Bileća: Expired medicine for the patient, bankruptcy for the pharmacy, and a new job for the former director

In September 2019, a patient from Bileća, who was diagnosed with lung cancer, was issued the medicine “Durogesic”, which expired, in the Public Health Institution (JZU) “Apoteka” Bileća. The date of validity of the medicine on the box was revised from the 7th month of 2019 to the 7th month of 2020. The medicine was issued by the then director of JZU Apoteka Bileća, Elizabeta Sekulić, who was also a member of the Management Board of the Republika Srpska Health Insurance Fund (FZO RS). The pharmacy is going bankrupt, and the former director recently got a job in the Trebinje branch of the FZO RS, in a place from which, as we learn, she will, among other things, control the things for which she herself was the subject of control.

What happened in 2019?

The patient who was given expired medicine died shortly after, and his daughter Jelena Veselinović (Vujović) tells “Direkt” that the family still does not know the epilogue of the whole case and that they heard the details from us.

“We got a prescription for that medicine at the Health Center in Bileća. The first two times when we applied the plasters, we didn't notice the expiration date, we simply didn't even think about it. Father was in extremely severe pain during those days. When we changed the patch for the third time, a neighbour who was a nurse helped us, and then we saw that the date had been redone with a black marker. There was one expiration date on the box – redone, and another expiration date in the box”, recalls Veselinović.

She says that because of everything, she still feels bad today and that remembering the year 2019 is difficult for her. She believes that it is important to talk about this so that other patients will pay attention when taking and buying medicines.

“I cannot describe how terrible it was to watch someone suffer and to know that someone knowingly changed the date and knowingly brought someone to such a painful state. I wouldn't initiate anything if the expiration date had accidentally expired, mistakes happen to everyone, but for someone to knowingly change the expiration date on any medicine, that's terrible… I know she was the director of the pharmacy, she issued it. We then took that medicine and they immediately gave us a replacement. They apologized to us, but I don't think there is any room for apologies. My father was a great fighter against injustice, and for him to go through it himself, it was terrible for me”, she adds.

The drug Durogesic must not be used after the expiration date stated on the box and bag. The validity period refers to the last day of the specified month. If the validity period of the patches has expired, return them to the pharmacy.

She says that in those days she dialled dozens of phone numbers to finally reach an inspector in the RS Inspectorate, who asked her to send him everything they had, which Veselinović did.

“Later, he called me on the phone to inform me that they had implemented these measures, that the director of the pharmacy would be fined a sum of money and that the process of revoking her license would be initiated. I received this information verbally, because the inspector personally called me to tell me that it had not been forgotten. He then apologised to me that all this happened. I had the impression that they were doing their job”, states Veselinović and adds that she only learned later from the media that the inspector committed suicide not long after their conversation.

From 23,000 to 3,300 marks

The Republic Administration for Inspection Affairs confirmed to “Direkt” that in October 2019, they carried out an extraordinary inspection at JZU “Apoteka” Bileć. On that occasion, Sekulić explained to the inspection that during the dispensing of the disputed medicine to the patient SV, she did not notice any corrections on the specified expiration date, and she learned about it through the media, a week after the dispensing of that medicine package. They explain that the party returned to the pharmacy a box with three plasters that were not used due to doubts about their correctness, while two plasters were already used.

“The master issued a new drug Durogesic to them, and the returned plasters were quarantined for write-off… At the time of the control, the acting inspector also examined the book of narcotic drugs and noted that on September 25, 2019, the master did not write to issue the drug DUROGESIC, and on September 30, 2019, issued the same drug in the name of patient MM and entered both drugs in the book of narcotic drugs on that date”, says the answer to “Direkt”.

Due to the issuance of expired medicine, the inspector issued a misdemeanour order to the subject of supervision – the pharmacy, in the amount of 20,000 marks, and to the responsible person in the amount of 3,000 marks.

After that, those who were punished asked for a court decision, so the Basic Court in Trebinje issued a decision that “Apoteka”, as a legal entity, should be fined 3,000 marks, and the director Elizabeta Sekulić a fine of 300 marks.

Incompetent ministry

We also asked for information from the Ministry of Health and Social Protection of Republika Srpska, however, they only briefly said that our questions were not within their jurisdiction. However, as “Direkt” learns, in October 2019, the Minister of Health, Alen Šeranić, requested competent action in this case from the Chamber of Pharmacy, the Health Insurance Fund of the RS, and the Inspectorate.

