'Medical Kalabule' probe: What the Committee missed

Shortly after the Fourth Estate released its documentary 'Medical Kalabule', the Health Minister formed a committee to investigate allegations made in the documentary. The committee's report indicted only one of the medical professionals named in the documentary for overcharging patients for surgical tools and recommended him for disciplinary action. Two other medical professional were exornerated. 

The committee's report also indicated that “After careful examination of the evidence presented, the committee concluded that allegations of deliberate collusion, commonly known as medical kalabule, between doctors and suppliers could not be substantiated.” 

In this episode of the podcast, Joojo Cobbinah who produced the Medical Kalabule documentary, walks us through the committee's report and reacts to its conclusion that the "allegations of deliberate collusion between doctors and suppliers could not be substantiated."

Transcript

SPEAKER_03 0:00

From the Media Foundation for West Africa, this is the Fourth Estate podcast. Hello and welcome. I'm Nia Krofis Matabe. The committee set up by the Health Minister to investigate the allegations made in the Fourth Estate documentary Medical Kalaboule has released its report. Unsurprisingly, it exonerated some of the medical professionals mentioned in the documentary. And unsurprisingly, the fourth estate is not particularly enthused by the committee's report. Jojo Kobner produced a documentary which is Medical Kalaboule, and he joins me today to talk about the committee's findings. Jojo Cubner, welcome back to the podcast.

SPEAKER_02 0:38

Thank you.

SPEAKER_03 0:39

First of all, let's take your reaction to the committee's report.

SPEAKER_02 0:43

I would say that the committee did an okay job. Um, had some loopholes that we are just about to explore. Um, I would say that it was it was just normal. Though there were no serious um revelations in there, and so it was just an okay job.

SPEAKER_03 1:01

One of the surgeons that's um Stephen Kusey, uh, he was singled out for violating the Ghana Health Um service code. Because I remember when you asked him directly.

SPEAKER_02 1:11

The first thing is are you allowed to take money from patients directly to procure things for surgery? It depends on the situation, but for me, I am not aware of anything.

SPEAKER_03 1:25

But he was singled out for doing that, but I haven't quite heard anything about uh Professor Kaba yet, even though I think Dr. Hassan and Danny was also mentioned.

SPEAKER_02 1:35

Okay, so now let's take it one by one because it looks like we've just got together three of them. Three of them. So let's take um Dr. Kusi's own. It's in black and white. Um, when you read the Ghana Health Service code, it's there. I mean, you don't have to take money from patients, and so that was where he cleverly tried to um divert the whole thing and said, Oh, I was helping them, you know, because the doctors have uh responsibility to um make sure that they take care of patients, help them make sure that they're okay. And so, yeah, definitely. I mean, if you're saving lives, that is that is the paramount. You have to do everything in your capacity to make sure that you save the patient. But it was abundantly clear that he was just trying to dance around an issue, taking money from a patient to buy uh Jiggly saw, which is very, very, very cheap. 200-300 Ghana CDs, and then you charge 3,000, 4,000 CDs. I mean, that is ridiculous. So the committee came out and said, well, whatever he said, I mean, um, was not tenable, and that he took money and it was against the code.

SPEAKER_03 2:41

So that was so he's gonna face disciplinary action.

SPEAKER_02 2:43

Yes, yes, yes. Apparently, um Red Hospital said they were initiating a disciplinary procedure, and the committee was saying that well, they want Ghana Health Service to be the body that's the bigger body to take responsibility and uh institute how do we call it? Um more or less a tribunal, a disciplinary um procedure. Then he comes there, explains, I mean, the situation, whatever happened, and then presents his case with his lawyer, and then they they issue out whatever um punishments or whether he he is asonerated or not, by the way, recommending punishments and that yes, he should phase the disciplinary procedure. So that one is clear.

SPEAKER_03 3:26

Okay, and then how about Dr. Hassan and Dani?

SPEAKER_02 3:29

This is where the whole thing gets very, very, very um messy.

SPEAKER_03 3:34

Because for those who don't remember, he's the um resident who signed for Professor Kaba.

