Following a complaint, a team of Auditors - Inspectors of Thessaloniki Regional Office of the National Transparency Authority (NTA) from 01.01.2019 to 30.05.2020 conducted an audit in a General Hospital Unit of a General Hospital from 01.01.2019 to 30.05.2020 to investigate the practices of handling, management and administration of oncological drugs to patients of the Oncology Unit.
During the on-site inspection by the Auditors - Inspectors it was found that:
- The Hospital's Organisational Chart does not provide operation of an Oncology Unit, yet it operates and serves a large number of oncology patients in the county and neighboring regions.
From the analysis of electronic data bases it was found that-at least- during the audited period (January 2019-May 2020) two doctors of the Oncology Unit were prescribing formulations of intravenous chemotherapeutic drugs, intended for cancer patients, on outpatient prescriptions so that they could be filled at private pharmacies, when the medication in question should have been prescribed in the Hospital's internal formulary so that it would have been covered entirely by the Hospital Pharmacy.
It is noted that one of the two doctors resigned his position while the audit was still in progress. This out-of-hospital distribution of chemotherapeutic drugs caused financial damage to the Greek State because there is a price difference between the drugs reimbursed by the National Organisation for Healthcare Services Provision (EOPYY) when they are available from private pharmacies and when they are available from Hospital Pharmacies.
In this way, EOPYY reimbursed for the period under review 4.700 packages of intravenous chemotherapeutic medicinal products for the amount of EUR 112.715 compared with the EUR 75.706, it would have paid if they had been supplied by the Hospital Pharmacy, as required by law, thus causing a loss of more than EUR 37.000.
- The prescriptions for chemotherapeutic medicinal products were almost exclusively dispensed at a particular pharmacy, which characterises the above harmful practice as directed dispensing.
Despite the express provision in the legislation for the compulsory establishment of an Oncology Committee in hospitals where chemotherapy is carried out, which coordinates and supervises the oncology-related activities in the hospital, the hospital's management did not take steps to establish such a committee, nor did it exercise its statutory obligation to take care of the way in which oncological medicines are distributed from the Oncology Unit.
The Audit Report of the NTA was forwarded a) to the Ministry of Health with a recommendation for relevant inspections in other hospitals b) to the relevant Ministry of Health for disciplinary action against the doctors involved and the hospital management c) to the EOPYY management for the application of the prescribed penalties to the doctors and private pharmacist involved and d) to the management of the Hospital for the reform of the way of drug distribution in the Oncology Unit and its inclusion in the Hospital's organisation and e) to the Athens Prosecutor's
Office of Appeals for criminal justice evaluation.