What elective surgery will be allowed now the coronavirus situation has improved? It’s up to your surgeon or hospital

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Stephen Duckett, Grattan Institute

Australian Prime Minister Scott Morrison has announced some elective surgery can start again in private hospitals, as it becomes clear the health system will cope with the additional coronavirus demand.

He said this week “all Category 2 or equivalent procedures in the private sector, and selected Category 3 and other procedures, which includes all IVF” can restart.

What’s this mean for you? It all depends on which category you are in – and what your surgeon has decided about how urgently your surgery is needed.

It also depends on whether you are a patient in a private hospital or public hospital. If it’s the latter, you can expect to wait a while until the hospital can tell you exactly when your surgery will happen.

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Category 1, Category 2, Category 3: what’s the difference?

Private hospitals have not had elective surgery waiting lists in the past and so have not categorised patients for elective surgery. So it’s no surprise this announcement has created enormous confusion.

States have not yet announced their plans for restarting elective surgery.

Elective procedures are categorised into three categories based on urgency:

• Category 1, the most urgent, is where patients should be seen within 30 days
• Category 2 patients should be seen within 90 days
• Category 3 patients should be seen within 365 days.

Categorisation is done by the surgeon and takes into account the specific circumstances of the patient. For example, they would consider the extent of the pain and mobility loss, and the impact on the work or education if the surgery was delayed.

Different surgeons can assign patients different categories

Unfortunately, different surgeons seeing the same patient may make different assessments of what category they should be in. This policy issue needs to be addressed.

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Elective surgery’s due to restart next week so now’s the time to fix waiting lists once and for all

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There is no fixed rule about whether a particular procedure is always in a specific category.

However, generally cardiac surgery, such as a heart bypass, will be classified as Category 1. More than half of all patients awaiting this procedure are treated within three weeks.

A patient waiting for a hip replacement, on the other hand, will be typically categorised as Category 2 or 3. In fact, half the patients waiting for that procedure had to wait up to four months.

Waiting times for public hospital treatment is longer in some states and others. Data for elective surgery waiting times it is published by the Australian Institute of Health and Welfare.

Categorisation is done by the surgeon and takes into account the specific circumstances of the patient.
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How do I know what category I’m in?

If you are scheduled for an operation in a private hospital, either the hospital or the surgeon will contact you.

They will let you know if your surgery is now going ahead, and discuss with you appropriate timing. Elective surgery will commence over the next week, so private hospital patients should hear from the hospital surgery within the next fortnight or so.

Because states haven’t yet revealed their strategies for restarting elective surgery, public hospital patients should not expect to hear from the public hospital until those announcements have been made.

Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Elective surgery’s due to restart next week so now’s the time to fix waiting lists once and for all

Monkey Business Images/Shutterstock

Stephen Duckett, Grattan Institute

The near-total shutdown of elective surgery across Australia will end soon, following National Cabinet consideration on Tuesday.

The shutdown was imposed to ensure there would be enough personal protective equipment (PPE) for doctors and nurses to manage a projected tsunami of COVID-19 patients in our hospitals.

But now there is a big backlog of Australians waiting for elective procedures.

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Elective surgery waiting times are the bane of every state health minister’s life. Better ways to manage such procedures could be a major benefit from the shutdown and restart.

But we have to act quickly if we are to change how we manage these wait lists, as federal Health Minister Greg Hunt wants a staged reintroduction to begin on April 27.

Rethink priorities

Currently, elective surgery is classified as urgent (category 1), semi-urgent (category 2) and non-urgent (category 3). But different hospitals and different surgeons actually classify patients in different ways.

What’s worse is that some procedures are undoubtedly unnecessary, such as spinal fusion or removing healthy ovaries during a hysterectomy, and would provide no value for the patient, as Adam Elshaug and I have argued before.

Of course, not all of the backlog is low-value procedures. As states consider how to recommence elective surgery, they should seize this opportunity to introduce new systems, especially in metropolitan areas.

A properly managed elective procedures system should have three key elements:

• there should be a consistent process for assessing a patient’s need for the procedure, and ranking that patient’s priority against others

• the team performing the procedure, and caring for the patient afterwards, should be highly experienced in the procedure

• the procedure should be performed at an efficient hospital or other facility, so the cost to the health system is as low as possible.

Unfortunately, Australia sometimes fails on all three measures.

Stop the inconsistencies

There is no consistent assessment process across hospitals. Even different surgeons in the same hospital seeing the same patient sometimes make different recommendations about the need for a procedure.

This means a patient lucky enough to be seen at hospital A may be assigned to category 2, but the same patient seen at hospital B might be assigned to category 3 and so have to wait longer.

Patient characteristics, such as gender or level of education, also seem to inappropriately affect categorisation decisions.

High-volume hospitals and other facilities generally have better outcomes for a given procedure than low-volume centres. And they are more efficient.

Yet most states ignore these facts. They have done little to rationalise services for the benefit of both the patient and the taxpayer.

