Who Pays The Price Of Rs. 30 Billion Drug Ma fia?

By Nirmala Kannangara-Sunday, October 20, 2013 Failure to increase budgetary allocations for the countrys free health service is an indication that successive Sri Lankan governments have neglected the free health care service in the country. Secretary, All Ceylon Medical Officers Association Dr. Jayantha Bandara said that the continuous decline in budgetary allocation to the health sector over the years when globally it is the opposite, signifies that the government is pruning free health service in the country. According to Dr Bandara, the total expenditure on health as a percentage of the Gross Domestic Product (GDP) is 3.7 in year 2000 which has reduced to 3.5% by year 2010. The World Health Organization (WHO), Central Bank and World Bank statistics shows that the Sri Lankan governments have systematically reduced finance allocated for the health sector. According to WHO statistics, global expenditure on health as a percentage of the GDP in 2000 is 8.2% and this has increased to 9.2 by 2010, said Dr Bandara. According to reports, most of the people in Sri Lanka do not take medicine for their sicknesses due to lack of money. When our people do not have means to spend on medicine they prefer to stay without taking medicine. This is evident clearly in rural areas. Unlike in urban areas rural folk depends on free medicine and as a result of drug shortages in government hospitals, the doctors ask the patients to buy the prescribed medicine from private pharmacies. Except for a very few, most of the patients do not buy the medicine from outside as they do not have means for this, he added. The non implementation of the Senaka Bibile Drug Policy over the years has allowed the private sector to sell medicine at exorbitant prices without any restrictions. It is certainly questionable why successive governments have postponed implementing the Bibile drug policy. Reports indicate that all attempts to get the drug policy bill passed in parliament over the years in order to ensure quality medicine for the people were hampered due to ulterior motives of certain politicians and high ranking officers in the Health Ministry. The delay is not for anything else but to please their stooges. If Senaka Bibile drug policy is implemented, drugs and other medical supplies cannot be purchased on the whims and fancies of those who are near and dear to these politicians. The government is not concerned to provide quality medicine to its people as the big wigs are bribed by multinational drug companies. The Health Ministry dances to the tune of these drug companies without providing the people a value oriented health service, he added. When the Health Ministry blacklisted Vivek Pharma, Laborate Pharma, Bafna Pharmaceuticals,

Elysium Pharmaceuticals and Alvita Pharma recently for supplying substandard drugs, the decision was reversed due to unknown reasons. Even in 2011 eight Indian drug companies were blacklisted but however the Indian government got the blacklisting withdrawn immediately. As a result the Health Ministry still purchase substandard, quality failed drugs from these companies. Although the Indian government was concerned about the loss of income to their drug manufacturers and got the blacklisting removed, the Sri Lankan government was not concerned about the wellbeing of its people and bent their backs to the Indian government, said Dr Bandara. He adds that multinational drug companies have openly stated that they do not need Senaka Bibile drug policy implemented in Sri Lanka but only a national drug policy. Knowing that in the event Senaka Bibile drug policy is implemented, there are no loopholes to import quality failed substandard drugs specially from Tamil Nadu, these multi-national drug companies do not want the government to put Bibile Drug Policy into operation. This policy was supported by the World Health Organization (WHO) and other UN agencies with enormous benefit to third world countries and this has now followed by over 100 countries including developed nations. The advantage would be enormous and people would be able to purchase any kind of drug under its generic name at a fair price. If this policy is implemented the government does not need to spend billions of foreign exchange to import a number of essential drugs, but only a few hundred verieties of drugs. Fixed prices for drugs with quality assurance would come into the market instead of sub-standard and quality failed drugs, added Dr Bandara. Meanwhile Bandara challenged the Health Minister to take action against the officers who have misplaced the government drafted National Medicinal Drug Policy (NMDP). Dr Bandara further explained as to how the drug prices have differentiated when they are sold under brand names instead of the generic name. When our own State Pharmaceuticals Manufacturing Corporation (SPMC) has the capacity and the knowledge to manufacture most of the drugs that we need with the best quality assurance, the Health Ministry, instead of supplying raw materials to them, keep on importing medicine which are commonly sub-standard. When I made a field visit to the SPC and some leading drug stores in and around the General Hospital I found out the big price difference between the SPMC drugs which comes under its generic name and the drugs that come under brand names. When doctors prescribe these brand names the patients have no choice but to pay higher prices, he said. The Medical Supply and Technology Division of the Health Ministry is the Drug Authority which has the National Drug Quality Assurance Laboratory (NDQAL) that can check the quality of all drugs that are imported. The SPC states that 90% of the countrys required drugs are imported from India which has no quality assurance since we have no facilities to check the quality of the medicine. The NDQALs role should be to check the sample from the manufacturer to give the approval to import the medicine and then to carry out a random check before the stock is shipped. Once the stocks are brought to the country another random check has to be done before they are distributed and to check once again if there are any complaints from the people. Instead of following this procedure, the Health Ministry carrying quality assurance tests only if there are complaints from the public. Knowing about these loopholes, India keeps on sending sub-standard quality failed drugs to Sri Lanka. Experts claim that due to the failure to carry out Chemical Analysis and quantitative analysis of

