Supplies instead of disposal: how hospitals received an expired antibiotic

A few days before the expiration date, the Ministry of Health ordered to ship 28 thousand packages to regional hospitals - these institutions did not order the drug.

Julia Suntsova

On November 15, 2022, Roman Viskov, Deputy Minister of Health of the Moscow Region, by his order No. 14ISH-24549 / 2022-17-01, ordered the subordinate institution of the GBU MO "Mosoblmedservis" to ship, and state medical organizations to accept, "timely and rationally use" 28.092 packages of the medicinal product Azithromycin.

During the very first days after the letter from the Ministry of Health, fifty-two public hospitals in the Moscow region really began to receive Azithromycin on invoices from Mosoblmedservis. According to Viskov's order, director Irina Poletykina was appointed responsible for the supply of this batch of antibiotics from the Mosoblmedservis GBU, and chief doctors from the hospitals.

On the ground, the drugs were actually taken by the heads of hospital pharmacies, from which further distribution is made - to inpatient and outpatient departments.

In the normal course of life, deliveries are initiated by chief medical officers and confirmed by orders from chief doctors in accordance with applications received from senior nurses. Nurses, in turn, form their order as needed, while applications are submitted in advance (so that the entire department is not left even for a day without the necessary drug). The case of Mosoblmedservis is simple - to deliver the ordered to the address, an employee of a state medical institution from the Moscow region tells NI. According to him, he was also forced to participate in this delivery. The source shared details of the event, asking for privacy for fear of being fired after the publicity:

- This time it was different. We never found someone who would really demand this supply from Mosoblmedservis. The chief medical officer of our hospital did not order. Colleagues from other hospitals in the region also say that they did not need Azithromycin. Shipped and forced to put the drug on the balance forcibly. They just signed the claim forms and invoices after the fact. Theatrically asked to pay attention to the fact that the expiration date is expiring! - as if they had been warned! The head doctors saw and knew everything, they were also not happy, but they could not do anything - the instruction was sent down from the very top, from the Ministry of Health, - says the hospital employee.

Khimki, Balashikha, Korolev, Krasnogorsk, Lobnya, Voskresensk, Mozhaisk, Dubna, Klin, Reutov, Dmitrov, Sergiyev Posad, Vidnoe, Dzerzhinsk, Volokolamsk, Chernogolovka, Shatura, Dolgoprudny, Domodedovo, Yegoryevsk, Zhukovsky, Istra, Lyubertsy, Zaraysk, Lukhovitsy , Chekhov, Schelkovo, Mytishchi, Odintsovo, Podolsk, Ramenskoye, Serpukhov, Solnechnogorsk, etc. - after the order of the Ministry of Health, fifty-two (52) state budgetary medical institutions accept Azithromycin, from 150 to 1000 packs of 500 mg., in depending on the hospital, total 28.092 packs.

According to the information in the Chestny Znak app, the shipped azithromycin was produced in 2020. The question is - why did he lie somewhere until the last month? Who pushed and why?

"Hospitals themselves would never ask for the drug in the gigantic volume in which it was received. This amount was spent for a whole year, and then in the active phase of the coronavirus. And the same volume arrives in hospitals with already closed covid departments a few days before the drug is written off. At the time of shipment of "Azithromycin" to our hospital, he had only 12 days left", - our source says.

Employees of budgetary medical institutions in the Moscow Region use a corporate chat where various working interactions take place, including on the supply of medicines.

After the mass shipment of Azithromycin really started according to the list of medical institutions prescribed by the Deputy Minister, indignation poured into the chat. Hospital staff warned that the antibiotic would expire on December 1, and once again said that the author-customer of this supply was unknown to anyone. In response to this, a user with a phone number that coincided with the phone number of the director of Mosoblmedservice, Irina Poletkina, imperatively replied to the indignation of her colleagues: “I draw the attention of EVERYONE. The duties (for azithromycin) of each are spelled out in a letter from the Ministry of Health [Ministry of Health] - both ours and yours. Read!" (A scan of the correspondence is at the disposal of the editors).

The chat also published a delivery schedule. If one were born naturally, this would mean that 52 hospitals in the Moscow region ordered the amount of azithromycin they did not need on about the same dates.

Hospital staff also drew attention to the fact that, according to the document, it is prescribed to spend a huge amount of azithromycin only as part of the implementation of the order of the Government of the Russian Federation of November 19, 2021 N 3261-r - in other words, only for the treatment of patients with COVID-19, which makes the task on the "rational use of the drug" cosmically unattainable.

Three days later, on November 18, 2022, Deputy Minister Roman Viskov corrects this mistake by issuing a new document with his signature No. 14ISH-24549/2022-17-0. The updated order addressed to the chief physicians this time allows the use of an antibiotic for the treatment of patients NOT only with coronavirus. Before the expiration date of the drug remains 12 days.

