| Treat them well
In Malda, sputum containers, laboratory consumables involving Rs 1.43 lakh were purchased by the deputy CMOH-II in 11 cases without obtaining the approval of the purchase committee. Forms and printed materials valued at Rs 1.94 lakh were not accounted for.
Doubtful consumption of Injection Streptomycin:
Streptomycin injections are required to be pushed dissolved in distilled water. As per guidelines of the NTI, the injections are to be administered daily only at the peripheral health institutes. In the 5 test-checked districts, 9.75 lakh vial injections, valued at Rs 46.01 lakh, were reportedly issued to the patients by test-checked centres without distilled water in violation of the prescribed norms. Use of such drugs was doubtful and the possibility of malpractice in the matter could not be ruled out.
Due to irregular supply of anti-TB drugs, TB patients did not get regular treatment, according to the medical officers of test-checked units, and the patients were likely to become drug resistant posing great public health problems by spreading the disease. The high drop-out rate, discontinuance of treatment, lack of awareness among patients, indiscriminate use of Capsule Rifampicin were the major reasons for the drug resistant cases. In the state, no survey of the status of drug resistant cases was undertaken.
Issue of anti-TB drugs to RNTCP districts:
In violation of GOI guidelines which stipulated purchase of drugs only for non-RNTCP districts, anti-TB drugs worth Rs 55.90 lakh, as detailed below, were issued by central medical stores to the RNTCP districts.
Diversion of anti-TB drugs/time-barred medicines:
In Bardhaman, Capsule Rifampicin (450 mg), valued at Rs 2.47 lakh under the tuberculosis control programme, was issued to the modified leprosy control unit, Katwa, during 1996-2000 for treatment of leprosy patients in deviation of the norms. As confirmed by the MLCU, Katwa, the capsules, received at the fag end of their validity period, could not be utilized as there was sufficient stock of blister pack meant for treatment of leprosy. In consequence, these capsules lost their shelf life and were damaged every year raising serious doubts of fraud. While accepting audit observations, the unit stated that Capsule Rifampicin (300mg) was only required for treatment of leprosy. This needs investigation.
In Birbhum, Capsule Rifampicin and Tablet Pyrazinamide worth Rs 1.13 lakh meant for domiciliary treatment were used in indoor department of Suri Sadar Hospital. Detection of TB was also not done there. ATDs valued at Rs 6.17 lakh in Malda and Rs 15.44 lakh in Darjeeling were issued to the indoor department of different hospitals in violation of guidelines.
In Darjeeling district tuberculosis centre, 2,080 pouches of 7 blister combipack, valued at Rs 1.92 lakh, received in July 2000 lost their shelf life in December 2000 as these could not be put to use in time.
Lack of quality control:
During 1996-2001 the chief medical officers of health of 5 test-checked districts utilized ATDs valued at Rs 3.97 crore without getting their potency and efficacy tested by the assistant director, drug control. Possibilities of drug reaction could not be ruled out in those cases.
In Darjeeling district, wide difference between the quantity issued by the CMS and received by 3 units, namely district reserve stores, district tuberculosis centre and the deputy assistant director of health (equipment and supply) Siliguri, was noticed.