Time for change

The large backlog of demand creates the opportunity for a new way of doing things. States should develop agreed assessment processes for high-volume procedures, such as knee and hip replacements and cataract operations, and reassess all patients on hospital waiting lists.

Reassessment could be done remotely using telehealth. Specialists in each area should be invited to develop evidence-based criteria for setting priorities. Where appropriate, patients should be diverted to treatment options other than surgery.

Private health insurers should be empowered to participate in funding diversion options so patients are able to have their rehabilitation at home rather than in a hospital bed.

A new, coordinated, single waiting list priority system in each state would enable all patients to know where they stand. A patient on the top of the list would be offered the first available place, regardless of whether it was closest to their home.

They could refuse the offer, without losing their place in the queue, if they wanted to wait for a closer location.

The health minister says it’s up to hospitals to decide which patients get to undergo elective surgery.
Roman Zaiets/Shutterstock

The single waiting list should include both regional and metropolitan patients, to ensure as much as possible that city patients do not get faster treatment than people in regional and remote area.

Patients with private health insurance can opt to be treated as a private patient in a public hospital. So the waiting list should include public and private patients, to prevent private patients gaining faster admission to public hospitals.

The system should be further centralised in metropolitan areas. The full range of elective procedures should not be re-established in every hospital. Some surgeons would need to be offered new appointments if elective surgery in their specialty was no longer being performed at the hospital where they previously had their main appointment.

Private hospitals can help

The private hospital system has taken a battering during the pandemic. Private hospitals have effectively been closed, and their viability may be under pressure.

States should consider signing contracts with private hospitals, at or below the public hospital efficient price, for elective procedures to be performed in these hospitals to help clear the elective surgery backlog.

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As part of the new service model, states should bolster their hospital-in-the-home systems. For many patients, rehabilitation at home or as an outpatient can produce better outcomes than in-hospital rehabilitation.

The pandemic is not over yet and policymakers are right to be turning their minds to the transition back to something approaching business as usual. But the new, post-pandemic normal should be nothing like the old.

Physical distancing seems to be beating the virus, but the second victim might be health reform. Not wasting the crisis is the cliché on everyone’s lips. Australia has the chance to improve our elective surgery system. For the sake of taxpayers and patients, we should grasp it.

Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Good news on elective surgery, but dire warning on the economy

Michelle Grattan, University of Canberra

Restrictions are to be eased on elective surgery, enabling a “gradual restart” to procedures next week.

But as national cabinet took early baby steps towards restoring normality, Reserve Bank Governor Phil Lowe warned the first half of this year would likely see the biggest contraction in Australia’s national output and income since the 1930s depression.

After Tuesday’s national cabinet meeting, Scott Morrison announced that from Monday, category 2 and some important category 3 procedures can restart in public and private hospitals. These were earlier suspended amid uncertainty about how hard COVID-19 would hit the hospital system.

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Category 2 covers cases needing treatment within 90 days; category 3 are ones that require treatment in the next year.

The easing will cover:

• IVF

• screening programs (cancer and other diseases)

• post cancer reconstruction procedures (such as breast reconstruction)

• procedures for children under 18 years of age

• joint replacements (incl knees, hips, shoulders)

• cataracts and eye procedures

• endoscopy and colonoscopy procedures.

More dentistry services will also be available.

The elective surgery easing has been facilitated by the extra availability of protective equipment; also, the low number of COVID-19 cases has meant the pandemic has not placed as much demand on beds as had been feared.

It is estimated the announced easing will lead to reopening about 25% of the elective surgery activity that had been closed in private and public hospitals.

Morrison said the situation would be reviewed on May 11 to decide whether all surgeries and procedures could recommence more broadly.

Clinical decisions will determine the priority given to cases.

The Prime Minister said the easing “is an important decision because it marks another step on the way back. There is a road back”.

On aged care, national cabinet was concerned some nursing homes are being too extreme, with full lockdowns that do not allow residents to have any visitors.

People in nursing homes are particularly vulnerable to the coronavirus and there have been outbreaks and deaths in the sector.

But “there is great concern that the isolation of elderly people in residential care facilities, where they have been prevented from having any visits … is not good for their well-being, is not good for their health,” Morrison said.

The national cabinet gave a “strong reminder” that its earlier decision was “not to shut people off or to lock them away in their rooms.”

This decision was to allow a maximum of two visitors at one time a day, with the visit taking place in the resident’s room. Apart from that, residents should be able to move around the facility.

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Hospitals have stopped unnecessary elective surgeries – and shouldn’t restart them after the pandemic

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Further restrictions would apply where there was an outbreak in a facility, or in the area.

On the economic front, in an indication of the devastating job losses that have already occurred, Morrison said since March 16, 517,000 JobSeeker claims had been processed. JobSeeker used to known as Newstart.

“By the end of this week we will have processed as many JobSeeker claims in six weeks [as] we would normally do in the entirety of the year,” he said.

In a speech at the Reserve Bank Lowe said it was difficult to be precise about the size of the contraction underway.

