Data obtained by BIRN shows that around 93 percent of the medications found in the central pharmacy of the QSUT are expired - a loss that accumulated year after year to 447 million lek, while hundreds of patients suffered the consequences of the lack of medicines.
At least four times a year, Fatjon Mara, 43, arrives at the Pediatric Hospital in Tirana with questions that torment him. His son was diagnosed with a chronic blood disease six years ago, and since then, the two of them have divided their lives between home and hospital.
“My son requires treatment at least four times a year. Sometimes the main illness causes other disorders and I am forced to spend up to two weeks in other wards,” Mara told BIRN.
Fluctuations in her son's health are Mara's main concern. But in addition to them, the 43-year-old has often had to wonder whether she would find the right medication at the hospital or whether the next treatment would improve her son's life.
In the six years of intensive therapy, he claims that there have been many times when he has run to the pharmacy with a prescription in hand.
"There has been medication recently, but in at least six years of intensive treatment, I have been forced to buy it at the pharmacy several times at high prices," Mara told BIRN.
The lack of medical medications is one of the main concerns of hundreds of patients and their families and a continuing "gangrene" of the healthcare system in Albania over the last two decades.
However, "a mountain" of expired medicines rose year after year in the central pharmacy of the "Mother Teresa" University Hospital Center in Tirana, while the sick were suffering the consequences of their shortages.
BIRN obtained an inventory report of the medications available at the QSUT central pharmacy until May 9, 2018, and processed the data, after entering it into a database.
The analysis obtained shows that about 93 percent of the medicines in the central pharmacy are expired and only 7 percent of them were still usable for patients.
The medications found in the QSUT belong to the years 2012-2018 and have a total accounting cost of 481.8 million lek [about 3.9 million euros]. Of these, medications with an accounting value of 447 million lek are expired and only 34.7 million are within the expiration date.
The accumulation of a large stock of expired medicines in the central pharmacy of the University Hospital Center has been considered a serious problem by the Supreme State Audit Office, KLSH. In two audit reports for 2014 and 2015, KLSH found that tons of medicines tendered or donated to the University Hospital Center had gone to waste and blamed this on mismanagement, but also the practice of tendering medicines on the eve of their expiry date.
The "Mother Teresa" University Hospital Center did not respond to BIRN's questions about the reasons for the stockpiling at the central pharmacy and the double damage caused to patients and the state budget.
In a written response, QSUT claimed that handling the right to information request required a long and unpredictable timeframe to process, as well as additional human resources, due to the voluminous documentation.
Data obtained by BIRN shows that the majority of the medicines wasted at the central pharmacy of the QSUT treated diseases that are quite widespread in Albania, such as cardiovascular diseases, mental illnesses, or antibiotics for the treatment of a variety of bacterial infections.
About 60 percent of them were purchased in 2011-2013 and fell out of use in 2014 and 2015. The rest expired during 2016-2018.
In the audit report published in March 2016, the Supreme State Audit Office highlighted the fact that the situation in 2014-2015 was extremely serious with around 520 thousand expired medications. Almost half of the quantity, according to the Supreme State Audit Office, had been tendered with state budget money in 2011-2013, while the rest were costly donations, which the system had failed to distribute to patients in a timely manner.
"..The amount of expired medicines is 172.705.615 lek, of which 48,366,589 lek are medicines contracted with state budget funds. The main part consists of donations, which fail to be used within their expiration date," the SAI report states.
In parallel with the tendered medicines, donations from pharmaceutical companies or international organizations occupy a significant part of the central pharmacy fund. By the end of 2015, according to the Albanian Supreme Audit Office, expired medicines from donations were around 234 thousand with a value of 124.3 million lek.
Data obtained by BIRN raises suspicions that the high cost of disposing of expired medications in EU countries has prompted various pharmaceutical companies to unload them as donations to the QSUT. An official contacted by BIRN said on condition of anonymity that the much-needed donations are arriving in Tirana with a serious problem.
"The medicines are being brought within the expiry date, with a period of 6 months or a maximum of 1 year," a QSUT official told BIRN.
The QSUT Directorate acknowledged the problem with expired medications, but blamed the previous administration for the responsibility in a response to the ALSHI.
According to her, the above medicines were planned and purchased during the years 2009-2013 - when the country was run by the Democratic Party - and that in the archive "there was no data on the medical structure that had requested the medicines".
The QSUT, which was led at the time by the current Minister of Health, Ogerta Manastirliu, declared in its claims that it had changed the way of planning and tracking the ordering structure, promising a change in the situation.
"This new way of planning needs has made it possible to trace the drug requester as well as to assign responsibilities to each structure, controlling their use or non-use according to deadlines," the QSUT is quoted in the report of the Supreme State Audit.
But despite this promise, the amount of expired medicines and their monetary value has increased two years later.
