Free National Movement (FNM) Deputy Chairman Dr. Duane Sands yesterday called a forensic audit of the Public Hospitals Authority's (PHA) supply of pharmaceutical drugs and medical
supplies "absolutely outrageous, earth-shattering and alarming".
"On the face of it, the details that were outlined in the report, both in the main body of [The Nassau Guardian] and in National Review would seem earth-shattering and alarming," Sands said.
"I think it speaks to the enormity of problems in many, if not all, of the agencies in The Bahamas that are so critically dysfunctional, so challenged by process, structure and technology that you can come up with a sordid tale for every one of them.
"The more important question is, what will this do? What will it spark? Will it provoke anything other than muted outrage?
"I think as someone who works in the system and who realizes just how dysfunctional the system is, you are still mandated by conscience to provide care for patients, even as you beg for improvements or corrections to long-held challenges."
The forensic audit obtained by The Guardian reveals that, at the end of 2013, there was a $10 million difference in pharmaceutical inventory between the physical count and what is reflected in the Princess Margaret Hospital's (PMH) computer system.
The report says there has been no satisfactory explanation for this.
The auditor, John Bain, also reports that at least one approved wholesaler took advantage of weaknesses in the materials inventory procurement process to re-use a purchase order number at least 100 times.
According to the report, the wholesaler also failed to deliver goods as contracted, was overpaid by PHA and held onto the overpayment until asked to return the funds or provide the goods.
The wholesaler is still on PHA's approved listing.
The auditor also points to alleged irregularities with how doses are administered to patients in some cases.
The report says, "Although some controls exist at the procurement and storage levels for the securing of pharmaceutical drugs, little control continues through to the ward level for the distribution of pharmaceutical drugs and medical supplies.
"A substantial amount of those people interviewed opined that drug and supplies shortages intensified at the ward level, pointing to nurses who do not record dispensed drugs, disobey the directive of physicians and provide different doses to patients, and horde drugs and supplies.
"One interviewee described the ward level as a 'black hole' for pharmaceutical drugs.
"This increased the risks to patients, and wasted the PHA's assets."
Sands, a cardiothoracic and vascular surgeon at PMH, said while there is a management system that determines unit doses of drugs from the pharmacy to the ward, on the ward that system has no way of verifying what dose is administered to a patient.
He said that is because it is recorded manually.
Sands also claimed that on any given day it is a "crap shoot at best" for certain drugs to be available.
"Let's say Duane Sands writes an order for drug 'A', and there is no stock on the ward," he said.
"Now [a nurse] may or may not notify the prescribing physician that, that dose was not given.
"Technically, she has defied the physician. In reality, she could not give a drug that did not exist.
"Oftentimes there are, and depending on how you look at it, a nurse who is attempting to solve a problem may then contact another physician and say 'Look, this order was written. We don't have this drug. Can I give such and such a drug instead?'"
Asked why that scenario was not reflected in the auditor's report, Sands said, "What I would say to you is every single day that you provide care at PMH is a battle to ensure seamless care, particularly for indigent patients.
"And it requires what some people would call innovation, what some people would call creativity. Other people would say you have deviated from the standard of care."
Sands said the whole system is fundamentally broken and needs to be broken down and rebuilt, but in the meantime, care must be provided.
No knowledge of corruption
Outside the House of Assembly, former Minister of Health Dr. Hubert Minnis said he had not read the report, but he commented on some aspects of it briefly.
He said he could not recall any incidents where nurses defied doctors' orders.
"Nurses can, especially in the Family Islands where we don't have sufficient physicians, the Pharmaceutical Act allows nurses to dispense medication," he said.
Asked whether he had knowledge of any corruption or slackness at PHA, Minnis responded, "I do not have any knowledge of it. I would not condone corruption."
The 92-page audit, dated March 31, concludes that the PHA operates a "defective system of procurement" that allows for the "continued control of the market by a cartel of pharmaceutical suppliers and suppliers of medical and surgical supplies, using a theory called selective tendering".
The auditor says the "selective tendering effectively excludes new entrants into the marketplace and introduced extreme risk of bid rigging, collusion, kick-backs and corruption".
The report also reveals that the group of vendors supplying the PHA with over 80 percent of its pharmaceuticals drugs and medical supplies is concentrated among a selected group of closely-held family entities, including some well-known and influential families in Bahamian society.
Sands said bid rigging is possible, but said the auditor's conclusion is "speculative".
He said public healthcare needs to be revamped and the level of accountability on all levels must be drastically improved.
Silence
When asked for comment outside the House of Assembly, Minister of Health Dr. Perry Gomez declined to speak.
The Guardian continued to press Gomez for a response as he walked on Bay Street, but he refused to comment.
The minister eventually asked, "Why don't you leave me alone?"
PHA Chairman Frank Smith, who was also asked for comment as he exited the House, said he has read the audit and would speak to the matter "very soon".
When asked whether he was shocked by the contents of the report, Smith declined to comment.
Minister of National Security Dr. Bernard Nottage, who was minister of health between February 2006 and May 2007, also declined to comment outside the House.
Sands said it is "unfortunate" that the relevant officials remained "defensive and ran for cover" over the revelations of the audit.
The report has not been tabled in Parliament.

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