In his letter, Šeranić stated that he was aware of the fact that Elizabeta Sekilić, MSc, had given the patient an expired drug that had been reformulated. Šeranić further stated that she dispensed the second substitute medicine, at the patient's request, without a prescription.

“After considering the allegations from the indicated notification of the Republic's Chief Health Inspector, this ministry proposes that, in order to improve the profession, protect pharmaceutical ethics, preserve the dignity of the profession, and first of all, in order to protect the patient's interests and improve the quality of health care, you act in accordance with the submitted notification and undertake adequate measures”, it is written in Šeranić's letter.

The Chamber of Pharmacy warns

The Chamber of Pharmacy of Republika Srpska concluded the disputed case in 2020. As they explained to us, the competencies of the Chamber related to the implementation of the disciplinary procedure after they received a request from the Inspectorate and the competent ministry. They acted, they assure, in accordance with the valid legal and by-laws.

“In this sense, the Commission for Ethics, Deontology and Professional Supervision gave its opinion on the case, and then the Court of Honor of the Chamber of Pharmacy issued a disciplinary measure of warning for the facts that could be established during the procedure”, they stated in the answer to our portal.

After we requested the Commission's opinion on the case and clarification of the specific facts they established, we did not receive a response from the Chamber of Pharmacy. We sent the inquiry two more times.

New job in the Health Insurance Fund

After the misdemeanour in the Bileč pharmacy, Sekulić stayed on as director until March 2021, when, at her personal request, she was relieved of that duty. Last year, in 2022, she got a job in the Health Insurance Fund of Republika Srpska, in the Trebinje Branch, headed by Valerija Lakić.

At first, she was hired for a few months under fixed-term contracts, and in November, FZO RS concluded an employment contract with her. As we learn, Sekulić is employed as a senior professional associate – cost controller of secondary and tertiary levels of health care. In practice, this could mean that she will now, among other things, control the thing for which she herself was subject to control and punished as a misdemeanour.

In the FZO RS, they believe that there was no obstacle to her employment, despite the facts established by the competent institutions of the RS. As we have unofficially learned, the FZO RS fined Elizabeta Sekulić for dispensing medicine without a doctor's prescription.

“The FZO RS concluded an employment contract with Elizabeta Sekulić, because there was no obstacle for that. Among other things, no criminal proceedings are being conducted against the mentioned worker, about which she submitted proof, as well as proof that she has not been convicted”, stated the FZO RS.

The pharmacy is not liquid

The public health institution “Apoteka” Bileća, whose founder is the Bileća Municipal Assembly, is no longer liquid, so it does not carry out its activities, it was confirmed to “Direkt” in the municipality of Bileća. A proposal to initiate bankruptcy proceedings has already been sent to the District Commercial Court in Trebinje.

“When bankruptcy will be initiated depends on the District Commercial Court and the consent of the Municipality, if the court determines that the conditions for bankruptcy have been met. The proposal to initiate bankruptcy proceedings was submitted for reasons of insolvency, blocking of accounts and outstanding obligations to suppliers from the previous period”, they stated in their letter from the Municipality of Bileć, which was delivered to our portal at the end of November.

The report on the work of this JZU was not adopted at the session held on January 25, 2021. At that time, Sekulić emphasized in front of the councillors that the submitted work report was not complete and that thanks to responsible business, she managed to reduce debts to suppliers.

“The obligations I assumed in the first half of 2018 amounted to almost 200,000 KM, and the largest part of these obligations were obligations to suppliers. Obligations towards only one supplier from Sarajevo on May 23, 2018, amounted to about 133,000 KM. Due to this unenviable situation, the primary focus in business was to reduce the obligation to suppliers, which was certainly large for such an institution. In less than a year of operation, we managed to reduce the aforementioned debt by about 30 per cent, that is, by about 50,000 marks, and thanks to responsible business operations, we managed to reschedule the rest of the debt for a period of three years”, Sekulić stated before the Bilec assembly.

She did not want to comment on anything for “Direkt”. In an informal telephone conversation, she said that she did not want to go back to something that was “completed and processed” and that after the publication of the text, she would consider the possibility of a lawsuit.

Direkt