• Orthopaedic surgical equipment shortage leaves patients waiting

Ongoing shortages of medical supplies are affecting patient care as the free healthcare system faces the dilemma of relying on patients to source required medical supplies. 

Previously, there existed a practice of healthcare professionals directing patients to purchase necessary medical supplies externally due to their unavailability within hospitals. This practice was especially present in the field of orthopaedic surgery where treatment is implant- and instrument-driven, making it extremely costly. 

Following the arrest of Dr. Maheshi Wijeratne, surgeons have been discouraged from asking patients to bring in implants, a well-placed source told The Sunday Morning. As such, orthopaedic procedures such as knee replacements have been halted in many Government hospitals. 

Dr. Wijeratne, a Consultant Neurosurgeon attached to the Sri Jayewardenepura General Hospital (SJGH), was arrested by the Commission to Investigate Allegations of Bribery or Corruption (CIABOC) last month in connection with the alleged sale of medical supplies at higher prices through a third party despite their availability within the hospital at significantly lower rates. 

While investigations continue, the arrest has caused concern among the medical community regarding their direction of patients to externally purchase medical supplies that are not available in hospitals. 

No Health Ministry guidelines yet

Despite medical professionals requesting authorities to issue clear written guidelines to be followed in such instances, the Health Ministry is yet to respond to the Government Medical Officers’ Association (GMOA), one body which had made the request. 

“Ministry authorities have verbally said that what we do is different and that it’s fine to get supplies from patients when necessary. But we need it in writing and so far we have not received a response from the Health Ministry on our request,” said GMOA Secretary Dr. Prabath Sugathadasa. 

He highlighted the need for medical supplies shortages to be addressed immediately as patients could no longer be treated without them. “We can’t write prescriptions for an outdoor pharmacy. If this causes an issue, the doctor who writes the prescription would face problems,” Sugathadasa added. 

Last week, Federation of Medical and Civil Rights Trade Unions Chairman Dr. Chamal Sanjeewa claimed that the incident at the SJGH was not an isolated incident. 

“Because of medicine and equipment shortages within the medical supplies network and their poor estimations of requirements, the medical supplies and surgical equipment mafia has been allowed to take patient lives,” he charged. 

Knee implants issue

He alleged that patients had been made to purchase knee implants which cost around Rs. 350,000 each by directly paying the agent of the company where the agent then directly brings the item to the surgical facility. He emphasised the fact that this was not a cost the average person could afford. 

Knee replacements are generally not considered life saving but they can significantly improve a person’s quality of life. It is learnt that these surgeries have stopped in many hospitals, especially those in the peripheries, due to the unavailability of implants. 

Implants for knee replacements and hip replacements are routinely procured by the Medical Supplies Division (MSD) of the Ministry of Health. However, these procurements generally happen in intervals where about 300-500 units are ordered at a time, according to the well-placed source who spoke to The Sunday Morning. 

Sri Lanka has about 75 orthopaedic surgeons operating islandwide, all of them trained in knee surgery. As such, these implants are distributed islandwide, with a consignment only lasting about 3-4 months. Waiting lists for knee replacements are long – for example, two years at the National Hospital of Sri Lanka, Colombo (NHSL). 

It is observed that the procurements of these implants are insufficient to meet the demands of patients in the field. Currently, two brands are imported to Sri Lanka costing around Rs. 525,000 and Rs. 350,000 each, with the former being an older brand which used to have a monopoly. The latter, a newer brand, is cheaper although not all surgeons are trained in its use and therefore not as popular, the source alleged.

The practice of offering to do the surgeries in the absence of stocks within hospitals if the patient supplies the needed implant has been adopted supposedly as a strategy of managing the accumulating waiting lists.

AMS urges legal guidelines

The Association of Medical Specialists (AMS) too has requested the Ministry of Health to issue a circular allowing patients to purchase medicines and surgical equipment from the private sector when these items are unavailable in State hospitals.

Although solutions such as acquiring necessary material through donations are suggested within the medical community, it is noted that there are no legal guidelines to be followed in such instances. 

Additionally, matters such the absence of implants in various sizes is also a driver of external purchase. There are fragment-specific plates that can be used to mend a broken joint or bone. While surgeons can operate with what is available at the hospital, patients have been offered the option of using the exact implant if they are able to supply it privately. 

Another channel of procuring necessary supplies is through local purchases, which gives hospitals the powers to purchase their requirements. This process also requires approvals from the MSD and approval is allegedly only given for items on the MSD list of priority items. This process takes between six weeks to two months, according to the source. 

Multiple attempts to contact the Sri Lanka Orthopaedic Association, Ministry of Health Medical Supplies Division Deputy Director General Dr. Lakshman Edirisinghe, Ministry of Health Secretary Dr. Anil Jasinghe, Minister of Health and Mass Media Dr. Nalinda Jayatissa, and Deputy Minister of Health and Mass Media Dr. Hansaka Wijemuni for comment on the current situation of supplies and mitigation strategies under discussion proved unsuccessful.