SPEAKER_02 3:39

Yes. So Hassan Andani is a resident. Residents are more or less apprentices, people who are learning, learning from consultants and specialists who've done it for many years. And so, of course, when you're doing that, as a normal procedure, your consultant can tell you, oh, Akofi, go and pick this for me. Hey, write this thing for me. So they do that. And so that is how come all the prescription forms, all the requisition forms is funny. I mean, later on we'll get into requisition and and and then prescription forms that he wrote. He wrote um Dr. Hassan and Dani for Prof. And so he was writing because he was the one who was actually leading the cases. And in the case of the uh Perfect Sunday Adebayo, the case was directly referred to Professor Kaba. Because if you remember, in the part one of the medical kalabouli, Perfect actually said, Oh, we were talking to Professor Kaba long before we actually came. And so definitely we know that it is Professor Kaba's uh case, and then um other cases, Madusambu, that one too, Prof Kaba's case. So he actually wrote on behalf of him, but the committee said, well, when they spoke to um Prof Kaba, he said he had not given him any instruction to write on his behalf. So that is where the confusion is. And when all the requisition was done and the equipment, the tools, the consumables that was requested, when it came, who used it in the theater for the whole process? It is definitely the consultants who did together with his team. And so can you say that Hassan Andani did this on his own? So, I mean, he he just um saw a patient and then decided that oh, patient, this is what you need. No, he got an instruction. So that is that is one loophole from the committee's I mean, report.

SPEAKER_03 5:36

So meaning that Professor Kaba didn't have a say in Dr. Andani directing Perfect Sunday and the others to access pharmacy as well, exactly.

SPEAKER_02 5:46

And and this is where it gets, I mean, uh very, very, very, very merky. The committee said something, said the newest agents were using access pharmacy um forms because Red Hospital had no requisition forms, and it is wild. In fact, this is a public hospital, a very big public hospital. They don't have um requisition forms. So, how come all of a sudden they found a requisition form from a private pharmacy? And also, if you look at the requisition forms, they had written pathology, that is type of disease. In fact, is that how pharmacies operate? And that is where the problem is. And then the name of it of the prescriber is also there. So that is where we are looking at prescription form and uh requisition forms. Now, let me let me ask you a question. So, what is a prescription form?

SPEAKER_03 6:42

Isn't that what they write to your usually the medicine you're supposed to get at the pharmacy is written on a prescription form, correct?

SPEAKER_02 6:48

Yes, so these are things that you are required to get. So, how different is it from requisition form? Well, you tell me exactly so you use prescription forms to get the required instruction from a pharmacy to get something, so that is prescription. I have prescribed this, go and get this. And so then, if you have also requested that I should go and get ABCD2, what are you doing? So it is a technicality and say, oh, well, there's a difference between prescription form and this, and so they didn't have one. So this was a question that I posed to um the Greater Carina Hospital medical director Leslie Adam Zakaria. Is it normal practice to have um the doctors or surgeons write your diagnosis and the things needed on the on a private pharmacy part, for example?

SPEAKER_01 7:43

No, no, no. That's that's if it that's inappropriate. Since I came here, uh I've never seen any other kind of prescription, and uh we don't I don't I don't know, I've not seen any other prescription, uh a private prescription. All I've seen is a hofslap produce, and and it is not expected of a doctor to use a private uh pharmacy prescription within the facility.

SPEAKER_02 8:09

So now all of a sudden the committee is saying that oh, um they they were using access pharmacy forms because um they didn't have one. And the man actually answered that, oh, even if doctors do not have prescription forms, they can write it and paper and stamp it that's coming from Ridge Hospital. So when I saw the finding from the from the committee, I was asking myself, I am not sure they did a very thorough job.

SPEAKER_03 8:38

And how about Professor Kaba? I am only bringing him because um he was mentioned, of course, having been the one that Dr. Andani signed for, and he was supposed to have also had an interview with you, which ended up with the national security being called in. Did he come up for discussion at all at the committees uh meet hearings? Do you know? And because I also I'm asking because I didn't see anything said about him in the report.

SPEAKER_02 9:04

Well, the only the only thing that they stated in a report was that he did not instruct Hassan and Dani to write. Because of that, I mean, yeah, he's off the hook because of that. And so then you ask yourself, is it enough? Because he's a he's a senior consultant, someone who has done this thing for many years. Is this how it's supposed to be done? We asked him that question. We said, How come you're using a private pharmacy form? At that moment, he did not say that, oh, we used it because um we didn't have one. He said, Oh, it is normal. Uh private pharmacies leave their um uh prescription forms as souvenirs, and so they always use it, and that was the response. And I said, Oh, but we we we stopped when when our attention was drawn to it that it was not was not proper. Someone who has done this business for so many years would say this. I mean, and so there are so many questions that we need we need to ask. And the committee said, Oh, well, um, it was wrong for Access Pharmacy to charge in dollars and that the appropriate authority should investigate. Yes, that's that that that one that one was it was known. I mean, something that we all we said, and they were received to show that, and the people actually admitted that they charge in dollars. Then you ask yourself, how come they do not itemize the things? You see, the thing is that prescriptions and requisition forms are supposed to be itemized. When we spoke to Dr. Divine by Umbala, the register of the Ghana Medical and Dental Council, he said it has to be clear.

