The Karlovo Multi-profile Hospital for Active Treatment "Dr. Kiro Popov" is experiencing an acute shortage of doctors. The medical facility is looking for doctors in all specialties and health care specialists. There are not enough doctors in all clinical units. Lawyer Gancho Ganchev, who is a municipal councilor in Karlovo, spoke to FAKTI about the problems in the hospital.
- Lawyer Ganchev, what is happening in the Karlovo hospital. I ask you because you are a lawyer, but also a municipal councilor in Karlovo. Will births stop?
- The problem with the cessation of births in the “Dr. Kiro Popov“ in Karlovo is not an isolated case, but the result of long-standing management failures, lack of personnel policy and institutional transfer of responsibility.
The problems of the municipal hospital in Karlovo are not from today or yesterday. The problems have been accumulating for years. The decisions and plans for the development of the hospital, presented by the management of the medical institution, and the efforts of the municipal management are not yielding results. The personnel crisis is deepening, the hospital is accumulating more and more liabilities, financial results are deteriorating, there is no strategic approach aimed at improving financial sustainability, quality of medical services and effective management of resources.
Against this background, the paradox is that only days before the municipality officially announced on social networks that “Births in the Karlovo hospital will stop from July 22”, the management of the hospital facility presented to us - the municipal councilors, a Development Plan for the “Dr. Kiro Popov - Karlovo” Ltd. (2025-2027). The analysis of the current situation shows that the hospital is at a loss of 274,000 leva for 2024, there are liabilities to suppliers of 139,000 leva, there is a staffing crisis and a shortage of doctors and healthcare specialists. Personnel costs are over 121% of total costs. Staffing and attracting and retaining young doctors and healthcare specialists, through financial (monthly scholarships) and material incentives, offering revolving housing, tripartite contracts and practical training, as well as providing specialists necessary for the hospital departments, except in the departments accredited for this, but also with tripartite contracts for training outside the hospital, do not yield results. These same goals and strategies remain rather aspirational in nature, without a practical dimension. No real development in this direction has been observed.
The lack of personnel also leads to an extremely high workload for the hospital staff.
Thus, to ensure overtime, the Karlovo Municipal Council voted to refinance a three-year overdraft agreement with a bank, starting in February 2025. The value of the overdraft is 300 thousand leva, of which 298 thousand leva has already been utilized. For the first quarter of 2025 alone, the “Dr. Kiro Popov – Karlovo” EOOD Hospital is at a loss of 109,000 leva. The overdue liabilities as of 31.03.2025, representing medical equipment, medicines and medical supplies, water, fuel, electricity and food for patients, amount to 180,000 leva.
In the context of everything I have stated, “YES” in practice, since July 22, births in the municipal hospital have been stopped, but the Municipality of Karlovo seems to have left everything for the last moment. The Municipality of Karlovo and the management of the municipal hospital have become registrars of events.
- Is it true that pediatricians from the Children's Department refuse to consult newborns with varying degrees of prematurity?
- When discussing a topic like healthcare, one should not get emotional. “Pediatricians from the Children's Department refuse to consult newborns with varying degrees of prematurity”, under such a title, the Karlovo municipality announced to the residents of six municipalities served by the hospital that the reason for the suspension of births in the municipal hospital were precisely the pediatricians from the Children's Department. In this regard, I believe that it is dishonest and immoral to shift the blame for the failures of the management of the municipal hospital and the municipality onto the pediatricians themselves. Despite the fact that the pediatricians had submitted their resignation requests on June 13, a meeting with them, with the aim of eliminating the problem, was held on July 21. It was attended by the mayor of the municipality, Dr. Emil Kabaivanov, and the chairman of the Municipal Council – Donyo Todorov, the manager of the MHAT “Dr. Kiro Popov“ EOOD – Dr. Daniel Prandzhev, Dr. Nasya Dimitrova and the head of the AG department at the medical facility – Dr. Andrean Minev. From the statements of representatives of the Karlovo Municipality – in the person of the mayor, the chairman of the Municipal Council, as well as the acting director of the hospital, the impression is created that they are rather following events than anticipating and preventing them. There is a lack of strategic vision and personal commitment of the management for the development of the hospital as a modern and working medical facility for the benefit of the people. It is alleged that new staff are constantly being sought, efforts are being made.
