The scandal in QSUT has been denounced for several weeks in the show “Vetting”. Concrete facts and evidence brought the panorama of what was said to have been discovered by the Prosecutor’s Office of Tirana yesterday. There, through a patient’s confession, it was learned what happened not only to the medicines, but also to the equipment that was found in the hospital, but that was never used.
The Prosecutor of Tirana, Bledar Valikaj, has received shocking testimony from patients, who have discovered acts of horror committed against patients suffering from serious diseases. The file made public includes wiretapping of doctors, who have committed several criminal offenses for which they will be investigated, but according to yesterday’s announcement, no one is under arrest. 7 orders have been issued, while the court has also decided the security measure. Investigations will continue to clarify the acts committed by them.
The Prosecutor’s Office of Tirana, in addition to the Oncology scandal, where sick patients with tumors were referred to private hospitals for monetary gain, has discovered that a Cobalt-Therapy device has also been installed in this hospital. This device serves for the treatment of patients diagnosed with tumor diseases and especially skin cancer diseases. Complaints from patients have revealed the whole scheme as the doctors and staff working at the Oncology Department encouraged patients to visit and provide services at the private clinic “Megis”, which was located at “Astiri”.
The file investigated by the prosecutor Bledar Valikaj for which the doctors of the Oncology hospital are being investigated, as well as the deputy director of QSUT. Halil Gashi, administrator of this clinic, is also under investigation. One of the witnesses is M. Xh. from Burreli, who had a mother with a tumor, who after initially going to the QSUT for a check-up, was transferred to the private medical clinic “Megis”, where he operated on his mother for 2700 euros. Also in this clinic it was suggested to undergo chemotherapy, but they did not accept.
In between was Emiljano Lela, coordinator at the Oncology Hospital at QSUNT, who directed him to Dr. Edmond Gashi, a doctor at the Oncology Hospital at QSUNT and then the latter to the “Megis” clinic to perform the biopsy, as in the state there would be delay. After the biopsy came out, Emiljano bargained for the payment that would be made for the operation in this clinic, which is owned by Dr. Edmond Gashi. From 3,000 euros, the payment would be reduced to 2,500 due to his intervention.
THE EVIDENCE
After they did the medical visits of his mother first at the Burrel hospital, it turned out that she was suspected of a bad disease, they directed her to the Oncology Department at QSUT, as she was told that only there are visits for these types of diseases. They brought the mother to Tirana and were waiting in line at the Oncology hospital. When he saw his mother, brother and his wife in line, Emiljano heard them from the accent that they were from Burrel and approached them saying that if they wanted he would help them to send them to the doctor and at the end of everything they would talk to Emiliano.
After he took them and sent them to doctor Edmond Gashi, who I don’t know if he is the only one who works at the Oncologist or not, the doctor only looked at the letters that they had brought from Burrel, he also did a superficial check of the mother and made her condition alarming, telling her directly that she should go into surgery as her condition was very bad. At that moment, he told him that the visits would be made continuously in Astir to his “Megis” clinic, as there were delays in the hospital, there were queues and the work was not waiting. That day, from QSUT, he went to the “Megis” clinic, where they did a biopsy, and after that moment, 1 month later, Emiljano called him on the phone, who, after introducing himself, exchanged phone numbers with his brother and his daughter-in-law, and told him that he was out. the biopsy answer and that the mother should come to have the operation.
Emiljano also told him on the phone that the payment was 3,000 euros, but since Emiljano recommended it, it would be 2,500. When they went to the hospital, they paid 2,700 euros as there were also hospital expenses. After they operated on the mother, a biopsy was done and when they gave her the answer, they told her that according to the doctor the answer was good, it was not a bad tumor and there was no need for anything, while they sent her to see another doctor inside the clinic that told him he had to do chemo! At that moment, he told her why he should do chemotherapy when the mother is fine and the doctor said the answer is OK, he gave her the papers with a frown on his face (because he didn’t like the fact that he said no to chemotherapy) and left. Doctor Mondi prescribed a prescription for a drug called “Femara 2.5 mg”, which he initially took from the pharmacy located at his clinic, while later he bought it normally at the pharmacy in Burrel,” the file states.