the imported drugs, the doctors that prescribe these medicine have no clue whether the active ingredients are there in the medicine or not. Director, Cancer Hospital Maharagama Dr Kanishka Karunaratne, when contacted said that there are no drug shortages in the hospital. However, he admitted that the Iodine Treatment Unit is not functioning due to non availability of the Iodine drug. We had to close the unit due to non availability of the particular drug. This medicine has to be imported from Singapore and it is the suppliers delay, said Dr Karunaratne. When asked as to how lifesaving drugs have been pilfered from the hospital, the Director said that he could not make any comment as the investigationswere in progress. Once the investigations are over, we will be able to reveal as to how this fraud had taken place and who the culprits are. Till then I cannot make any comment, he added.

The Iodine Treatment Unit of the Cancer Hospital Maharagama is not functioning due to non availability of the Iodine drug Drug shortage at the Cancer hospital has sent the cancer patients from pillar to post. According to reliable cancer hospital sources, due to the shortage of Calcium Folinate, Co-Amoxiclave and Meropanan drugs over the past three months, patients have to suffer immensely. Since these medicines are not available we have requested the patients to bring them from outside. We know that these patients do not have money to buy them from outside but since there are no other options we are bound to make requests to them with the greatest difficulty, added the sources. According to the sources, Calcium Folinate is given to stop side effects from chemotherapy given for patients who have colon cancer. For one cycle the cost of this drug could be around Rs.25,000 to Rs.30,000. Co-Amoxiclave is a strong antibiotic specially given for leukemia patients as they get fever very often as their immune system is very weak. This particular medicine is also out of stock over the past one month and the patients have to be given this antibiotic injection three times per day for five days. This medicine cost Rs.8,000 and the oral medicine which is not effective cost Rs.4,000. Since 99.9% patients cannot afford the cost of the injection they bring the oral drug but the expected results cannot be anticipated, added the sources. It is the same with the IV drug Meropanan, according to the sources. When The Sunday Leader visited the National Cancer Institute Maharagama last week, patients were seen lying along the ward corridors and some were seated on chairs keeping all their belongings on their laps. While lying on the floor and seated on chairs they were given saline. I came from Matara on the 8th. As there were no beds or chairs I was asked to sleep on the floor, one of the patients said.

