• Audit report raises concerns on irregularities in procurements of the existing machine, effectiveness of related treatment, costly expenditure 

The Cardiothoracic Surgery Intensive Care Unit of the Teaching Hospital in Karapitiya has requested the Ministry of Health for a new extracorporeal membrane oxygenation (ECMO) machine in spite of the various irregularities that have taken place in the procurements made with regard to an ECMO machine, the questionable situation regarding the effectiveness of ECMO treatment provided to patients, and the extravagant expenditure on such.

The ECMO machine is similar to the heart-lung bypass machine used in open-heart surgery. It pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest.

Following the hospital’s request for a new ECMO machine, the Auditor General’s (AG) Department has conducted an audit regarding matters pertaining to ECMO treatments at the request of the ministry. During the audit, problematic situations with regard to several matters, including the procurement of the existing ECMO machine and spare parts, its inclusion in the hospital inventory, and the effectiveness of ECMO treatments, have been revealed. 

The audit report, which was seen by The Daily Morning, states that according to information provided by Dr. Tolusha Harischandra, ECMO treatment has been carried out in the hospital since 2014 and that 32 (67%) out of 48 patients who received treatment from that year to last year (2022) had died. However, according to the documents in the operation theatres where the treatment was carried out and the information provided by the chief nursing officers, 25 (83%) of the 30 patients who received ECMO treatment had died. It also states that according to the relevant monetary regulations, all goods received by a Government institution should be entered in the goods registration book immediately, but that the relevant process had not been followed regarding the said ECMO machine. 

The machine, which was received as a donation from a private company, has been used for patient treatment since 2014, but it had not been included in the hospital’s inventory until 7 February 2020. The spare parts and surgical equipment required for it have been purchased for six years although the machine had not been included in the inventory. According to the report, the concerned authorities of the hospital had failed to provide sufficient information to calculate the value of the spare parts and the surgical equipment purchased and stocked for use in the machine. It has been observed that between one and 17 years have passed since the expiration of some such equipment, thereby causing a significant loss of public money. The audit report has recommended the preparation of a formal report on the matters that led to the waste of public money by making such purchases without proper planning and leaving them unused. 

The audit report prepared by the Audit Superintendent of the Senior Assistant Auditor General’s Office in Matara, B.M. Sisira Kumara further reveals that there had been another waste of public money through payments made to a private company for the construction of a National ECMO Centre near the said unit of the hospital. Accordingly, the hospital has entered into a contract with a private company on 27 December 2021, for the construction of the centre at a cost of Rs. 21,002,903 (approximately Rs. 21 million). The construction work should have been completed by 28 June 2022, as per the contract, but, as of the date of the audit, Rs. 7,319,097 (Rs. 7.3 million) has been paid to the company, while the construction is yet to be completed. 

In a letter dated 28 June 2022, the Hospital Director had informed the relevant Procurement Committee that the contractor had informed that the construction could not be completed at the pre-agreed cost due to raw material and fuel price hikes. As the newly submitted estimate was Rs. 40,918,214 (194%), the Procurement Committee that met on 15 August 2022 had decided to cease the contract. As per the initial agreement, the contractor should have completed the construction within six months, by 28 June 2033, but, it has been observed during the audit that less than 35% of the construction had been completed by that time. Noting that it had not been possible to complete it due to the abnormal slowness of the contractor, the audit report mentions that had the authorities of the hospital properly monitored and followed up, the work could have been completed at the initially agreed cost. It has also been revealed that the Medical Specialist of the said unit had continuously informed the Hospital Director in writing that this construction may cause harmful conditions to the particular unit and its patients, but that the construction had been carried out without conducting a formal investigation or feasibility study. 

The report states that it is observed that the relevant construction affects the patients in a negative way, and this has also been further confirmed according to the written and verbal evidence obtained during the discussion with the relevant medical specialist during the audit. It further reads that a controversial situation had arisen among the staff of the specific unit due to not obtaining the consent of the concerned parties before starting the construction work, which would have adverse consequences for the patients.

Commenting on the hospital’s request for a new ECMO machine, a medical specialist attached to the hospital said that it costs approximately Rs. 3 million to provide one patient with ECMO treatment. He said that the fact that the majority of the patients who received ECMO treatment have died raises questions about its effectiveness and that therefore, the authorities should think twice about purchasing another machine. 

“ECMO treatments are usually given to patients whose lungs are not functioning. The possibility of saving their life is extremely low. With the extravagant expenditure on ECMO treatment, it is possible to provide the necessary facilities to perform a large number of bypass surgeries (coronary artery bypass surgery), and procure many other medicines and medical equipment,” he explained.  

When contacted by The Daily Morning, the hospital’s Director, Dr. S.D.U.M. Ranga said that he could not comment on the matter as it is the Health Ministry that is authorised to divulge such information. The Ministry’s Secretary Janaka Sri Chandraguptha was not available for comment.