His doctor, Rafael J., confirmed that he was showing signs of skin cancer again just two weeks ago. A new wound to the head, very close to the scar left by the previous wound, set off an alarm. The doctor treating him at the public health system in Tres Cantos, where the 79-year-old man lives with his wife, immediately put him on a waiting list for surgery, saying, “We will contact you within a month at the latest, within a month at the latest.” But the phone call I received a few days later from La Paz Hospital, where this outpatient surgery was scheduled to take place, had a different purpose. The cancerous lesion cannot be removed because he is pending reconstructive surgery on his leg and regulations prevent him from being placed on the surgery waiting list at the same time.
When Rafael received the phone call, he was speechless and didn’t ask many questions. I don’t know the law or if Nadi was in the same situation before. Shortly after, when he commented to his doctor that he had been taken off the list, he had no choice but to conclude that he didn’t know why either.
Manuel Castro, a trauma specialist at the October 12 Hospital and deputy secretary of the Amitz union, points out that the regulations, approved by the Madrid Regional Health Council in 2016, cover “99% of doctors” and, by extension, all patients. “La unconocen por en su trabajo no les afecta. Los Médicos prescriben y ya luego el servicio de admisión el incargado de las de las deswaiting.”
Order 804/2016, which prohibits patients from being placed on the surgery waiting list at the same time, is mandatory for all public hospitals in the region. Castro said the regulation was in response to a promise made by local resident Esperanza Aguirre that Madrid residents should not wait more than a month for surgery. “With this same idea, the law has been improved so that only patients on the waiting list are 100% ready for intervention.”
Castro explains that this is a norm specific to the Madrid community, which has no other community. Although it seems illogical, the doctor explains that this only makes sense from the doctor’s perspective. “For example, if you are recovering from an artificial wheel surgery, you cannot do the same surgery another time.” But he also points out that medicine is not mathematical and it depends on each case to determine the need for intervention.
Mr. Castro pointed out that the number of patients in Madrid waiting for surgery who arrive at Selmas every month does not include all patients who objectively need surgery, but also includes patients who are medically comfortable having surgery this morning, for example. “There are specialists who prescribe surgery, but for some reason anesthesiologists are not able to perform it,” Castro said, explaining the waiting list of patients who are not reflected in public data.
Amitz said the system does not indicate that patients are treated any worse or better than in other communities where the law does not apply. If services and waiting times in public health in Madrid are working well, in theory there should be no problem for patients to finish a procedure before starting the next one.
A spokesperson for the Health Council said of Rafael’s specific case: “This patient was placed on the dermatology waiting list with normal priority due to the nature of the disease, which is a type of basal cell carcinoma and is not serious and is slowly progressing.” According to a spokesperson, the code stipulates that “whenever there is overlap on the waiting list, there is no priority person,” the patient will be “determined in collaboration with experts,” or “the person with the most seniority” will intervene. And they make it clear that they will “never remove a nadi from that waiting list if the pathology or process is marked as neoplastic.”
After his case was reported by the CC OO union, Rafael received another call from his hospital, La Paz, informing him that he was scheduled for kidney reconstruction surgery on November 24th. “There was no further explanation. It was only towards the end that I realized they knew specifically about me,” Rafael commented. He spoke to EL PAÍS from his home in Tres Cantos and asked that his face and last name not be revealed. He spent four months preparing for the surgery and believes he will probably still be waiting for it if his situation doesn’t become public. “I won’t go out because public health is important.”
In the Madrid region, as of September 2025 (last data available), there were 101,459 patients on the surgical waiting list in any department, with an average delay of 58.9 days. At La Paz Hospital, 8,557 people were waiting for surgery before this closure, and it can take an average of 61 days from being placed on the list to being operated on. In the case of Rafael’s specialized eye surgery to treat his skin, there would probably be fewer delays: 1,143 patients used adhesives, resulting in a delay of 57.8 days. There were 400 patients in the dermatology department and the waiting time was 68.4 days.
never ending story
Rafael knows that his cancerous lesions are not progressing adversely with each passing day, but his experience in public health makes him wary. Coastal interventions began to be evaluated in 2023, but were accompanied by cataracts. According to ophthalmologists, as we age, this skin deteriorates and our vision becomes narrower and narrower, so it’s best to have surgery as soon as possible. He suggested a follow-up at a center run by Chiron, and Rafael agreed, even though he left due to confusion when attending the aforementioned final viewing, which would take place again in La Paz a few months later.
Next, a campimetry test was performed, which had not been possible until now, but was found to be OK due to a technical error. “They removed the bandage to raise my shoulder, but of course he could see everything this way,” Rafael said, adding that his doctor put his hand on his head to find out what happened to the bandage.
Raphael tells it like a joke, or as if it were a memo on the surface of a story with no logic. A few months later, another round of campimetry determined that he needed foot surgery again, and he was referred to another doctor. “He was looking at me a lot and asked me if I was interested in going to the center. Nadi would like to go to the center, but he said no.” The business returned for a pause, but a new revision at the end of 2024 further raised suspicions that the grassland crust had grown so much that it would have to be discontinued at the hub. However, it was placed on the waiting list for surgery until June 24, 2025, two years after it was first planted.
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