Showdown at Commission of Inquiry – Fabro maintains innocence; Sosa says shortages at hospital still “a fact of life”
Posted: 23/12/2009 - 11:05 AM
Author: Aaron Humes
The Karl Heusner Memorial Hospital (KHMH) Commission of Inquiry is fast winding down, and for fans of drama in public life, it has left much to be desired, when compared to the probe into the Development Finance Corporation (DFC) in 2006, for instance.
But this Commission has largely eschewed such drama in favour of an exercise in soul-searching for the nation’s leading hospital, and that examination continued today with three of the most high-profile names to appear for public hearings to date.
Dr. Jose Guerra, whose name was called in the Auditor General’s report as a shareholder in PharmaBiz International, which did business with the hospital to the tune of over $200,000 in 2008, tried to dispel any notion of wrongdoing on his part.
The obstetrician/gynecologist admitted that PharmaBiz won a tender bid to supply pharmaceuticals for the current tender year, 2009-10, but none before then.
As for the matter of the Precision glucometer machines and strips the company introduced to the hospital at a profit, Dr. Guerra disclaimed any participation, telling the Commissioners that the other main shareholder in the company, who is also its marketing and sales manager, approached the then-director of medical services (a Dr. Cuellar) and reached a verbal agreement with Dr. Cuellar, with the consent of then CEO, Dr. Alvaro Rosado, and then Director of Finance, Cecil Knowles, to promote the machines and strips within the hospital and even teach the nurses how to use them.
A total of 28 machines were donated between July of 2006 and this year, costing $50 each; strips were sold for a total of $85,946, imported, Dr. Guerra reported, directly from Puerto Rico, where they are manufactured.
However, Dr. Guerra said he did not know why the hospital, after being introduced to Precision, did not decide to seek out the equipment independently instead of through PharmaBiz, although he did mention that the company was the primary supplier of this brand throughout the Caribbean and his partner the sole representative.
Dr. Guerra’s testimony proved to be mostly appetizer – the main course was the mouth-watering showdown between Dr. Ricardo Fabro, deposed chairman of the Board of Governors, and Dr. John Sosa, president of the Belize Medical and Dental Union (BMDU), whose rivalry precipitated the events that led to this Commission of Inquiry in June when the Union “went to bat” for disgruntled colleague Dr. Khalid Ghazy, who had been demoted from the post of Director of Medical Services and would have been transferred to the Accident and Emergency Unit on the approval of the Board were it not for the intervention by the Union and his subsequent reinstatement. (He has since resigned the post and according to Dr. Sosa, is currently in the U.S.A.)
While Dr. Sosa apologized for failing to either meet with the auditors or responding to the Commission’s letters to him (which he said he discussed with Union members, but due to an “oversight” did not respond in the appropriate time), he was blunt in describing the events that became the proverbial, as he put it, “straw that broke the camel’s back.”
It had been rumored in certain circles that Dr. Ghazy had stood up to management over the purchase of the Ultravist brand of contrast media for usage in CT scans that cost $84.73 in the United States, when a better brand, Omnipak, according to Dr. Sosa, could have been had for just $18 from GE company of Guatemala.
Confirming those allegations today, Dr. Sosa said that the Union, in addition to Ghazy’s demotion, had been hearing “rumours” of purchases of drugs at “exorbitant” prices, and began to gather evidence to challenge the Board over these allegations.
The rest, as they say, is history, but two noteworthy issues raised by Sosa are that: 1) $16,000 worth of Ultravist contrast bought by the hospital is currently stocked and not being used; and 2), far from improving, the situation with regard to availability of needed medicines and equipment remains about the same as it was in June.
(Dr. Sosa’s specialization is neurology, and according to him, fentanyl, phenobarbital, Dilantin, and valproic acid - items he called “front-line” medications he uses on patients - are in short supply, and elective surgeries have been put on hold because fentanyl was not available, except for the last month.)
The contrast purchase raised eyebrows. According to Dr. Sosa: “…we said that why are we paying so much for something when we need that money to spread because money is in short supply and we need to get medicine and supplies for our patients. It is unfortunate that I ask for things every week. If you go in the wards and you’ll ask the nurses, every week they fill out a requisition book and they only get half of what they fill out. That is a fact of life.”
While the Union had no proof, it was widely believed the Board wanted Ghazy out, Dr. Sosa said; he himself was three times offered the post, but declined each time due to his conflict with his private practice and work at Belize Medical Associates.
On the question of doctors employed with KHMH holding shares and ownership in companies doing business with the hospital, Sosa said he could find nothing in the KHMH Act prohibiting it, but opined that it was nonetheless an “unethical” practice.
Countering Sosa’s testimony were the statements of Dr. Fabro, who while out of the public eye since his reported voluntary step-down in July of this year after a negotiated agreement with the Union by Labour Commissioner Ivan Williams, said that he has been “on public trial” since the scandal broke.
While he was not on trial today (though attorney Leo Bradley, Jr., appeared with him), the confident Chairman of June and July seemed slightly rattled as the Commissioners hammered away at his wife Marie’s MC Pharmaceuticals, which had been given a tender contract for $759,419.16 in 2008-09 for the provision of pharmaceutical and medical supplies.
In an apparent show of loyalty, Dr. Fabro often used the pronouns “our” and “we” in his testimony whenever MC was brought up, though maintaining his personal distance.
For instance, he maintained that he had nothing to do with MC’s operations, save witnessing the signing of the contract with the Ministry, and being consulted by his wife when the Ministry’s CEO, Dr. Peter Allen, wrote to MC concerning the failure of certain macro IV giving sets, or droppers. The droppers were replaced by a product from Mexico, at a loss to MC.
Dr. Fabro further refuted allegations that he directed underlings in the purchasing of non-tender pharmaceutical and medical supplies, stating that he had no direct input in supply purchases and did not know personally from whom the hospital bought.
Nevertheless, in the interest of transparency, he had “recused” himself from chairing the Board until the Union’s allegations could be sorted out.
Dr. Fabro did mention that the preliminary audit of July was erroneous in its comparison of prices by tender to prices paid on the open market; they were “apples and grapes” to him.
On the subject of Dr. Ghazy, he would only say that the Board had requested certain things of the former DMS that he failed to accomplish, and that that was the reason for his demotion. He denied that there was any plot afoot to specifically replace him.
Fabro answered this way when Commissioner Orvin Nicholas questioned how he was able to separate his KHMH post from his relationship to MC (Quotes courtesy Channel 7):
Nicholas: “How do you separate yourself, your wife being a part of a company and you as the Chairman of the KHMH when it comes to advice, when it comes to decision making? How do you draw that thin line between benefits accruing to your family and benefits accruing to the institution?”
Fabro: “I think they are two separate issues.”
Nicholas: “Can you separate it?”
Fabro: “I have always separated them.”
The Commission continues with testimony from CEO Dr. Gary Longsworth on Wednesday, plus employees Merlene Myvett and Miriam Coleman.
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