The witness said that Emiljano himself approached the half-mother to help her and directed her to the doctor so that they could then go to the private room, since now that they see the answer, he says that he understood that the situation is not so alarming. From the amount of 2,700 euros that was paid to the private hospital, he says that he does not know how much percentage Emiljano would receive, since he did not know how they had their relationship and the sharing of things with each other. Asked about the fact that Emiljano contacted him after the operation, he says that he did not contact her, and he does not even recognize her as a face, since, as he pointed out, he first met his bride and his mother and only communicated on the phone directed to the doctor and told him about the payment.
In relation to the practice of registration at the QSUT and the discharge form from the hospital, he stated that to his knowledge all the papers are at the QSUT that he went there for the first time when they registered and they did not receive the file after they went to private and that’s where the whole file got messed up. He made available a hospital recommendation and a prescription issued to Edmond Gashi, which bears the QSUT logo.
HOW THE CLINIC WORKED
Emiljano Lela, Oncology doctor Edmond Gashi, clinic administrator Halil Gashi and doctor Alketa Ymeri were part of the scheme. Emiljano Lela, who had the task of coordinator in the Oncology Service, took patients without a queue and sent them to another doctor than the one who had been recommended, specifically to Edmond Gashi. He received a percentage for the patients sent to Edmond Gashi’s clinic. Then the doctor Edmond Gashi suggested the patients to go to his private clinic, explaining to them that there is a long line in the state hospitals and the situation is emergency.
“The doctor did not go to the patients he had in his private clinic when he was informed by the nurses that the patient has a fever, saying ‘hang the wool’, this is proven by the telephone interception described above. He does not tell the patients that in his private hospital only scans, biopsies are done and for chemotherapy and radiation patients have to go back to the state hospital. This doctor takes the patients’ records and keeps them in his office when they should normally be left in the surgery room,” the file states.
Halil Gashi, who was the administrator of the “Megis” clinic, did not issue tax invoices for the operations performed or other medical services performed near this clinic, such as scanners, mammography, etc. Doctors also worked unregistered, as in the case of doctor Aleta Ymeri (Pere), who signed the patient card B.XH, but is not a registered doctor at this clinic.
PART FROM THE TIRANA PROSECUTOR’S FILE:
For this equipment to be put into use, it is necessary to have a building in the form of a bunker, with exact specifications and to protect the staff from the radiation emitted by this source, a building which does not exist in the Oncology Hospital or in QSUNT. Concern has been raised by the staff regarding this issue and the fact that it was brought for medical treatment but was never used until today. For receiving all equipment that is not put into use.
Regarding this Dr. Adrian Hoti, an imager, has repeatedly raised concerns about these projects by addressing the leaders of the oncology service. Due to this situation and this concern, dr. Adrian Hoti, after presenting this concern and no action was taken by the leaders of the Oncology Service, he resigned leaving his job due to his repeatedly raised concern about possible health damage as a result of these equipment and resources with the potential to endanger the lives of staff and patients in the event of an incident. In the statement of this citizen, Dr. Adrian Hoti was also mentioned, who stated that at the beginning of September 2021, he learned by chance that a source of Cobalt 60 was placed in the room next to the radiology cabinet. With his knowledge as a radiologist and as the person in charge of imaging at the Oncology Hospital has met the head of the Assistance service professor Silvana Çeliku to get more accurate information on the situation.
The chemical element Cobalt is artificial, it is created artificially on nickel by bombarding it with radioactive nuclei, and after this process Cobalt acquires a property that is eternal radiation, which until today cannot be stopped as a process. Simply put, this type of radioactivity penetrates all the usual barriers to normal activity and cannot be allowed to settle in non-specific environments. Its use is based on several international rules that in themselves represent radiation protection and are summarized in a terminology called Halara. In order to use Cobalto Therapy, an anti-radioactive or anti-atomic bunker must be created under the conditions approved and presented by the Vienna Atomic Agency or the international agency called IEAHEA.
