Peshawar: Contaminated instruments at LRH may have claimed 500 lives annually

The Express Tribune

With the province still reeling under the blow of a health scam involving substandard interferon vaccines, another deadly scandal has come to light at the Lady Reading Hospital’s (LRH) nephrology department – one that may have claimed 500 lives annually since 2005. An inquiry report, a copy of which is available with The Express Tribune, states a total of 34 patients tested positive for hepatitis C virus (HCV)/hepatitis B virus (HBV) from June 1, 2012 till December 31, 2012. These patients were said to be HCV negative upon their admission to the hospital, indicating they contracted the virus through contaminated or reused artificial kidneys used for their dialysis. The inquiry team only collected data for the six-month period, claiming it was not possible to vet the full record – from 2005 onwards. “Annual turnover of 34 HCV/HBV cases is detected in the dialysis unit of LRH. This clearly shows it is a killing field rather than a curative unit of LRH – the largest and most prestigious hospital of the province,” read the text of the inquiry, which was conducted by director administration of the health department Dr Muhammad Zaman Afridi and section officer (Budget 1) Muhammad Zakir. The report adds some HCV/HBV patients received dialysis through machines not meant for HCV patients. This indicated all the machines were contaminated, with hapless patients not aware of the deadly dose.

Catching the culprits

According to the report, at least some ill-fated patients died due to the criminal negligence of the nephrology department’s head Professor Dr Akhtar Ali and dialysis technician at the LRH unit, Nasrullah. The first page of the report states technician and storekeeper Nasrullah has been coming to the unit between 5 and 6am every day since the last 14 years. He illegally reuses discarded artificial kidneys and blood tubes while performing dialysis on patients till the arrival of doctors at about 9am. Nasrullah then comes for his second shift from 3pm till 7pm. The report estimates the offence – spread over nearly a decade and a half – may have resulted in the deaths of 500 patients each year. The report states Nasrullah pocketed the money he received from patients as fees while the receipts were never deposited so no hospital record exists. “The grievous matter was brought to the notice of the nephrology unit’s head, but no action was taken, which indicates he is fully involved in the unlawful practice,” it reads. The dossier shows staff members at the dialysis unit also bore witness. During investigation and interviews with the employees, many swore Nasrullah was indeed reusing artificial kidneys. Money matters Till April 20, 2013, the main pharmacy at LRH issued 33,472 BHD and AHD solutions to the dialysis unit – each containing four and 10 litres, respectively. The stock was meant for 61,075 patients. Against the same, 45,480 dialyses were performed, while the remaining stock of solutions was used with reused artificial kidneys. The Rs1,500 fee charged from patients was then misappropriated with receipts not deposited to the hospital account. In its conclusion, the report states the government suffered a loss of Rs21.855 million which could further increase if the main store’s data on earlier stocks was available. “The inquiry team is fully convinced organised crimes were committed in the dialysis unit of LRH for a few worldly gains. All the malpractices were committed by two individuals, Professor Dr Akhtar Ali and dialysis technician Nasrullah,” reads the text of the report.

Recommendations

The team has given strong recommendations to the government, saying strict punishment may be handed to the two accused under the Efficiency and Disciplinary Rules, 2011. “Pakistan Medical and Dental Council (PMDC) may be requested to put a lifetime ban on the practice of Dr Akhtar Ali. A major punishment of dismissal from service may be awarded to Nasrullah and the medical faculty of K-P may be requested to put a lifetime ban on his private practice.” It also recommends Rs21.855 million may be recovered from Dr Akhtar Ali and Nasrullah, while the former may be transferred and not posted to any position where financial matters are involved. The dialysis unit may be closed and quarantined till the contaminated dialysis machines are disinfected, it added.

Biased inquiry?

The Provincial Doctors Association (PDA), K-P has rejected the report, saying those who conducted the inquiry know nothing about the medical field. “There are technical faults in the report, and is biased to defame the medical fraternity and hospital,” PDA Chairman Dr Shah Sawar told reporters on Tuesday. He demanded the health department conduct a second inquiry into the alleged scandal and include technical people so that the matter can be properly highlighted. If any person is involved, they should be given punishment, he added.