LAHORE: The Punjab government’s policy for the central procurement of cardiac stents for public hospitals has been hit by a controversy after the committee of senior medics constituted for the purpose failed to implement the official policy for procurement of the stents against the approved rates, Dawn has learnt.

The issue surfaced when three out of the eleven public sector cardiac hospitals of the province made procurement of expensive cardiac stents of various categories through respective ‘institutional tenders’ while some others raised objection to violation of uniform policy.

The government had constituted a central purchase committee (CPC) to initiate the process in July this year for the central procurement of the specific category of cardiac stents & surgery devices for financial year 2019-20.

Headed by Punjab Institute of Cardiology Chief Executive Officer Prof Dr Saqib Shafi, the committee comprised of Rawalpindi Institute of Cardiology (RIC) CEO retired Maj Gen Azhar Mehmood Kiani, Jinnah Hospital cardiology unit head Prof Dr Zubair Akram, Wazirabad Institute of Cardiology (WIC) Executive Directive Prof Dr Abdul Waheed and Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC) Multan Executive Director Prof Altaf Rana.

From the government side, the procurement specialist of Specialised Healthcare & Medical Education Department Punjab Tayyab Farid and Section Officer Engineer Abdul Jabbar Bajwa were also members of the committee.

Three hospitals go for ‘independent’ procurement at high cost; govt body fails to implement policy

According to the official documents, the committee had received demand of procurement of 17,000 budget stents from the 11 cardiac institutions of the province through the central procurement. Of the total, the PIC Lahore had sought 7,500 stents, RIC 1,000, Faisalabad Institute of Cardiology (FIC) 2,500, RIC 1,000, CPEIC Multan 2,000, WIC 500, Mayo Hospital Lahore 1,400, Jinnah Hospital Lahore and Bahawalpur Victoria Hospital 1,000 each and the Shaikh Zayed Hospital Rahim Yar Khan 400 stents.

After a couple of initial meetings, the committee had approved the rate of Rs33,335 (per stent) when one of the participating firms – The Ferozsons Laboratories Ltd – offered the last price.

The single category ‘FDA (Food and Drug Authority, USA) approved ‘budget stent’ of higher classification was to be purchased for all the 11 cardiac institutions/centres as per the government policy.

Started in 2017, the policy was introduced following recommendations of the then Chief Minister Inspection Team (CMIT) after a massive stent scandal surfaced in the Mayo Hospital the same year, an official told Dawn.

He said Faisalabad Institute of Cardiology (FIC) executive director Prof Dr Anjum Jalal had headed the committee for first two consecutive years and all the stents were purchased through the central procurement and the institutional tenders were abandoned to avoid any controversy. Again in 2019, the CPC completed technical part of stent procurement at central level and finalised the brand and price of the stents.

In the starting phase, the official added, all was going well but the process hit a snag in middle of the process when three out of 11 hospitals, namely the RIC, PIC Lahore and the CPEIC, initiated procurement of expensive cardiac stents of various categories through ‘institutional tenders’.

Of them, the RIC categorically refused to follow the CPC’s decision and the government’s policy of the central procurement starting purchase of 6,000 high-grade cardiac stents of various categories at high rates, raising eyebrows of those institutions that have been strictly following the CPC’s recommendations in letter and spirit.

According to the documents, the RIC has placed order for only 1,000 budget stents out of its requirement of 7,000 stents. It formed the technical advisory committee (TAC) consisting of eight members to initiate the institutional bidding process. Headed by a woman medical officer, the committee allowed a single bidder in nine of the 10 categories of high-grade stents rather involving others for competition in the process that seems violation of the Public Procurement Regularity Authority (PPRA) rules. Similarly, the RIC also placed order of 4,500 stents out of 6,000 to only two firms out of around 10 participating companies.

The RIC has given approval to purchase 100 stents at price of Rs56,000 (per stent), 400 at Rs67,000 (per stent), 200 at Rs50,000 (per stent), 1,000 stents at Rs100,000 each, 1,500 stents at Rs67,000 each, 2,000 at Rs95,000 each, 400 at Rs95,000 each, 100 stents at Rs95,000 each and 100 stents at Rs90,000 each.

The Punjab government would have to bear additional financial burden of Rs300m in the wake of the institutional procurement done by the RIC while purchasing various categories of 6,000 expensive stents. Like the RIC, the PIC Lahore and the CPEIC Multan also went through with the respective institutional tenders for the purchase of high-grade stents.

Similarly, the high-grade stents purchased through these institutional tenders this year cost Rs84,500 per stent for the PIC and the CPEIC and Rs90,000 for RIC against the rate of Rs64,000 (per stent) for the same stents purchased through centrally procurement policy in 2018, according to the documents.

When contacted, RIC head Prof Kiani strongly opposed the centralised procurement policy of cardiac stents, saying that he had raised objections when it was launched in 2017.

“A treating cardiac surgeon knows much better as to which category of cardiac stent suits his patient and it would risk his life if this job is given to a non-professional,” he said and added that the health department officials particularly lacked the expertise, being non-technical in this respect.

He said it was not first attempt of his institute to purchase stents as it had been making procurement of cardiac stents through institutional tenders since 2017.

“My institute attends all kinds of patients, including the poor and the rich, and we can’t refuse if any of them puts a demand for high quality cardiac stent,” Prof Kiani added.

He believed the cardiac institutions must have a stock of variety of stents to recommend according to the disease pattern of the patients.

“Sometimes, a patient visits with narrow heart arteries and the cardiac surgeon can’t take risk of recommending him the CPC-approved stent only that may endanger his life.”

He also strongly rejected violations in respect of the PPRA rules, saying the entire process was flawless and transparent.

CPC head Prof Shafi said this year the committee had allowed the cardiac hospitals to make procurement of 25pc of the total stents through institutional tenders.

“The institutions were of the views that they required various categories of stents to meet the demand of the patients.”

Prof Shafi said nearly 80pc of the total patients might be suggested single category of cardiac stent approved by the CPC but not those visiting with different diseases.

About eight other hospitals that didn’t make purchase of various categories of stents when they were also receiving patients with different diseases and they could better tell about the issue, he added.

To a question about the RIC, which had made more than 90pc procurement through institutional tenders in violation of the CPC recommendations, he refused to comment on the matter.

Health Secretary Momin Agha said the matter was brought to his notice recently and he would be in a position to comment once inquiry was finalised which was under process. He said an inquiry had been launched to look into the matter.

Published in Dawn, October 28th, 2019