Rafael J.’s family doctor confirmed just two weeks ago that he still had signs of skin cancer. Two new head wounds, very close to the scars where the previous ones were, set alarm bells ringing. The doctor who treats him in the Tres Cantos public health facility, where this 79-year-old neighbor lives with his wife, immediately put him on the waiting list for surgery: “They will call you in a month, or at most a month and a half.” However, the call he received a few days later from the hospital in La Paz, where the outpatient surgery was to be performed, was for something else: They couldn’t remove the cancerous lesion because he had eyelid reconstruction surgery pending, and regulations don’t allow him to be on two surgical waiting lists at the same time.
When he received the call, Rafael was speechless and hung up without asking many questions. He didn’t know the law or anyone who had been in his situation before. Shortly afterwards, when he told his family doctor that he had been removed from the list, he could only tell him that he didn’t know why either.
Manuel Castro, traumatologist at the 12 de Octubre Hospital and deputy secretary of the Amyts union, emphasizes that this regulation, approved in 2016 by the Directorate of Health of the Community of Madrid, is foreign to “99% of doctors” and, by extension, to almost all patients. “They don’t know because it doesn’t affect them in their work. Doctors prescribe and then the admissions service deals with the waiting lists.”
Ordinance 804/2016, which prohibits patients from being on two surgical waiting lists at the same time, is mandatory in all public hospitals in the region. The regulation, Castro says, responds to a promise made by former regional president Esperanza Aguirre that no Madrid resident would wait more than a month for surgery. “With the same idea, the law was refined so that only patients who were 100% ready for surgery were on the waiting list.”
This is a specific rule of the Community of Madrid, which other communities do not have, explains Castro. While it may seem illogical, the doctor explains that it makes medical sense: “If you’re recovering from knee replacement surgery, for example, you can’t have another surgery at the same time.” But he also underlines that medicine is not mathematics and that the need to intervene depends on each case.
Castro points out that the number of patients waiting for surgery in Madrid that Sermas provides each month does not include all those who objectively need surgery, but rather those who will have no medical objection to entering the operating room, for example tomorrow. “There is not even anyone who has been prescribed surgery by a specialist, but for whom the anesthesiologist for some reason does not deem it suitable,” exemplifies Castro, about other patients who are waiting, but are not reflected in public data.
This system, underlines the deputy secretary of Amyts, does not mean that patients are treated worse or better than in other communities that do not have this law. If service and waiting times in Madrid’s public healthcare system work properly, in theory there should be no problem if a patient completes one procedure before undertaking another.
The Ministry of Health speaks through a spokesperson about Rafael’s specific case: “The patient was placed on the dermatological waiting list with normal priority due to suspected basal cell carcinoma, a non-serious and slow-growing lesion.” According to the spokesperson, the regulation provides that, “if there is duplication in the waiting lists, as long as none of them has priority”, the intervention “decided by the patient together with the professionals” or “the one with greater seniority” will be carried out. And they clarify that “if the pathology or process is marked as oncological, no one is ever excluded from that waiting list”.
After his case was reported by the CC OO union, the La Paz hospital, to which Rafael belongs, called him again and informed him that the eyelid reconstruction surgery was scheduled for November 24. “They didn’t give me any further explanations, just the date, but it was clear that they knew my file,” says Rafael, who spoke to EL PAÍS from his home in Tres Cantos and asked that neither his face nor his surname be revealed. He had been in line for that surgery for four months and believes that if his situation hadn’t been made public, he would probably still be waiting. “The way public health is going, I wouldn’t be surprised.”
In the Community of Madrid, up to September 2025 (latest data available), there were 101,459 patients on the surgical waiting list for any specialty, with an average delay of 58.9 days. In the La Paz hospital alone, as of that same date, there were 8,557 people waiting for surgery, which usually takes an average of 61 days from being placed on the list to being performed. For the intervention of the ophthalmology specialty, the one that will treat Rafael’s eyelids, the delays would be shorter: 1,143 patients in line and a delay of 57.8 days. For dermatology there were 400 people and a wait of 68.4 days.
An endless story
Rafael knows that his cancerous lesion will not evolve unfavorably overnight, but his experience with the times of public health is what puts him on alert. Eyelid surgery began to be considered in 2023, while he was being treated for cataracts. The ophthalmologist told him that as he aged, the skin was sagging and would increasingly reduce his field of vision, so it was best to have surgery as soon as possible. They proposed that he be followed to a center run by Quirón and Rafael agreed, even though, due to his confusion in showing up for the appointment, months later he found himself in treatment, again in La Paz.
There they did the campimetric test which had never been done before, but due to an error in the technique it turned out that he had no problems. “They put two tapes on me to lift my eyelids and, of course, I saw everything very well that way,” says Rafael, who says that the doctor who was treating him at the time put his hands to his head when he learned about the story of the tapes.
Rafael tells it as a joke, or as a footnote to a story that doesn’t seem to make sense. When the campimetry was repeated months later and it was again determined that eyelid surgery was necessary, another doctor treated him. “He told me I actually looked good and asked me if I was interested in going into an operating room. Nobody likes going into an operating room and I said no.” The operation was suspended again, but at the end of 2024, in a new review, the skin on the eyelids had grown so much that there was no longer any doubt about the need to remove it. However, his inclusion on the surgical waiting list did not occur until June 24, 2025, two years after he was first offered it.
