Just days after reports emerged of a severe shortage of essential medicines in government hospitals across Keralam, the revelation that medical equipment worth approximately Rs 450 crore was lying unused in government hospitals across the state has raised serious concerns about public expenditure, healthcare administration, procurement practices and accountability. Ironically, patients from poor backgrounds are still being referred by many government hospitals to private medical facilities and diagnostic centres.
The issue has not only highlighted the potential wastage of public funds and the failure to put expensive medical equipment to effective use in patient care, but has also raised questions about possible conflicts of interest, including whether decision-makers involved in large-scale procurement may have colluded with medical equipment companies for personal or financial gain.
An official report submitted by the State Health Department to its parent ministry early this week stated that substantial quantities of medical equipment, including ventilators, dialysis machines, digital X-ray units and mammography machines, have reportedly remained unused in government hospitals and medical colleges. According to the report, a total of 1,252 pieces of equipment are lying around gathering dust across 215 hospitals. Another 222 units have not even been installed.
"Most of these equipment were purchased over the last ten years," alleged State health minister K Murlidharan, who has apparently initiated an inquiry into these deals.
While Keralam’s public health sector has faced several allegations in the past involving the key procurement agency, Kerala Medical Services Corporation Ltd (KMSCL), as well as senior health department officials and other decision-makers, including ministers and political leaders, this is the first major allegation of fund misutilisation or systemic lapses of this nature to be reported.
“One of the serious concerns surrounding these reported hospital procurements is the possibility of large-scale corruption or conflicts of interest in the deals. I see a high probability of government-industry collusion, or a nexus among key decision-makers, resulting in undue personal benefits,” says Joseph C Mathew, a senior political observer who has closely tracked such scams in the state and the involvement of senior politicians from ruling parties.
The matter nevertheless raises serious questions about the effectiveness of public procurement and asset management, even as the government was, at times, compelled to procure large quantities of medical equipment and consumables under considerable pressure. For instance, during the Covid-19 pandemic in 2020–21, the health department purchased ventilators, personal protective equipment (PPE) kits and oxygen cylinders from various vendors at short notice and, in some cases, at higher prices, given the critical need for these supplies and concerns over shortages.
“Those were times when saving patients’ lives was the priority. Alongside routine procurement through the KMSCL, we also constituted a core committee, chaired by the Chief Secretary and comprising Industrial Secretary and other senior IAS officers, senior medical officials and technocrats, to undertake emergency procurement,” says former health minister K. K. Shailaja, while talking to TNIE on this issue.
Procurement through KMSCL typically takes time, as it follows established procedures, including inviting quotations, selecting vendors based on the lowest bids, and verifying vendors and product quality. These processes can take a month or two.
Explaining the procurement process for expensive medical equipment, such as catheterisation laboratories (cath labs), MRI and CT scanners, digital X-rays, mammography machines, etc., Shailaja said; "...normally separate funds are allocated for medical equipment --to equip a new facility-- at the time of establishing a new hospital or medical college. Several new hospitals were also set up during the Covid-19 pandemic. However, the installation of some equipment, particularly that not urgently required during the emergency, may have been delayed at certain facilities, she said.
“As far as I know, all procurement during my tenure followed fair and transparent procedures,” Shailaja said, adding that she believed all previous and subsequent governments had followed the same practices.
“What is important now is to examine facilities where medical equipment was genuinely required and purchased but has not been installed, as well as identify machines that have not been properly maintained and need repairs. They must be put to proper use. While, the government can also investigate whether any equipment was procured unnecessarily or without following the proper procedures,” the former health minister said.
Investigators need to establish whether the equipment was purchased according to genuine medical requirements, whether the prices paid were reasonable, whether procurement procedures were followed correctly and whether the equipment was delivered and installed in accordance with contractual terms. It is also necessary to determine whether the relevant authorities verified hospital readiness before approving purchases and whether timely action was taken when equipment remained unused.
