Right To Reply

Dr Shanthi Samarasinghe, Provincial Director of Health Services of the Central Province has sent us the following right of reply:-

On the 2nd of April, 2017, in an article entitled “High Tech Medical Equipment Idle At CP Hospitals”, the Provincial Director of Health Services (PDHS) Central Province and me, Dr. Shanthi Samarasinghe, the Provincial Director were accused of improperly spending millions of Rupees of taxpayer money to purchase needless and unusable high-tech medical equipment in excess.

The reporter stated in her article that my office did not provide necessary training for the medical staff in the relevant hospitals, thereby causing the new machines to be rejected and left unused. The reporter further accused me and my staff of lacking in administrative skills by quoting the Chairman of Health Statistical Officers Union of Central Province Mr. Pradeep Dharmasuriya and an unnamed Medical Superintendent employed by the Central Province. The allegations are paraphrased below:

1.   The Central Province Department of Health Services spent millions of tax payers’ hard earned money to purchase medical equipment but did not provide the necessary infrastructure facilities and buildings, medicine or training for the staff to operate these equipment, thereby causing the hospitals to reject the devices.

2.   Dr. Samarasinghe purchased more technologically advanced Cardiolife Defibrillators with added features for Rs. 1.99 million per unit, while the same unit with less features was purchased for Rs. 642,000 per unit in 2015. Both these machines can perform the same services and yet those purchased in 2016 costs Rs. 1 million per unit more, essentially costing the country at least Rs. 18 million in excess.

3.   18 Hospitals rejected the new Defibrillators claiming they lacked skilled and trained staff to operate them. These hospitals are: Wattegama, Bokkawela, Talatu Oya, Galaha, Panwilatenna, Kolongoda, Hasalaka, Jambugahapitiya, Morayaya, Galagedara, and Ambagahapelessa in Kandy District, Leliambe, Muwandeniya, Maraka and Illukkumbura in Matale District, and Gonagantenna, Lindula and Walapane in Nuwara Eliya District. After the hospitals rejected the machines, Dr. Samarasinghe asked the supplier to remove the additional features and refund the money. However, the initial high-tech nature of the machines that were ordered ended up costing the taxpayers more money because the machines were ordered with ETC02 and IBP features, even after TMI solutions removed ETC02 and readjusted the cost of the machines.

4.   Dr. Samarasinghe tried to prove that two parts of the defibrillator had been removed while only money for ETC02 was reimbursed.

5.   Although the Central Province PDHS claims that the Defibrillators were purchased at the request of Health Directors of Nuwara Eliya, Kandy and Matale in order to establish Emergency Treatment Units (ETUs) in hospitals, none of the Medical Superintendents or Directors asked for these machines as there were no such plans to establish ETUs.

6.   Ten out of Twelve hospitals in Central Province have rejected Multi Para Monitors that were purchased by the PDHS because there was no skilled staff to operate them. These.Multi Para Monitors were redistributed to Nawalapitiya, Matale and Dambulla hospitals.

7.   Infusion Pumps bought in 2015 with Health Sector Development Project (HSDP) funds remain unused at hospitals in Uduwela, Sangarajapura, Narampanawa, Dolosbage, Yakgahapitiya, Akurana and Deltota. 11 syringe pumps were rejected by Wattegama, Talatuoya, Bokkawala, Galaha, Panwilatenna, Jambugahapitiya, Kurunduwatta, Udagama, Atabage, Galagedara and Ambagahapelessa. An incubator, which was rejected by Galagedara Hospital due to lack of a premature baby care unit was later relocated to Rikillagaskada Hospital.

As I was not given the rightful opportunity to disclose the facts relevant to the purchase of the medical equipment prior to the article being printed, I will do so now in this letter as I address each allegation listed above.

1.   This allegation is filled with errors. A national health policy by the Ministry of Health decrees ETUs to be built in hospitals countrywide. Documents outlining this initiative is available should you need further proof. This initiative is funded as a part of the HSDP Project, based on the achievement of predetermined disbursement-linked indicators (DLI). The DLIs include relevant medicine, infrastructure and equipment, which are essential for the establishment and operation of ETUs. These DLIs must be achieved before the funds are released.

ETUs significantly reduce the number of deaths in 24 hours of critical patients. That is why the Ministry of Health is aggressively establishing these new units, so that many lives across the province can be saved.

My office purchased the equipment mentioned in the article in order to achieve the DLIs. Prior to placing the equipment at peripheral stations, special training sessions were carried out for the doctors and other staff members to ensure the proper handling of the high-tech medical equipment . Members of the ETU staff were trained in the functioning and maintenance of the services using high-tech equipment. Such training is a national requirement according to the health development plan under HSDP. Information on attendance for those training sessions are attached herein. (Attachment 3)

All the health care institutions mentioned in the article possess the basic infrastructure including buildings, water, electricity, medical and non-medical equipment and the staff members as well. These institutions are being upgraded with the introduction of new facilities including medical technological innovations. Every single improvement in these hospitals is based on the priorities of the experts in administrative and technical health fields of the province.

As per HSDP DLIs, all recommended medicines have been made available at the hospitals with ETUs, in a timely manner, as soon as the construction was completed and were ready to function. Ministry of Health Supervisory staff have been monitoring the establishment and operation of ETUs. The heads of these institutions are well aware of the need to estimate the annual requirement of essential medicines for the management of emergency cases that include patients with acute heart diseases. National and regional medical supplying divisions are also responsible for making the required medicine available at ETUs in a timely manner. Therefore, their drugs distribution programs have prioritized ETUs.