But on the bank’s current thinking:

• national output was likely to fall by about 10% over the first half of 2020, with most of the decline in the June quarter

• total hours worked were likely to decline by about 20% in the first half of the year

• unemployment was likely to be about 10% by June, “although I am hopeful that it might be lower than this if businesses are able to retain their employees on lower hours.”

Lowe predicted inflation would turn negative in the June quarter, and it was likely prices would turn out to have fallen over the entirety of this financial year, the first time that had happened in 60 years

Lowe expressed confidence the economy would “bounce back”, but stressed the recovery’s timing and pace would depend on “how long we need to restrict our economic activities, which in turn depends on how effectively we contain the virus”.

“One plausible scenario is that the various restrictions begin to be progressively lessened as we get closer to the middle of the year, and are mostly removed by late in the year, except perhaps the restrictions on international travel.

“Under this scenario we could expect the economy to begin its bounce-back in the September quarter and for that bounce-back to strengthen from there.

“If this is how things play out, the economy could be expected to grow very strongly next year, with GDP growth of perhaps 6–7%, after a fall of around 6% this year,” Lowe said.

He said unemployment was likely to remain above 6% over the next couple of years.

“Whatever the timing of the recovery, when it does come, we should not be expecting that we will return quickly to business as usual.”

“It is highly probable that the severe shocks we are now experiencing will change the mindsets of some people and businesses. Even after the restrictions are lifted, it is likely that some of the precautionary behaviour will persist.

“And in the months ahead, we are likely to lose some businesses, despite best efforts, and some of these businesses will not reopen. There will also be a higher level of debt and some households might revaluate the risks of having highly leveraged balance sheets.

“It is also probable that there will be structural changes in the economy. We are all learning to work, shop and travel differently. Some of these changes will probably stay with us, requiring a rethinking of business models. So the crisis will have reverberations through our economy for some time to come.”

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hospitals have stopped unnecessary elective surgeries – and shouldn’t restart them after the pandemic

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Adam Elshaug, University of Sydney and Stephen Duckett, Grattan Institute

Part of Australia’s response to the coronavirus pandemic was a severe reduction in elective surgery, and so private hospitals have stood almost empty for a month now.

People who might otherwise have had a procedure are experiencing “watchful waiting”, where their condition is monitored to assess how it develops rather than having a surgical procedure.

The big question is whether all those procedures which didn’t happen were even necessary. There has now been a steady stream of work which suggests many procedures don’t provide any benefits to patients at all – so called low- or no-value care.

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Bringing about change in health policy is usually difficult (or slow, at best) because it’s like turning a big ship around. But in the past six weeks that ship has made a sudden about-turn.

Australia’s elective procedure system after the pandemic should be different from before the pandemic. We should dramatically reduce the number of low- or no-value procedures.

What is low- or no-value health care?

Low- or no-value health care mean the intervention provides no or very little benefit to patients, or where the risk of harm exceeds the likely benefit.

Reducing such “care” will improve both health outcomes for patients and the efficiency of the health system.

Research in New South Wales public hospitals showed up to 9,000 low-value operations were performed in just one year, and these consumed almost 30,000 hospital bed days that could have been used for high-value care.

One example of low-value care is spinal fusion surgery for low back pain. This is a procedure on the small bones in the spine, essentially welding them together. The alternative is pain management, physiotherapy and exercise.

Spinal fusion for low back pain is an example of low-value care.
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The NSW analysis revealed up to 31% of all spinal fusions were inappropriate. But even this figure is likely an underestimate.

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Needless treatments: spinal fusion surgery for lower back pain is costly and there’s little evidence it’ll work

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Other examples include:

• vertebroplasty for osteoporotic spinal fractures: surgery to fill a backbone (vertebrae) with cement

• knee arthroscopy for osteoarthritis: inserting a tube to remove tissue

• laparoscopic uterine nerve ablation for chronic pelvic pain: surgery to destroy a ligament that contains nerve fibres

• removing healthy ovaries during a hysterectomy

• hyperbaric oxygen therapy (breathing pure oxygen in a pressurised room) for a range of conditions including osteomyelitis (inflammation of the bone), cancer, and non-diabetic wounds and ulcers.

Low-value care can harm patients because of the risks inherent in any procedure. If a patient having a low-value procedure gets even one complication, the time they spend in hospital doubles, on average.

For some patients, the hospital stay can be much longer. For example, a low-value knee arthroscopy with no complications consumes one bed day. If a complication occurs, that length of stay increases to 11 days, on average.

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For most low-value procedures, the most common complication is infection.

The situation is even worse in private hospitals, where a much greater proportion of elective procedures are low value.

Prioritise treatments that work

Most state health departments and private insurers now know the size of the low-value care problem and which hospitals are providing that “care”.

Due to the COVID-19 response, the tap for these procedures has been turned down for some and off for others. This is a risk for some patients, but others will benefit from not having the surgery. We must grasp the opportunity to learn from this enforced break.

