have very limited results.

In Barreiro—and to keep the obstetric emergency room operating—obstetricians, particularly older ones, continue to work in the emergency room, despite the majority of clinicians being over the age of 55, which exempts them from working in this type of service. However, this ongoing availability among obstetricians could change if the government decides to mobilize these professionals to fill shifts in the obstetric emergency room at Garcia de Orta. "We work [emergency rooms] because we're at home. Otherwise, we don't," the same source asserts, adding that obstetricians from the Barreiro hospital are not available to work at Garcia de Orta.

Last Friday, the weekly newspaper Expresso reported that the Minister of Health, Ana Paula Martins, was preparing the forced mobilization of obstetricians from Barreiro Hospital to the emergency room at Garcia de Orta Hospital in Almada. The order informing about the forced transfer was already ready and submitted to the legal team, awaiting only the Minister of Health's signature. This news was somewhat surprising, considering that Ana Paula Martins had repeatedly stated in recent weeks that negotiations with medical unions would be necessary before any concentration of teams, since relocation is a labor matter, and doctors are not required to travel to other municipalities.

However, two events likely precipitated Ana Paula Martins' decision to forcefully mobilize doctors without prior negotiation: first, the simultaneous closure of the three obstetric emergency rooms on the Setúbal Peninsula during the second weekend of September; and second, the failure to implement the plan to reinforce the Garcia de Orta Obstetrics department with seven doctors from the private sector (so far, only two have been hired). Reinforcing the Garcia de Orta emergency room with doctors from Barreiro is a solution that, if confirmed, will be severely criticized by unions and the Medical Association itself.

"This solution will further complicate the current situation. The solution isn't forced relocation, because that creates anger among the people," says a source familiar with the matter, referring to how the team received the information about Ana Paula Martins' intentions. The same source asserts that forcing Barreiro's obstetricians to move to Garcia de Orta "is a shot in the foot, if it goes ahead."

Forced mobilization will lead to "more departures" from the NHS, doctors warn. The minister has not yet called unions to negotiate.

According to a source interviewed by Observador, Nossa Senhora do Rosário Hospital in Barreiro currently has a team of seven obstetricians, five of whom are over 55 years old and are therefore exempt from working emergency services during the day or night. This exemption falls within the scope of both the agreements signed between the Government and medical unions in 2012 and the Collective Bargaining Agreements for Doctors, which are currently in effect. "Medical workers, from the date they reach 55 years of age, if they so declare, are exempt from working in emergency services," clarifies the Central Administration of the Health System in a document clarifying the work organization of the medical profession.

Of the seven doctors working in the Gynecology/Obstetrics department at Barreiro Hospital, most are on full-time assignments, a scheme that allows doctors to be deployed to emergency services within a 30-kilometer radius of their original workstation. However, deployment under this scheme only applies to doctors under 55, as age is a factor, according to the same source. This information was confirmed to Observador by the president of the National Federation of Doctors (FNAM), Joana Bordalo e Sá, who assures that the " age limits of the ACT supersede full-time assignments."

The government's strong stance, which is reportedly preparing a forced mobilization of obstetricians, may yield very limited results. In addition to the five doctors over 55 (who, besides not being legally required to relocate, also do not intend to do so), another obstetrician is threatening to terminate her contract if the measure goes ahead. " A doctor [in the service] says that if this happens, she will terminate it. It's almost like forcing the younger ones to leave the NHS. It's incomprehensible, " says the source who spoke to Observador. In other words, the order being finalized at the Ministry of Health may only serve to mobilize one doctor; if it does, it would have a very limited impact on the development of the Garcia de Orta Obstetrics emergency room schedules, which remain severely deficient.

" This is pointless because there are no doctors to mobilize . Doctors are already working under enormous difficulties, with understaffed teams and more overtime," emphasizes the FNAM president, who argues that, to strengthen the obstetric response on the south bank, "what would make sense would be to strengthen the teams," by hiring more professionals and improving the working conditions offered to doctors.

From Barreiro to Leiria: experts will propose the creation of five regional obstetrics and pediatrics emergency units

The Minister of Health is also aware of the risks of moving forward with forced mobilizations of doctors to other hospitals. In the summer of 2023, when Ana Paula Martins was president of Santa Maria Hospital, the obstetricians at that unit were instructed to move to São Francisco Xavier Hospital, where obstetric emergencies would be concentrated, due to the closure of Santa Maria's maternity ward for renovations. The mobilization generated strong internal opposition, leading to the dismissal of the then-director of the service, Diogo Ayres de Campos, and the termination of eight doctors' contracts .

Last Sunday, September 21st, Garcia de Orta—whose obstetric emergency room should have been operating without restrictions—was forced to refer patients to Barreiro Hospital because it again lacked sufficient doctors to cover the full schedule. Therefore, between 8:00 AM and 8:00 PM, the emergency room was only open to cases referred by the National Institute of Emergency Medicine (INEM)'s Urgent Patient Guidance Center, while for most of the day, Barreiro Hospital was providing obstetric care to the entire Setúbal Peninsula.

Observador asked the Ministry of Health whether it has a guarantee that Barreiro doctors will agree to work in the emergency department at Garcia de Orta, whether there were any contacts with the service before the decree providing for forced mobilization was drafted, and when the decree is expected to be published. However, Ana Paula Martins' office did not respond to any of the questions. The ministry stated only that "teams from the Ministries of Health and Finance are finalizing the legal framework for the future regional emergency department in the Setúbal Peninsula , which will meet the needs of pregnant women and newborns in the region," and that "the legislation also aims to ensure fair and due compensation for professionals working in the NHS."

When contacted about the possible mobilization of doctors to Almada, the Arco Ribeirinho Local Health Unit, which encompasses the Barreiro and Montijo hospitals, also did not respond.

The Gynecology/Obstetrics service at Barreiro Hospital performs around 1,200 births per year, explains the source contacted by Observador (who did not wish to be identified), covering an area comprising the municipalities of Barreiro, Moita, Montijo and Alcochete and also the Quinta do Conde area (in the municipality of Sesimbra).

If the creation of a regional obstetric emergency unit at Garcia de Orta Hospital is implemented, with the consequent concentration of teams, the easternmost areas of the municipality of Montijo (particularly the Pegões area) will be 70 kilometers from the reference obstetric emergency unit in Almada —a distance greater than recommended by experts. In June, the coordinator of the National Commission for Women's, Children's, and Adolescent Health, Alberto Caldas Afonso, emphasized that clinical safety for patients is ensured with a distance of up to 50 kilometers between centers.

However, in the case of the Setúbal Peninsula, there will be no going back on the decision to concentrate Barreiro's obstetric emergency unit at Garcia de Orta. Last week, the Minister of Health announced in the Assembly of the Republic that the government will launch the Setúbal Maternal and Child Center , located within the Garcia de Orta Hospital, in 2026. It will be staffed by teams from the region's three hospitals (Garcia de Orta in Almada; Nossa Senhora do Rosário in Barreiro; and São Bernardo in Setúbal). The obstetric emergency unit at Setúbal Hospital will remain open to support the Alentejo Coast region. The Maternal and Child Center is expected to be completed within three to four years.

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