Has Petersburg City Hall Made a Shambles of New Hospital Construction?

Part of the old facilities at the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village
Part of the old facilities at the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village

Petersburg Municipal Hospital and Clinic Construction Program on the Skids
Svetlana Zobova
Delovoi Peterburg
February 3, 2017

Petersburg Governor Georgy Poltavchenko has botched ex-Governor Valentina Matviyenko’s ambitious program of building 32 healthcare facilities at a cost of upwards of 30 billion rubles. The city lacks a force that could consolidate physicians and builders to campaign against construction delays.

DP has audited all the municipal healthcare facilities that have been built, are under currently construction or are in the planning stages. The circumstances surrounding them are far from ideal. In each specific case, we can speak of certain objective causes as to why a particular clinic has not been completed or is not yet treating patients. But if we look at the issue as a whole, it becomes clear our city has no system for overseeing and managing the sector. Accountability is split between two committees whose specialists, to put it mildly, are not very happy with each other.

Both doctors and builders tell obscene jokes about each other behind each other’s backs and complain of their opponents’ extreme incompetence and their unwillingness to compromise. They cannot work together to finish nearly any of the projects. But no one is ready for a showdown that could reverse the situation and establish new, functioning rules of the game.

The few examples when new hospitals and clinics have been successfully opened either conceal sad stories of protracted construction delays or were overseen by federal officials, and the degree of oversight and accountability were thus on a completely different level. Aside from federal facilities, this study did not take into account facilities that merely underwent renovations, only those that were slated for complete makeovers or new facilities.

DP received quite detailed replies from the city’s Construction Committee and Healthcare Committee about the causes of the delays at dozens of facilities and the complications with bringing operating facilities online. However, there was no answer as to why these processes have been implemented so poorly, with so much anguish and pain.

Good Intentions

To equip the city with the three dozen modern medical facilities it so badly needed, the Matviyenko administration allocated around 30 billion rubles. However, under the current administration, construction companies have been paid less than 10 billion rubles from the budget, completing only a few facilities in fits and starts. Our sources in the Health Committee say the sector’s underfunding has been due to delays in construction.

In some cases, the quality of their work has caught the eye of the prosecutor’s office, while in other cases, expensive medical equipment has been ruined due to mistakes and miscalculations. Deadline overruns have been ubiquitous. It would be wrong to say that the only cause has been poor work on the part of builders and designers. The city authorities have kept on awarding new contracts even to those contractors who have attempted to turn over blatantly shoddy facilities to doctors and brazenly lied.

DP discussed the problem with a dozen head physicians and their deputies, as well as well as contractors and city officials. We got the impression Petersburg has not become Russia’s northern healthcare capital less because of the economic crisis and a lack of financing, and more because of bureaucracy and the complete absence of a genuinely efficient system for managing municipal construction projects. In several instances, it is obvious that if city officials had done nothing at all, it would have been much better, as was the case, for example, with the closure of the maternity hospital on Vavilovykh Street.

Petersburg’s Hospitals

When she departed from Petersburg, Valentina Matviyenko left a legacy of numerous ambitious construction projects, including healthcare facilities. She had planned for the construction or reconstruction of 32 medical facilities by 2016, including new hospital wings, outpatient clinics for children and adults, dentistry clinics, ambulance stations, and specialized early treatment and prevention centers (as per Petersburg Government Decree No. 149, dated 10 February 2011).

As of late 2016, city authorities had built and opened only six facilities on the list. Another four facilities have been built, but their directors, the Construction Committee, and contractors have been bogged down in fierce arguments as to the quality of the construction. The other projected facilities have either been frozen or not assigned a contractor, and their designs are now outdated.

Initially, Governor Poltavchenko seemed inclined to keep improving healthcare in Petersburg. In 2012, he added several dozen future facilities to Matviyenko’s list. Design and construction work on the facilities was to have been completed in 2013–2014.