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The coronavirus ban on elective surgeries might show us many people can avoid going under the knife

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One of the challenges for policymakers in the past in controlling low-value care has been difficulty in ratcheting down supply by reducing or redirecting a hospital’s surgical capacity and staff.

In many ways, the COVID-19 response has done this for them. After the pandemic, we can reassess and reorient to high-value care.

Some people will need catch-up surgeries after the pandemic, but some won’t.
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This does not necessarily mean reducing capacity. Some people aren’t currently getting the care they need. When the tap comes back on, this unmet backlog of care must be performed.

But this needn’t detract from a focused effort to keep the low-value care from re-emerging. The last thing we need is for low-value care to take the place of high-value care that has been delayed because of the COVID-19 response.

So how do you do it?

Australia should take three immediate steps to ensure we don’t return to the bad old days of open slather.

First, states should start reporting the rates of low-value care, using established measures. This reporting should identify every relevant hospital – public and private – and it should be retrospective, showing rates for the past few years.

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Australians are undergoing unnecessary surgery – here’s what we can do about it

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Second, states should require all public hospitals to take steps to limit low-value care – and hospitals that don’t comply should be called to account.

States have the insights and data necessary to do this.

Hospital strategies might include requiring a second opinion from another specialist before a procedure identified as low-value care is scheduled for surgery, or a retrospective review of decisions to perform such surgery.

Hospitals could require second opinions before scheduling low-value procedures.
Shutterstock

In the post-pandemic world, states should also consolidate elective surgery, so the number of centres performing elective procedures in metropolitan areas is reduced, with decision-making tools to highlight downsides of low-value care and the alternatives.

Third, private insurers know low-value care is provided in private hospitals, but currently have fewer levers at their disposal to reduce such care. The Commonwealth government should legislate to empower funds to address this issue. Given the Commonwealth government is providing financial support to the private hospitals during their downturn, perhaps a requirement should be that they work with the insurers and Medicare to police the re-emergence of low-value care.

It would be a dreadful shame to waste this unprecedented opportunity, and revert to the old status quo of low- and no-value care.

Adam Elshaug, HCF Research Foundation Professorial Fellow, Professor in Health Policy and Co-Director, Menzies Centre for Health Policy, University of Sydney and Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It’s perfectly legal for doctors to charge huge amounts for surgery, but should it be allowed?

Desperate families are increasingly turning to crowdfunding campaigns to raise tens of thousands of dollars for surgery and other medical expenses.
From shutterstock.com

Louisa Gordon, QIMR Berghofer Medical Research Institute

Australia’s Chief Medical Officer Brendan Murphy will investigate how to better protect patients from doctors charging “really unjustifiable, excessive fees” of up to A$10,000 or more for medical procedures.

Murphy said it was potentially unethical for doctors to charge such high out-of-pocket fees that left families in severe financial pain, and that contrary to some patients’ hopes, paying more didn’t equate to better outcomes.

The call comes as desperate families increasingly turn to crowdfunding, remortgaging their homes and eating into their superannuation to raise tens of thousands of dollars for surgeries and other medical expenses.

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We need more than a website to stop Australians paying exorbitant out-of-pocket health costs

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It is perfectly legal for a doctor working in private practice to charge what they believe is fair and reasonable. It’s a private market, so buyers beware.

But that doesn’t mean it’s right, or that it should be allowed to continue.

Not everything is available in the public system

Some patients’ out-of-pocket costs are from the gap between what their private health insurance and/or Medicare will pay for a procedure or treatment.

But some treatments aren’t funded by Medicare or offered in public hospitals because their safety, efficacy and value for money have not yet been demonstrated.

Medical technologies, devices and surgical techniques need to be rigorously tested in clinical trials to demonstrate safety and clinical effectiveness. They will only be widely adopted when they have a strong evidence base.

Out-of-pocket costs can be particularly high for patients with cancer.
From shutterstock.com

When the government pays for a health service, value for money is also considered. For really expensive services and medicines that have the potential to greatly benefit patients, the government will try to negotiate prices down, to reduce the impact on the health budget.

While a lack of evidence of a benefit does not necessarily mean the procedure does not benefit patients, the outcomes need to be reviewed and demonstrated to justify its ongoing use.

Sometimes new technologies are adopted prematurely based on weak evidence and strong marketing which can lead to poor investment decisions. This was the case with robotic surgery for prostate cancer, offered early in private practice in Australia, only to find later it was no better than traditional surgery.

If a patient chooses to spend money on a high-risk surgery, is it really anyone’s business?

Sometimes patients will choose to undergo high-risk surgery, not covered under the public system, and are willing to pay out of their own pocket, or raise the funds through crowdsourcing or remortgaging their home.

Some will argue the value is whatever the patient is willing to pay for it and it’s up to the patient’s own risk-benefit preferences.

There are some major problems with this. Patients often make health decisions while distressed, ill and emotional. They may not be able to determine the best course of action or have all the information at hand. They must trust the doctor and his or her superior knowledge and experience.

