ISLAMABAD: The Supreme Court has sought the record of a number of public and private sector hospitals containing information about the number of cardiac stents they have implanted in patients and the price they have charged for each stent over the past three months.

“We are issuing notices to the hospitals as to what the package is and the price they charge their patients for angioplasty and implanting stents,” Chief Justice Mian Saqib Nisar said while dictating an order on a suo motu notice on Monday.

The apex court took the suo motu notice on reports that a few public health institutions, like Lahore’s Mayo Hospital and other government hospitals of Punjab, were either putting stents in heart patients even when the intrusive procedure to implant therapeutic medicine was not required or if the same was needed, the patients were charged exorbitantly — up to Rs180,000 for each stent.

The hospitals, which will furnish records, include Punjab Institute of Cardiology (PIC), Lahore; Rawalpindi Institute of Cardiology (RIC); Pakistan Institute of Medical Sciences, Islamabad; Shifa International Hospital, Islamabad; Kalsoom International Hospital, Agha Khan Hospital, Karachi; and National Institute of Cardiovascular Diseases, Karachi (NICVD).

Prof Dr Nadeem Hayat of PIC and Dr Azhar Kiani of RIC are also required to appear in person before the court on Saturday. The hospitals are required to come up with the complete record of billing with identity cards of the patients who had undergone angioplasty procedure.

Chief Justice Nisar concerned over quality and high cost of device

On Monday, Dr Murtaza Najabat, the head of the School of Mechanical and Mechatronic Engineering of the National University of Science and Technology (NUST), told the apex court that they were on the verge of locally producing stents, the estimated cost of which would be Rs15,000. The locally manufactured therapeutic medical device will soon be sent to Germany for medical trials and certification within this week and is expected that the same will be available in the local market in June this years.

The court, while appreciating the efforts, said that one would hear the good news that the country had locally developed stents. The court observed that it wanted cardiac patients to get quality, but inexpensive medical devices.

“I would love to be implanted with locally produced stent in case I developed cardiac problem,” the chief justice observed.

He wondered whether patients got receipts from hospitals or not and what type and quality of stents were used by them. He cautioned that exorbitant prices should not be charged from poor patients.

The chief justice also dropped hints of sending the issue regarding developing rules and regulations for stents to the recently appointed committee currently looking after the affairs of the Pakistan Medical and Dental Council (PMDC).

Additional Attorney General (AAG) Muhammad Waqar Rana informed the court that so far 72 kinds of stents had been registered, besides there was a difference of Rs40,000 in the cost of stents, explaining that the device imported in Pakistan for Rs70,000 inclusive government taxes were sold to patients at Rs110,000.

The AAG submitted a report on behalf of the chief executive officer of DRAP (Drug Regulatory Authority of Pakistan) stating that the authority had written letters to companies and importers of cardiac stents on Aug 24, 2017, for provision of import invoices. But the importers refused to provide the same on behalf of the Health Devices Association of Pakistan on Sept 6, 2017, that the apex court had asked to ensure reasonably affordable prices of cardiac stents through steps so that the prices of stents should be known to public but not on price control implementation like drugs.

The government has also written letters to health secretaries of the four provinces and to relevant hospitals regarding provision of procurement of prices of cardiac stents, but despite three reminders except for the Punjab, no province has ever replied.

The Medical Devices Rules, 2017, have been notified on Jan 16, 2018 after approval by the federal government and a period of nine months was provided to manufacturers/importers of cardiac stents for enlistment/registration of stents.

Meanwhile, DRAP is in the process of collecting import invoices of stents imported from different countries, besides field offices have been directed to collect import invoices from importer of cardiac stents for analysis.

The Supreme Court, however, asked the Health Care Devices Association to submit a rejoinder on the government report.

Published in Dawn, January 30th, 2018