I made the effort to check almost all job sites, but I did not find any job advertisements from the hospital management anywhere.
There are no advertisements even on the municipality's website and Facebook page, there are none in over 20 – they Facebook pages and information channels on the territory of the municipality, which have tens of thousands of followers. The most paradoxical thing is that such information is also missing on the official page of the Municipal Hospital “Dr. Kiro Popov“ EOOD. The last announcement is from April 10 and it is for submitting the necessary information for vacant positions for residents in clinical specialties under a contract concluded with the Medical University of Plovdiv for specialties - Obstetrics and Gynecology and Nervous Diseases. Is this the interest of the management? In this regard, it is periodically commented in the public space that the hospital is deliberately being led to bankruptcy, and petitions are initiated for its preservation and development. The citizens of the municipality are worried about the status and future of the hospital.
- What team takes care of the babies?
- There are three pediatricians in the municipal hospital today, and there is also one intern. For such a department to function normally, between 5-7 doctors are needed. The fact that the department works 24 hours a day must also be taken into account. The attempt of the Karlovo municipality and the management to shift the blame for the current situation is, to put it mildly, immoral. It is evident that pediatricians are very busy and are at the edge of their physical capabilities. Until now, one doctor took over all the consultations, after his retirement there is no one, note - “even after they were offered additional payment“ they refused, this is the opinion of the municipality. The problem in this case is not financial, but rather moral. The excessive workload of the available medical staff, the insufficient specialization of some pediatricians in neonatology (care for premature babies) and the high responsibility and risk in monitoring such patients are the leading reasons for the refusal to consult newborns with varying degrees of prematurity. I talked to pediatricians and I can say that their position is principled, because the responsibility for each newborn, especially premature, is the responsibility of pediatricians. The lack of staffing and material support leads to high risks for newborns. In this regard, the municipal hospital does not have neonatology and the necessary equipment to care for these children. After stabilizing the newborns, they are sent by specialized transport to Plovdiv. The transport itself comes without staffing and a pediatrician is required to accompany the newborn to the hospital, which automatically leaves the department in Karlovo without a pediatrician.
- How many births are there per year in the hospital?
- According to NHIF data, the annual births in the municipal hospital are 150-200 children per year. Unfortunately, it is mainly minors and underage women who give birth in the municipal hospital, who account for about 80% of the total births. In most cases, there is no pregnancy monitoring for young women in labor. Unfortunately, the state systematically ignores one of the most serious and worrying problems, namely births at an early age among minors and underage girls. This phenomenon is especially common among representatives of the Roma community, where the lack of pregnancy monitoring is common. Expectant mothers do not undergo a single obstetric and gynecological examination and arrive at the hospital only at the moment of birth itself - often in crisis, with premature birth and severe risks for the fetus. Municipal hospitals lack a neonatal ward, and newborns - premature, weighing 700 grams, 1 kilogram or a maximum of a kilogram and a half - require intensive care, specialized incubators and teams to stabilize them. In practice, the obstetrician-gynecologist ends his work with the birth, but from there on the responsibility falls entirely on the pediatricians, who are often absent or categorically refuse to take on such severe cases.
The pediatric departments in small municipal hospitals are subjected to an impossible workload, and pediatricians - literally work 24 hours a day without support.
In many cases in small towns there is no one to take responsibility for premature babies. This leads to emergency transportation to larger hospitals - most often in Plovdiv. Until transport and admission are provided, every minute is critical for the life of the newborn.
The Hippocratic Oath obliges every physician to observe a standard of conduct and responsibility towards the patient, but neither in the Health Act nor in the Criminal Code is the physician obliged to perform an activity: outside his competence, in the absence of conditions and a team, in the event of a real risk to the patient's life.