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Health economists call this “asymmetric information”. The doctor has extensive years of training, expertise and qualifications. The patient has Dr Google.

A key reason governments intervene in health care systems is to avoid market failure arising from unequal information and the profiteering of providers.

Our ‘fee-for-service’ system is failing

In the private system, doctors are paid a fee for each service they provide. This creates an incentive for doctors to provide more services: the more services they provide, the more they get paid.

But the high volumes of testing, consultations and fragmented services we’re currently seeing aren’t translating to a better quality of care. As such, economists are calling for major reforms of our fee-for-service private health system and the way that doctors are paid.

This could involve paying doctors for caring for a patient’s medical condition over a set period, rather than each time they see the patient, or charging private patients a “bundled fee” for all the scans, appointments and other costs associated with something like a hip replacement.

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More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up

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Out-of-pocket costs are very high for some Australians with cancer. A quarter of Queenslanders diagnosed with cancer will pay provider fees of more than A$20,000 in the first two years after diagnosis.

While what constitutes “value” will be in the eye of the beholder, a well-functioning and sustainable health system is one that puts patients’ interests above all others and holds health providers accountable.

Australia’s universal health care system is one of the best in the world and we need to work hard to preserve it. Surgeries costing tens of thousands of dollars will continue unless the government regulates private medical practice or reforms the way doctors are remunerated.

It’s time to cap what physicians can charge for services and provide incentives for specialists to bulk-bill their patients.

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Why do specialists get paid so much and does something need to be done about it?

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Louisa Gordon, Associate Professor – Health Economics, QIMR Berghofer Medical Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Limited Posts

I have had some surgery in recent times and while everything seems to be going OK, healing well and all the rest, I have been finding some difficulty while sitting at the computer – so I have been easing off on the posts in recent times. I expect this will continue for the next couple of weeks or perhaps a bit longer than that. I don’t intend to stop posting completely, but there will be far fewer posts during this period. One or two Blogs that I have will receive no posts during this time, while one or two others will continue to receive the same number of posts throughout this period. However, it is all a bit of a daily thing as to just how many posts I upload.

So all is going well, but a bit of a break and rest is needed to ensure a full recovery. Thanks all 🙂

Surgery

I will soon be having a break from Blogging as I am scheduled to undergo surgery in the near future, so early November is shaping as a lean period for my various Blogs. However, it is quite possible that there will be a large number of posts once I am able to sit comfortably in front of my computer again. I expect there will be no posts for possibly the first week of November. Up until November there will be short periods of no posts, with the various preparations required previous to surgery.

Alleged Bomber of Christian Boy in Israel to Stand Trial

Hearing could determine whether Jack Teitel is transferred from mental hospital.

ISTANBUL, September 3 (CDN) — An Israeli man accused of planting a homemade bomb that almost killed the son of a Messianic Jewish pastor in Ariel, Israel has been declared competent to stand trial.

Jack Teitel, 37, who in November was indicted on two charges of pre-meditated murder, three charges of attempted murder and numerous weapons charges, is expected to enter a plea on Sunday (Sept. 5).

David and Leah Ortiz, parents of the teenage victim, said that the 10 months since the indictment have been difficult but their stance toward Teitel remains the same; they have forgiven him for the attack but want him to face justice before a judge and seek salvation from God.

If nothing else, they said, they want him incarcerated to keep other Messianic Jews from being attacked either by Teitel or those following his lead.

“He’s dangerous,” Leah Ortiz said. “He’s an extremely dangerous person. He’s totally unrepentant.”

Sunday’s plea will open the way for a trial expected to start within weeks and last for more than six months. Officials at a hearing possibly the same day as the scheduled plea will decide whether Teitel will be moved from the mental hospital where he has been held for most of his detainment.

It is possible Teitel will enter no plea on Sunday. He has publically stated that he doesn’t “recognize the jurisdiction” of Jerusalem District Court.

 

Bombing

On March 20, 2008, Ami Ortiz, then 15, opened a gift basket that someone had left anonymously at his family’s home in Ariel. The basket disappeared in a massive explosion that destroyed much of the Ortiz home and shattered Ami’s body.

When he arrived at the hospital, Ami was clinging to life. He was bleeding profusely, had burns covering much of his body and was full of needles, screws and glass fragments the bomb-maker had built into the device.

The doctors had little hope for him and listed his condition as “anush,” meaning his soul was about to leave his body.

After countless hours of surgery and even more spent in prayer, Ami went from “near dead,” to burned and blind and eventually to playing basketball on a national youth team. Both his parents said his recovery was nothing short of a miracle from God.

 

‘Most Radical Evangelist’

When Teitel was arrested in October 2009, police found him hanging up posters celebrating the shooting of two teenagers at a gay and lesbian community center in Tel Aviv.

