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NIK: Overpaid Interim Hospital in Opole and underutilized isolation facilities in Opole region

MedExpress Team

Medexpress

Published Sept. 29, 2023 11:58

The wasteful spending of PLN 2.7 million for the adaptation of the Exhibition and Convention Center in Opole to a Temporary Hospital for COVID-19 patients, self-construction, the unjustified spending of PLN 530,000 for an isolation room in a hotel to which not a single patient was referred, a delay of more than 7 months in the development of the fire safety manual required for the Hospital, and the conduct of fire training by persons without authorization are the main findings of the Supreme Audit Office. As a result of the audit, a notice of reasonable suspicion of a crime committed by the former Opole governor involving large-scale property damage to the State Treasury was filed.
NIK: Overpaid Interim Hospital in Opole and underutilized isolation facilities in Opole region - Header image
fot. NIK

The Opole Delegation investigated how the Opole Governor's Office carried out the management of tasks related to the prevention, counteraction and eradication of COVID-19, including the establishment of the Interim Hospital, the conversion of hospitals into single-name infectious hospitals, the establishment of isolatoria and the disposition of funds from the COVID-19 Prevention Fund. The subject of the audit was also the organization and operation of the Interim Hospital by the University Clinical Hospital in Opole, and how the Provincial Hospital ran isolatoria.

According to the NIK auditors, the Governor's actions related to the establishment of the Temporary Hospital were fraught with serious irregularities. The Governor did not ensure a reliable verification of the price offer for the adaptation of the building of the Exhibition and Convention Center in Opole to the needs of the Temporary Hospital. An expert appointed by NIK estimated that expenses of almost PLN 2 million 700 thousand higher than the market value of the completed works were incurred for this purpose. It was obvious to NIK from the beginning of the audit that the establishment of the Temporary Hospital at the CWK could not be limited solely to the insertion of beds and medical apparatus into the hall. Meeting the requirements envisaged for the Temporary Hospital required a number of adaptation works, including the separation of a clean zone and a contaminated zone in the facility. However, the incurred cost of PLN 11.81 million was overstated given that the base for the establishment of the Temporary Hospital was the existing modern CWK facility commissioned in 2014 and equipped with all connections, systems and installations, except for the installation of medical gases.

Reliable supervision of medical equipment purchases was not ensured, so that the Temporary Hospital was equipped with a device for automatic cutting and packaging of drug blister packs worth almost PLN 870,000, which was not necessary for its operation. Construction work on the adaptation of the CWK to the Temporary Hospital was carried out under conditions of arbitrary construction - i.e. without the required building permit and in violation of the Local Land Use Plan, and some construction work was carried out in violation of technical requirements and the rules of construction.

The selection of the contractor for the construction works was carried out without the application of the Public Procurement Law, which was a legitimate and expedient action given the required short deadline for the establishment of the Temporary Hospital. No documentation was prepared at the Provincial Office to show why Mostostal Zabrze was selected as the contractor for the investment. From the explanations obtained by the NIK, it appears that this was an arbitrary decision by the Voivode, with the Voivode explaining that he does not remember who contacted the contractor regarding the implementation of the investment, nor does he remember by whom the contractor was indicated to him as a company capable of carrying out the investment.

The remuneration for the construction work was determined on the basis of the price quoted by the contractor without ensuring that negotiations were conducted fairly or attempts were made to solicit bids from other potential contractors. When negotiating with the contractor, the Governor had no knowledge of the market value of the intended adaptation works. A lump-sum settlement was accepted for their performance without first preparing an investor's or bidder's cost estimate. Settlement was made on the basis of an agreed and approved table of settlement elements with a breakdown of elements with a very broad and imprecisely defined scope, in which the cost of some of the elements included in the implementation of the task was summarized in a very general and incomplete manner. Lack of clarity and precision, while inaccuracies in the inclusion of the cost of individual elements of the valuation meant that such a statement did not reflect the cost of implementing the task.

The provincial governor, as well as the team members participating in the negotiations on behalf of the contracting authority, had no knowledge or experience of the method of settlement with construction contractors, in terms of the value of the works, market prices, prices of construction materials, margins, the current value of the works, etc., and unanimously admitted that they therefore did not substantively verify the accepted method of settlement established in the negotiation protocol. The only person involved in the discussions with the contractor who had expertise in construction was an individual from outside the Provincial Office who acted as an advisor to the Governor. However, the scope of this advisor's tasks or the responsibility he bore was not specified in any way - no contract was concluded with him and he was not given authority to negotiate with the contractor. He explained that he participated in the negotiations like a social advisor to the Governor, personally pointed out elements of the investment that were overpriced, but did not directly negotiate prices with the contractor's representative.

