The Maharashtra Association of Resident Doctors’ unit in Yavatmal’s government medical college has already submitted to the Shri Vasantrao Naik GMC’s Dean on March 22 a list of 34 vital medicines that have gone off the shelves. ON MARCH 25, Kaliprasad Ramlakhan, 36, was rushed to Mumbai’s JJ Hospital, the largest state-run hospital in Maharashtra, after being bitten by a dog. As it did not have even basic medicines like TT injections and antibiotics like Amoxicillin, his brother had to go and queue up at a private chemist shop nearby.
“There were no medicines in the hospital. It refused to give me even a rabies injection from their stocks, although they obliged when I pleaded,” said Ramlakhan, who was running a high fever and had to wait outside the hospital. It is another matter that JJ Hospital gets over 30 dog bite cases daily for treatment.
Ramlakhan’s case is not an isolated one. With the outbreak of the Covid-19 pandemic in early 2020, the footfall of patients in the OPD and emergency sections of government hospitals across Maharashtra dropped by nearly 70 per cent, as per the state’s public health department. Now, with the flattening of the pandemic curve, these hospitals are flooded with non-Covid patients. For instance, the number of patients visiting JJ hospital daily has almost doubled to 1,100 since February this year from 600 during 2020-21. A senior hospital doctor said, “Most patients refrained from visiting hospitals during the pandemic. Now, the patients with more severe complications are rushing to hospitals. To meet the demand, we have also added beds.”
Maharashtra’s nodal official body for centralised purchase of medicines, Haffkine Bio-Pharma Corporation, Mumbai, however, failed to foresee the sudden surge in requirement of medicines and delayed the annual procurement of over 2,500 types of non-Covid medicines, which has resulted in the 18 state government hospitals affiliated with the government medical colleges (GMCs) now running out of even basic, life-saving medicines.
Consequently, the hospitals are refusing to treat even patients with diabetes and hypertension. A 57-year-old unemployed man from Dogri, Hasan Mehdi, who is a chronic diabetic patient, has been forced to shell out Rs 2,000 monthly to buy medicines. “I have to ask my relatives to support me financially for my medication,” he said.
The Maharashtra Association of Resident Doctors’ unit in Yavatmal’s government medical college has already submitted to the Shri Vasantrao Naik GMC’s Dean on March 22 a list of 34 vital medicines that have gone off the shelves. Red flagging the shortages of “emergency and essential” drugs for months, the resident doctors said they “are facing many difficulties while treating patients” in the hospital.
The plight of patients in rural districts like Latur, Amravati, Dhule, who have been dependent on government hospitals’ free treatment and medicines, is more distressing. A 39-year-old Dhule worker, Amir Ali Siddiqui, recently suffered severe burns in his hand while making roti. All he could get at the Shri BhausahebHire Government Medical College (SBHGMC), Dhule, was paracetamol. “I had to spend Rs 650 to buy medicines (Amoxicillin, Pantoprazole and Polyvitamin tablets) from outside,” he said.
Due to the limited drug stocks, the hospitals have asked their doctors to ‘rationalise’ the use of medicines, putting them in a moral dilemma. “For us, all patients are equal. It is ethically wrong for us to rationalise the use of medicines when a patient is in a need. But due to the situation we are being forced to provide the limited medicine only to emergency patients and ask others to buy it from outside,” said a resident doctor at the Yavatmal GMC.
When The Indian Express visited JJ hospital’s OPD ward, several patients and their relatives were seen pleading before the hospital staff at the drug counters for medicines. “We have been given targets for daily allotment of medicines. We can’t surpass it to help the patients as we are accountable,” said a hospital personnel.
Dr Pallavi Saple, Dean, JJ hospital said, “Currently, we are procuring the medicines at the local level to handle the shortage. We have given the list of required medicines to Haffkine. We are hopeful that we will get the medicines within the next 15 days.” Also, she has instructed the hospital’s drug store department to intimate its requirement one month in advance.
The issue of medicine shortages at JJ hospital reached the Assembly too. When contacted, Medical Education Minister Deshmukh blamed the deans and medical college superintendents for the delay in placing their requisition for medicines, which led to the crisis. “They need to place their requisition for medicine procurement to the government in advance… They need to be more efficient so that there is no time lag in procedures. It is about reforming the whole structure,” he said.
Many hospital deans refuted such charges and pointed fingers at Haffkine for “their failure to meet the requirement of bulk medicine purchase, leading to the shortfall”.
When contacted, Dr Madhavi Khode Chaware, Medical Director, Haffkine Bio-Pharma, said technical issues were behind the delay. “In some cases, despite floating a tender, we couldn’t place the order as the consigning list was with DMER. Without that list, I didn’t know the requirements of the colleges to place the orders.” To address this, the state has for the first time, linked medicine procurement with the centralised portal—E-Aushadhi. “With the starting of the portal, we will get real-time updates about the requirements and supplies, dissolving the intermediary issues. We have cleared all the tendering of last year. Also, we will start our inspection from Monday, starting with Yavatmal GMC,” she said.
A Haffkine officer, who did not wish to be named, said, during the pandemic they primarily focused on procuring medicines for the treatment of Covid patients. “We have nearly 40 per cent vacancies in the department including in the procurement cell. So, we are overwhelmed with Covid and non-Covid procurement of medicines. Many of our existing staffers contracted Covid which further delayed our procurement process,” the officer said.
Besides this, the pandemic also disrupted the supply of essential materials required for drug production from China, Japan, and other countries, due to which manufacturers, the officer claimed, were struggling to meet the demand for non-Covid medicines. “There has been nearly 30 per cent less response from the bidders,” the officer said.
Drug vendors, however, said they “boycotted” the bidding process due to their pending dues worth nearly Rs 220 crore for supplying drugs and non-surgical equipment to the 18 government hospitals. The All Food And Drug License Holder’s Foundation (AFDLHF)’s president Abhay Pandey said the vendors were yet to get their 2019-20 dues of Rs 90 crore and 2020-21 dues of Rs 30 crore from Haffkine. The Directorate of Medical Education and Research (DMER) also owed around Rs 100 crore to the suppliers. “We are still compiling the pending dues of the ongoing financial year,” Pandey said.
This is despite the state government having made a provision of Rs 2,077 crore for procurement of medicines in 2021-22. When asked about it, Minister Deshmukh said it was for the authorities to examine discrepancies in medicine procurement. “It takes some time to clear the (procurement) files. After due diligence, it (vendors’ dues) will be cleared too,” he said.
Deshmukh said the department has also issued rules authorising the deans to procure medicines from the District Planning Committee (DPC) funds.
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