Srinagar: Lack of prescription audit and its strict implementation , alleged medical corruption, freebies to doctors are counted among the vital reasons for mass medications in Jammu and Kashmir hospitals—leaving poor patients at high risk.
Greater Kashmir has learnt that no prescription audit has been carried out for a long time, besides pharma companies have been given free hand in the distribution of the medicines in hospitals and outside hospital premises—which is worsening the scenario in Jammu and Kashmir, especially in Kashmir region.
“Both lack of prescription audits as well as freebies are important factors in creating this menace in Jammu and Kashmir,” a senior doctor, who is heading one of the departments at Sher-e-Kashmir Institute of Medical Sciences, told Greater Kashmir, wishing to remain anonymous. “In fact, these are two sole factors.”
A few senior doctors whom this correspondent interviewed, vehemently lashed out at the government for its “lackadaisical approach” over running the affairs of the patient care in government-run hospitals. They say that the poor patients have to shell out much more than they ought to.
“The patient suffers from the side effects of medicine which isn’t required and many a time low quality medicine prescribed on account of freebies is ineffective in treating their ailments and on the contrary causes adverse effects,” a group of doctors lament. “It is a completely devastating situation for the poor patients.”
Another doctor from SKIMS Medical College, Bemina revealed that because of the corrupt practices among a section of doctors have given rise to the mass medication in Kashmir’s government-run hospitals.
“Illegal and unethical mass medication is rampant in Jammu and Kashmir hospitals. I am witness to certain doctors taking bribes and also accepting high-end vehicles and also indulging into donations,” revealed the doctor.
“We have many brilliant doctors, but they say black sheep are everywhere. Whenever a patient comes, these handful of doctors which remain in every nook and corner of the hospitals begin to rob and rip the poor patients for their petty gains,” he added.
A senior paramedic at SKIMS Bemina (JVC) alleged that the majority of implants used in ortho patients are labelled as Johnson & Johnson, Stryker, however they are actually manufactured in Delhi slums.
“If you will ask for the bill. You won’t get it. Go and ask them yourself. they will never give it to you. It is a structured mafia and they carry out all the unethical things and operations under the set protocol.”
“Not just this, hefty amounts used to be given to people at the helm in these hospitals etc to release bills under Ayushman Bharat scheme,” he alleged.
‘The Long Flight’
Another group of doctors say that the government must check the credentials of many of these unethical doctors and launch a severe campaign against them. They alleged that it is a “long flight that takes them to the route of these unethical practices”. They alleged that the pharma companies have gone so deep into the system that they even “dictate” that doctor how many prescriptions to write for the day, month and the year.
“It is not just about mass medication or unethical practices. We have seen some near and dear ones of doctors being sent to Bangladesh, Ukraine, or other institutions in India for MBBS by pharma companies,” they alleged. “Even Hajj and Umrah is sometime sponsored for them for prescribing their medicines,” they said, adding “During one of the former director’s times at SKIMS, one person was allotted a dedicated place to sit in Cath Lab, who was selling costly cardiac devices at double price like pace makers etc. This all happened in front of the administration and eyes were closed upon these things.”
A young Radiographer, Owais Maqbool, said that he had joined the health sector with many hopes and wanted to give his best to the poor patients of his area. “When I came back from Bangalore after finishing my studies, I had started understanding the sector well. There are many reasons why a handful of doctors are indulging into malpractices and violating a code of conduct is only because they have been given that free hand.
They are the ones, who initially make name and fame and then misuse it at their later years and these are handful and there are still many best doctors around who are always there resist it,” he said, adding however, “I must admit that this menace is only because of the mass prescriptions or mass medication because most of the doctors are getting paid by so called pharma companies for their own benefits so they go on misusing their position and profession.”
“A few of their doctors I have personally seen getting gifts, paid huge amounts monthly and getting gala parties in big restaurants.”
Elaborating on his discipline, he said that few doctors are getting paid from particular diagnostic centres. “For instance, if a particular patient has to undergo CT, MRI, and the doctors recommend any dedicated diagnostic center and later they get their dividends.”
‘Resistant to drugs’
A senior paramedic from Department of Microbiology, Government Medical College, Srinagar, argued that there are two possible reasons for the mass medication in Kashmir hospitals which include, prescription of the medicines by medical shop owners due to which people in Kashmir have become resistant to many drugs.
He said that in order to salvage the lives, doctors have to counter resistant strains and prescribe multiple drugs for that. He further said that blooming of multiple licensed pharma companies is also adding to the menace and the companies, not upto the medical standards, finally “lure the doctors” with lucrative offers for prescribing their drugs in abundance.
Another doctor from department of medicine, GMC, Srinagar, said mass medication has become a multifaceted problem embedding patients, doctors and pharmaceutical companies and medical representatives (MRs).
“It’s a very grim situation concerning all of India’s states but more prevalent in Kashmir population,” he said.