PLN 1.52 million overstatement of costs on 10 items of investment settlement

Regardless of the expert's valuation of the investment, the NIK's detailed examination covered 10 items in the release of funds protocol with a total value determined by the contractor to be PLN 3.03 million net. It was found that the subcontractors' remuneration for the delivery and installation of the corresponding items of equipment, installations or facilities amounted to PLN 1.79 million net, which means that the contractor increased the value of these items by PLN 1.24 million net, or 69.27 percent.

The test sample included elements of the investment, which were completed by the subcontractor in a comprehensive manner and handed over to the contractor as a finished and fully functional product, i.e.: a mobile treatment station, radiant heaters, electric heaters, elements of the plumbing system, elements of the ventilation system, 96 screens, the installation of medical gases, a lift truck and four racks for cold rooms. As the NIK found, the contractor - in its settlement with the ordering party - increased prices from 28.9 percent up to 329.4 percent. The radiant heaters installed over the beds, the subcontractor purchased from the manufacturer for 52.7 thousand zlotys net and sold to the contractor for 260 thousand zlotys net, while the contractor in its settlement showed the value of these devices at 425.2 thousand zlotys.

Self-construction and violation of local zoning plan

Construction work on the adaptation of the CWK to the Temporary Hospital was carried out without obtaining the required construction permit. The adaptation was inconsistent with the provisions of the applicable Local Development Plan. During the period when the works were carried out, there were no regulations permitting a derogation from the application of the Construction and Land Use Law.

As part of the adaptation of the CWK to the Temporary Hospital, a steel shelter for ambulances, a shelter for corpse removal and waste, a shelter for spare medical gas cylinders, a foundation for an oxygen tank, and a helipad for an LPR helicopter were built.

However, the works were carried out without the required construction permit. The governor notified the Architectural and Construction Administration authority (the Mayor of Opole) of his intention to change the use of the CWK to a Temporary Hospital, but the notification was insufficient, as it did not refer to the execution of construction works. The CWK site was covered by a zoning plan. By a resolution of the Opole City Council in September 2018, the site was designated for public or business services. The permitted use of the site did not include healthcare services, and the location of temporary facilities was prohibited on the site.

Technically, the construction work was generally performed and accepted correctly, but shortcomings and deficiencies were not avoided:

  • no equalizing cable was connected in the fan room,
  • The canopy posts for ambulances and corpse removal were attached to paving stones instead of the foundation,
  • The canopy of the oxygen cylinder shed was based on elements of the glass facade without maintaining the required support width,
  • welded joints of the canopy purlins, which were intended to be bolted together, were made,
  • Paint coatings were not performed at welded joints,
  • all required tests and checks of electrical installations have not been carried out.
  • Unauthorized purchase of a device for nearly PLN 869,000.

Equipment necessary for the Temporary Hospital was acquired for its operation. The exception was a machine for automatic cutting and repackaging of drug blister packs at a cost of PLN 868,660.

At the request of the University Clinical Hospital in Opole - i.e., the unit that runs the Temporary Hospital - the Governor purchased an Automatic Drug Packaging System with Blispack configuration. Such a system in large hospitals brings about savings in medication management in the long run. This is because medications cut up and packaged in blisters retain the usefulness of medicines in their original packaging. They do not have to be discarded, as do drugs removed from the package, after they are not used directly. However, the purchase of this system for the Temporary Hospital was unauthorized, since, according to the decision of the Minister of Health, expenditures from the COVID-19 Prevention Fund, in this case, could only apply to equipment and supplies necessary for the operation of the Temporary Hospital. In the opinion of the NIK, the purchase of a machine for automatic cutting and repackaging of drug blister packs did not meet this requirement. None of the 20 other Temporary Hospitals in the country - including the much larger ones - purchased such a device. The University Clinical Hospital in Opole, at its parent facility, also did not use such a device, despite the fact that the number of its patients more than doubled the number of beds at the Temporary Hospital.

