Need for proper audit of medical items in government hospitals


Is the recent dumping of unused medical items at the Penang Hospital just the tip of the iceberg to a much bigger problem of lack of supervision over procurement, use and disposal in government hospitals?

What society needs, and what consumers deserve is proactive action on the part of the government, namely the Ministry of Health, to ensure a proper monitoring system over all dealings of hospital with suppliers. It is not prudent spending for hospitals to waste taxpayers’ money to buy medical items in quantities or of types that they do not need, and then to simply discard them.

Many questions arise over the Penang Hospital incident where damaged cardboard boxes of unused medical and laboratory items worth thousands of ringgit were found scattered at the officers’ quarters. Only a few could still be used as most of the products had expired.  The dumping may have its cause in poor control over either the procurement leading to oversupply, or the disposal leading to indiscriminate dumping.

The hospital authority should take responsibility over what occurred, and follow this up with a thorough investigation. The hospital director’s admission that unused medical items were being kept at the quarters temporarily, while cleaning and maintenance works were carried out on the store, speaks of an apparent lack of accountability.

The Consumers Association of Penang  is concerned over the procurement and disposal practices in government hospitals – and even in private hospitals – in view of the dangers these clinical wastes may pose.

There are about 150 government hospitals in Malaysia, and the hospital waste management – from unused and used medical items – has drawn the concern of the authorities and the public.  Regulations for the management of medical or clinical wastes were implemented in 1993, namely: the Policy on Hospital Waste Management; Guidelines for the Management of Clinical and Related Wastes in Hospitals and Health Care Establishments; and the Action Plan for Waste Management in Hospitals and Health Care Establishments. .

Prior to that, waste management practices differed among hospitals and the wastes were not clearly categorised nor correctly discarded. There was also little awareness then on how to properly manage hospital wastes among the healthcare workers.

The government privatised the management of clinical wastes in 1997, outsourcing the task to three private consortiums to manage the clinical or medical wastes in the government hospitals for a concession period of 15 years.

There is now a large amount of clinical wastes generated– and the volume keeps increasing year to year – giving rise to much concern. Among the root causes are overbuying, overuse, increased demand for supplies in the face of infectious diseases and the ageing population in Malaysia, the widespread use of disposable clinical instruments and hygiene items, and shoddy internal and independent audit of hospital procurement. The concessionaires are responsible for the collection, transport and eventual disposal of wastes but the management of waste at source remains with the hospital authorities.

In 2009, the three concessionaires managed almost 16,000 tons of discarded needles and syringes, gauzes, gloves, plasters, medicines, scalpels, discarded surgical instruments, contaminated bandages, and other wastes – which was three times the total load generated in 2000. Clinical wastes are expected to grow at an average rate of 12.8 percent annually, and will reach 32,891 tonnes by 2020; this volume is considerably greater than the 18,000 tonnes per year capacity of the current incinerator infrastructure.

CAP therefore calls for the government, particularly the Ministry of Health, to reduce wastage and wastes in government hospital as follows:

1. Minimise wastes at source
a. Proper documentation of supplies and making purchases according to need.
b. Regular audit of purchases and disposals, to avoid overbuying.
c. Proper diagnosis and treatment to prevent over-prescription/overuse of drugs.
d. Promote rational drug use as advocated by the World Health Organisation.
e. Disposal of surplus items stored must be approved by the hospital director, and all disposals shall be recorded.
f. Buy the right product to prevent wastage, overuse, and unnecessary spending.
g. Ensure hospitals do not become dumping grounds for expired, or inferior medical products from companies.
h. Better administration for procurement and inventory, to avoid hospitals throwing out perfectly good equipment or products barely or never used.

2. Accountability
a. Head/director of each hospital must ensure compliance with regulations of the Ministry of Health on clinical wastes management.
b. Training of hospital staff to handle and segregate wastes within the hospital for collection by the concessionaires, to prevent indiscriminate dumping.
c. The director should coordinate and monitor all waste disposal operations.
d. Ensure the quality of products purchased to ensure these are not substituted with inferior quality that does not last as long.

3. Relationship between hospital and equipment/drug industry
a.  There must be transparency in the relationship between doctors and industry to prevent any real or perceived influence over the purchases.
b. Code of conduct for doctors, administrators and others in positions of influence in hospitals from receiving gifts, favours, etc. that makes them bias or indebted to industry.

4. Prudent behaviour
a. Scrutiny and effective cost comparison to ensure hospitals do not pay twice as much for dressings, medications, and other medical supplies.
b. Collaboration between the government hospitals to negotiate the best procurement deal with suppliers.
c. Avoid falling prey to sales discounts for bulk buying and purchasing beyond their need.

It is important for hospitals to get value for money spent and keep away from wasteful procurement of any sort. The hospitals should draw on the expertise of government advisers if need be to manage the procurement, use and disposal of medical supplies wisely.

CAP calls for more efficient procurement practices and waste disposals at the various government hospitals, in accordance with the Ministry guidelines.  We call on the government to have proper auditing and accountability to prevent incidences of overpayment for products, overbuying, and mismanagement of wastes within the hospital grounds. Transparency and accountability measures must be used to hold hospital administrators accountable.

Letter to the Editor, 13 June 2011