All radioactive elements are managed and controlled by this agency. He communicated with the head of the service about the measures that were taken for radiation protection, since signs should have been placed that there is radiation here, the personnel introduced in that area should have been notified and the dosimetry should have been submitted in the form of a minutes from the competent bodies. His boss, Silvana Çeliku, has called his request excessive as an excess of competence and unnecessary for the problem to be discussed with him. His insistence was not about the use of the apparatus but in the field of radiation protection. The room in which the device was and is located is built with ordinary brick and mortar material with a thickness of 10.20 to 30 cm and does not meet any of the criteria required for such an environment. The basic criteria for the use of a radioactive therapy require at least concrete walls with a high specific gravity over 1 m thick and after talking with the boss he called it his duty to communicate with the governing bodies of the hospital as an emergency to solve the problem. Where lies the danger of this situation:
The cobalt source is wrapped in an insulating capsule that minimizes to the maximum the uncontrolled output of radiation, but inside the capsule the radiation continues forever in a continuous manner and by all the rules established for such devices.
After 5 years the efficiency of the source is taken, all other technical conditions must be prepared and it is not storable to save for later. Above all, there is no absolute iguri in the capsule that has enveloped it. So that at any moment seismic movement can occur can rupture the capsule and return to always in the bunker and when the use of one of an accident a radioactive source ends.
The effect of these rays is in two planes when they do radiation with large doses consciously and used in medicine which is necrotizing and the other case when we receive radiation involuntarily with minimal doses perhaps and immeasurable but for a long time. In this case, the changes in our cells are at the level of the genetic code and this leads to the appearance of malignant diseases after a few years. In the conditions that exist today, the source of cobalt in oncology facilities with dosimetry devices that have doses below the maximum allowed values exist, but no matter how small they are, there is another dose, no matter how small, that is radioactive in an environment where other radiations of the same nature exist and have the property of multiplying one another.
His request to the authorities was to make an assessment of the standards of the Brachi Therapy cabinet because they do not find it supported by international conditions and of course these communications are via emails with the director of QSUT, with the radiation protection office at the Ministry of Health, with the minister of that time and of this day. The conversations reflected sensitivity but not in resolving the situation. His constant request was that the cobalt apparatus be moved from the room where it was without protection to the adjacent bunker rooms, so that the minimum possible be realized so that the apparatus, at least from the technical conditions, does not cause damage.
The debates took place for approximately 1 year and this caused him as a radiologist to contact and be informed about the knowledge they have and colleagues about the properties of radiotherapy, the knowledge the degree of responsibility they had and have, the governing bodies that although theoretically know the problems are aware of the effects causing damage to the device, they did not take the necessary measures. After her efforts, he saw fit to continue his activity as a doctor in another country, and to this day, in their premises, a source of cobalt continues to be discharged without being used, without justifying the purpose for which it came. Since the source of cobalt did not come through smuggling or other means, but was bought by the state, it is monitored by the state and it is its property, this matter does not have one person in charge, but there are many institutions.
inquiry
Doctor Ardian Hoti’s statement was taken back, where he was asked if from his experience he could tell us what the benefits of treating patients with cobalt rays, which would replace iridium, were, he stated that despite the fact that he is not an expert in this field, starting from the principles of radiotherapy as a doctor with experience in oncology, cobalt treatment today is not the way of radiation treatment in brachytherapy or in general.
Cobalt radiotherapy is more damaging being a stronger radiation than needed so for many years this has been replaced by other materials such as iridium which performs the same effect as cobalt on the disease but leaves the possibility of preserving healthy tissue from radiation. If we make an observation in the world today, the map of countries using cobalt is shifted to India, Africa but not to the part of the countries that we claim to belong to. As far as he knows the choice of cobalt has been a compromise of the oncology leaders for its nature that taking a cobalt nature is used for 5 years while when we get an iridium source it is only used for 3 months. For the specifics of our country, not having a permanent long-term contract with the relevant international institutions, the taking of iridium created interruption of the activity. To circumvent this kind of impasse cobalt was accepted or proposed.