For example, the new governor promised to rebuild the morgue at the Bureau of Forensic Medicine, design a hospice, build several antenatal clinics, design new wings for the Kashchenko Mental Hospital, and build a TB prevention and treatment clinic in Kolpino.

A little later, Matviyenko and Poltavchenko’s plans were drafted as a program for the healthcare sector. The document originally promised that city officials would arrange for the construction or reconstruction of 29 ambulance stations and medical facilities capable of taking in 36,000 patients a day by 2015.

In reality, the healthcare facilities construction program has been the most disastrous line item in the city’s targeted investment program for several years running.  In 2016, none of the medical facilities under construction used 100% of the funds allocated to them in the budget. Certain facilities did not touch literally any of the funds allocated to them.

The prosecutor’s office and the Audit Chamber have highlighted construction delays. The city’s vice-governors for construction policy and Construction Committee chairs have come and gone, but federal officials are still asking the same questions.

At our request, the Construction Committee listed all the medical facilities that have been either built or constructed in the last ten years. According to the officials there, from 2009 to 2011, the three years before Poltavchenko took office, eleven major facilities were brought online. After he arrived in the governor’s office, from 2012 to 2016, another eleven facilities were completed, according to officials, although two are still closed, and the others opened considerably later than they were completed.

The city’s Health Committee provided us with different information. Officials there calculated that 28 facilities had been completed between 2006 and 2016, although Poltavchenko’s program had stipulated either renovating or building 63 facilities from scratch. The difference in figures is due to the fact that officials from the two committees used different timespans. In reality, both lists show outright that the city has got worse at building medical facilities since Poltavchenko’s team came on board.

As health professionals who were well versed in the issues told us, city officials would always ask contractors the same questions during regular on-site debriefings. Why is the facility not under construction?  You’ve been working here for five years, but you’re still at stage one. How much of your advance have you gone through? Who produced such a bad design?

Subordinates would be reprimanded, and contractors would be fined and have their contracts torn up, but nothing would change. Construction completion dates would be postponed, and cost estimates would be increased.

By 2016, the list of construction projects had been greatly reduced. Currently, the target invested program lists 14 medical facilities, almost all of them projects from the Matviyenko period that have been subjected to protracted delays.

The construction sector professionals we surveyed estimated that, on average, one and half years are needed to design a large medical facility, while it would take another three years to build the facility.  A small ambulance station could be built in a year. In Petersburg, however, actual times to completion are many times longer. It takes five to 15 years to build many facilities.

The Causes Are Plain to See

The Smolny believes that the virtual breakdown of its grand social policy plans has been due to insufficient funding. Thus, in 2017, Petersburg’s most renowned delay-plagued construction project, the Zenit Arena, gobbled up nearly a billion rubles. But this is fibbing, for, in reality, line items for financing the building of facilities that have obviously been abandoned were simply stricken from the budget, because no one was spending any money on them.

In addition, according to the city hall officials we talked to, careless contractors are to blame for construction delays and poorly designed projects, and for not calculating their risks. As you might guess, in this way of seeing the world, officials bear no blame for the fact they are surrounded by bunglers and swindlers.

But there is a more complex view of the issue. A source at one of the city’s largest hospitals told us that the ceremonial communiques and press releases issued by city officials belie the serious friction between the Construction Committee and the Healthcare Committee, as well as between the relevant vice-governors. For while hospitals and clinics are still under construction, the Construction Committee’s budget is replenished. They even purchase medical equipment. But when hospitals start treating patients, the money for that is allocated via the Healthcare Committee. This does not mean, of course, that the Construction Committee deliberately delays building projects. Of course, they want to get delay-plagued facilities off their hands as quickly as possible. But Construction Committee staffers bear no personal accountability for missed deadlines and the poor quality of construction.

A senior official, who has worked in the Healthcare Committee since the Matviyenko administration, says during the past four or five years he and Vice-Governor Olga Kazanskaya have had to wage a “quite serious fight” with the construction bloc in the Smolny. Describing the state of affairs in the Construction Committee, the official spoke of confusion and complained about the frequent change of leadership.

