The 12 days of ‘Operation Bug’ – The Madrid region’s disastrous plan to save its senior residences

On March 26, the premier of Madrid, Isabel Díaz Ayuso, announced an action plan to curb coronavirus contagion in the region’s senior residences. By the time the Popular Party (PP) leader had made the announcement, 1,130 nursing home residents had already died from Covid-19. Hours later, the so-called “Operación Bicho,” or Operation Bug, got underway. This was the code name used by the person who, without any relevant experience, was tasked with protecting the health of nearly 50,000 seniors. That person was Encarnación Burgueño.

Burgueño is the self-appointed managing director of Cardio Líder, a trading name that is not properly registered as a company. On the same day as Díaz Ayuso’s announcement, Burgueño was placed at the helm of the regional health department’s response to the crisis. This consisted of providing medical assistance in senior care homes, instead of transferring patients to hospital.

Burgueño did not have doctors or ambulances or knowledge of healthcare management, but thanks to her father’s contacts she was given the opportunity of her dreams: the chance to run a company in the lucrative health sector. Encarnación Burgueño is the daughter of the former managing director of hospitals in the Madrid region, Antonio Burgueño, whom Díaz Ayuso had tasked with coordinating the health sector’s response to the pandemic. Antonio Burgueño is also the mastermind behind the privatization of Madrid’s healthcare system.

EL PAÍS has had access to dozens of documents and audio recordings with the details of the chaotic and glaringly insufficient plan to “medicalize” senior homes in Madrid, a plan that lasted just 12 days.

The initiative came to an abrupt end on April 6, when EL PAÍS revealed that Encarnación Burgueño was leading the crisis response in Madrid’s senior homes. By the time the brakes were suddenly put on the plan, more than 4,200 seniors had already died in the region’s nursing homes.

Encarnación Burgueño, 50, directed “Operation Bug” from lockdown in her home. Not once did she set foot in a nursing home. She persuaded the head of a private ambulance company, Transamed, to be part of the plan. She sent the firm a paid contract by email “for the integral management of the Covid-19 crisis in social and healthcare centers in the Madrid region.” The contract was signed digitally by a senior official in the regional health department, Carlos Mur de Víu, the then-head of social and healthcare services coordination.

Evidence from Transamed could strengthen the accusations of more than 400 families of victims, who have filed a lawsuit in the Supreme Court against the premier and other regional leaders for denying elderly patients their right to medical treatment

Four Transamed ambulances visited nearly 200 of the 475 residences in Madrid in two weeks, following the instructions given by Burgueño, who in turn received guidelines from Mur de Víu.

It was not “one-off support” as the regional health department claimed after EL PAÍS exposed Burgueño’s role in the operation. For 12 days, until April 6, Transamed health workers were the first and only outside medical assistance received by thousands of senior care residents in that time. This is according to dozens of documents showing the details of the visits, signed and stamped by Transamed, as well as by representatives of Madrid’s nursing homes. The head of Transamed, Eduardo Esteban Aragonés, has shown EL PAÍS proof of what the regional government’s much-vaunted “medicalization” of nursing homes really consisted of.

“At no time was an outside doctor from Summa [Madrid’s emergency health service] or primary doctor there before us,” says Aragonés. “The care homes told us that they were calling for help but no one turned up.”

Another private ambulance company, SAMU from the southern Spanish city of Seville, visited Madrid nursing homes in this period, but not to medicalize them. Its goal was to organize the centers according to patient symptoms and provide staff with guidelines on disinfection and preventing contagion.

Two weeks ago in the Madrid regional parliament, Díaz Ayuso unrolled a long sheet of paper with a list of all the supposed medical interventions in Madrid’s care homes. But the evidence from Transamed could strengthen the accusations of more than 400 families of victims, who have filed a lawsuit in the Supreme Court against the premier and other regional leaders for denying elderly patients their right to medical treatment.

Encarnación Burgueño has declined to comment on this story. Mur de Víu has admitted that senior residents received poor medical attention for weeks, an admission that calls into question the regional government’s defense of its response to the crisis in the region’s care homes, where nearly 6,000 people have died from Covid-19.

Putting out a fire without water

Transamed chief Aragonés says that he became aware of Encarnación Burgueño on February 16 thanks to Israel Jara, one of his contacts in the health sector. Jara and Burgueño are not staff members but work instead as self-employed collaborators at Cardio Líder, a project to rent out defibrillators to shopping malls and other businesses. The two partners wanted to grow the business with the help of Antonio Burgueño’s connections, but they did not have any of their own medical supplies, as they explained to Aragonés. Jara proposed to Aragonés that he provide ambulances and health workers in a project to help residences in Castilla-La Mancha and the Madrid region.