According to the national policy guidelines, there is a fixed list of criteria as determined by the Ministry of Health that decree the specification requirements of an ETU building. In every hospital mentioned in the article, which have all been selected by the HSDP project, ETU buildings that have been built according to the specification requirements are available.

2.   This allegation is untrue. The model of defibrillator purchased in 2015 (TEC5621K) cannot perform the functions of the model purchased in 2016 (TEC8352K). TEC5621K is a basic defibrillator that supports restarting of the heartbeat, whereas TEC8352K is equipped with a monitor that provides information on a patient’s blood pressure, ECG, temperature, and SP02. As Mr. Sampath Kularatne has clearly stated in the article, the advanced features and improved technology of the model purchased in 2016 has caused the model to be superior and therefore more expensive.

The machine purchased in 2015 is only capable of restarting the heartbeat by sending an electric shock to the heart, whereas the machine purchased in 2016 provides information on the vital signs of critical patients, based on which, the doctor on site can determine the condition of those patients and treat them accordingly. This is why the Technical Evaluation Committee (TEC) including critical care consultant have recommended the purchase of TEC8352K.

3. This allegation is erroneous due to ignorance. The Defibrillators were given to the 18 hospitals as based on a national health policy and all hospitals have to adhere to decisions made by the Ministry of Health at national level. Therefore, it was not an option for any of the 18 hospitals to reject the machines and it is worthwhile to note that the Defibrillators were never rejected, and that in fact, they are currently in use.

To purchase these machines, there is a preset procurement procedure in place, which my staff and I have rigorously followed. As a part of this procedure, a TEC comprising of a critical care consultant and a biomedical engineer make recommendations towards the specifications of the machines to be purchased. The initial recommendation made by the TEC called for IBP and ETC02 features to be included in all the Defibrillators and the order for the machines was placed. Afterward, the TEC made a second recommendation that for some hospitals, the ETC02 and IBP features were not necessary and could be removed. I requested the IBP and ETC02 features to be removed based on the second recommendation. The ETC02 feature is an extra component and could be removed, whereas the IBP was an inbuilt feature of the machine, and could not be removed. As an inbuilt feature of the machine, the IBP component did not cost extra money. TMI solutions refunded us the pertinent Rs. 270,000 per unit for removing the ETC02 feature. As mentioned before, it was the advanced features of the machines, which is imperative for better patient care-and not an error made by me or my staff-that contributed to the increased cost of the machines. It is worthwhile to note that the Provincial Health Department did not lose any money as accused by the reporter, simply due to the fact that the IBP is an inbuilt component.

4.   There is no truth to this allegation whatsoever. I did not intend to prove that I was taking actions to remove both IBP and ETC02 features while knowing that only the ETC02 feature could be removed, in order to mislead any party or exonerate myself at future inquiries. The correspondence exchange shows that I made this revision according to the second, aforementioned recommendation by the TEC.

5.   This allegation is false. Apart from the regional directors, Medical Superintendents and Directors of the Hospitals regularly submit their annual requirement of medical equipment in a priority order. The requests consist of high-tech equipment including Defibrillators, Multi Para Monitors, and Infusion Pumps, which are vital for the curative care services. The Ministry of Health has given instructions to make these equipment available at the curative care locations, especially to target the reduction of case fatality due to Dengue/Dengue Hemorrhagic fever by improving the patient care with fluid management.

As we mentioned earlier, according to the HSDP plan, all the hospitals mentioned in the article need ETUs. There is proof in the form of an action plan and correspondence between the hospital directors and myself that medical equipment for these ETUs was requested and to fulfill those requests, the equipment was purchased. The statements made by Mr. Dharmasuriya and reported by the reporter regarding this are false.

The claim that there were no plans to start ETU is unfounded. The plans laid out by HSDP from 2012 to 2017 has special emphasis on improving ETUs, which has led to the development of provincial plans to establish ETUs, to achieve HSDP DLIs. According to this plan, all the hospitals mentioned in the article should have ETUs by the end of the year 2018.

6.   This allegation is false. Provincial Health Department has not been informed of any refusals of Multi Para Monitors from the mentioned hospitals. But a special request by major hospitals has given the priority to provide those Multi Para Monitors to District Base and General Hospitals leaving Divisional Hospitals for future procurement.

There are doctors and nursing officers working in these hospitals. Both categories are extensively exposed to use high-tech medical equipment in their basic and post basic trainings; hence the staff is skillful enough to use these Multi Para Monitors. Additionally; technical staff of the Bio Medical Engineering Unit, Technical representatives from the vendors, and other officials commonly visit the mentioned institutions to train the staff to use the equipment.

There is a fixed procedure to provide equipment to the hospitals in the province. The reason that Multi Para Monitors were delivered to the Nawalapitiya, Dambulla, Matale and Rikillagaskada hospitals was in response to their requests-not because they were rejected by other hospitals- and now they are in use for patient care.

7.   This allegation is erroneous. An Infusion Pump is used for intravenous administration of medicines or other fluids in a metered dose per given time in a continuous supply. The doctors and nursing staff has been prepared to use these equipment at their basic trainings.

An ETU should possess Infusion and Syringe Pumps according to the HSDP guidelines, regardless of whether the equipment was not used for a period of two years, because the institution must be ready and equipped with these pumps to use them when necessary.

No Divisional Hospital has rejected the Infusion Pumps or requested the Provincial Health Department to redistribute them.

The allegation on incubator is also false. DH Galagedara is a type A Divisional hospital which should be upgraded to an intermediate level below the Base Hospitals as it is situated in a geographically important location between Kandy and Kurunegala. As a part of this plan, an incubator was given to DH Galagedara, but it was later redistributed to DBH Rikillagaskada as an administrative decision due to a high demand.

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