- It turns out that the cases of premature babies born, in which a consultation with a pediatrician is required, are between five and seven per month. Why?
- Your question is a continuation of the previous one. The phenomenon - births at an early age among minors and underage girls is increasingly deepening. In this regard, the statistics presented by the municipal authorities are that between five and seven babies per month are born prematurely, in which a consultation with a pediatrician is required. These are almost half of the births in the municipal hospital.
The municipal leadership is calling on pediatricians to make a “compromise“ at this difficult time for the hospital!
No doctor should be forced to choose between compromising their conscience and the “convenience“ of a sick system.
Births in Karlovo must continue. But not with lies, not with guilt imposed on specialists and not with closed eyes to the problems. But with actions. With responsibility. And with the whole truth about the problems, as it is.
Pediatricians have no legal obligation to take in premature newborns, especially without equipment and specialized support. This is not a compromise, but a crime with a potentially lethal outcome. The compromise that some expect from them would be a compromise with conscience and medical ethics and with the lives of the most vulnerable patients – newborns.
In this battle for life, we cannot leave doctors alone, we cannot demand more from them than they can give. The issue is not about money, but about support and staffing. We must be with the doctors, not against them.
It is good for the municipality, before criticizing them, to thank them for their dedication and take responsibility for the situation in which the medical facility is.
- The management of the health facility continues to look for specialists in “Children's diseases“. How many doctors are needed…
- The efforts of the hospital regarding staffing and the search for new staff are somehow not confirmed by their actions. There is no campaign in this direction, we are following the events and hope that the problems will pass us by. The search for personnel is not a declarative form, these are actions, meetings and drawing experience from successful models of other municipal hospitals.
As you saw, the Strategic Development Plan of the “Dr. Kiro Popov – Karlovo” EOOD (2025-2027) was presented to us - the municipal councilors, just days before the births in the ward stopped.
It talks about stabilizing and sustainable development of the medical institution, about effective management, strategic investments and development of human capital. According to the plan, the hospital can strengthen its role as a key provider of health services in the region, in order to guarantee sustainable access to medical care for the residents of the municipality. When, within what timeframe? We will see!
- The hospital is municipal. What is the municipality doing to preserve it?
- The problem with municipal hospitals in Bulgaria is deep and multi-layered. It affects not only the health system, but also the security, development and future of entire regions. The main challenges can be summarized as follows: lack of staff, fewer and fewer young doctors and nurses choose to work in small towns, mass emigration of medical personnel abroad, where pay and conditions are better, retirement of key specialists without adequate replacement - as in the case of Karlovo, where the only pediatrician consulting in the maternity ward retired, without anyone to replace him. Last but not least. Insufficient state funding, municipal hospitals are commercial companies that have to support themselves - paradoxically for a public health service. The National Health Insurance Fund (NHIF) covers a limited volume of activities and often with delays.
There is a lack of targeted subsidies from the state to maintain vital departments (pediatrics, ENT, surgery) in remote areas.
In addition. Political and local interests and unhealthy interest in the future of medical institutions. Many municipal hospitals are victims of political conflicts between the mayor, municipal council and the central government. There is evidence and suspicion of deliberate bankruptcy, with the aim of privatization or turning hospitals into private structures, under the control of certain economic circles. Local interests prevent appointments, contracts with specialists and effective management. If urgent structural decisions are not taken, the prognosis is alarming.
Many hospitals will be transformed into Emergency Care Centers, hospices or social services.
leading to a medical desert. Patients will be forced to travel dozens of kilometers to the nearest functioning hospital. To reverse this grim statistic, a new national strategy is needed to finance and protect municipal hospitals, because they are social infrastructure. A change in the model – not as commercial companies, but as public medical institutions with basic state-provided funding. Linking medical education to directing personnel to problem regions through contracts and bonuses. Control and accountability of local governments and hospital boards – including legal measures against intentional bankruptcy or abuse. If the state abdicates from municipal hospitals – it abdicates from the health of its people.