But he did not receive more news until Tuesday, March 10, when Jara asked to meet that coming Friday. It was a frantic week, with hospitals overwhelmed by a surge of coronavirus patients. During those days, the Madrid regional government made several key decisions on how to manage nursing homes amid the crisis. On Thursday, March 12, regional health chief Enrique Ruiz Escudero announced a plan to medicalize care homes and provide medical attention to infected patients where they were. That same day, news broke of the controversial hiring of Antonio Burgueño as a regional government advisor on the coronavirus crisis. On that Friday, Mur de Víu set up a group of geriatricians who designed a policy to exclude elderly patients with dependencies from being transferred to hospital.

Hospitals began refusing admission to elderly patients, but the second half of the plan – to medicalize senior residences – did not get underway until March 26, because it hadn’t yet been approved by the regional health department. The idea was to “make home hospitalization a reality” in residences and avoid transferring patients, according to the proposal set out in the nine pages created by Cardio Líder and Transamed, which feature each company’s logo as well as that of Madrid’s public healthcare system, SaludMadrid. Finally Burgueño had good news. In an energetic WhatsApp audio message sent to Jara and Aragónes, she explains that “Operation Bug” had been given the green light.

The audio recordings from the first hours reveal conversations from a small, under-resourced team, with a huge task ahead of them. They also reveal the unfitness of the person in charge

Díaz Ayuso told the press that health chief Escudero was leading the response to the health crisis in the region’s social service residences. In a press release regarding the “action plan,” the regional government says that the Emergency Military Unit, Civil Protection and the regional fire fighting brigade would be involved in the operation. These organizations would be in charge of disinfecting senior homes and transporting the bodies of coronavirus victims. But on the question of healthcare measures, the press release provided only scant and generic information. It said: “The regional health department will assume single control of carrying out the healthcare measures in these centers.” It did not mention the involvement of Cardio Líder or Transamed.

The audio recordings from the first hours reveal conversations from a small, under-resourced team, with a huge task ahead of them. They also reveal the unfitness of the person in charge. “They need moral support. They need encouragement, for you to go even if it’s without equipment,” Burgueño is heard to say in one message, suggesting that healthcare staff enter the residences without personal protective equipment (PPE). Aragonés’s team was made up of four healthcare vehicles with four doctors, two nurses, seven ambulance crew and two coordinators.

Burgueño, on instructions from Mur de Víu, gave orders to the healthcare staff on the ground. She told Aragonés that there were 10 residences that were “terrible” and another 30 that were bad. Mur de Víu wanted them to go to four that were in a critical condition first: San Celedonio, Amavir in Colmenar Viejo, las Hermanitas de los Pobres and Fundación Reina Sofía.

The companies were trying to save their reputations, and the dramatic situation in these centers was reaching the press from first-person accounts supplied by relatives and staff

The scene that Aragonés’s staff found was Dantean. Seniors in agony with no morphine, bodies that had been lying there for five days without being collected, and many faces marked by horror. The medical staff entered the rooms dressed in full protective suits, and sometimes the seniors would burst into tears from fear. “Why isn’t Antonio here, my friend from dominos?” one elderly man asked Aragonés. “I’m going to die, aren’t I?” said another.

Many residences were on the edge of a cliff, and were in an even worse situation than that described by their bosses by telephone to the inspectors from the Social Policy department and contained in an Excel spreadsheet that had got into the hands of Burgueño. The companies were trying to save their reputations, and the dramatic situation in these centers was reaching the press from first-person accounts supplied by relatives and staff.

Burgueño wanted to verify whether the information in the spreadsheet was true, to the surprise of Aragonés, who didn’t understand why they had to dedicate their time to auditing tasks instead of making people better. Only when a patient needed immediate attention did they make an emergency intervention in the residence. No one showed him the exclusion protocols for hospital transfers, which he only heard about during visits.

The leader of the operation explained to him that they had to “map out” the situation so that they could choose centers that could be turned into geriatric hospitals. Her idea was to centralize the attention for these residences before the arrival of ventilators – a piece of equipment that half the world was fighting over. But thinking about intensive care resources like those seemed like a pipe dream given that the centers Aragonés was visiting were lacking the most basic equipment: oxygen tanks, pain-relief drugs and sedatives. Without prescriptions, Aragonés was also unable to buy the medications being used against the virus in hospitals, such as antiviral drugs. The oxygen that they were carrying in their vehicles ran out after a week and there was no way of getting hold of more.