“The Ministry of Health of the Moscow Region, in addition to the previously sent letter dated 11/15/2022 regarding the shipment of the drug (Azithromycin tab.pp.pl.vol. 500 mg No. 3) to state medical organizations of the Moscow Region, informs that in connection with improvement of the epidemiological situation, a significant decrease in the level of hospitalization of patients with a new coronavirus infection COVID -19 and changes in temporary guidelines <…> the drug "Azithromycin" is recommended for use in inpatient and outpatient settings according to medical indications for the treatment of patients with diseases not associated with COVID -19".

The “safety” letter was needed by the Ministry of Health, obviously, in order to relieve itself of further responsibility for the order to carry out the obviously impossible.

But even with the indicated allowance for the introduction of additional categories of patients on whom azithromycin can be spent, the head nurses' headaches did not decrease. The imposed supply was not even several times, but dozens of times higher than the real need.

Comparison in numbers. In November 2021, when there were still a lot of people infected with coronavirus infection in Russia, in the order of the Government of the Russian Federation of November 19, 2021 No. 2021 (that is, for 1 month and 11 days). At the same time, the purchased drugs were supposed to be spent in inpatient departments of hospitals in all (!) regions of the country.

85 constituent entities of the Russian Federation consume an antibiotic for 41 days during the active phase of coronavirus

And

1 subject of the Russian Federation - Moscow region - consumes an antibiotic for 12-15 days (during the period without an influx of coronavirus patients),

and the difference is only three times...

"Received azithromycin was hastily discharged in pulmonology, therapy, surgery. But even so, I am sure that by December 1, only a tiny part of the stocks received would have been spent. The second question is, to what extent is it in the interests of patients and how much does it affect their health if doctors set them to intensively prescribe this drug?", - says our interlocutor.

Why was the antibiotic stagnant in warehouses pushed to hospitals at the last moment?

The source of "NI" expressed his version that in this way "Mosoblmedservis" (or the organization that used it as a "gasket") tried to save on the disposal of the medical product. The expired drug "Azithromycin" belongs to the category of class "G" waste. Unused antibiotic, starting from December 1, hospitals will have to activate. A commission will meet to conduct an inventory and identify drugs with an expired shelf life. Then they will issue a disposal order and give the goods to a contractor for destruction, who will be hired at their own expense.

True, the amounts that can be “laundered” for recycling are not so large to deploy this large-scale operation for their sake.

For the disposal of 1 kilogram of Class G waste, contractors in the Moscow Region charge an average of 45 rubles. Even if we assume that together with a package containing three 500 mg tablets, a pack weighs 10 grams, it comes out to only 12,641 rubles for the disposal of all 28,000 packs of azithromycin supplied to all 52 hospitals.

It can be assumed that the Mosoblmedservice contract for the transportation and shipment of the drug to 52 hospitals in different cities of the Moscow region is clearly paid more. And if it is possible to fulfill the state contract, why not fulfill it?

However, if we rely on the perfection of the search system on the official portal of public procurement, it turns out that the State Budgetary Institution of the Moscow Region "Mosoblmedservis" last ordered the drug "Azithromycin" long before the coronavirus epidemic - already in 2016. Throughout its history, the company has made only three purchases of azithromycin through the official auction system in Russia - all in October-November 2016 for a total amount of 520 thousand rubles, the drug was purchased to provide preferential categories of citizens.

However, the legislator simplified the norms of the law on the contract system for state customers in the context of a pandemic, and medicines purchased then in a simplified manner for the treatment of coronavirus infection might not be included in the statistics on the electronic portal.

By the time the material was published, the State Budgetary Institution of the Moscow Region "Mosoblmedservis" had not responded to the inquiries of the editors, and we do not have answers to all these important questions.

We cannot yet speak with confidence about the violations of any of the officials.

However, the fact of an inefficient management decision, which led to the overspending of public funds spent on the purchase of a huge amount of medicines, which were not eventually sold, is indisputable.

From a letter from the Deputy Minister of Health of the Moscow Region dated November 18, 2022. Roman Viskov knows that azithromycin was bought, from which it became urgent to get rid of, at the expense of the budget of the Moscow region.

According to the invoices that came into our possession from the second half of November 2022, the cost of one package of Azithromycin delivered to hospitals from the List by order of the Ministry of Health of the Moscow Region is 77 rubles.

77 rubles * 28092 packages = 2 million 163.082 thousand rubles. This amount, at least, was paid by the budget of the Moscow region for the medicines in demand, which, due to a miscalculation of managers, were not spent in a timely manner.