Ernesto fears for his life. Every day his health deteriorates further. He needs to take his medication (nilotinib) to control the chronic myeloid leukemia that he has suffered from for twelve years. But the IESS Teodoro Maldonado Carbo hospital (HTMC) 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. He costs $6,200.
In the absence of this drug, his condition was complicated. In August he developed a deep vein thrombosis, blood clots in the veins that impeded circulation in his legs and arms and caused large bruises, intense pain and numbness in his limbs. After two weeks of being hospitalized he regained mobility, but the white blood cells, which indicate that the disease is active and that he would have an infection, continue to rise.
“The normal is up to 11,000. When I left the hospital I had 72,000 and yesterday (September 28) they repeated my control tests and they have risen to 140,000. My life is at risk, I can’t wait any longer,” says this affiliate, who last week was gathering documents to ask to be referred to Solca.
The last time he received the drug, for three months, was in February of this year, when the reserve of the 200 mg nilotinib drug that the Teodoro Maldonado hospital had bought from the pharmaceutical company Novartis SA for $1.1 million in June 2021.
Effects due to lack of maintenance in the Teodoro Maldonado Carbo hospital, of the IESS
The hospital arrived at that purchase following four and a half months following the former head of Pharmacy, Eulalia Suárez, made the request (on February 1). As support, the official attached the ‘stock 0’ certificate in the general, outpatient, hospitalization, emergency and operating room warehouses.
Even so, the acquisition was not accelerated. For this hospital and all those of the IESS, which are managed with the same processes, the purchase of medicines “is not a matter of life or death” as it is for Ernesto, who survives with chronic myeloid leukemia.
The process of buying a medicine can take four, six, seven months, even more. It all depends on the time in which the 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 stated in the flowchart applied by the Teodoro Maldonado hospital, and which was sent to this Editorial Office.
The first steps begin in the requesting area, the one that needs the drug, supply or equipment and where nine steps must be fulfilled, including preparing the need report, requesting the warehouse stock, issuing the medicine deficit certificate , ask the manager for authorization, do the market study, request the certificate that the purchase was foreseen in the Annual Purchasing Plan, among others.
But The area where the process takes the longest is in the Public Procurement department., with 18 steps. The purchase method is decided there (electronic catalog, reverse auction, special regime, direct contracting), the area is in charge of certifying that the medicine is included in the plan, giving notice to the Sercop (National Public Contracting Service), preparing the specifications with the technical specifications, upload the information to the Sercop portal, prepare the resolution to start the process, supervise the schedule, prepare the award resolution, and more.
IESS did not provide requested information a month ago
Between the legal and expense authorization area there are another twelve steps, between the supplier and the contract administrator six more and the rest is completed by other departments.
If in that long journey a report has not been done well, the process returns to the area to be corrected, and the steps and time increase, while the patients continue waiting.
The purchase of medical supplies for the newborn area (Neonatology) of the hospital, awarded on September 16, lasted seven months, from February 14. “The existing balances in the HTMC to date is 0 units, urgent purchase is required,” warned Alexandra Andrade, head of the area, which admits 60 babies in critical condition per month.
For seven months there were no nasogastric tube holders, catheters to aspirate secretions, feeding tubes and other devices that the relatives acquired while the officials collected signatures and wrote documents. The hospital needs –as of September 20– 76% of supplies. It barely had 569 items (24%) of the 2,378 it needs, and in pharmaceuticals, the shortage reached 52%.
The initial resolution, which is step 29, in the case of Neonatology took almost six months, 176 days, it 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”, questions the head of an area where -he assures- he has more than 30 purchases in “drag” and that correspond to the 2022 plan, which was approved in November 2021.
That month, every year, the hospital budget is approved. November 2022 is approaching and previous purchases are still pending. The current manager, Francisco Pérez, stated that when he took office on July 27, only 5% of the plan had been fulfilled.
The purchases are interrupted, consider the heads of the area consulted, due to the instability of the authorities.
No process has continuity, every time a new manager comes to review what the predecessor has done, this causes everything to stop purchasing processes, payments, everything
Head of the Teodoro Maldonado Carbo hospital area
Thus, the pilgrimage for a medicine to reach the patient is lengthened. For example, since April 7, when it was reported that there was ‘stock 0’, the purchase of 145 platelet collection kits (which are extracted from the blood through a piece of equipment) is pending. After four months, on August 5, it was decided to declare the process void because the only supplier that offered did not meet a requirement.
Half a year from the beginning 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 are awarded. It’s the bureaucracy, we make the PAC, but they put unrealistic, low values in Quito”, criticizes the head of a room at the HTMC.
In the meantime, in the streets the relatives protestThey scream, they cry. Others contain their indignation and look for friends, relatives, chulqueros, someone to help them save their patient from the disease and also from the indolence of the IESS authorities who dispatch their offices in Quito.
There is a “late” reaction from the authorities, claims Gustavo Dávila, director of the Youth Against Cancer Foundation, who denounces that neither the IESS nor the Ministry of Health comply with the Constitution, which in its article 50 provides priority care for patients with catastrophic and rare evils: “They don’t care, they ignore court rulings. If a patient does not receive his chemotherapy for three, four months, when his cycle is every 21 days, what are we condemning him to? To die”. (YO)
