The Ga-West Municipal Hospital (GWMH) in Amasaman, Accra is guilty of resorting to the practice of re-labeling patients existing folders that have been dormant for a period of five years and re-selling them to fresh patients who attends the hospital,-a practice the Ghana Health Service (GHS) says it is illegal unacceptable, our investigations have uncovered.
The practice is called recycling. Pictorial evidence, after months of coat-and-dagger investigations by this reporter at the hospital’s records unit show that over 10,000 folders have been recycled as at June 2016. This means, the hospital has generated close to Ghc50, 000 from February 2016 to June 2016. One of the three persons of the recycling group said, for every 600 folders they recycled, each received Ghc30. This means each got 50 Pesewas for every recycled folder.
A former senior staff at the records department of the GWMH who pleaded anonymity stated that recycling becomes necessary when the hospital runs short of folders or the facility is indebted and does not have the capacity to buy new ones. He admitted that the Ghana Health Service (GHS) has not given the approval of such practice, but “we need to do that to satisfy new patients’ demands for folders. The practice is not peculiar to this hospital alone but some hospitals also do that”.
Their modus opradi is that some staff at the records unit go through folders and select the ones that have been inactive for about five years. The sheets that contain their records are torn-out in order to have a complete and an “unwritten” folder. Water Glue is used to wet the inside page of the hard cover that contains patients’ demography; then it is covered with printed new sheet that makes it easier to enter the details of another patient. The folders are left in the sun to dry then ready to be sold at a cost of Ghc5 each.
The former head noted that the torn-out sheets are placed in a file for future reference. However, evidence exists to prove that the torn-out sheets are put in sacks whiles many of such sheets scatter in the container where folders are kept as at June 2016. Users of the container sometimes walk on them to retrieve folders.
What necessitated this probe stems from the numerous complaints by some patients at the hospital owing to the reason that their folders could no longer be traced and that was affecting the quality of their healthcare. Yet when they buy new folders too old ones are given instead.
The head of Archives and Records Management of the GHS in Accra, Mr. Frank Boris-Hemans, in an interview said that it had come to his knowledge that some hospitals recycle patient’s folders after some time when they become inactive and that his outfit is taking steps to deal with it.
“Probably they could be indebted by the National Health Authority but GHS has not given hospitals approval of such practice. This practice amounts to tampering of patients’ records and has medico-legal consequences. Tearing is not acceptable in records keeping management because “when you tear, you alter”, was the reason he adduced for the rot at the Amasaman hospital.
Mr. Boris-Hemans noted that hospital folders are supposed to be at the primary office (active storage) and at the records centre (inactive storage) for 5 years each. “That means after 10 years of inactivity, it has to be disposed, but before this can be carried out, appraisal needs to be carried out and order given for the disposal.
The Head of Records Management Division at the Public Records and Archives Administration Department (PRAAD), Mr. Maxwell Ampofo, said this practice is inappropriate in records management. “Every patient should have a file which is called a case file; it’s for an individual and that file is unique to that patient. You don’t recycle somebody’s folder, re-label it and sell to another patient”, he said.
PRAAD was established by a Legislative instrument (L.I. 1628) in 1996. The department is responsible for the proper and effective management of records in public institutions of government. Asked if his outfit had failed in doing this constitutional responsibility, Mr. Ampofo said such practice must go through a process.
“Before destruction is done, we need to give appraisal by determining whether it is worth destroying or retaining. They need to write to us, and then we conduct an intense assessment of such records. Should they be fit to be destroyed, we supervise it and issue certificate of destruction afterwards”, he stated, and fumed that “This evidence (upon seeing pictures of the destroyed folders) clearly shows they are destroying without informing us and that could have dire consequences on them, Mr. Ampofo”
The 2015 Guidelines for the Retention Periods of Medical Records on the Ministry of Health website defines retention periods as the period of time the medical records should be kept for following:
i. the date of the last discharge from hospital or last attendance at a clinic;
ii. the patient being considered “inactive” (e.g. not having been to the HCI in the last 3 years);
iii. the patient’s death.
“It is advised that the retention periods “kicks in” only after patients have turned inactive, or have passed away. This ensures that the majority of patients who have chronic medical conditions, or are likely to require their medical records in the future, will have access to them” (moh.gov.sg, 2015).
This policy by the Ministry of Health is clearly being abused. How then can patients who “are likely to require their medical records in the future” get acces to them since their folders have been destroyed or relabelled and sold to new patients? One would expect that an institution that has a binding mission as: “to provide and prudently manage comprehensive and accessible quality health service with emphasis on primary health care in accordance with approved national policies” would respect such a “national policy”.
The Head of Training and Resource at PRAAD Madam Pendah Futah cautioned that such practice is a wrongdoing. “In records management, you don’t temper with the original order. The moment this is done, it amounts to a wrongdoing. You don’t recycle a person’s hospital folder. You can’t give my personal file to someone because it will always remain mine”, she noted.
On 1st February, 2016, Ghana was commended for being one of the few African countries to have enacted a data protection law (ACT 843, 2012) to protect people’s personal information and to safeguard their privacy. However, this commendation is nothing good to be happy with since the practice by some hospitals in the country does not seem to be protecting patients’ medical records.
An administrative manager at the GHS who pleaded anonymity claimed that “some patients have allergies. They are not given certain drugs and such vital information is written in the folder. If that folder is recycled and a new doctor or physician comes, how would they get to have access to the primary information of such patients who have allergies”.
As at 29th May, 2016, the Whatsapp status of the Medical Superintendent of the GWMH Dr. Jarvis Abilla reads as “No woman should die in relation to delivery. We must be available as much as possible and acting promptly my fellow health workers”. How can this be achieved if such unauthorized practice is right under his supervision together with the hospital accountant, Mark Anakuga and the Director of Records Jacob Ayesu?
A bio-statistician at the Ridge Hospital in Accra, Peter Arhin told this paper that even tippers and cancellation are not allowed in records management due to medico-legal issues. “How then do you destroy or recycle patients’ folders after five years?” he questioned.
If one of the main reasons for keeping medical records is medico-legal issues as stated by all the interviewees is anything to go by, then such patients who have had their folders destroyed “have every right to institute legal actions against the hospital”, Mr. Boris-Hemans noted.
He added that not all hospital have the storage capacity to satisfy the required storage years. He said it is required that hospitals reviewed their storage capacity annually but maintain even if they want to do away with such folders, his outfit needs to be notified.
If a patient comes to the hospital and resurfaces again after five years and is made to buy a new folder owing to the reason that his folder has been recycled and resold to another patient, how then do you add intergrity, discipline and professionalism as part of your core values? The vision of the Ghana Health Service is “A Healthy Population with Universal Access to Quality Health Service”. Since health care is a continuous process, how can universal access to quality health service be achieved if patients’ folders are recycled and sold to new patients?
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