Teitel’s background is still somewhat of a mystery. An emigrant from the United States, he became an Israeli citizen in 2000, got married not long afterwards and is the father of four children. Usually portrayed in Israeli media as part ultra-orthodox ideologue and part fringe survivalist, it is clear that Teitel was motivated by a fascination with end-times prophecy and an extremely violent interpretation of Judaism and Jewish nationalism.

He is a self-described follower of such anti-missionary groups as Yad L’Achim. According to authorities, Teitel sought to kill those he deemed enemies of traditional Judaism: Palestinians, homosexuals, liberal Jewish intellectuals and, in the Ortiz case, Messianic Jews.

David Ortiz is well known in Israel, both for his activities in the Jewish community and for his efforts to expose Palestinians to the gospel.

“He said the reason why he wanted to kill me was that I was the most radical in evangelism, so I had to be first,” said Ortiz, who has seen transcripts of Teitel’s confessions.

Along with the Ortiz case, police said Teitel is responsible for the June 1997 shooting death of Samir Bablisi, a Palestinian taxi driver who was found in his cab with a single bullet wound to his head. Two months later, police said, Teitel allegedly shot Isa Jabarin, a Palestinian shepherd who was giving him driving directions to Jerusalem.

Police also said that Teitel attempted to burn down a monastery and unsuccessfully planted several bombs. He also is accused of the September 2008 bombing of Zeev Sternhell of Hebrew University in Jerusalem. The bombing left the emeritus history professor slightly wounded.

During one court hearing, Teitel flashed a victory sign and reportedly said, “It was a pleasure and honor to serve my God. God is proud of what I have done. I have no regrets.”

 

Long Road to Trial

David Ortiz said that as bad as the bombing itself was, waiting for the trial has been yet another ordeal.

As officials investigated the bombing, police harassed Messianic Jewish friends of theirs, saying, “If you are Jewish, why did you become a Christian?” Ortiz said.

The Ortiz family had to sue police and pay 5,000 shekels (US$1,320) to obtain a copy of a security camera video belonging to the family that police had seized as evidence. The video shows Teitel laying the basket at the Ortiz home.

“We had to hire a lawyer because we understood clearly that our rights as victims had to be protected,” said David Ortiz.

Particularly galling to the pastor has been the hands-off response of government officials to the attack.

“We are the only family in Israel that has been a victim of an attack that hasn’t been visited by a government official,” he said, adding that officials have made no public condemnation of the attack. “If the leaders do not condemn an act, it emboldens others who want to do the same thing.”

According to the International Religious Freedom Report 2009 issued by the U.S. Department of State, there are 10,000 Messianic Jews in Israel. The report documents several cases of violence against Messianic Jews, including cases where baptismal services have been disrupted, Messianic Jews have been beaten and Christian literature has been torched.

 

God Shows Up

Leah Ortiz said that what Teitel intended for evil, God meant for good in order to reach people.

“The Lord has taken the worst tragedy that could possibly happen and has used it for the greatest good that He possibly could,” she said.

The incident, and how the Ortiz family has dealt with it, has become a lightning rod of sorts in Israel, forcing people to think more seriously about the claims of the Messianic Jews.

In a place filled with the type of hatred that causes people to strap bombs to their bodies to kill others, the attack has given people a reason to think and, for some, to choose forgiveness and peace.

Ortiz said he has gotten calls from Palestinians who had said if he could forgive a man who bombed his child, then they can forgive what has happened to them. Orthodox Jews have called him and asked forgiveness for their hatred toward Messianic Jews. Muslims have called Ortiz offering blood for transfusions for Ami.

Ortiz said he was devastated after the attack, but that he has been blessed to see God working “supernaturally” through the incident. Ami is an example of God’s grace and healing power, Ortiz said, explaining, “Ami has been a wonder within my own eyes. How could anyone who went through so much be so peaceful?”

Ami’s high school friends, most of them not Messianic Jews, have sought him out and asked him about the ordeal.  Ortiz said he thinks God will use him in a big way.

His wife explained, “I have that sense this is about something bigger. This is something bigger than what has happened to us and to our family.”

Report from Compass Direct News

Baseless Case Against Turkish Christians Further Prolonged

Justice Ministry receives international inquiry about progress of trial.

SILIVRI, Turkey, February 15 (CDN) — Barely five minutes into the latest hearing of a more than three-year-old case against two Christians accused of “insulting Turkishness and Islam,” the session was over.

The prosecution had failed to produce their three final witnesses to testify against Hakan Tastan and Turan Topal for alleged crimes committed under Article 301 of the Turkish penal code. The same three witnesses had failed to heed a previous court summons to testify at the last hearing, held on Oct. 15, 2009.

This time, at the Jan. 28 hearing, one witness employed in Istanbul’s security police headquarters sent word to inform the court that she was recovering from surgery and unable to attend. Of the other two witnesses, both identified as “armed forces” personnel, one was found to be registered at an address 675 miles away, in the city of Iskenderun, and the other’s whereabouts had not yet been confirmed.

