Ernesto fears for his life. Every day his health is getting worse. He has to take his medication (nilotinib) to control the chronic myeloid leukemia he has been suffering from for twelve years. But the IESS Teodoro Maldonado Carbo (HTMC) hospital has not provided it for five months. He can’t buy it either because the $650 he earns a month isn’t enough to buy a bottle. It costs $6,200.
In the absence of this medicine, his condition worsened. In August, he developed deep vein thrombosis, blood clots in the veins that impeded circulation in his legs and arms and caused extensive bruising, severe pain and numbness in his limbs. After two weeks in the hospital, he was moving again, but the white blood cells, which indicate that the disease is active and that there will be an infection, continued to rise.
“Normal is up to 11,000. When I got out of the hospital I had 72,000 and yesterday (September 28) I had my follow-up tests again and it was 140,000. My life is at risk, I can’t wait any longer,” says this affiliate who last week was collecting documents to ask to be referred to Solca.
The last time he received the drug for three months was in February this year, when the reserve of the 200 mg nilotinib drug that the Teodoro Maldonado Hospital had purchased from the pharmaceutical company Novartis SA for $1.1 million in June 2021.
Effects due to lack of maintenance in Hospital Teodoro Maldonado Carbo, IESS
The hospital came to this purchase four and a half months after the former head of pharmacy, Eulalia Suarez, made the request (on February 1). As support, the officer attached the “stock 0” certificate to the general, ambulatory, hospitalized, emergency and operating room stores.
However, the acquisition was not expedited. For this hospital and all those at IESS that are governed by the same processes, purchasing drugs is “not a matter of life or death,” as it is for Ernesto, a chronic myeloid leukemia survivor.
The process of buying a drug can take four, six, seven months, even longer. It all depends on the time in which IESS officials complete at least 55 steps established for the acquisition and that there are no problems in the 16 departments involved in the purchase, as indicated in the flowchart applied by Teodoro Maldonado Hospital and which was sent to this editorial.
The first steps begin in the requested area, the one that needs the drug, supply or equipment, and where nine steps must be completed, including preparing a report of need, requesting stock, issuing a drug shortage certificate, requesting the manager for permission, do a market survey, ask for a certificate that the purchase is foreseen in the annual purchase plan, among others.
But The area where the process takes the most time is in the Public Procurement department., with 18 steps. The method of purchase is decided there (electronic catalogue, reverse auction, special regime, direct negotiation), the zone is responsible for certifying that the drug is included in the plan, sending a notification to Sercop (National Procurement Office), preparing specifications with the technical specifications, uploading the information to the Sercop portal, preparing the resolution to start the process, overseeing the schedule, preparing the award resolution, etc.
IESS did not provide the requested information a month ago
Between the legal area and the expenditure authorization area there are twelve more steps, between the supplier and the contract administrator another six, and the rest are performed by other departments.
If in this long journey the report has not been done well, the process returns to the correction area and the steps and time increase while the patients continue to wait.
The purchase of medical supplies for the hospital’s newborn ward (Neonatology), awarded on September 16, lasted for seven months starting from February 14. “Existing balances at HTMC as of today are 0 units, an urgent purchase is needed,” warned Alexandra Andrade, head of the district, which admits 60 critically ill babies a month.
For seven months, there were no holders for nasogastric tubes, catheters for aspiration of secretions, feeding tubes and other devices that relatives obtained while officials collected signatures and wrote documents. The hospital’s need – as of September 20 – 76% of supplies. There were only 569 items (24%) of the required 2,378, and in pharmaceuticals the shortage reached 52%.
The initial decision, which is step 29, in the case of neonatology, took almost six months, 176 days, and was only given on August 9. “There are areas that control the processes. For example, if we need a legal criterion, they take time…, there are processes that have a legal year and do not come out”, asks the head of an area in which – he assures – there are over 30 purchases in “drag” and which correspond to the 2022 plan, which was approved in November 2021.
This month every year the hospital budget is approved. November 2022 is approaching and previous purchases are still pending. Current manager Francisco Perez said that when he took office on July 27, only 5% of the plan had been completed.
The purchases have been interrupted, according to the leaders of the consulted area, due to the instability of the authorities.
No process has continuity, every time a new manager comes in to review what the predecessor did it makes everything stop buying processes, payments, everything
Head of Hospital District Teodoro Maldonado Carbo
Thus, the pilgrimage route of a drug to the patient is extended. For example, as of April 7, when it was reported that there was “stock 0”, 145 platelet collection kits (which are extracted from the blood using a piece of equipment) are pending purchase. After four months, on August 5, it was decided to declare the process invalid because the only proposed supplier did not meet the requirement.
Half a year since the start of the process and the purchase of this reagent is uncertain. “What needs to change is the system. You start (the process) in May and in August you get a reward. It’s the bureaucracy, we do the PAC, but they put unrealistic, low values in Quito,” criticized the head of a room at HTMC.
Meanwhile, in the streets, the relatives are protesting, shouting, crying. Others hold back their indignation and look for friends, relatives, a chulkero, someone to help them save their patient from the disease, and also from the indolence of the IESS authorities, who send their offices to Quito.
There is a “late” reaction from the authorities, argues Gustavo Dávila, director of the Youth Against Cancer Foundation, who condemns that neither the IESS nor the Ministry of Health respects the Constitution, which in its article 50 provides for priority care for patients with catastrophic and rare evils: “They don’t care, they ignore court decisions. If a patient does not receive his chemotherapy for three, four months, when his period is 21 days, what do we condemn him to – to die”. (YO)