The apparatus has been removed from use for fibrosis that causes in our short range of action does not give fibrosis. Measurements must have been made there several times and personally his debate with his colleagues is due to these measurements at the moment when he was told that there is a source of cobalt near the radiology cabinet, he requested to provide the preliminary dosimetry data, this legal duty of the office for radiation protection. This was refused under the pretext of confidential information. With his knowledge, an expert from the Vienna Atomic Agency came there after it became possible to put the device into operation. It was transmitted orally after measurements performed with the device turned on and without patients, i.e. in the air, the doses in the corridors of the Oncology Center were about 20 times higher than the allowed rate (foreigners).
After that, he asked for a meeting with the leaders of QSUT, where the report would be presented to him, and everyone together would make a decision as soon as possible to correct the problem. His request was to remove the apparatus from unprotected premises to protected premises and transform it into an environment, as required by normal standards. The meeting was held under the direction of the deputy director of QSUT Birkena with the participation of the head of Oncology Silvana, the head of radiotherapy dr. Orgest, the head of biomedical at QSUT whose name I don’t know, the oncology administrator Mrs. Alketa and the person in charge of radiation protection at QSUT, together with the head of radiology Durim Çela, this meeting, instead of giving a solution based on the truth of the facts, turned into a trial against him, the question that was addressed to him was whether he had been irradiated or no, and this question was asked by director Brikena, repeated several times, whether or not she should be exposed to radiation.
From the beginning of the meeting, he requested that the meeting be recorded so that everyone would be responsible for what he said. This task was left to the administrator Alketa, while after a few minutes it turned out that nothing was being recorded. In the presence was invited the former responsibility of the radiation protection office Xulja whose last name I don’t know, who left her job, the surprise from this meeting was from the responsibility of the radiation protection office at QSUT who issued me a letter that he did not see fit to read which claimed that QSUT was licensed to store radioactive waste. My contention about the cobalt resource is that a resource that is not so much used in an inconvenient location cannot sit there if it is sent to specific locations.
It does not happen anywhere that we find a radioactive source that stays there physically and does not go to its destination. matter and asked by us what the patients have lost from not being treated with cobalt rays, but what continues are the years 2008-2011 as a brachytherapy service and this with interruptions. With his knowledge, iridium sources have arrived, 50-100 patients have expressed the need for this type of treatment, for the sake of truth from 20 or so years that in our country per year is approximately, he knows oncology has approached only in interruption corresponding to approximately 15 months. In the other time span, this service has not come close to this day. Brachytherapy performs radiation inside the organs inside the body and specifically intravaginally and performs radiation directly on the tumor or tumor lodge, so it is more direct and causes less damage than transabdominal radiotherapy.
We do not have a concrete study of the success or failure of patients treated with conventional radiation or brachytherapy, but in the totality of time it is a missing treatment, in daily practice doctors have the duty to tell patients what they want and who it is the best and some of them do the solution themselves as well as many other needs by going to Macedonia or other countries in the region. We cannot say that practically whether the patients have lost or not. This should be done with a study.
As a whole, brachytherapy is a missing service and when the solution for cobalt was made, it was not done in the entirety of the best, but of what we can do, and this, according to his personal opinion, suited someone. Asked about the measurements carried out by ZMR and the measurements carried out by the Vienna Atomic Agency that they produce. Since the meeting was not being recorded, the matter for which we had gathered was not being discussed, I thought it appropriate to leave the meeting. While later, after a few months, when I had left the Oncology Hospital due to his disagreement with the working conditions that were coming to him, he learned from a colleague that it turned out to be an unsuitable environment neither for work nor for the possibility of transformation for bunkers./panorama.al
