Punjab’s facilities to handle, store and use blood are in a deep mess, in utter disrespect to ordinary people, who voluntarily donate nearly 97% of the state’s total collection in blood banks to save lives.
Most of the blood banks run by the government are failing their purpose outright, and the health department has no idea of how the private ones are functioning.
The state has a robust set of acts, rules and guidelines regarding blood banks, but it is the implementation, compliance and enforcement that is absent.
It is only now, after a recent petition was filed in the Punjab and Haryana high court, that the government is rushing for cover and trying to set things straight overnight, or at least by the next date of hearing.
There are 101 blood banks in Punjab and, of these, at least 25 are running without a valid licence. A few blood banks are without a licence owing to the lengthy procedure involved in obtaining one, but there are also those whose licences haven’t been renewed for the past 15 years and they are brazening it out without fulfilling the basic requirements.
Among the 101 blood banks, 45 are run by the government and 14 of these are without a licence simply because they do not have the requisite equipment or the equipment that is there is out of order.
The authorities are confused about why the blood banks that do not have a valid licence have been allowed to function. Not only that, there is also lack of agreement on whether the illegal blood banks should be allowed to run or not.
Dr Sukhvinder Singh, head of the State Blood Transfusion Council, Punjab, says the rules provide for a blood bank to be allowed to continue even without a valid license because they are dealing with human lives.
“The process of licensing is very long as the licence has to be renewed by the Central Drugs Standard Control Organisation (CDSCO), Government of India,” he says. “In the meanwhile the blood bank cannot be shut down.”
The CDSCO disagrees. BK Samantray, the assistant drug controller, CDSCO sub-zonal office, Chandigarh, says the CDSCO does not issue licences to blood banks.
the rules “clearly say” that a blood bank whose licence has not been renewed because of discrepancies should not be allowed to run, “precisely because it deals with human life”.
“CDSCO is not the licensing authority. The state drug controller renews licences. We only hold joint inspections with them, and later, when the licence is issued, we approve it. Currently there is no delay or pendency with us of even a single case,” he says.
The state drug controller, however, admits to the problem. “The delay caused by the process can be of one or, at the most, two years. There is no justification for blood banks running without valid licences for 10-15 years. These blood banks are obviously not complying with the conditions,” says drug controller, Punjab, Bhag Singh.
A glaring example of the mess is the government blood bank at Civil Hospital Nakodar. The facility has a licence that expired in 2000. The case for the renewal of the licence till 2012 was sent to the authorities in September 2013. The blood bank has yet to mitigate the discrepancies pointed out during an inspection in January 2013. In fact, the drug controller’s office sent a letter asking the blood bank to confirm compliance of the requirements was sent only early this month.
Basic equipment missing/non-functioning
In July this year, at two blood banks — one in civil hospital in Jalandhar and the other in sub-divisional hospital, Phillaur —the refrigerator was not working.
In fact, according to the government data for 2014-15 provided to the Punjab and Haryana high court, three civil hospitals —in Phillaur, Fatehgarh Sahib and Ludhiana — did not collect blood at all.
The situation in many private hospitals is also no different. Following a complaint to the blood bank’s vigilance cell, run under the state drug controller’s office, a team of drug controllers checked the Dayanand Medical College (DMC), Ludhiana, in April this year and reported a host of glaring shortcomings. Many of the emergency medicines in the blood collection room were expired. Some other drugs, required to be available in the blood collection room, were not there. Dust had accumulated at several places in the blood bank and no colour coding was being done on blood bags.
The license of the DMC blood bank was suspended for 15 days, but Pradeep Mattoo, assistant drugs controller Punjab, says the hospital met with the various conditions and the license was revived.
Mattoo added that besides DMC, show cause notices were also issued to private blood banks in Phagwara, Nawashahr and Hoshiarpur as well.
Overcharging by private banks
The prescribe that no charges can be levied on supplying blood to patients, although blood banks are allowed to charge a processing fee, which is clearly laid down by the State Blood Transfusion Council (SBTC) for government and private blood banks. The blood banks overcharging the processing fee are liable to penal action.
The private blood banks, however, are flouting these rules with impunity. A patient who needs blood is charged anything between Rs 2,500 and Rs 17,000 per unit of blood, while the processing fee laid down by the government ranges from Rs 300 to Rs 1,500. (see box)
Till recently, the drug inspectors carried out no independent checks to find out exactly how much the private blood banks charged.
“Private hospitals are using blood to loot money. Other than the processing fee, some blood banks are also charging security from recipients in case they are not able to supply a replacement unit of blood. Other blood banks are taking two positive blood units for giving one negative blood unit,” alleges Vitin Puri, president of the Hindustan Welfare Blood Donors Club, which filed the petition in the high court.
Mandatory checks not carried out
Apart from the enquiry on the rate of blood, the drug inspectors have also not conducted the annual checks prescribed under the rules..
“An audit of records of June 2013 of the state drug controller showed that the shortfall in conducting inspections ranged between 53 and 61% in government blood banks and between 56 and 83% in private/charitable blood banks during 2010-13,” says a 2013 CAG report on the working of blood banks in Punjab.
Many government blood banks have been checked only during a joint inspection for the renewal of licence, which is done once in five years.
High court makes impact
The government action against the blood banks came only after the issue was brought to the high court’s notice.
“The case was filed in July this year and action against some blood banks was initiated only after that,” says Hitesh Kaplish, the counsel for the petitioner.
Things are working indeed. A comparison of the pendency of licenses between April this year and December is telling. In April, the number of blood banks running without a valid licence was 35. By December the number had come down to 25.
Show cause notices have been issued to many blood banks, and three have even been asked to shut shop.
CAG report awaits attention
A 2012-13 CAG report tabled in the assembly had pointed out that 70 out of 99 blood banks in the state were functioning without valid licences.
“Equipment costing Rs 22 lakh for establishing a blood component separation unit were lying idle since September 2009,” the report said.
The report said rules and regulations of the SBTC provided for a governing body meeting at least twice a year, and an executive committee meet once in three months “or more often, if necessary”.
The audit of records of SBTC, however, showed (in July 2013) that the governing body and the executive committee met only twice during 2010-13, the report added.