A senior professor, Department of General and Minimal Access Surgery, Government Medical College Srinagar, Dr Iqal Saleem Mir, opined that he would be happy if there were examples of this mass “medication practice” made on the paper.
While as the Zonal Medical Officer, Srinagar, Dr Sameena, argued that it is true that the number of medications per prescription has increased in recent years especially among the middle aged and older individuals. The reasons seem to be many.
She said that at the outset, it must be realised that due to poor lifestyle, a number of non-communicable diseases have attained pandemic proportions and often multiple conditions coexist in the same patient setting the stage for poly pharmacy.
Besides, due to advancement in the medical field, an increasing number of medications are now available for treating these various ailments and risk factors.
For example, a common scenario is to see a 60 year old man with heart ailments, hypertension, diabetes, obesity, deranged lipid profile, kidney impairment and thyroid abnormalities all together in the same patient.
“Consequently, medication for such patients would be 4 to 8. some patients also have a medication seeking tendency as suffering is intolerable,” Dr Sameena said, adding “It is possible that doctors experience pressure from pharmaceutical companies including the lure of inducements to prescribe more medications, but this becomes possible when patients do have such medical conditions and doctors tend to prescribe more than necessary.”
Prescription Audit
Jammu and Kashmir’s Health and Medical Education Department recently accorded sanction for the constitution of prescription audit committees at the Government Health Institutions across the Union Territory of Jammu and Kashmir.
The prescription audit committee, according to the government circular, would be formed at the Government Medical College, district and sub-district levels. The circular further said that prescription committees would keep a check on the prescriptions given by the doctors and to contain the reported unethical practices by some health care professionals.
According to a government order, at the Government Medical College Level, the Medical Superintendent of the concerned hospital shall be the chairman of the committee, while the Assistant/Associate Professor Pharmacology along with the RMO/ senior CMO shall be the members.
The order further said that at the District Hospital Level, the Medical Superintendent would act as the chairman and District Immunization Officer/DHO along with the Sr. Medical Officer, nominated by the Chief Medical Officer, shall be the members.
However, doctors said that no substantial work is done on the ground as the Audit committee recommendations aren’t being implemented. The government order further said that the HODs (Principals) of Government Medical Colleges, Director Health Services Jammu/Kashmir, Director, ISM, J&K shall nominate nodal officers in their respective institutions. The nodal officers nominated shall at random collect photocopies of at least 1% (one percent) of the prescriptions written by the Government Doctors in the OPDs.
Accordingly these prescriptions collected by the nodal officers shall be scrutinized by the Prescription Audit committees to check whether the prescription are written legibly in Capital Letters with the name of the doctors, his/her signatures and registration number, generic drugs are prescribed and preference given to the drugs which are available free in the Hospital supplies, unnecessary diagnostics test are not prescribed and patients are not referred to private clinics/specialists without requirement and whether drugs are prescribed in contravention to the provision of Drug and Cosmetics Act and Regulations.
It shall be again ensured by the prescription audit committee that fortnightly reports are sent to the HODs. HODs shall prepare a comprehensive monthly report along with their recommendation highlighting the actionable points, which shall be submitted to the Administrative Department.
Director, Health Services Kashmir, Dr Mushtaq A Rather, said that the Directorate of Health Services, Kashmir (DHSK) has asked the districts to nominate Nodal Officers for a prescription audit even as the CMOs have been directed to constitute a District level Prescription Audit Committee (PAC).
He said that in this connection a Divisional Level Prescription Audit Committee is also being constituted which will make the necessary recommendations based on inputs received from the district.
About the terms of reference for the Prescription Audit Committee, it will scrutinize prescriptions collected and will see whether the prescriptions are legibly written in capital letters with the name of the doctor, his/her signature & registration number.
He said that PAC would also see if generic drugs are prescribed and preference is given to the drugs that are available free in hospital supplies. It will also check the unnecessary tests, diagnostics; procedures and referrals to private clinics/ specialists without requirement. The PAC will also see if the drugs are prescribed in contravention to the provisions of the Drugs & Cosmetic Act & Regularizations.
‘Remedies’
A large group of doctors suggested that signatures and stamps of all doctors on their prescription should be made mandatory. They said that in hospitals fair price medicine should be made mandatory and the prescription should only go out of the hospital if the medicine isn’t available at the fair price shop.
Moreover, the procurement of medicine by the hospitals (hospital supply) must be audited so that all hospitals procure those medicines which are more commonly prescribed for common ailments.
A few other doctors said that not just iron and folic acid supplements, antiepileptics and those antibiotics like amoxicillin and cotrimoxazole ( septran ) which are no longer or are rarely indicated or prescribed in infections.
They should procure azithromycin, paracetamol, cough expectorants, cough suppressants, co amoxiclav, cephalosporins, Ofloxacin+ Metranidazole , etc which are most commonly prescribed
“Medicines which a doctor prescribes commonly should be available free of cost in hospital,” they said.