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Malpractice
in the office of the drugs controller
A medical doctor and activist belonging to the Drug Action Forum,
Karnataka, lodged a complaint in February 2003. A preliminary
investigation revealed multiple irregularities.
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The
office of the drugs controller (ODC) is mandated to ensure
that only authorised drugs of specified quality are sold.
Although over 249 drugs were tested and found to be
sub-standard, the test results were available only after ten
to 15 months. No action was taken to withdraw the sub-standard
drugs from the market, nor was any action taken against the
companies manufacturing these drugs. As a result, enough time
passed for all the drug stocks to be sold.
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The
ODC is responsible for controlling prices of essential drugs,
76 of which have been listed. However, it is estimated that
the people of Karnataka paid almost Rs 200 crores in excess in
the past year due to non-enforcement of price control orders
by the ODC.
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The
ODC is in charge of enforcing norms by granting licenses to
drug manufacturers and retailers. In practice, those paying
kickbacks were granted licenses circumventing norms through
slight modifications in the composition of drugs, and other
means. Those refusing to bribe, of which there were very few,
were harassed.
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The
ODC grants licences for private blood banks. This was done
with practically no monitoring or enforcement of standards. A
private blood bank in Gulbarga supplied blood that was
HIV-positive. Although a complaint was filed with the ODC, no
action was taken.
Having
observed these lapses, the KLA called a meeting of over fifty
officers. Some officers, banking on leniency for having
co-operated with the KLA investigation, were vocal in exposing the
corrupt practices. All the officers acknowledged that they were
corrupt, but claimed that they had no choice. Each drugs inspector
was required to hand over Rs 20,000 every six months to the drugs
controller, who in turn gave it to the minister. Furthermore, the
demands were increasing in frequency.
The media had a field-day when details of how bribes were
collected and how much had been paid to whom emerged at open
hearings. To contain the damage, the three officers who were
co-operating with the investigation were suspended. The KLA then
threatened to hold the government in contempt of court for
obstruction of justice if these officers were not re-instated and
protected from harassment. All three suspensions were
unconditionally withdrawn.
When two previous health ministers were mentioned by witnesses,
there was pandemonium in the state assembly. Initially there was
an attempt to close ranks and deny charges, but given the stature
of the KLA, the drugs controller was increasingly isolated. Since
then he has gone on leave, pending the KLA final report. Meanwhile
concerted action to clean up the ODC began with an Indian police
service officer in charge of bringing about reforms.
Purchase
of drugs by the general medical store
The
government periodically updates an ‘essential drugs’ list of
drugs which should be purchased and distributed by the general
medical store (GMS). Forty per cent of the drugs used by
government hospitals and primary/community health centres in the
state are purchased in bulk by the GMS. The district health
officer (DHO) of each of the 27 districts assesses needs and
requisitions the GMS for supply of these drugs.
Nine months ago, a member of the youth wing of the Congress Party
complained to the chief minister that the supply of drugs to
hospitals and primary health centres was irregular and inadequate.
The government itself requested the KLA to investigate.
Investigations showed that GMS did not even look into indents from
the DHOs’ offices and instead purchased large quantities of
drugs that were not listed on the essential drugs list. For
example, 18 per cent of the year’s budget for purchase of
essential drugs was spent on purchasing the anti-inflammatory drug
Nimesulide. This is not approved in the US and UK due to high
levels of toxicity, particularly in children, but is approved in
India. Huge stocks of Nimesulide were lying unused, while
essential and cheaper drugs such as Paracetamol were in constant
short supply.
Further research into several instances of irrational purchase of
drugs showed that the GMS favoured particular drug companies by
adding non-essential drugs to the list and buying them at thrice
the cost in the market. A system of calling for tenders was in
effect, but this was manipulated by middlemen, who appropriated
the orders, and then manufactured and supplied spurious drugs.
When questioned, the companies in whose favour the tender orders
were given stated that they had not received these orders at all.
Purchase
of medical equipment by the department of medical education
A
complaint was received against the director of medical education
and the equipment purchase officer. Why a public sector
antibiotics company was procuring dialysis machines was in itself
intriguing. Further examination showed that 11 of these machines
were purchased at the cost of Rs 11.6 lakhs, and in a hospital in
Hubli, six machines at Rs 12.3 lakhs. Yet, similar machines were
purchased by well-known private hospitals at a cost of Rs 4.5
lakhs, substantially less than half the price. Investigations
showed that costs of other medical equipment were similarly
inflated. Dealers set up companies, which existed long enough to
sell such equipment to government hospitals and then disappeared.
Many hospitals ordered unnecessary equipment at inflated costs and
these were lying unused.
Medical
education
A
few days before an examination the department head, using a house
surgeon as his middleman, informed students that they would have
to pay Rs 2,500 each if they expected to pass. While most students
paid, one chose to complain to the KLA.
Since the examination was only two days away, the examiner was
changed with the help of the registrar. The KLA called in all the
students for an investigation. The house surgeon who had acted as
middleman claimed that he was blackmailed for fear of not getting
his housemanship completion certificate. The department head,
hoping to get leniency for his co-operation, not only admitted to
his own role, but gave details of how private colleges were
charging Rs 30,000 per subject for passing grades. A joint
mechanism for vigilance was set up by the university and the
police wing of KLA to unearth such transactions. When the
department head reverted to demanding bribes, the Council of the
college passed a resolution to suspend him.
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References
(also applies to We need to fix this leaky vessel in Humanscape,
September 2003):
Anuradha Rao, May 2003. Karnataka
Lokayukta: Initiatives in the Public Health Sector, a review
conducted for the Public Affairs Centre, Bangalore.
Interview with Dr H Sudarshan
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