So the court issued instructions for the female witness to be summoned a third time, to testify at the next hearing, set for May 25. The court ordered the witness in Iskenderun to submit his “eyewitness” testimony in writing to the Iskenderun criminal court, to be forwarded to the Silivri court. No further action was taken to summon the third witness.

International Inquiry

Judge Hayrettin Sevim, who has presided over the last five hearings on the case, informed the plaintiff and defense lawyers that recently his court had been requested to supply the Justice Ministry with a copy of relevant documents and details from the case file.

An inquiry outside Turkey about the progress of the case, he said, prompted the request.

Seven different state prosecutors have been assigned to the case since Prosecutor Ahmet Demirhuyuk declared at the fourth hearing in July 2007 that “not a single concrete, credible piece of evidence” had been produced to support the accusations against the Protestant defendants. After Demihuyuk recommended that the charges be dropped and the two Christians acquitted, he was removed from the case.

Originally filed in October 2006, the controversial Article 301 case accused Tastan and Topal, both former Muslims who converted to Christianity, of slandering the Turkish nation and Muslim religion while involved in evangelistic activities in Silivri, an hour’s drive west of Istanbul in northwestern Turkey.

After Turkey enacted cosmetic changes in the wording of Article 301 in May 2008, all cases filed under this law require formal permission from the justice minister himself to go on to trial.

According to the Turkish Justice Ministry, only eight of more than 900 Article 301 cases sent for review since the law’s revision have been approved for prosecution. On Friday (Feb. 12) the Justice Ministry declined in writing a Compass request last month for a list of the eight cases in question.

Despite the lack of any legally credible evidence against Tastan and Topal, the Silivri case is one of those eight cases personally approved by the Justice Minister.

According to a CNNTURK report dated Dec. 8, 2009, U.S. President Barack Obama raised the Article 301 issue with Turkish Prime Minister Recep Tayyip Erdogan during their last face-to-face meeting in Washington, D.C.

“I think those asking about this don’t know what Article 301 is,” Erdogan reportedly said. “Until now it has only happened to eight persons.”

This month the Organization for Security and Cooperation in Europe criticized Turkey’s revision of Article 301, declaring that the government should simply abolish the law.

The Parliamentary Assembly of the Council of Europe (PACE) in Strasbourg also warned earlier this month that Turkey is violating Article 10 of the European Convention on Human Rights to the extent that the European Court of Human Rights may impose sanctions on Turkey over Article 301.

Noting that the Assembly welcomed previous amendments to the law, the most recent PACE report declares it “deplores the fact that Turkey has not abolished Article 301.”

Report from Compass Direct News 

SOMALIA: ISLAMISTS BEHEAD TWO SONS OF CHRISTIAN LEADER

Father refuses to give al Shabaab extremists information about house church pastor.

NAIROBI, Kenya, July 1 (Compass Direct News) – Islamic extremists have beheaded two young boys in Somalia because their Christian father refused to divulge information about a church leader, and the killers are searching Kenya’s refugee camps to do the same to the boys’ father.

Before taking his Somali family to a Kenyan refugee camp in April, 55-year-old Musa Mohammed Yusuf himself was the leader of an underground church in Yonday village, 30 kilometers (19 miles) from Kismayo in Somalia. He had received instruction in the Christian faith from Salat Mberwa.

Militants from the Islamic extremist group al Shabaab entered Yonday village on Feb. 20, went to Yusuf’s house and interrogated him on his relationship with Mberwa, leader of a fellowship of 66 Somali Christians who meet at his home at an undisclosed city. Yusuf told them he knew nothing of Mberwa and had no connection with him. The Islamic extremists left but said they would return the next day.

“Immediately when they left, I decided to flee my house for Kismayo, for I knew for sure they were determined to come back,” Yusuf said.

At noon the next day, as his wife was making lunch for their children in Yonday, the al Shabaab militants showed up. Batula Ali Arbow, Yusuf’s wife, recalled that their youngest son, Innocent, told the group that their father had left the house the previous day.

The Islamic extremists ordered her to stop what she was doing and took hold of three of her sons – 11-year-old Abdi Rahaman Musa Yusuf, 12-year-old Hussein Musa Yusuf and Abdulahi Musa Yusuf, 7. Some neighbors came and pleaded with the militants not to harm the three boys. Their pleas landed on deaf ears.

“I watched my three boys dragged away helplessly as my youngest boy was crying,” Arbow said. “I knew they were going to be slaughtered. Just after some few minutes I heard a wailing cry from Abdulahi running towards the house. I could not hold my breath. I only woke up with all my clothes wet. I knew I had fainted due to the shock.”

With the help of neighbors, Arbow said, she buried the bodies of her two children the following day.

In Kismayo, Yusuf received the news that two of his sons had been killed and that the Islamic militants were looking for him, and he left on foot for Mberwa’s home. It took him a month and three days to reach him, and the Christian fellowship there raised travel funds for him to reach a refugee camp in Kenya.

