By DANNY HAKIM

ATHENS — Fotini Katsigianni wears a white nurse’s hat that protrudes prominently from the top of her head. She is head nurse at Evangelismos Hospital, one of the city’s most prominent.

So she was surprised last month when she was approached by a man in the hospital’s hallway. At the time, Ms. Katsigianni’s husband was a patient there. The strange man extended an arm with a business card and averted his face, so she could not identify him. He offered to rent her a cut-rate nurse.

“He told me for 30 euros I could have whatever I want!” Ms. Katsigianni said, laughing at the idea of the head nurse being solicited to buy illegal nursing care.

First the men come to the hospitals of Greece during visiting hours, leaving business cards with pictures of nurses under pillows and in waiting rooms. Then the women come at night, mostly foreigners from countries like Georgia, Romania and Bulgaria. They are the nurses of Greece who aren’t really nurses.

Greece’s dire finances have gutted its health care system. Universal coverage effectively ended under the austerity measures imposed under the terms of the country’s bailout. Budget cuts have also thinned the ranks of hospital staff nurses, who are supposed to handle medical tasks like changing IVs.

Now, when patients come to a hospital in Greece, they increasingly have to hire their own nurses just to receive basic care. While private nurses have long been a feature of Greek health care, the country’s wrenching economic crisis has left many patients with neither the money nor the insurance coverage to hire licensed caregivers.

Instead, patients are turning to illegal nurses, often immigrants with little or no training. One top official said he believed that half of the nursing care came from 18,000 illegal providers.

The situation reflects the grip of the black-market economy on Greece, where even paying skilled workers like mechanics and plumbers under the table to avoid taxes is commonplace. Frustrations among Greeks over the deterioration of living standards helped feed the left-wing Syriza Party, which came to power last month vowing to reject austerity policies.

Illegal nurses typically pose as family members or say they are longtime personal employees of a patient. In reality, temp agencies employing these women send men into the hospitals to distribute business cards advertising 12 hours of nursing care for less than $60. By contrast, a contract nurse at another hospital, Sotiria, costs nearly $70 for 6 hours and 40 minutes, though those who still have insurance can be reimbursed for about a third of the cost.

Thanos Maroukis, a professor at the University of Bath, England, who has studied the problem, said temporary agencies are taking “over control of the hospital’s workplace,” adding, “It’s incredible what’s happening, but it’s true.”

Nurses are just the beginning. Almost anything can be rented.

“We have the same thing with TVs, with ambulances, I would say with bedding,” said Anastasios Grigoropoulos, the chief executive of Evangelismos Hospital. “Or chairs.”

Chairs are carried in by strangers who rent them to groups of visiting relatives. Or they bring televisions.

In many other developed countries, hospital security would simply expel unauthorized visitors. But administrators face staff shortages and impoverished patients. They also say they lack the legal jurisdiction to act without police intervention.

“Because of the crisis, the last three years, we see more and more illegal nurses,” said Mr. Grigoropoulos. “You can’t do anything.”

He has called the police, and a few days earlier, Evangelismos was raided. Several illegal nurses were arrested, but that is a fairly rare event, because the police have had their own cutbacks.

Government agencies, too, have been overwhelmed. An influx of immigrants since the 1990s swelled a pool of cheap labor.

These immigrants “filled the space and found themselves in every clinic and every hospital,” said Dimitrios Papachristou, a senior official at the Social Insurance Institute, a state agency known by its Greek acronym, IKA, which provides insurance and pensions to 2.2 million Greek workers, including nurses. “Why is that? There was a great demand by the patients” for cheaper care, Mr. Papachristou said.

Part of the problem, he said, was that his agency had been given the task of conducting inspections of nursing credentials, a task beyond its typical expertise.

“Let me give you an example,” he said. “I’ll send an inspector to a hospital to inspect contract nurses who work there. So I find at that hospital 15 people who are working there do not have an IKA permit.”

But often he does not have the authority even to issue fines. Instead, his agency reports such incidents to hospital directors, and they decide whether to call the police.

“It’s an extremely illogical thing,” he said.

Because most illegal nurses are immigrants, Golden Dawn, the far-right extremist party, has attempted some of its own “raids” on hospitals, advancing its xenophobic agenda.

But some of the real nurses having trouble getting work are themselves immigrants, like Eleni Souli, a 41-year-old Albanian who married a Greek man and works as a contract nurse. She was sitting among a group of eight other nurses at a cafe outside another Athens hospital recently. All had studied for two to four years to become nurses, and they poured out their frustration over coffee and cigarettes.

“They are not nurses," Ms. Souli said of the illegal workers.

Maria Skiada, 54, has been a nurse for 23 years. She said she recently saw a woman who did not even use gloves when she cleaned up.

“That is how you get bugs all around the hospital,” she said.

Ms. Souli said doctors would sometimes be surprised at how infections spread.

“When they see that in the blood work of a patient, they’ll see something and say, ‘Where did he get that from?’ ”

She counted eight illegal nurses at the clinic where she worked the previous evening. “At night,” she said, “it’s full of them.”

That was clear in another part of town, at Sotiria Hospital, on a recent chilly night.

A young Georgian woman in a striped blue shirt was caring for a patient. She said she had already been working at the patient’s home and came with him to the hospital, a claim administrators say is frequently used. A second woman peeked out of the room next door, then waved away questions, saying she could not speak Greek.

“They take food out of our mouths. That’s how it is,” said Stavroula Antoniou, 46, a licensed nurse who works on temporary contracts at Sotiria. She emphasized that her bitterness was not tinged with racism and that many legitimate nurses were foreign-born.

“We’ve earned this,” she said of her job. “We’ve studied and we’ve sat in classrooms.”

Dr. Miltiadis Papastamatiou, Sotiria’s chief executive, said retired nurses were often not replaced, “and that’s led to the needs of both patients and staff not being adequately met,” though he downplayed the extent of the problem at Sotiria.

But a staff nurse there, who would not give her name for fear of losing her job, acknowledged the severity of the issue.

“We know what’s going on,” she shrugged. “Everybody knows.”

Source: www.nytimes.com