By Camelia Nathaniel
There are around 40,000 cancer patients in Sri Lanka at present and from the time they are diagnosed, the government spends around Rs. 1.5 million per patient per year. During the entire course of their treatment the Health Ministry spends between Rs. 9 – 15 million per patient. Yet, while the government spends so much trying to provide the best care for these patients, there are some heartless persons who try to make profits even at the cost of terminally ill children.
Oncaspar is a drug that is mainly prescribed to children with cancer, specifically leukaemia. The cost per vial of this drug is Rs. 237,000. In spite of making a huge profit from the sale of these drugs, these persons have also been using employees of the Health Ministry to smuggle out these drugs and have attempted to resell them to the Health Ministry. Hence the ministry officials believe that the labels were tampered with as the ministry puts a seal on the vials of drugs once it is in their possession.
It is pathetic and totally unimaginable that people can be so heartless as to try to make profits and play with the lives of these children who are suffering from cancer.
This particular incident had taken place in 2013, where the chief pharmacist of the Cancer Hospital had noticed several labels of vials of Pegylated Asparaginase 3750 IU injection (Oncaspar), had allegedly been tampered with. Most cancer drugs are prescribed to individual patients by name as they are very costly. In this incident a pharmacist attached to the cancer hospital had made a complaint in 2013 regarding four vials of the drug Pegylated Asparaginase 3750 IU injection (Oncaspar), as the labels of the vials had been smudged and she had felt that it had been tampered with. She had then reported the matter to the Cancer Hospital Director and rejected the four suspicious vials. As a result the hospital administration had called for an inquiry into the incident.
Smuggled out
The drugs supplied to the Health Ministry is only through the medical supplies division (MSD) and upon investigations carried out, it was revealed that the vials concerned had been smuggled out of the stocks already supplied and it had been resold to the Health Ministry.
Accordingly, the three employees of the Health Ministry, who were suspected of being involved in the theft, had been suspended from service, while the investigations continued.
The particular drug Pegylated Asparaginase 3750 IU injection (Oncaspar) is only supplied to the Health Ministry by SJ Enterprises and distributed in Sri Lanka by Omax Healthcare, and Markss Health Care. The investigations had revealed that the drug Oncaspar was being supplied to the Medical Supplies Division and it was used exclusively at the Maharagama Cancer Hospital.
According to details of the investigations report submitted by the police to the courts (Case No. B220/15) 31 vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) had been supplied by Omax Healthcare but they had not been able to produce proper purchase details for 11 of those vials. Hence statements were obtained from several employees of the Health Ministry in this regard.
In his statement to the investigating team, the Assistant Investigations Officer of the Health Ministry stated that on 28-08-2013, the pharmacist of the Maharagama Cancer Hospital, N. Ranatunge had informed the director regarding tampering of four vials of the drug Pegylated Asparaginase 3750 IU injection (Oncaspar) 13-B 06-0450, Order Number MSD/SB14/SPE/444/13 supplied to the Maharagama National Cancer Institute stores. She had stated that on four vials of the particular drug, the labels had been tampered with.
Extremely expensive
According to Ranatunge, drugs supplied to the Medical Supplies Division are purchased through calling of tenders. He also stated that since these drugs are extremely expensive, in order to avert any discrepancies when a drug is issued from the stores, a seal ‘PF NCI Maharagama’ is stamped on the vials of the drug and issued. This particular drug Pegylated Asparaginase 3750 IU injection (Oncaspar) was supplied to the Maharagama Cancer Hospital since October 2012. Each vial contains 3,750 units. Unlike other drugs, this drug is not imported in bulk and stored, and is only ordered and supplied on a specific prescription for each individual patient. While this drug had been first supplied to the Maharagama National Cancer Institute on 17-10-2012, from then to 27-08-2013, the medical supplies division had purchased 32 vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) from Markss Health Care and 31 vials from Omax Healthcare amounting to a total of 63 vials for that period.
