Specialist on-call doctors at the Larnaca general hospital are being paid without turning up to work, according to a report released by the audit office on Tuesday.

The report stated that “on-call specialists … in most cases in the sample are not documented as having presented themselves” to the hospital’s accident and emergency unit, “even when patient admission was required”.

As such, it said, “the examination and care of patients appears to have been undertaken by resident doctors”, even though the on-call specialists who were not there received between €450 and €850 each per shift.

“It was found that this practice has become established, without a clear process which ensures the optimal use of resources, maximum patient safety, and appropriate training of resident doctors,” it added.

Later in the report, it said that in 22 of 23 cases in which patients presenting themselves at the hospital’s accident and emergency unit were admitted for inpatient care, “the on-call specialist does not record the clinical picture of patients on the accident and emergency form or the time of their examination”.

This information, it added, it required to ensure the quality of the healthcare services provided to patients, the requisite updating of their medical file, and the documentation of the attendance of on-call specialists at their service”.

It said that to this end, “it is presumed that it is a rule that on-call specialists do not show up for their shift but that resident doctors handle the cases”.

Because of this, it said, “patients may not receive appropriate services in an accident and emergency unit sitting, which may put their health at risk”.

“Telephone communication between resident doctors and on-call specialists instead of immediate and meaningful patient assessment may lead to incomplete medical assessments, incorrect medical actions, or even premature patient discharge,” it said.

It also highlighted the fact that “public money is being paid out without the corresponding services being received”, and that “a climate of non-implementation of guidelines is being established within the hospital”.

“We believe that the current operating framework does not clearly define win which cases the supervision of resident doctors by specialists may possibly be carried out without the physical presence of specialist doctors. It is advisable to have specific instructions on this matter,” it said.

As well as this, the report also found that documentation produced by the accident and emergency department “are kept in completely unsuitable spaces, without an archiving system”.

“This practice poses serious risks of losing valuable medical data and breaching personal data security,” it said.

Later in the report, it added that in those documents, “fields relating to critical stages of the provision of healthcare were not completed or signed”, with those fields documenting stages such as the triage process and the patients’ medical history.

It also found that there was an “absence” of timestamping on those documents, saying that “these findings highlight issues of adequacy in the observance of the prescribed procedures and may negatively affect the transparency and traceability of the care provided”.

A photo of a storage area for those documents was provided in the report, with the photograph featuring cardboard boxes piled on top of one another in a room containing piled desks and upturned chairs, among other things.

“It was found that the forms were placed haphazardly in a temporary storage area which used to be a physiotherapy fool. They were stored in a disorderly manner, without chronological classification, which made it particularly difficult to locate and retrieve them,” it said.

In terms of finances, the report found that the hospital had submitted a total of 76,885 claims to the health insurers’ organisation (HIO) in 2023 and received as such exactly €28,975,912 from it.

 However, it also found that a total of 5,116 claims for outpatient care – just over 7.5 per cent of all visits – were not submitted, amounting to a loss of revenue of €67,681.

On this matter, it found that one doctor at the hospital did not file claims to the HIO for more than half of their visits, “without any consequence”.