Later that month his family met up with him at the refugee camp.When the family fled Somalia, they were compelled to leave their 80-year-old grandmother behind and her whereabouts are unknown. Since arriving at the Kenyan refugee camp, the family still has no shelter, though fellow Christians are erecting one for them. Yusuf’s family lives each day without shoes, a mattress or shelter.

But Arbow said she has no wish to return.

“I do not want to go back to Somalia – I don’t want to see the graves of my children,” she said amid sobs.

Mberwa said that Arbow is often deep in thought, at times in a disturbingly otherworldly way.

Border Tensions

Western security services see the al Shabaab ranks, reportedly filled with foreign jihadists, as a proxy for the Islamic extremist al-Qaeda group in Somalia. If the plight of Christians in Somalia is horrific – some are slaughtered, others scarred from beatings – the situation of Somali Christians in refugee camps is fast becoming worse than a matter of open discrimination.

“We have nowhere to run to,” Mberwa told Compass. “The al Shabaab are on our heads, while our Muslim brothers are also discriminating against us. Indeed even here in the refugee camp we are not safe. We need a safe haven elsewhere.”

He said that in April three al Shabaab militants were arrested by Kenyan security agents at Ifo refugee camp in Dadaab and taken to Garissa, Kenya’s North Eastern Province headquarters. But local provincial administrators denied any knowledge of such arrests.

“I don’t know” is all Dadaab District Officer Evans Kyule could say when asked about the arrests.

In Naivasha, Kenya, 19 Somali extremists were arrested last month and are scheduled to appear in a Nairobi court tomorrow, according to Kenyan television network.

Al-Shabaab militants have waged a vicious war against the fragile government of Somali President Sheikh Sharif Sheikh Ahmed. In a show of power in the capital city stronghold of Mogadishu, last week hard-line Islamic insurgents sentenced four young men each to amputation of a hand and a foot as punishment for robbery.

After mosques announced when the amputations would take place, the extremists carried them out by machete in front of about 300 people on Thursday (June 25) at a military camp. It was the first such double amputation in Mogadishu by the rebels, who follow strict sharia (Islamic law) in the parts of south Somalia that they control.

The rebel militants’ strict practices have shocked many Somalis, who are traditionally moderate Muslims, though residents give the insurgents credit for restoring order to regions they control.

Al Shabaab militants are battling Ahmed’s government for control of Mogadishu while fighting government-allied, moderate Islamist militia in the provinces. In the last 18 years of violence in Somalia, a two-and-a-half year Islamist insurgency has killed more than 18,000 civilians, uprooted 1 million people, allowed piracy to flourish offshore, and spread security fears round the region.

Somalia’s government, which controls little more than a few blocks of Mogadishu, has declared a state of emergency and appealed for foreign intervention, including help from Somalia’s neighbors. Kenya recently has stepped up patrols along her common border with Somalia, vowing to respond militarily should militants make any incursions. At the same time, al Shabaab militants have warned that they would invade Kenya should the military patrols persist.

Nearly Losing a Son

On Oct. 7, 2008, al shabaab militia attacked the 28-year-old son of Mberwa in Sinai village, on the outskirts of Mogadishu. They interrogated Mberwa Abdi about the whereabouts of his father, maintaining that they had information that incriminated him as the leader of a Christian group.

Abdi denied having any knowledge of his father’s faith, and the Islamist extremists took Abdi out of the village and threatened to kill him. Covering his eyes and tying his hands behind him as he knelt down, they began beating his back with a gun. Abdi remained silent. The militants fired at his left side near the shoulder, and when Abdi fell they left him for dead.

On hearing the sound of the gunshot, neighbors ran to the scene and found Abdi still alive. They rushed him to Keysany Hospital in Mogadishu, where he underwent surgery.

Salat Mberwa received information from neighbors that his son had been killed on Nov. 1, 2008 by al Shabaab extremists, and that his body was in Keysany Hospital. Later he heard that his son was in a coma and sent 2,500 Kenyan shillings (US$35) for medical care. He also arranged for his wife and two youngest children to flee, knowing that they were the next target. They reached a refugee camp in Kenya in mid-December of last year.

After a month, Abdi was discharged from the hospital and arrived in the same refugee camp on Jan. 8. Medicins San Frontiers provided medicine for the ailing Abdi. Abdi bears the scars of bullet wounds on his body, and he still looks ill.

Asked why he denied his father’s Christian faith, Abdi said Christians are hunted like wild beasts.

“Everybody is afraid of this militia group and always tries to play things safe,” he said. “There is urgent need to help Christians in Somalia to get out as soon as possible, before they are wiped out.”

Salat Mberwa said he is concerned about the way Christians are being mistreated in the refugee camp.

“The Muslims cannot come to our aid in case one of us gets into a problem,” he said. “They always tell us, ‘You are Christians and we cannot help you. Let your religion help you.’”

While thankful for aid from Christian groups in Nairobi, Mberwa lamented that aid agencies and denominational associations have not employed Christian refugees in the camp, though many are qualified as drivers, electricians, carpenters and educators.

Report from Compass Direct News