SPEAKER_00 10:39

Maybe for you to use the system, you require a certain component. You have to be clear. You because here it gives the impression that it's the entire virtual reality system. Exactly. So you have to indicate what 026 means.

SPEAKER_02 10:54

So then all of a sudden, you would write uh maybe hydrokephalus, then you write 001. How do I know exactly what it means? Exactly. In fact, I have also seen other um what do you call it, uh prescriptions from the rage hospital where they're requesting for things, they actually list them. So if they are drips that is used to cover the um equipment, it is listed. If they are what do you call it, they are drills, you list the type of drills, you list everything, everything is clear. So you just write and say that oh, accession with with neo navigator 003. So is that a tool? That is just describing a procedure. This is what we are going to do. So that is where the challenge is. I mean, it's a very big challenge, and for a whole senior neurosurgeon to have uh supervised Hassan and Dani, are we saying that he did not see exactly what he wrote on the prescription forms? Because the things were very, very uh not clear, and that is where it becomes a bit shady, you know. That is the reason why patients will say, Oh, can I see the equipment? Can I see it?

SPEAKER_03 12:04

Yeah, because they they are not clear on what they're supposed to buy. What am I wanting to see it?

SPEAKER_02 12:09

What am I buying? Can I see it? No, no, you can't see it because yeah, it has to be sterile, it has to be taken directly into the theater, rightly. So, can I even see a picture of it? Then you you tell them no, and that is where the issue is. Now, access pharmacy, we asked that question. What did the people buy? I mean, Perfect Sunday buy that amounted to seven thousand dollars. Said, oh well, the appropriate authorities will be the ones who will tell. We're not going to do that.

SPEAKER_03 12:37

And that's the question I was going to ask you about because the committee did say they were recommending that the appropriate authorities deal with it, especially when it comes to they charging dollars in Ghana when it's not allowed. What appropriate authorities are we looking at when it comes to the recommendation from the committee that the appropriate authorities should look at access pharmacists' involvement and the authors?

SPEAKER_02 12:59

You see, the committee has done a work where they're clothed with the power to actually follow the money, to actually do a forensic investigation. No, do they have the power to subpoena documents? Um, tell the people to bring their bank statements and everything, go behind and even go directly to the bank and get all these documents. These are the issues. So that is where the OSP comes in, the office of the special prosecutor, and that is where we are actually going next. And so, yes, the committee has done some work, but do they have all the powers to actually do a very thorough work? So that is where we're actually going to push it to the OSP, and then the Ghana Medical and Dental Council, they also have to investigate a professional side of this because we had testimony from Dr. Devine Bay Mbala. He was very explicit in his in his thoughts, and he was like, no, this is wrong. We have to ex we have to investigate, and even said at the end of the um publication of the of the documentary, they want to actually take it further. So this is where we actually put the ball in their court for them to take it further.

SPEAKER_03 14:06

But the fourth estate was invited by the committee, but they say you are a no-show. Why?