More than 7 months without the required Fire Safety Manual, and fire training of personnel without authorization

The Supreme Audit Office also found irregularities in the operation of the Temporary Hospital by the University Clinical Hospital in Opole. Among the most serious of these were the operation of the Hospital for more than 7 months without fulfilling the obligation to develop a Fire Safety Instruction, and the carrying out of fire safety training for staff for almost a year by persons without the required authorization to do so.

Delays in medical equipment insurance

Another negligence was the failure to insure the equipment donated to equip the Temporary Hospital for dozens of days by the Opole Governor, among others. The director of the University Clinical Hospital fulfilled this obligation late, and the Governor did not enforce timely insurance of the equipment. The value of the CT scanner alone is PLN 2.8 million.

Expensive and empty - lost money spent on isolators. In the case of one hotel - 530 thousand zlotys paid and patients zero

Although the maintenance of an excess of places in the 13 isolation centers established by the Opole voivode over the number of places used - in principle - was justified by the need to guarantee the availability of services. However, in the opinion of the NIK, the degree of utilization of places did not justify keeping the number of places at such a high level. The governor neglected to reliably monitor the use of places in isolation centers and adjust their number to actual demand. As a result, far more places were kept on standby than needed. In the period from April 2020 to March 2022, only 6.7 percent of the places made available in isolators were used.

The glaring result was that the entrepreneur was paid PLN 530,000 for keeping the isolatorium at the DeSilva hotel in Opole on standby, despite the fact that not a single patient was ever admitted to it. During the same period, the utilization of places in the isolatorium at the Mercure Hotel - which, by the way, belongs to the same entrepreneur - never exceeded 20 percent.

As an aside, it can be noted that Isolatoria in general proved to be an ineffective solution to COVID-19. The demand for Isolatoria care was negligible in relation to the number of places prepared. As for the reasons, one can only speculate. Patients, for psychological reasons, preferred to receive isolation in a home setting - without regard to the danger to household members. Doctors were reluctant to refer patients to isolators, perhaps due to a lack of discernment and confidence in this intermediate form of care between home and hospital treatment, which may also have been fostered by the ambiguity of indications for isolator care.

Financial results of the audit

The financial results of the audit totaled PLN 4,156,800, including:

  • PLN 4,087,860 amounts spent in violation of the principles of sound financial management,
  • PLN 61,500 reporting impact of irregularities,
  • PLN 6,480 depletion of funds or assets,
  • PLN 960 of the amount improperly obtained.

As a result of the inspection, a notice was sent to the prosecutor's office on a reasonable suspicion of a crime committed by the former Opole governor involving the infliction of property damage of great magnitude to the State Treasury by failing to comply with duties related to determining the contractor's remuneration for the execution of the CWK adaptation works for the Temporary Hospital and adjusting the number of places in isolation rooms to actual demand.

The Opolskie Voivode was responsible for the implementation of tasks related to countering COVID-19 in the Opolskie Province. Throughout the audit period, expenditures for this purpose amounted to PLN 416 million, including PLN 290 million in 2020, PLN 119 million in 2021 and PLN 7 million by the end of May 2022. In particular, the Governor was responsible for organizing the Interim Hospital in Opole. The cost of its establishment and operation amounted to PLN 46.7 million. The hospital from December 27, 2020 to March 31, 2022 admitted 2,338 patients, of whom 758 died.

The NIK audit also covered the provision of isolators for those ineligible or lacking conditions for home isolation, for which the Governor was responsible. During the entire period of operation of isolators in the Opolskie Province, 559 patients benefited from care in them. The total cost was PLN 2.3 million, including PLN 0.6 million for patient care and PLN 1.7 million for keeping the places open.

Applications

NIK requests the Opole Governor to:

  • Ensuring reliable verification of bids submitted by contractors, as part of procurement procedures conducted under conditions of limited competitiveness,
  • careful analysis of the current regulations of the Construction Law at the stage of referring documentation to the architectural and construction administration bodies,
  • exercising special care in implementing the new solutions introduced by the provisions of the so-called "specustaw", in particular, the introduction of mandatory verification of issued decisions by the services of the Governor.

To the General Director of the University Clinical Hospital o:

  • Take organizational measures to reduce the risk of not providing employees with the required uninterrupted daily rest,
  • Increasing oversight of the proper implementation of time-keeping obligations.

Source: nik.gov.pl

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