Data analyzed by BIRN shows that from a list of 1200 types of medications available at the central pharmacy, only 315 products were consumable with an expiration date after May 9, 2018.
While in 2014-2015, the damage caused by expired medicines was 172.7 million lek, in 2018 this figure reached 447 million lek.
The SAI audit group blames the situation on the lack of a complete analysis at the University Hospital for the causes that led to this situation and the direct responsibilities.
"A lack of planning based on real needs for medications; lack of clear rules on requests made by ward doctors; in tenders for the purchase of medications, a longer period of their use should be required, as the findings show that most of them have an expiration date of 6 months to 1 year," argues the SAI.
The wastage of hundreds of thousands of medications at the University Hospital over the last six years occurred at a time when numerous patients and their families were publicly complaining about their shortage.
Representatives of patient associations in Albania told BIRN that this problem has put the lives of many citizens at risk and has caused discrimination due to health conditions.
Besart Nezaj, a patient and representative of the Hemophilia Association, told BIRN that the lack of medication and prophylactic treatment has caused great damage to the health of patients suffering from this disease - who, according to him, have found leaving the country as a last resort.
"Out of 320 hemophilia patients, 197 remain. They have emigrated to the EU, as their lives were at risk as a result of hematomas due to the lack of prophylactic treatment and failure to take the amount of medications recommended by hematology specialists," said Nezaj.
The representative of the Hemophilia Association claimed that patients were not always provided with the full dose, while they had to wait for hours to receive it, which further aggravates their situation. Nezaj also added that most of the medications for this category of patients are provided by donations rather than by QSUT contracts.
"We are forced to not lead a normal life due to large hematomas... in these conditions the risk of hemorrhage is greater, hemorrhage in the tissues, cerebral, etc.... We cannot integrate due to the lack of treatment with the right medications," he told BIRN.
In early September, the medication "factor" for hemophilia patients became a cause for retorts between the Democratic Party and the "Mother Teresa" University Hospital Center, with the former denouncing the shortage while the University Hospital Center denied this claim, stating that this medication had been distributed regularly.
Beyond the time-limited responses, organizations dealing with patient rights note ongoing problems with the provision of medications.
Eglantina Bardhi, director of the “Together For Life” association, has been following up on patients’ complaints about the lack of medication in recent years. She told BIRN that the Commissioner for Protection from Discrimination and even the courts have found discrimination based on health conditions in some of the cases.
“[We have followed] the case of the lack of the drug L-Asparagine in the Onco-Hematology Pavilion in the Pediatrics Service where children with leukemia are treated. With Decision no. 196, dated 29.12.2016, of the Commissioner for Protection from Discrimination, it was found that the practice followed by the “Mother Teresa” University Hospital Center, Tirana, by not making it possible to make medical medications available to sick children, constitutes indirect discrimination due to health conditions…,” Bardhi told BIRN.
"It was recommended that this Center, in the future, provide medical medications on time and in the right quantity. Following this Decision, the Ministry of Health and Social Protection has taken effective measures and the problem of the lack of this medicine has been resolved," she added.
Another issue brought before the Commissioner for Protection from Discrimination is the lack of certain medications in the Hematology service at the QSUT, where patients from all over the country are treated for serious blood diseases.
According to Bardhi, in this case too, the Commissioner found direct discrimination against a citizen and all patients of the Hematology Service and ordered the QSUT to provide medical medications on time and in sufficient quantity, for which, according to her, the QSUT was later penalized with a fine.
"Even after these sanctions, it turns out that the problem of lack of medicines still persists and there is no improvement in the situation of medicine supply in this Service," Bardhi told BIRN.
Expired pharmaceutical products are classified as pharmaceutical waste and, according to the legislation in force and a decision of the Council of Ministers in 2010, must be disposed of in a controlled manner. This fact constitutes an additional burden and new costs for the “Mother Teresa” University Hospital Center - which were not foreseen.
KLSH auditor Marjola Llanaj told BIRN that in addition to the proven large financial cost, the stock of expired medicines requires other financial sums.
“We have requested their destruction, but the annual budget of the QSUT does not include funds that would enable their destruction,” Llanaj told BIRN.
Auditor Llanaj explains that the disposal of medicines, like other hospital waste, requires specific technology.
Environmental experts agree, while raising concern about the phenomenon that has frequently recurred in recent years, where expired medications have been dumped into river beds, causing environmental pollution.
Valbona Mazreku, head of the environmental organization “Milieukontakt Albania,” told BIRN that expired medicines at the QSUT should be disposed of in accordance with relevant legislation, whether by burial, incineration or through autoclave treatment.
"The time has come for the Ministry of Health and drug agencies to undertake projects to collect expired drugs from citizens so that they do not end up in public bins, but rather their controlled disposal takes place," Mazreku concluded./BIRN