The proposed review hopefully covers the purchase, delivery, installation, commissioning, maintenance and utilisation of these medical equipment. The investigation is intended to identify the reasons for non-utilisation and determine whether deficiencies in administrative planning, procurement decisions or maintenance arrangements contributed to the situation.
According to the health department report some equipment is said to have remained unopened, while other machines have reportedly become unusable because of inadequate maintenance, shortages of spare parts and delays in installation or commissioning, he stated quoting the report.
These developments have however raised serious questions about the planning and supervision of medical equipment purchases over several years in State.
One of the principal concerns is the apparent lack of coordination between equipment procurement and the readiness of healthcare facilities. Medical equipment requires suitable buildings, adequate space, reliable electricity, trained personnel, essential consumables and appropriate technical support. If these requirements are not met before equipment is purchased and delivered, expensive machines may remain idle for extended periods. Such circumstances can result in deterioration, technological obsolescence and additional expenditure on repairs or replacement.
Another significant concern is the maintenance of equipment after purchase. Medical machines require regular servicing, calibration, inspection and timely replacement of defective components. Where maintenance arrangements are inadequate or contractual obligations are not fulfilled, equipment may become unusable even before the end of its expected service life. The reported condition of certain machines in certain medical colleges in Keralam highlights the importance of examining maintenance contracts, warranty provisions, service records and the responsibilities of suppliers and hospital authorities.
The consequences of the controversy extend beyond financial expenditure. Government hospitals serve patients who may not have the resources to obtain expensive treatment from private institutions. When ventilators, diagnostic machines and other essential equipment remain unavailable, hospitals may be unable to provide services at the required level. Patients may face delays, referrals to distant facilities, additional expenses and difficulties in obtaining timely treatment. Consequently, the effective utilisation of medical equipment is an important component of both financial accountability and public healthcare delivery.
Other serious allegations that emerge along with the reported pile up of unused medical equipment in government hospitals are the gross shortage of technicians required for operating them.
"Often, delays in appointing the required staff are deliberate. The failure to install or properly maintain the machines may also be part of a nexus between the administrations of public hospitals and private medical service providers operating in the respective markets,” said officials from several hospitals who spoke to TNIE on condition of anonymity.
A comprehensive and independent investigation is therefore necessary.
The authorities should conduct a physical verification of all equipment covered by the inquiry and prepare an inventory recording purchase prices, suppliers, delivery dates, installation status, operational condition, maintenance history and present location. Procurement documents, payment records, tender proceedings, installation certificates and maintenance contracts should be examined to establish whether public funds were spent appropriately. Equipment that can be safely operated should be installed or transferred to hospitals where it is required. Machines that have deteriorated should undergo technical assessment to determine whether repair, refurbishment or replacement is economically justified.
Responsibility must be determined on the basis of documentary evidence and the duties assigned to the officials and contractors concerned. Where the investigation identifies administrative negligence, appropriate disciplinary measures should be considered. If evidence establishes fraudulent procurement, deliberate misappropriation, collusion, overbilling or other unlawful conduct, the matter should be referred to the competent investigative authorities for action in accordance with the law. Allegations of corruption should not be treated as proven until supported by adequate evidence.
To prevent similar incidents in the future, the government should introduce stronger procurement controls and a centralised digital system for monitoring medical equipment throughout its service life. Expensive equipment should be purchased only after confirming that the intended facility has the necessary infrastructure, trained personnel, operational funding and maintenance support. Periodic inspections and public reporting of equipment utilisation would improve transparency and help identify problems before substantial public resources are wasted.
The reported circumstances indicate the need for a detailed examination of procurement planning, installation delays, maintenance arrangements and institutional accountability.
However, the available reports do not by themselves establish that the entire amount represents stolen public money or that a criminal scam of Rs 450 crore has been conclusively proved. The principal objectives should be to establish the actual extent of financial loss, identify responsibility wherever wrongdoing is demonstrated, restore usable equipment to service and introduce safeguards to ensure that public funds allocated to healthcare produce tangible benefits for patients.
