Glaring irregularities in district health infrastructure during Raghubar regime: CAG

Substandard medicines, expired vaccines  distributed from hospitals 

The report was tabled in state assembly, East Singhbhum among 6 districts surveyed

Ranchi, March 16: An audit carried out by the Jharkhand principal accountant general (audit) under the Comptroller and Auditor General of India (CAG) on district hospitals of state for the 2018-19 FY has pointed out several loopholes in the district healthcare system. The report, titled “Audit Report on District Hospital Outcomes in Jharkhand for the Year Ended 31 March 2019”, was tabled in the assembly by finance minister Rameshwar Oraon on Tuesday afternoon.

In it, the CAG has pointed gaping holes in building infrastructure, availability of essential drugs, infection control, hygiene and compliance with the biomedical waste disposal manual along with a host of other issues in the district hospitals during the penultimate year of the BJP-led NDA government which was headed by former chief minister Raghubar Das.

The CAG had prepared its audit report based on the findings in district hospitals in Ranchi, East Singhbhum, Hazaribag, Deoghar, Palamu and Hazaribag. The auditor’s restricted report has concluded that even though several district hospitals had shortages of beds to the tune of up to 86%, only 250 beds were added during the five-year tenure of Das.

The report has also concluded that the sampled district hospitals had only 11%-23% of essential drugs in their inventories between 2017 and 2019. It also stated that hospitals did not adhere to the established norms in the storage of drugs which resulted in the loss of efficacy and shelf life of the drugs. The hospitals audited by the CAG did not obtain necessary clearances from the state pollution control board and did not properly monitor and handle the biomedical waste they generated. Moreover, the hospitals also failed on the hygiene front as they did not wash their linen through mechanized laundry systems. “The standard operating procedures for handling, collection, washing and transportation of linen were not carried out by five of the six checked district hospitals,” the report said. None of them had also ophthalmologic equipment as mandated by the IPHS, the report added.

It was found that at the district hospital in Ramgarh, Acyclovir 200mg tablet (Batch T-15818) through JMHIDPCL on August 31, 2018 was reported ‘not of standard quality’ on March 15, 2019 by state drug-testing laboratory, Jharkhand but out of 140 of the 5000 tablets of the same batch were distributed between November 23, 2018 and March 27, 2019 to OPD patients and remaining 4860 were lying in store as of February 2020.  In the same hospital, 410 doses of hepatitis-B vaccine with self-life up to October 2018 were administered to children between November 2018 and January 2019.

In the district hospital in Deoghar, criminal negligence was detected in the administration of the injection. It was observed that CS-cum-CMO in between July 25, 2018 and January 23, 2019 issued 17500 vials of Dexamethasone Sodium Phosphate (Dexona) 2ml injections to the hospital. Drug inspector of the Deoghar on July 30, 2018 collected samples of the injections of the same batch from the store of CS-cum-CMO which was found spurious by the Regional Drug Testing Laboratory, Guwahati on March 8, 2019. The samples were retested by Central Drug Laboratory (CDL), Kolkata on the order of the civil court, Deoghar and were again found ‘not of standard quality’ on September 11, 2019.

However, it was noticed that 4185 out of 17500 vials of injections were issued in between July 28, 2018 to March 12, 2019 to different wards from the store of the hospital and were administered to patients till March 2019. Audit further noticed that 309 vials were administered between March 12 and March 31, 2019 even after the injection was detected to be spurious by Regional Drug Testing Laboratory, Guwahati. The injection was further declared ‘sub standard’ by the Central Drug Laboratory, Kolkata on September 11, 2019.

Principal accountant general Indu Agrawal shared the observation while reading the CAG report during a press conference at the AG Office, Doranda saying the state government should take help of the report to improve the health system of the state.  She, on the occasion, also shared several loopholes in the health system.

The district hospitals taken for audit included Ranchi, Palamu, East Singhbhum and Hazaribagh besides Ramgarh and Deoghar.

The PAG sharing the main points of the report said that there is a heavy load on doctors in OPD as the number of outdoor patients increased while the number of doctors remained the same. She said facility of all the 70 tests according to Indian Public Health Standard was found at none of the six district hospitals taken for audit. She said in Sadar Hospital Ranchi, Dental X-Ray purchased in 2017 remained unused till 2020 and laboratories in these hospitals did not have NABL accreditation.

The PAG said that all the nine essential services were not found in any of the hospitals. She said that in the audited hospitals there was a shortage of 19 to 56 percent of doctors while lack of paramedical was in between 43 to77 percent. Similarly, shortage of staff nurses was found ranging in between 11 percent to 87 percent. PAG Agrawal said all the 23 types of equipment required to run an OT were found not in a single audited hospital.

The PAG also shared how poor the building infrastructure development work is, saying out of Rs 550 crore allocated for building projects in between 2014 to 2019 only Rs 96 crore could be spent so far.