A telling example occurred when we asked Igor Albin, vice-governor for construction, to explain why the Botkin Infectious Diseases Hospital, whichas far back as 2015 he had publicly promised would soon reopen, was still not treating patients. However, he gave us no explanation, shifting the blame for the situation on Healthcare Committee staffers. In turn, they said it was the Construction Committee who was responsible for construction at the Botkin. Off the record [sic], they told us about a long list of defects and unfinished work to which contractors wanted doctors to turn a blind eye, making them sign off on the facility even though it was unfinished. Of course, a dispute like this could go on indefinitely until someone takes responsibility for the entire project.

No Accountability

Our source in the medical community, who spoke out about the construction community in a somewhat biased way, argued that no one except medical professionals had any interest in bringing facilities online. As a consequence, officials failed to make purchase requests for equipment, did not calculate the costs of logistics, and fined the medical facilities.

“There is way too much politicking and money at each stage. Everything is bureaucratized and corrupt in the extreme. What matters is that everything looks right on paper,” said our source.

He was surprised that, under Poltavchenko, the Construction Committee did not “tremble” for failing to execute the annual budget. Under Matviyenko, he claimed, failing to spend funds allocated under the yearly budget was considered an extremely grave offense for officials to commit.

Another senior medical administrator sees the root of the trouble not in corruption per se, but, rather, in the overall “muddle” and the fact that “the system doesn’t function.”

“Every staffer needs to know his function and the consequences that await him in case of failure. Step left, step right, and you can step on a land mine and blow up. Now, though, there is basically no accountability for mistakes, and no one feels personally to blame.”

The Construction Committee has no specific department or expert responsible for medical facilities. A personal curator is usually appointed to oversee each of them. A considerable part of the work is overseen by the Fund for Capital Construction and Reconstruction, which is controlled by the committee. Its longtime head was Andrei Molotkov. It was Molotkov who was criticized by Igor Albin for the numerous missed deadlines and unscrupulous contractors. Ultimately, in April 2016, Molotkov resigned his post, a job that is still vacant.

The Healthcare Committee employs one senior professional builder, Igor Gonchar, head of the Office for Medical Facilities Development. However, he deals with repairing and rebuilding the facilities his committee oversees. Since 2014, the Healthcare Committee has also been tasked with designing healthcare facilities. It was a seemingly reasonable step, meant to reduce the risk of drafting projects that were not suitable for physicians and had to be redone on the fly. In the last three years, however, the Healthcare Committee has not spent nearly 40% of the money allocated to it for design, i.e., 158 million of the 250 million rubles allocated in its budget for survey and design work.

Gonchar gave detailed answers to our questions, explaining that, out of eight planned facilities, the design work had been completed for six of them. Problems had arisen around a large project, estimated to cost 100 million rubles: new wings for Children’s Hospital No. 1. Due to the fact that, last year, changes were made to the law on historic preservation, the specs for facilities adjacent to historic Pozhelayev Park had to be redrafted. Similar difficulties have arisen with another problematic facility, the Dunes Children’s Rehabilitation Center. However, the difficulties having to do with historic preservation were in that case aggravated by the bankruptcy of the design subcontractor, Oboronmedstroy.

A view of the new campus of the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village
A view of the new campus of the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village

Sabotage

One of the most unpleasant consequences of delaying when medical facilities are brought on line is the premature purchase of expensive medical equipment. For when a senior official says a hospital or clinic is about to open, his underlings will willy-nilly have to purchase CT scanners and MRI machines. But then no one is responsible for the fact they have to spend several years in a warehouse, where they are not only of no use to patients but also run through their warranties and sometimes even are damaged due to improper storage conditions.

According to medical professionals, premature equipment purchases are also part of a cynical calculation by officials. They can report the city has already purchased everything a hospital in the midst of construction needs and demand its administrators move into a poorly constructed building.

