Patients Face Longer Delays as Santa Maria Probe Halts Weekend Skin Clinics

Scarce operating-theatre time in Portugal’s capital is about to stretch even further. A disciplinary bombshell at Hospital de Santa Maria has removed one of its busiest surgeons, exposed fragile oversight mechanisms and raised awkward questions about how public hospitals reward extra work.

A Rare Public Suspension Rocks Lisbon’s Flagship Hospital

Until last week Miguel Alpalhão was known mainly to colleagues and patients in the Dermatology wing; today his name headlines prime-time news. The Unit for Local Health of Santa Maria (ULS) imposed an immediate suspension with total loss of pay, citing conclusions from an IGAS inspection that documented an unusually lucrative run of surgeries performed under the “produção adicional” regime. The internal board acted on 28 November, and within hours the 46-year-old specialist tendered his resignation, effective 12 January. In his departure letter Alpalhão described the decision as “humiliating and persecutory,” arguing that management was scapegoating one physician to hide systemic failings.

Investigators say the doctor not only operated but also authorised, coded and billed his own procedures more than three-hundred times. Records show earnings above 700 000 € in just three years, including almost 400 000 € generated during ten Saturdays in 2024. Portuguese regulations allow doctors to earn extra by tackling surgical backlogs at weekends, yet the report alleges that codification shortcuts converted simple ambulatory acts into higher-paid interventions. The hospital now faces the prospect of reclaiming funds and responding to scrutiny from the Public Prosecutor’s Office and the Portuguese Medical Association.

How an Incentive Turned into a Personal Windfall

The produção adicional scheme was introduced nationwide to shorten waiting lists without forcing patients into the private sector. Surgeons volunteer for overtime; taxpayers foot the bill; oversight is expected to ensure fairness. In Santa Maria’s dermatology block that formula unraveled spectacularly. According to the inspection, Alpalhão scheduled rapid excisions that often lasted five minutes, yet were filed as small-scale hospital surgery, a category that pays more than standard outpatient care. He even treated his own parents without the mandatory external referral, pocketing 5 500 € for the family procedures.

Auditors highlighted an environment where internal controls were either weak or bypassed. Computer flags that should have prevented a surgeon from validating his own codes were ignored. Meanwhile, teams of residents sometimes logged cases under the absent senior’s name. The episode throws light on a broader tension within the National Health Service: hospital managers are under public pressure to cut queues but have limited capacity to verify every overtime record. As one senior clinician phrased it privately, “the same incentives that move lists forward can also move the dial on honesty.”

Fallout for Patients and Staff: Longer Waits, Leadership Vacuum

The immediate casualty of the scandal is access to care. Dermatology’s weekend operating slate—precisely the tool designed to clear backlogs—was frozen in May when suspicions first emerged. Since then the waiting list for skin surgery at Santa Maria has swollen by roughly 1 000 patients, according to figures released by the board. Senior staff describe a service in “near-collapse,” with urgencies often handled by residents on their own and elective cases piling up. The previous head of department stepped down and, after months with no takers, Joana Antunes finally accepted the directorship.

That leadership vacuum coincides with national anxiety over rising hospital protests and winter pressures. For Lisbon residents accustomed to Europe’s second-longest dermatology waits, any additional delay feels intolerable. Some have already opted for private clinics, shifting costs from the state to household budgets. The hospital says 3 919 electronic files have been reviewed and re-entered into the system, a painstaking process that should allow new overtime rosters—this time under tighter scrutiny—to resume in early 2026.

Accountability Maze: What Happens Next

Multiple institutions are now stepping onto the stage. IGAS has forwarded its dossier to the Public Prosecutor, which will decide on possible criminal charges, including fraud. The Medical Association’s Southern Disciplinary Council is assessing potential breaches of professional ethics; its sanctions can range from warnings to expulsion. Within the hospital, a second internal inquiry is quantifying the money to be reclaimed—a figure likely to exceed half-a-million euros once recalculated tariffs are applied.

Policy specialists point out that Santa Maria is hardly the only unit relying on overtime packages to tame surgical queues. Earlier this year health minister Ana Paula Martins ordered a national audit of production-additional payments; preliminary findings are due in February. Reform ideas on the table include independent coding teams, realtime dashboards and an upper limit on weekend earnings. Whatever emerges, the Santa Maria affair has already forced a reckoning: transparency in public-sector healthcare is no longer optional but existential.

Portugal’s oldest teaching hospital prides itself on being a crucible for medical innovation. Yet its latest headline is a cautionary tale about what happens when financial incentives outrun control systems. For the families still waiting for a dermatology slot, the true cost of the scandal will be measured not in euros but in weeks—and possibly months—of delay.