SPEAKER_02 14:12

Yes, we explained in a press release, we actually stated that looking at the composition of the committee, there were issues that we had. There are medical doctors. It's like doctors, I mean, investigating doctors, and these doctors were investigating, they are not the statutory body to actually investigate. So, for example, in the subsequent publications, we'd realize that the same practice that is happening at um Rage Hospital, same happening at Cape Coast. We had someone from Cape Coast Teaching Hospital on the committee. Tamale, also the same practice, uh Tamale also feature in the next documentary. So it was like we are actually investigating institutions that these professionals are coming from. And we had also not finished our publication. I mean, many, many more publications are coming up, and so we are asking ourselves, are we going to just go to the committee to actually give them leads to things that we are we are yet to yes to yet to publish? No. Also, the medical and dental council was not also represented on the committee. We subsequently got to know that um Dr. Divine Bay Mbala, the register, was also called before the committee too. But now the dental council has to sit down and look at this particular holistically, not just the register on their own. Okay, because they have they they have been clothed with the power to actually do that. And so we looked at all these and we're like, no, we we are not going. In fact, there are many more um reasons that we can't even disclose all of them, but subsequently, you would know why we did not go to the committee. And in fact, looking back and looking at how everything banned out, I think it was it was good that we did not appear before the committee because we want the statutory bodies to actually take charge. We have done our investigations, we've made some allegations. Who are the appropriate authorities to actually look at it? The ministry has seen it, yes, because they are responsible. The Ministry of Health, they've seen it. Why didn't the ministry quickly refer it to the Medical and Dental Council and refer it to OSP? But it will form the committee, and then the committee, the composition of it, then oh, let's quickly investigate and let's get on with it. But this is a systemic issue. You see, many people are not appreciating um the challenge here because they have not been victims to it. But let me give you a very practical example of what is happening here. And this is a practical example. I went to my mechanic, I said, Oh, said, Oh, you need to replace your water pump, you need to replace something else. I was like, okay, can you list it for me? The person gave me a list of everything. I was like, okay, then I realized that the thing was like more than 20,000. I was like, hey, this is expensive. Then the person said, Oh, yeah, they were getting quality products and stuff. So, well, if you if you want to bring from somewhere else, you you can. So then I sat down and I Googled and I realized that the most expensive part was way cheaper than what my mechanic was actually selling to me. So then I approached another shop and then they got I got it. I mean, at like very, very, very discounted rate. When I bought it, my mechanic was unhappy. Why have you gone somewhere else to go and get you that you doesn't mean you don't trust me, I'm not going to do the car again. Apparently, he was embarrassed. This is the situation, and that is how many people find themselves in. You're sick, you have an accident, you've gone to a hospital, they tell you, orthopaedic, oh, we need to put an implant in your body to to heal you. But before you get this thing, go to this particular place and then send them a WhatsApp message, and they will bring the thing into the theater for me, and you would not see it, no one would see it. As to whether it actually goes into your body, you don't really know because I mean you maybe you just have to take their word for it. Your word for it, anesthetized, and you don't you wouldn't know. But let's say that yeah, it goes into your body. Why is it that the breakdown, proper breakdown of of the of the tools, of the implements, of the implants are not spelt out well? That is where the problem is. In part three, there is something that I want all of us to do right now. I want us to Google subdural evacuation port system. And when you finish, you write what is the most expensive subdural evacuating port system. Look at the price. What you would see would be 150 to 300 dollars. That is on the high side. Can you believe that this same access pharmacy charged someone 30,000 CDs for that? That is where the problem is, and that is what we are actually exposing.

SPEAKER_03 19:01

Okay, so to wrap before we wrap up, rather, I should say, uh, I just want us to touch on this final bit of the report, which I think is at the very heart of this investigation. The report said after careful examination of the evidence presented, the committee concluded that allegations of deliberate collusion, commonly known as medical kalabulé, between doctors and suppliers could not be substantiated. I wonder how you re react to this because it means after all that you've presented, they say they do not really see the connection between um the doctors and the suppliers being in cahoot, as we like to say, or that there's any kalaboule happening.

SPEAKER_02 19:43

So this is where we'd say, okay, number one, how come miraculously access pharmacy's prescription form is in the consorted room at REG at REGE Hospital. That's number one. How come Dr. Hassan and Dani would write a code, not list the what was needed, but just write a code and then the code will be sent directly to Access Pharmacy and they will know exactly what is needed. That is number two. Why is it that consultants, residents, newer surgeons are referring people to this particular pharmacy alone? What is also very interesting, when the hospital procured the new set of equipment for um newer cases, they got them from life care technology, they got them from um East Cantonment Pharmacy and even the um consumables and all that. How come patients are not being referred there? And I'm not talking about only one or two or three or four referrals, we have a whole docket of receipts of prescriptions directing patients straight to the access pharmacy. And of course, the committee did not follow the money, they didn't um get all these. So, how are they going to find create a link? That is the reason why we are saying that the link can be found directly if we follow the money, they follow the money, and there's a forensic investigation. In fact, we could have done that, but there are limitations to our work, except if we decide that we are going to hack into bank accounts of people, which is unethical. But we have the state agencies that have been close with the power to actually call people to actually bring all these documents, and then we know clearly what the relationship is. Because, in fact, it is known Ridge Hospital has no formal arrangements with Axis Pharmacy. It was clear in their internal audit report, they actually flagged it. If there was nothing wrong with it, why would the internal audit report flag it in the very first place? And in the reports, the internal audit report also said the Doctors were even keeping some of these consumables in the theater. And then they use it. Ask yourself this particular question. You refer a patient to a private facility. The patient pays $7,000. But the people who actually do the surgery and do everything, at the end of the day, they charge us 54,000 CDs. Does it really connect?

SPEAKER_03 22:24

Well, I guess we'll have to leave the audience with that question. And we'll hope to get the answers. Well, because we still have part three and part four of Medical Calaboli coming up. So hopefully by the end of this run of this series, we'll get to know the answers. And we'll also be following how the um escalation of the petitions to the OSB, to the medical and dental council uh pans out. So we'll have you back again, Jojo Kobna, for more discussion on this. And uh, but for now, we'd like to thank you very much for your time with us on the podcast. That's it for today. My name is Nia Kroofis Matabe. Join us again next time for another episode of the Fourth Estate Podcast.