It was disheartening to see as to how this patient was sleeping on the ground on few pieces of cardboard and with no pillow to rest his head on. A Boodhi Puja book was by his side and when asked whether he recites the gathas, the patient looked at this reporter without uttering a word which spoke volumes of expectation he had in his mind. I have three sons and they are doing odd jobs in Matara. I came all alone to the hospital as we could not find the money for the bus fare. I came to Matara and from there to Galle and from Galle to Maharagama in a bus and took another bus to the hospital. We are very poor so how can I pay money to buy medicine. If I have the luck to survive, I will survive. If not once I die I cannot see anything, he added. Somaratne who has undergone a colon cancer also told his tale of woe and added that he had to depend on his daughter as he spends his entire pension for cancer drugs. I was asked to buy a few injections which cost Rs.30,000 if not the drug cost only Rs.9,000. I know that the oral drug is not effective like the injection but what can I do if I am not financially stable. My wife and myself get a pension of Rs.35,000 but the entire amount is spent on my medicine, said Somaratne. It was the same with Dayananda as well. He too has been asked to bring medicine from outside which cost Rs.13, 000. I was a driver and is suffering from a cancer for the past three years. At one time we were asked to get the CT Scan from outside and those who cannot afford were asked to wait till the Scan machine was repaired. So we had to wait three months. Since the medicines are given after going through the scan report, we were not given medicine during the period the scan machine was out of order. Although doctors and nurses do not tell, we know that when drugs are not given to us our cancer spreads rapidly. When you are born poor, you have to face lifes intricacies, said Dayananda. However in pediatric wards in the cancer hospital there are no such drug shortages, according to the medical staff. Since these are pediatric wards, we make sure that there are no drug shortages here. If there are, we get the medicines as soon as possible utilizing donor funds. Although most of the small children in these wards do not know what their sicknesses are, they were lucky enough to get the best attentions from doctors and nurses. When this reporter spoke to some children, they sounded ill. They were seated on their mothers laps. The source further said that the guardian who are with the children in the pediatric wards have faced immense troubles as they are unable to make a living. Most of these children come from rural areas. Their sole income generates from farming. When the mother is in the hospital with the child, the father had to look after the other children neglecting his work. In most cases the father does not come to see the child unless if it is for an emergency. There are other cases where the mother or the father who is in hospital with the child goes on no pay leave. If the government can help these working parents by getting them paid leave till the child is discharged it would be helpful. In most cases we know the parents have lost their jobs because they did not report for duty, said the sources. The Iodine Treatment Unit at the Cancer Hospital was closed two weeks ago due to non availability of iodine drug that is given for thyroid cancer. There is a long waiting list for this treatment as this is an expensive treatment if taken from a private hospital. Only six patients can be given treatment at once and once the treatment is given the patient is kept for six days in the hospital as they emit radiation from their body. The patients are kept in small dark rooms and CCTV cameras have been installed in each room for the nurses to monitor them. They are provided separate toilets and no one goes closer to them. They have been provided TVs and if a patient falls sick, the medical team has to wear the security gear to protect them from radiation before they go closer to the patient. The CCTV cameras are not functioning and the medical

