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A former IHSS hospital manager criticized the government's L10 million in payments to private hospitals for 145 surgical procedures, arguing that spending on private care cannot substitute for strengthening the weak public health system through better staffing, resources, and administration.

Liberal Party congressman Carlos Umaña questioned whether the Asfura government negotiated lower surgical prices as required by an emergency health decree, alleging that 145 procedures totaling over L10.3 million (about $412,000) were overpriced compared to private-market rates.

The president of the Medical College says public hospitals are canceling operations due to shortages of sterile surgical supplies, sutures, and lab reagents—a broader crisis beyond the fentanyl shortage—while questioning the government's accounting of emergency surgeries performed in private centers.