Yvonne Ba­boolal

The lives of thou­sands of can­cer pa­tients are at stake be­cause of a rack­et in which mil­lions of dol­lars' worth of can­cer drugs have gone miss­ing from the phar­ma­cy at the St James Med­ical Com­plex and the Ch­aguara­mas build­ing where the Min­istry of Health's drugs are stored.The drugs, main­ly used in chemother­a­py, are end­ing up in the pri­vate of­fices of doc­tors on the "out­side," Health Min­is­ter Dr Fuad Khan dis­closed yes­ter­day as he told what his min­istry had un­cov­ered in on­go­ing in­ves­ti­ga­tions.

A lot of can­cer vic­tims who re­ceive treat­ment at the St James Med­ical Com­plex have writ­ten to him about what they are told is a short­age of drugs at the in­sti­tu­tion, he said. The trau­ma­tised pa­tients said to get the drugs they now have to pay very high prices for them at pri­vate doc­tors' of­fices."Pa­tients are ob­tain­ing the drugs," he said. "Some­one is giv­ing it to them. A lot of them have writ­ten to me but they are afraid of vic­tim­i­sa­tion, that they will be de­nied the drugs.

"We are pur­chas­ing a lot of can­cer med­ica­tion and it's ex­treme­ly ex­pen­sive, about $12,000 to $15,000 per vial. Some­times one pa­tient needs ten to 12 vials. They are most­ly sec­ond-line drugs, which are used when first-line drugs are not ef­fec­tive enough."What we un­cov­ered is that a lot of can­cer drugs, which are in the phar­ma­cy at the St James Med­ical Com­plex and are dis­trib­uted to the wards of the var­i­ous hos­pi­tals, find their way out­side of the hos­pi­tals, in pri­vate med­ical prac­tices."

Khan said a sys­tem had been put in place to min­imise the loss of drugs, where­by both the doc­tor and pa­tient at St James had to sign the pre­scrip­tions."Pa­tients have to sign to re­ceive them too. When I last checked, this sys­tem of dual sig­na­tures was in place."He said what re­mains a mys­tery is who are the phar­ma­cists and peo­ple dis­trib­ut­ing the drugs, since there are no records of the names of the peo­ple on du­ty.

"We are try­ing to fig­ure out who are the phar­ma­cists and peo­ple as­signed, but it has been chal­leng­ing, be­cause of a lack of at­ten­dance records," Khan said."Phar­ma­cists from the Port-of-Spain hos­pi­tal are some­times as­signed to St James, but there are no records of phar­ma­cists sign­ing in or out."As a re­sult, he said, "There is a short­age of drugs, and no at­ten­dance records of phar­ma­cists. I have to be sus­pi­cious."

The min­istry's med­ical drugs are pro­cured and stored and man­aged by the Na­tion­al In­sur­ance Prop­er­ty De­vel­op­ment Com­pa­ny at the C-40 build­ing in Ch­aguara­mas.Khan said there has al­so been "leak­age" at C-40 and blamed care­less se­cu­ri­ty for this."Se­cu­ri­ty is not strin­gent enough," he said."There is pro­tract­ed loss at oth­er lev­els, at the phar­ma­cy (in St James)."The Gov­ern­ment al­lo­cates $120 mil­lion year­ly for the treat­ment of can­cer, re­port­ed­ly the sec­ond lead­ing cause of death in T&T.

The T&T Guardian yes­ter­day spoke to a med­ical source at the St James Med­ical Com­plex, who con­firmed there is a short­age of five chemother­a­py drugs there. He said he had al­so heard about med­ical per­son­nel us­ing fic­ti­tious doc­u­ments to ac­quire can­cer drugs."I have heard sto­ries of med­ical per­son­nel who present these fic­ti­tious pre­scrip­tions to the phar­ma­cists for the can­cer drugs and then take them to pri­vate fa­cil­i­ties where pa­tients are charged ex­or­bi­tant fees for treat­ment."

He said there has been a rapid growth in the num­ber of can­cer pa­tients at the in­sti­tu­tion and, at one point, there were about 1,000 new pa­tients every year. The source said there is no al­ter­na­tive treat­ment that can­cer pa­tients at the in­sti­tu­tion can be of­fered."They just have to wait un­til we get."He said with­out their treat­ment, these pa­tients face the risk of ear­li­er death.

Yes­ter­day, Khan said it is for this rea­son that the min­istry wants to in­tro­duce the health card, which con­tains, in a mi­crochip, a pa­tient's med­ical his­to­ry and what med­ica­tion they are us­ing. "This will track where the drugs are go­ing and in­to who. A pa­tient will not get the drugs un­til he presents the card."The min­is­ter al­so dis­put­ed charges that the Gov­ern­ment was not buy­ing a suf­fi­cient amount of drugs and that sup­pli­ers were not be­ing paid on time.

Asked how the min­istry was deal­ing with can­cer pa­tients who did not get their drugs at the St James Com­plex, Khan said: "Once there is a short­age, there is no sub­sti­tute."As the phar­ma­cy and C-40 re­quest, we buy it, make an or­der for more. If it's be­ing pil­fered, it's like putting wa­ter in­to a hole. There are al­ways short­ages and we are al­ways re­plen­ish­ing."

Head of the T&T Can­cer So­ci­ety Dr Jacque­line Sab­ga, who runs Vi­tas House Hos­pice, a home for dy­ing can­cer pa­tients at the St James com­plex, said yes­ter­day she was not aware of a short­age of can­cer drugs and there is no short­age for pa­tients at her fa­cil­i­ty.But she added, "This doesn't mean it does not ex­ist."She said a pa­tient's life would be in dan­ger if they did not­get their med­ica­tion.

A pa­tient's or­deal

A can­cer pa­tient who was di­ag­nosed with the dis­ease last year cried when she went to the St James Med­ical Com­plex, where she had been re­ceiv­ing treat­ment, and was told there was no med­i­cine for her. This was around May, she said."A nurse hand­ed me a pre­scrip­tion and said they don't have any drugs. I sat down and start­ed to cry. I was scared. I felt so hurt," she told the T&T Guardian, ask­ing that her iden­ti­ty be pro­tect­ed."I nor­mal­ly get two sets of drugs, one to be tak­en in­tra­venous­ly and one oral­ly."

She said she re­turned re­cent­ly and was told the same thing. She re­lat­ed the ex­pe­ri­ences of oth­er can­cer vic­tims who were al­so turned away."Avastin, one of the main drugs we use, is not avail­able at the hos­pi­tal," she said. "There are oth­er types of drugs miss­ing. Those who have breast can­cer say they are not get­ting the med­ica­tion for their spe­cif­ic con­di­tion."When some of them hear this, they are afraid they will die."

The source said even sim­ple drugs which can­cer pa­tients use out­side of chemother­a­py, like B-6 pills and creams for their hands, are not avail­able.Asked how she fared af­ter the hos­pi­tal told her the drugs were not avail­able, she said: "I went with­out it. I didn't feel any ma­jor dif­fer­ence but tests showed that the lack of treat­ment had a neg­a­tive ef­fect on the dis­ease."