staff are unable to monitor the patients from their office. Although the excreta of these patients have to be treated properly before disposing to the environment we understand that it is not happening. There are four sewerage tanks for the IodineTreatment Unit. All the waste has to be collected to one tank and after three months this has to be emptied to the second tank. The second tank has to be emptied to the third tank after three months and again after three months this has to be emptied to the fourth tank before it is disposed as excreta too carries radiation. However we understand this is not happening and this could lead to a serious situation if untreated excreta are disposed to the environment. Those who are around the areas are prone to cancers very easily as a result, said the sources. The sources further added as to how the Health Ministry had failed to provide expert training for the pharmacists that mix medicine to make chemotherapy drugs. Lives of these pharmacists are at great risk as they are exposed to cancer. It is they who mix the necessary medicines to make the chemotherapy drug. Although they wear the protective gears to cover their bodies they wear simple gloves to cover their palms. When they take cancer drugs to the syringe, it could prick their fingers accidentally. This is dangerous. This happens very often as they over work due to lack of pharmacists. There are only 14 pharmacists where at least 24are needed, said the sources. The sources further added that lack of beds and chairs at the Chemotherapy unit has caused concern amongst the OPD patients. Chemotherapy drug has to be given to OPD patients on weekdays at the said Chemotherapy Unit. Since there is lack of beds we have had to increase the speed of the drip to finish off the medicine quickly. This is not good. Generally we have to give one chemotherapy drug dissolved in saline within 45-60 minutes but we have to increase the speed of the drip to finish within 30 minutes. This should not be done but due to lack of space, beds and chairs we have had to do this. There are times we have to administer three or four types of chemotherapy drugs for certain patients within one to one-and-a-half hours. One after another we give these drugs at a faster rate. If the Health Ministry can increase the number of beds and space for the sake of these patients the cancer patients can get the chemotherapy drug as it has been prescribed, added the sources. The sources further alleged that the drugs that are imported from India are substandard. When we mix the medicine to make the chemotherapy drug, we notice that most of the medicines are substandard. We have seen medicine in the same batch in two different colours. We have also received empty vials and the quantity of most medicine differs to each and every one. When we inform this to the hospital authorities they send it to Colombo and the report says the medicines are not substandard. Due to failure to carry out Chemical Analysis and quantitative analysis of the imported drugs, the doctors and the pharmacists that prescribe and mix the medicine to make the chemotherapy drug have no clue whether the active ingredients are there in the medicine or not, said the sources. Meanwhile it was reported that a massive life saving cancer drug has been pilfered from the hospital to the supplier. This has to be investigated thoroughly and bring the culprits to book. We know after it was reported that four vials of Oncasper (Peg Asparaginase) were missing from the stocks, the pharmacies tried to find out what had gone wrong with the stocks. While they were re-checking the stocks and the drug entry books, the pharmacist in charge of the stores had noticed that four vials have come to the store with a tampered seal. Generally when the drugs are taken by the stores a special seal is printed in every box. It was this seal that somebody had tried to erase but had failed which shows that this particular vial has been

come to the stores earlier and was brought for the second time. Knowing that it should be the same vials that have gone missing the pharmacist has informed the hospital authority. Now the Health Ministry has initiated an investigation and we are waiting for the report next week to see how this has been pilfered, said the sources. However the sources said that it was not fair by the pharmacists as media has reported that three pharmacists have been involved in the racket. We dont mind taking action against anyone but when the report is not out how can the media accuse a certain group for the theft, added the sources. Meanwhile Director Marketing Omax Health Care Pvt Ltd said that he is not aware as to how his companys name was dragged for the said fraud and added that he knew nothing as to how this has happened. I came to an agreement with SJ Enterprises in January 2013 and became the sole distributor for this particular cancer drug for a period of one year. I placed an order for 20 Oncasper vials in January for Rs.4.2 million. I supplied these drugs to the MSD. Out of the 20 vials I gave 14 at a rate of Rs.280,000 each and the rest Rs.237, 000 each. Later on September 15, I donated three vials of Oncasper and another on a later date as the expiry date was nearing. Since the MSD do not accept medicine that does not have a life span of six months I donated this to the cancer hospital. Now allegations have been levelled against my company for fraud. How can we pilfer these drugs from the cancer hospital? May be the hospital staff was involved in this racket as I have come to know that some pharmacists own pharmacies in Maharagama. What was the reason for them to drag our name to this? Was it because we supply the drug to the MSD, queried the Director Marketing who did not want to publish his name in the paper.
Senaka Bibile Drug Policy Prof. Bibile played the leading role in developing a rational pharmaceutical policy to ensure that impoverished people would get quality drugs at a lower price. A careful selection of drugs was an essential component of the policies he advocated. Since there were allegations that pharmaceutical companies in the country made considerable profits by selling drugs under their trade name Prof. Bibile investigated the issue and recommended the establishment of a state body to regularize the trade. He became the founder chairman of the State Pharmaceuticals Corporation (SPC). The SPC then channelled all imports of pharmaceuticals, calling for worldwide bulk tenders which were limited to the approved drugs listed in the national formulary. The public and private health sectors obtained all their requirements from the SPC. Hence the drug trade was regulated by this body and drug sellers were forced to compete with each other, said Dr Bandara.