Patients suffer as BMC fails to approve bulk supplies

Contractors say tenders for purchases have not been floated in three years; commissioner says he is breaking the monopoly.

MUMBAI: Sonali Shetty’s 44-year-old aunt has been in and out of Lokmanya Tilak Medical General Hospital (LTMGH) in Sion for over a year now as she suffers from a weak heart condition. On Tuesday, she spent ₹300 at a pharmacy close to the hospital on an IV set and fluid as doctors of the hospital said there was a shortage of supply. “The hospital regularly requests for supplies – such as gloves, fluids and medicines -- from outside. This has been going on for a year now,” said Shetty. A similar situation persists at KEM Hospital. The hospital has told Niyazi Asif, whose brother-in-law is being treated for a neurological disorder here, that the family needs to procure almost all medicines from outside. “Someone at the hospital guided us to a shop that stocks all the supplies that would give it to us at bulk rate. We have been purchasing medicines from them for a while now,” said Asif.

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Shetty and Asif are among a teeming number of patients at the city’s civic hospitals and dispensaries who are compelled to pay for medicines that they should have received free of cost. Over the last three years, patients and their relatives, as well as doctors have complained about hospitals often running out of supplies.

The scarcity, it would seem, is the result of a rot that runs deep within civic administrative offices. This was recently pointed out by the All Food and Drug License Holder’s Foundation (AFDLHF), which represents over 500 pharmaceutical manufacturers and 1000 distributers across India. The association has placed the blame on Brihanmumbai Municipal Corporation (BMC) officials in-charge of procurement. They have alleged that for over two to three years BMC’s Central Purchase Department (CPD) has not floated tenders for bulk purchases, leading hospitals to procure basic and life-saving medicines, such as paracetamol, antibiotics, injections, saline, surgical gloves and dressing material, from local vendors at exorbitant rates. This, the body claimed has resulted in BMC incurring a loss of almost ₹100 crore over the last two years. The association also shared this with municipal commissioner and administrator Iqbal Singh Chahal on April 11.

It has claimed that the artificial shortage is benefitting local suppliers who sell the medicines at inflated prices, at the cost of cash-strapped impoverished patients.

On April 24, Chahal had forwarded the email to Dr Sanjeev Kumar, the then additional commissioner (health), who ordered an investigation the same day. Thereafter, the deputy municipal commissioner (public health), Sanjay Kurhade, requested all the hospitals to provide details of local purchases of medical supplies. HT is in possession of copies of the correspondence.

Abhay Pandey, president, AFDLHF said, “The contract for bulk purchase of IV fluids, IV sets, gloves etc expired in 2019. The CPD has floated tenders for only 612 of the 1779 schedule (bulk) medicines. The rest are being sourced by hospitals from the open market for the last three years.”

When the severity of shortage was flagged, CPD in a meeting in June 2022 proposed an increase in the purchasing power of hospital deans from ₹3 lakh per order of regular medicines to ₹25 lakhs. However, the proposal, which was signed by Suresh Kakani, then additional municipal commissioner, remains on paper.

It is not uncommon to witness serpentine queues outside pharmacies of civic-run hospitals, with names of medicines scribbled by doctors on a small blank sheet of paper, which is kept in the possession of the private pharmacist. They are legally bound to give medicines against prescriptions only.

In his letter to Chahal, Pandey has alleged a nexus between officers in CPD with some suppliers who only work locally. So, when the “artificial shortage” is created, local suppliers benefit from it since the products are doled out at a higher rate.

Another association member said, “Products bought in bulk are not just less expensive but also offer the opportunity of fair play. In return, BMC gets the best prices for the medicines. However, this is not what they (BMC) want.”

Civic run hospitals put out their requirement of supplies every two years. After this, CPD floats tenders. After tenders are awarded, rates of every medical supply, including medicines, are finalised and locked for a selected period – also called the Rate Contract (RC). All future purchases, including those made by a hospital, during that tenure are based on the RC.

Senior officials from hospitals have said the RC has not been prepared for two years. “This is not a road contract. Since lives are at stake here, we have to procure medicines at whatever rate is available and quoted as lowest,” said an official. Since bulk purchases are not available, small tenders worth ₹40,000 or less do not attract bigger players and hence prices are not discounted either. “We end up paying higher prices to buy medicines because CPD has not put out the schedule and RC for over two years now. Sometimes we receive audit queries as well on purchasing medicines at higher prices. But what can we do? There are not enough bidders, and we cannot let the supply run out. Even the accounts department refers to the old RC, but the prices have gone up since the last RC was given,” he added.

Dr Mohan Joshi, dean of LTMG Sion Hospital said this apathy has been raised by the fraternity to BMC several times. He said while doctors have been trying to meet the demands with a local purchase, certain medicines are difficult to procure. “Our constant effort is to serve the impoverished patients but we are unable to do so a 100 per cent,” said Joshi.

A dean of another hospital put it down to the CPD’s lackadaisical attitude. It has also led to doctors dealing with a load of paperwork, which is hampering their administrative duties. “We have to sign multiple papers for the local purchases before the stock gets exhausted. But the most crucial factor is that our purchase limit is far less than the demand,” he said.

Another senior official said they are often compelled to purchase supplies at higher prices, which is often flagged by the audit department. It leads them to depend on donations and poor patients’ funds. “Earlier we were able to dispense medicines for chronic illness such as diabetes and hypertension to patients every month. Now, we can give them the same only for a week or two due to the shortage supply. This often angers patients who have to visit hospitals routinely,” said a doctor from a BMC-run dispensary.

While the civic chief skirted the issue of shortage of supplies, he refuted allegations made by the licence holders, saying they were in the habit of monopolising CPD. “They would keep taking extensions on their contracts even after they expired. I am trying to streamline the CPD so that this monopoly is broken, which will take sometime,” said Chahal. “I have changed the system – instead of giving extensions to these contractors, deans of hospitals have been empowered to make their local purchases.” The commissioner added that since “the deans are more educated than the clerks in CPD, they know what is needed”. “Now these contractors have no control over the deans, and they are the ones facing the losses,” said Chahal.