While Omax Healthcare had only purchased 20 vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) from the importer SJ Enterprises, it was suspicious as to how they had supplied the MSD with 31 vials. Due to the suspicion and confusion regarding the 11 vials, the investigation was initiated.
It was then revealed that there had been an attempt to remove the rubber seal that was placed on the vials when being issued by the MSD on four vials. The funds for the purchase of these drugs are provided by the President’s Fund and the treasury. Hence when the investigations were carried out, it was revealed according to documentation, that 59 vials had been supplied to the Maharagama National Cancer Institute and that there should have been 16 vials remaining. However, there were only 12 vials that were accounted for while 4 vials were missing from the stocks. The total cost of the 4 vials is estimated at Rs. 948,000.
Meanwhile, in order to bridge the gap of the 4 missing vials, H. N. Manoj Priyantha, who was in charge of these drugs, had acted to obtain 3 vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) from Omax Healthcare as a gift on the instructions of the chief pharmacist of the chemotherapy division, K. W. Weerasinghe. However, this action was carried out without the knowledge of the Cancer Hospital director nor the medical supplies unit of the Health Ministry.
In a statement given to the investigating team, a specialist attached to the Maharagama Cancer Hospital had stated that he had prescribed the drug Pegylated Asparaginase 3750 IU injection (Oncaspar) for five patients, under prescription numbers 3900/2012, 6358/2013, 6253/2013, 6287/2013 and 7076/2013 and forwarded it for the approval of the hospital director. However, as the specialist had been informed that there had been some discrepancy in the supply of the drug, he had then prescribed an alternative drug for these patients.
Four vials
However, the pharmacist of the National Cancer Institute Maharagama, Niranjala Ranatunge in her statement to the investigating team had revealed that she had been working as the person in charge of the drugs stocks at the National Cancer Hospital Maharagama, and that according to order No. 13-B06-0450 the drug Pegylated Asparaginase 3750 IU injection (Oncaspar) according to priscription numbers 7076/2013, 6358/2013, 6253/2013, 6287/2013, four vials of the drug Oncaspar had been received by the stores of the Maharagama National Cancer Institute by the MSD.
The junior staff members of the cancer hospital, Samaraweera and Dhanushka Chandrasekera had taken the four vials of the drug from the stores in cool boxes and upon examining the vials, Ranatunge has noticed that the labels had been tampered with and the rubber seal had also been smudged, in an attempt to erase it.
With regard to the missing vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) and the discrepancy of the supplier Omax Healthcare regarding the 11 vials unaccounted for, a few weeks ago the CID took four persons into custody, including the CEO of Omax Healthcare. They had informed the CID that the 11 vials of Pegylated Asparaginase 3750 IU injection (Oncaspar) which was not purchased by SJ Enterprises, had been sold to them by an Indian company called Lal Traders.
They had claimed that although Pegylated Asparaginase 3750 IU injection (Oncaspar) is a German manufactured drug, Lal Traders had sold them the stock, which was nearing the expiry date. However, there is a rule that no one other than the registered supplier can supply drugs to the MSD.
Meanwhile, the CID had sought the assistance of the INTERPOL with regard to investigations on Lal Traders India, and the INTERPOL report was handed over to the CID. Although the suspects had said they had received the drugs from Lal Traders in Kerala, when INTERPOL investigated the address, it was revealed that there was only a garden supplies shop there called Lal Gardens. It was owned by a retired Indian post master. His son is an Ayurvedic doctor who had no connection with cancer drugs supplies. Hence the statements given to police by those taken into custody were allegedly false.
The suspects who were arrested had also claimed that the drug had been brought to the country hidden in the handbag of a person, but that too had been proven to be false as this particular drug contains a chip in it, when read by a computer, reveals the exact path from the time of manufacture to the point it is checked and the various temperatures it had been stored at. Hence the claim that this drug was brought to the country hidden in a handbag has been disproved.
The investigation into this incident was ordered by the Minister of Health at the time, Maithripala Sirisena.
Attempts to contact Health Minister Rajitha Senaratne for comment failed.