Trọng Kiên

HÀ NỘI — Red tape is not usually a matter of life or death, in the literal sense. 

And it usually attracts the ire of those affected for the needless inconvenience and frustration it seems to cause. The Government, which creates the “red tape,” and is always blamed for it, is driven by the need to regulate things, to ensure order, and to prevent things like monopolistic control by cartels and such.

However, there are times the procedures it puts in place are so complicated, so rigid, that it can literally become a matter of life and death, and in such cases, public outrage is valid and perfectly warranted.

One of such recent cases involved getting drugs from a Swiss multinational firm to treat a particularly dangerous type of blood cancer. As many as 20,000 very costly tablets received in the form of ‘non-project drug aid’ had expired before they could reach the critically ill patients. Let’s take a look at how this travesty unfolded.

The HCM City Hospital of Haemotology and Blood Transfusion said that on July 15, 2013, it received a letter from the Switzerland-based multinational Novartis, offering to export to Việt Nam its Tasigna tablets for treating chronic myeloid leukemia (CML), a rare, deadly form of leukaemia.

The hospital accepted Norvatis’ offer by the end of August. However, it was not until three months later that the hospital submitted necessary documents for approval to the Drug Administration under Ministry of Health, for approval.

On December 27, the Drug Administration approved distribution of the Tasigna tablets; three days later, the hospital asked the HCM City Department of Health for permission to distribute the drug to the patients who needed it.

The four months that it has taken thus far is already a lot of time, but since it was a new drug, I can give relevant agencies the benefit of doubt for taking time to check things out thoroughly before allowing its import and consumption.

What happens next is bemusing.

It takes another six, I repeat, a whole six months, for the HCM City branch of the Union of Friendship Organisations (VUFO) and the municipal People’s Committee – both institutions with no medical authority whatsoever, to give the hospital the go-ahead on June 24, 2014.

All this time, did anyone think of the patients battling for their lives?

One month later, the Drug Administration gave the hospital the green light to receive the drugs. Two weeks later, HCM City Customs did not allow import of the drug, saying that the tablets’ expiry date was less than 12 months away, which contravened existing regulations. A few days later, the hospital explained the circumstances and asked for special consideration; then the municipal health department backed this request, and the Customs department acquiesced.

It took 13 months for the life-saving tablets to reach the hospital, with less than 10 months before they expired. And since the tablets were not used up, the municipal Health Department allowed the hospital to dispose of all 20,000 expired tablets, which the city’s inspectorate estimated to be worth some VNĐ 17 billion (nearly US$750,000), not by any means a small sum.

This is not to speak of how many CML patients could have benefited from the timely receipt and administration of the tables.

Where did the buck stop?

A former director of Drug Administration admitted there were many agencies that stood in the way of drugs coming into the country, but when an incident like this happened, no one stood up to take responsibility.

Haven’t we been here before, time and again?

Bạch Quốc Khánh, deputy director of the National Institute of Haematology and Blood Transfusion, offered a different take on the issue. He said he didn’t think existing procedures were the problem by themselves, because, “living in Việt Nam, we should be aware of what could go wrong and take precautionary steps.”

He noted that at his hospital, receiving drugs from abroad was commonplace, and there was nary a hiccup in getting approvals from different agencies if the hospital prepared the required documents carefully.

Then came the clincher. If the staff in the HCM City hospital had “cared enough”, they would have found ways to urge the agencies to expedite the approval process, Khánh said. While the concerned agencies “are always overburdened,” but “if we expressed some sense of urgency, that we truly need it, then they’ll give the respective dossiers higher priority,” instead of the first-come-first-served processing.

If only they’d cared enough. “Cared enough.” That’s the operative phrase here.

And when the story broke, the hospital’s comment tried to ‘damage control’ by saying  that the inspectorate’s VNĐ 17 billion figure was “incorrect,” that the actual figure was one fifth of the estimate, at about VNĐ 3.8 billion ($167,300).

The hospital director, Phù Chí Dũng, admitted “they hadn’t read carefully the draft of the inspectorate’s report that was sent to the hospital before being made public.”

These words speak louder than actions about the attitude and sense of responsibility that has been at play.

And even before this story had cooled, another one cropped up, about the disposal of 267 cancer tablets (Nexavar) given as ‘aid’ at HCM City Hospital of Oncology, also because they’d expired. Each of these tablets cost VNĐ 1 million ($42), with the company subsidising 50 per cent of the price and the patient covering the rest. Previously, Nexavar’s cost was covered under health insurance, but after a policy change in 2015, the insurance plan would covered just 50 per cent of the cost, causing the number of Nexavar users to dip down to one third compared to before. More unused tablets and drugs set to expire and be destroyed, I guess.

Makes us wonder if policy-makers are aware of the ramifications of their actions. Or, is it that since the buck apparently stops nowhere, it does not matter to them?

The administrative agencies, like the Drug Administration and Department of Planning and Finance, said the procedures for reception of non-project aid was “clear” and in effect throughout the country, and the recent incident in HCM City was just a “human error” exception. Indeed.

Have those entrusted with ’approval process’ thought about the consequences of their ’errors’? The city’s authorities said ’disciplinary measures’ and ’strictures’ are in order for this tardiness, but the public is just tired of hearing those words that sound large, but ultimately fall on deaf ears.

From here, we could go to another aspect of healthcare, and see that this same bureaucratic lethargy is what makes many people hesitate to join the official health insurance scheme even as the government tries every trick in the book to get more people to enrol.

There’s no denying the financial benefit that accrues from such schemes should one contract a serious illness or suffer a serious accident, but for regular check-ups or common ailments, it’s not hard to find health insurance cardholders foregoing the card and opting to make out-of-pocket payments.

Why do they do this? They believe that cardholders will not receive the same treatment as those who pay the full charges on their own. They’d rather front the full sum rather than wait for an indefinite amount of time and then have to deal with icy countenances and perfunctory services.

Vũ Tiến Lộc, Chairman of the Việt Nam Chamber of Commerce and Industry, has made some caustic comments on the issue – understandable, given the number of times businesses have complained about red tape strangling their growth.  

Lộc said this has cast "an unfortunate pall" over the Prime Minister’s meeting with 2,000 enterprises scheduled for next week aiming at "reaffirming efforts in building a constructive government, marked by integrity, assisting enterprises to become the nation’s driving force."

Rings a trifle hollow, if the Government cannot demonstrate clearly that it means business.

Concluding his thinly-disguised diatribe, Lộc characterised the bureaucracy in this scandalous affair as “peak apathy.” This recalls the words of Marx Weber – the German philosopher who’s considered one of the founding fathers of sociology, who wrote that the more bureaucracy develops perfectly, the more ‘dehumanised’ it becomes. He meant this ‘dehumanisation’ as a virtue, in that it removes all irrationalities or emotions from interfering with official businesses.

However, in this case, concerned agencies have somehow attained a combination of both incompetence and apathy.

When a basic human right, healthcare, is involved, we have to be both rational and emotional, and frankly, it is time that our bureaucracy undergo some much-needed re-humanisation. — VNS