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Contract for dialysis costs 51 Guatemalans their lives

Acción Ciudadana

In February 2015, a group of patients with kidney failure in Guatemala suddenly started coming down with dangerous infections. They suspected their new provider of dialysis — a treatment meant to keep them healthy — was actually making them ill.

This helped to uncover the alleged wrongdoings of unscrupulous government officials and health care providers which have become one of Guatemala’s biggest corruption scandals and caused 51 people to die before their time.

Earlier that month, PISA, a Mexican supplier of medicines that had a branch in Guatemala, had taken over providing peritoneal dialysis to 530 patients of the Guatemalan Institute of Social Security (Instituto Guatemalteco de Seguridad Social (IGSS)). As this is an invasive technique, it carries a high risk of infections and careful hygiene is essential.

The patients complained they were given substandard equipment and products, which were poorly used and protocols for maintaining hygiene were not being followed. Less than one month after PISA took over, two patients had died and fifteen more were suffering from infections. Patient Sorayda Macz, a 43-year-old businesswoman from Guatemala City, asked Transparency International’s Guatemalan chapter, Acción Ciudadana, to intervene.

Inexperienced and unlicensed

Acción Ciudadana found that the 116 million quetzales (US$14.9 million) contract had been awarded to PISA in late November 2014 in suspicious circumstances. At the time of the bid, PISA did not employ any medical personnel, had no previous experience of providing the service and was not licensed to provide it. The company also only operated out of three rooms sublet from a private hospital. Nevertheless, the tenders committee disqualified the other bidder — incumbent Baxter — and gave the contract to PISA.

During the spring of 2015 as the number of patients with infections increased, they set up a patients’ association led by Ms. Macz. Acción Ciudadana alerted the Guatemalan media and managed to hold a special session in the Guatemalan parliament to try to get the contract cancelled, but without success.

By May 2015, with the help of the United Nations-backed International Commission Against Impunity in Guatemala (La Comisión Internacional Contra la Impunidad en Guatemala (CICIG)), Acción Ciudadana had enough evidence to get the contract rescinded and convince the Guatemalan public prosecutor to issue orders for the arrest of 15 people, including the managers of IGSS and PISA. A criminal investigation, leading to a trial, was set in motion.

Son of judge

Otto Fernando Molina Stalling, son of influential Supreme Court judge Blanca Stalling and an advisor to IGSS’s president, was a key figure. A joint investigation by CICIG and Guatemala’s Special Prosecutor Against Impunity (Fiscalía Especial Contra la Impunidad (FECI)) recorded conversations during which Molina Stalling boasted of his IGSS connections and promised the managers of PISA that he could rig the tender process. In one recording, he asked for a cut of 15 per cent of the contract value, although it was never proven how this amount was to be shared out.

Ms. Stalling was a highly visible presence in the courtroom during the trial until January 2017, when Judge Carlos Ruano revealed that she had taken him aside and requested favourable treatment for her son. She is now being investigated for alleged influence peddling. Many of the accused, such as the IGSS governing board, were powerful members of the Guatemalan elite — ex-intelligence officer, Juan de Dios de la Cruz Rodríguez; business leader, Max Erwin Quirin; union leader, Julia Amparo Lotán; and ex-head of the national bank, Julio Roberto Suárez.

Leading the victims

While the criminal investigation was underway, Ms. Macz worked hard to keep the patients mobilised. According to Edie Cux, president of Acción Ciudadana, she would call the other patients one by one to encourage them to come to meetings, visit the hospital to document the case, speak at press conferences and help other patients understand the legal ins and outs as the case progressed. “Her role was decisive in getting the contract cancelled,” said Mr. Cux. “Acción Ciudadana provided the legal assistance, but she led the cause and was a powerful figure.”

On 5 October 2016, Ms. Macz died from a generalised infection after 11 days in hospital. Her health had been badly damaged by two bouts of peritonitis since 2015. Fifty-one of the 530 patients who received dialysis treatment from PISA died.

In September 2018, the four members of the IGSS governing board, five members of the tenders committee, plus another manager were found guilty of fraud. Mr. Molina Stalling was found guilty of unlawfully charging fees. PISA’s managers and an IGSS doctor were cleared of all charges.

Those found guilty appealed and in July 2019, Judge Beyla Estrada reversed the ruling. The public prosecutor’s office has since taken this second not guilty verdict to the court of cassation.

Commission closed down

September 2019 saw CIGIG shut down, following an announcement by Guatemalan President Jimmy Morales the summer before that he would not renew its mandate. The decision, believed by some to be motivated by CIGIG’s investigation of his family members, ended the operations of a key institution in the fight against corruption in the country.

In 2019, 44 per cent of Guatemalans thought most or all judges and magistrates were corrupt, according to the latest Global Corruption Barometer — Latin America and the Caribbean. This is a survey of more than 17,000 citizens in 18 countries across the region on their perceptions and day-to-day experiences of corruption. This figure rises to 49 per cent when it comes to government officials.

Today, the patients and families affected by the PISA scandal are still waiting for justice. “The justice system here is not designed to help the victims. During this case all the arguments focused on the accused and how they suffered but never on the real victims, some of whom even lost their lives,” said Mr. Cux.

Transparency International’s Advocacy and Legal Advice Centres (ALACs) provide free and confidential legal advice to witnesses and victims of corruption. With more than 100 offices in over 60 countries, ALACs provide an accessible, effective way for people to report corruption and demand action. Learn more: www.transparency.org/reportcorruption

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This article was written as part of the Global Corruption Barometer 2019 — Latin America and the Caribbean.

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