“In my opinion, the people running the city are not very interested in healthcare, because it involves more political questions,” says Lev Averbakh, executive director of CORIS Assistance LLC (Saint Petersburg) [a private ambulance company]. “I think there no political will for it. No one says, ‘Let’s finish them!’ as with the stadium, for example. Besides, they have begun reducing the number of hospital beds available while changing the regulations. Under the new rules, not as many beds are needed in Petersburg as were required under the old rules.”

Another professional from the field of private medicine argues that Olga Kazanskaya, now the ex-vice-governor for social policy, and Healthcare Committee Chair Valery Kolabutin lack medical training.

Sergei Furmanchuk, co-founder of Hosser [a Petersburg-based company specializing in the design and construction of medical facilities], argues that problems arise when design work is done by people who have never done design work, and they do the construction work as well. He believes that each case has to be examined individually. However, it has to be acknowledged that having a lot of experience and even medical training, unfortunately, is no guarantee of impeccable work, as, for example, in the case of Rosstroyinvest and the Botkin Hospital, Petrokom or Oboronmedstroy, which is currently undergoing bankruptcy proceedings, abandoning several large healthcare facilities unfinished.

Translated by the Russian Reader

P.S. This article, its author, and Delovoy Peterburg obviously have a heavy axe to grind more against one faction of Petersburg city hall (still referred to as “the Smolny,” the headquarters of the Bolsheviks during the 1917 October Revolution). Normally, I would not translate and post this kind of potential journalistic hit job, although it does describe an urgent problem—the collapse of Russia’s post-socialist free healthcare system—more or less objectively, a problem I have touched on elsewhere in my translations of less dodgy printed matter.

But the author does signally fail to point out the role of Putin’s infamous “power vertical” in encouraging the lack of accountability among local officials, whether in Petersburg or Vladivostok.

Petersburg’s current governor, Georgy Poltavchenko, was first appointed outright by President Putin after the latter “upmoted” the city’s previous governor, Valentina Matviyenko, to the Federation Council, which she now chairs, after she had become deeply unpopular for, among other things, trying to ram Gazprom’s infamous Okhta Center skyscraper down the throat of Petersburgers, and flagrantly failing to clean snow from streets and rooftops during one particularly snowy winter, leading to massive residential property damage and a cityscape described by many locals as resembling what the city looked like during the 900-day WWII Nazi Siege.

Poltavchenko was later “freely” “re-elected” to the governorship in an election marked, as usual, by irregularities, running against a field of sock puppets that had been preemptively purged of any real competition.

From the get-go he has seemed more concerned with the matters spiritual and ecclesiastical than really running the city, which has looked especially dingy this winter, when it has become apparent that the previous street maintenance and cleaning system has collapsed altogether, possibly for a lack of poorly paid Central Asian migrant workers to keep it “affordable.”

Is is fair, though, to blame all local failings on the almighty power vertical? Probably not, and that is why I devote so much of this blog to Russians doing it for themselves at the grassroots, often against daunting odds and in the face of outright police repression. But their efforts won’t make a dent in all the issues they are tackling until the country becomes a real federation and power is devolved maximally to the regions, cities, towns, and neighorhoods.

In this light, it amounts to cynical mockery to repeatedly refer to President Putin as a “strong leader,” as the new Fascist Pig in the Poke did during his campaign and now after he has occupied the White Pride House in Washington, DC. Putin is not a strong leader in any sense, but his weakness has been especially apparent in the myriad ways his regime has disempowered Russians at all levels, making it increasingly difficult for them not only to solve but also even discuss the problems that concern them most.

Finally, I should point out that the original article in Russian features a map of the city marked with all the hospitals and other medical facilities built, currently under construction or abandoned under the municipal program described, above, as well as a table with more detailed information about each of these real, abandoned or planned facilities. I was not able to include the map or table in this translation. TRR

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