“It was like sending a single fire engine to a forest fire,” says Aragonés today, reflecting on the experience. “What do you do when the water runs out?”

Aragonés would leave home at dawn and would get to sleep at around 3am, after uploading the documentation from each nursing home to a computer. Burgeño, however, was not always available despite the fact that they depended on her for the organization of routes or to pull strings when the residences wouldn’t let Aragonés’s team in, because they didn’t trust them. “Some of the directors feared that we were from the press,” Aragonés explains. Burgueño would sometimes fall asleep and she would take a siesta in the afternoon. “I crashed out, sorry,” she would say.

In news reports from those days, Aragonés and members of his team are seen before the TV cameras with uniforms carrying the logo Ambulancias GTM, the other trading name used by the company. They asked Burgueño for uniforms with the regional government logo on time and again, but they were never supplied.

After various requests, on March 30 the head of the operation finally gave the team the Excel sheet so that they could organize their routes better. The tables showed the terrifying situation of that day, including the number of deaths per center and their requirements. Many things were missing, including such basic supplies as morphine, which 25 centers had requested.

Everything was going well for Burgueño on April 4, when she sent an audio message to Aragonés to congratulate him. “We’ve seen around 8,700 old folk,” she says in the recording. “Do you know what that means? The work that you’ve done? In a week… I’m freaking out. If we carry on like this we’re going to end up being the kings and queens of healthcare management in the Madrid region. OK? I can’t believe it. You’re amazing. You’re going to make my dream come true, which is to work in the world of healthcare, and have my own company.”

But on April 6, those ambitions were dispelled. At 3.01pm, EL PAÍS published the news story about who Burgueño was, and who her father was. An hour later she called for the work to be halted. “Listen. Don’t go anywhere this afternoon Eduardo, I’ll call you,” she says to Aragonés in an audio message. He was left waiting for news at the company base in the Madrid city of Coslada. That morning they had continued making their visits to residences, which were seeing external medical staff for the first time.

Burgueño stopped answering Aragonés’s messages and calls, in which he was demanding to be paid. The contract that Burgueño had sent him on March 25 signed by Mur de Víu stipulated that the payment for services and materials would be deposited in an account that he had specified. Aragonés sent Burgueño an invoice for €16,450, which only covered the hours worked by his staff.

Aragonés continued to work during the crisis, because his vehicles and staff had been hired by other clients, such as the Vitalia group of care homes, which distributed its seniors between its five residences in Madrid according to symptoms.

Burgueño reappeared on April 14 to say that Mur de Víu wanted to pay them, but that he was waiting for the right moment and way to do it. “The fire has burned, but it hasn’t burned too much,” she told him. “Mur is defending himself. After this crisis he is going to go [from his job] but he wants to pay us for that beforehand. My father is talking to him.” She adds that Mur de Víu is seeking a trusted supplier to make the payment. “He can’t sign for any payments until the counselor speaks in [the regional] parliament,” she said. “I can’t send him messages or speak to him right now. I’m waiting for my father to speak to him.”

A tweet from Madrid regional premier Isabel Díaz Ayuso announcing the sacking of Carlos Mur de Víu.

The excuses continued. Aragonés realised that he wasn’t going to get paid, in particular on May 13 when Mur de Víu was sacked. The regional premier published a tweet in which she praised Mur’s work. “Carlos Mur has done a great job in the senior residences, and is one of the people who have contributed the most to stopping the virus in them. This change has nothing to do with his work; we are reshuffling the department and I will be counting on him.”

Burgueño wanted to turn the page on the whole situation. “In theory we were there voluntarily,” she told Aragonés. The ambulance manager has filed a complaint against Burgueño, and due to the non-payment his company has entered into an arrangement with its creditors, leaving the healthcare staff it has employed for years in the lurch. These employees are suffering given that they work covering sports or leisure events, activities that are yet to start due to the coronavirus. Aragonés says that he is willing to continue working with public administrations during the health crisis, but provided that they are honest.

“I’m not doing it for money,” Aragonés explains regarding his revelations to EL PAÍS. He says that he is seeking justice for the families of the coronavirus victims and for his staff. “It’s as if all of the work that we did didn’t exist,” he continues. “We worked our fingers to the bone, 12 hours a day face-to-face with Covid and now no one appreciates it and only prejudges how badly everything was done in care homes. But no one has seen all of this.” He is right. No one had seen what really happened in Madrid’s care homes, but slowly and surely it is all coming to light.

English version by Melissa Kitson and Simon Hunter.