A doctor working nonstop for 70 hours and 10 minutes. That is how long one of the medical staff spent in the hospital, during which he was supposed to provide medical assistance to those in need. The Supreme Audit Office challenges such practices and orders legal regulation to prevent situations that, as NIK emphasised, can endanger patients’ lives and health, because a doctor working for almost three days can lead to that.
“The irregularities in this area were primarily due to staffing shortages and sudden staff absences. During the audit, it was also pointed out that hiring medical staff under civil law contracts is not subject to the Labour Code regulations, and decisions to continue working after a shift (over 24 hours) were often made by the doctors themselves based on patient condition assessments. Some of these shortcomings were due to administrative mistakes, including errors in scheduling and lack of information flow” – NIK said in a statement.
That doctors worked too long – as NIK points out – is not just a simple breach of regulations, but also a real danger to patients who were supposed to be cared for by doctors working continuously for two to three days.
“In the Supreme Audit Office’s view, the lack of real oversight over the total workload of medical staff in multi‑shift conditions poses a direct threat to health safety and the quality of healthcare services in hospitals. Systemic regulation changes are necessary: introducing a uniform mechanism for recording medical staff working hours, covering all forms of employment, and extending the duty to monitor rest and breaks also for contract staff” – we read in the statement.
Major concerns about the functioning of clinical hospitals
The list of irregularities found by the NIK audit is very long and concerns almost all inspected facilities. They included: the University Clinical Centre of the Warsaw Medical University, the University Clinical Hospital in Białystok, the University Hospital No. 1 named after Dr. Antoni Jurasz in Bydgoszcz, the University Clinical Centre in Gdańsk, the Independent Public Clinical Hospital No. 1 named after Prof. Stanisław Szyszko of the Silesian Medical University in Katowice, the Independent Public Health Care Institution University Hospital in Kraków, the Independent Public Health Care Institution University Clinical Hospital No. 1 named after Norbert Barlicki of the Medical University of Łódź, the Independent Public Clinical Hospital No. 4 in Lublin, the University Clinical Hospital named after Fryderyk Chopin in Rzeszów, and the University Clinical Hospital No. 2 in Szczecin.
Among the neglects identified by the NIK were those concerning hospital infrastructure. The most serious irregularities were found in hospitals in Rzeszów and Warsaw. In these facilities, the technical and sanitary condition of rooms left much to be desired. Some rooms did not meet the 2019 Ministry of Health requirements.
“In Rzeszów, the concerns directly related to the operating block, which, due to technical defects, had been allowed for use only conditionally by the sanitary inspection since 2018. In Warsaw, parts of wards were found to have damaged walls, floors, and electrical installation elements, and in one ward the floors were not made of materials that allow washing and disinfection” – NIK reports.
The auditors also identified irregularities concerning the use of medical equipment. As the audit showed in some cases, it was inefficient.
“The purchased equipment and medical apparatus were installed and put into use, but in three hospitals (Kraków, Zabrze, Rzeszów) NIK assessed the use of equipment as ineffective, among other reasons due to limited operating time, delays in starting devices, insufficient use due to failures or technological obsolescence, and lack of suitable conditions to expand the range of services provided” – NIK informs.
Comments also concern the management of the medical facilities’ assets. NIK found that in six of the ten inspected clinical hospitals, the principles of economy and transparency were violated.
“In one hospital (Warsaw) irregularities were found, including improper calculation and enforcement of receivables (including lack of rent indexation, non‑collection of commissions, unjustified rent reductions), which resulted in a reduction of funds amounting to PLN 2,287.8 thousand. In other entities, formal‑organisational shortcomings were found, including unreliable documentation of activities, lack of required opinions and justifications, and entering into contracts without proper analysis. The causes of the irregularities were incorrect interpretation of regulations, formal and procedural errors, and insufficient documentation of decision‑making processes” – NIK reports.
A Warsaw hospital with huge debts
NIK also examined hospital documentation, detecting irregularities related to procedures for outsourcing services to external entities and contract staff. Shortcomings were also found in competitive procedures.
The Supreme Audit Office also scrutinised the finances of the inspected clinical hospitals. The greatest financial stability was shown by hospitals in Gdańsk and Zabrze, which operated with a positive net result in core and operational activities for almost the entire period under review, i.e. between 2022 and 2024. As NIK pointed out, facilities in Lublin, Bydgoszcz, and Łódź had low profitability. The most serious financial problems – as NIK indicated – occurred in the hospital in Warsaw.
“Despite showing a positive result on service sales in 2023–2024, daily medical activity was conducted under chronic deficit conditions, generating a high level of due obligations” – NIK reports.
As the audit showed, by the end of 2024 the hospital in Warsaw’s debt reached a level of 68.6% of its annual sales revenue. The facility’s obligations were PLN 1,475.5 million, and sales revenue was PLN 2,147.9 million.
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