Cancer patients in Bulgaria are being forced to find their own medicines, even though securing access to treatment is the responsibility of the state. In the case described by one of the women affected, who contacted “Za Istinata”, the state had formally fulfilled its obligation to patients – it had created a mechanism for obtaining substitute medicines, but had failed to establish any system to ensure that the mechanism was actually being used.
On 15 May this year, a cancer patient from Tryavna was due to undergo her third cycle of chemotherapy at a private hospital in Pleven. Instead of preparing for treatment, however, she received a phone call the evening before her admission.
Hospital staff told her that the required drug, epirubicin, was unavailable and that she would have to find it herself.
In practice, this proved impossible
Epirubicin is a powerful chemotherapy drug that stops the growth of cancer cells. It is mainly used in the treatment of breast and bladder cancer, but it is not available through Bulgaria’s pharmacy network.
With only a few hours left before her scheduled treatment, the patient’s only option was to miss the chemotherapy cycle – a decision she made knowing that any delay could affect the effectiveness of her treatment.
She meanwhile began looking for ways to obtain the drug from abroad.
She found it in Turkey, but on the day she was supposed to collect it, she received another call: the medicine could only be prescribed to Turkish citizens, was intended exclusively for use in Turkey and could not be exported.
With no other option, the patient sent an email to the prime minister, copying the ombudsman. She described her situation and ended with the words:
“I hope for your prompt intervention, because I do not have much time.”
The prime minister’s office responded by forwarding the complaint to the Ministry of Health. The ombudsman has yet to respond.
The case reveals something else
The Ministry of Health’s response shows that when a particular medicine is unavailable in Bulgaria, a special mechanism exists allowing hospitals to obtain, for a specific patient, a medicine authorised for use in another EU member state but not marketed on the Bulgarian market.
Epirubicin is included on precisely this list.
The procedure requires the head of the medical institution to submit a reasoned application. Following approval by a medical committee, the application is sent to the Bulgarian Drug Agency.
The agency then approves the request for a substitute medicine or rejects it with reasons.
This is the procedure that hospitals in Bulgaria are apparently not following, as this case suggests – and it is unlikely to be an isolated example.
This is where the questions begin
Following the complaint, the Ministry of Health asked the hospital to explain what action it had taken.
The response, obtained by “Za Istinata” but kept fully anonymous at the patient’s request, simply stated that the medicine was unavailable on the Bulgarian market and that the reasons for the shortage were beyond the hospital’s control.
The response, however, does not make clear whether the hospital used the legal mechanism for obtaining the medicine from another EU member state, or whether it took any other steps to ensure that the patient’s treatment was not interrupted.
In reality, the treatment was interrupted. The woman was forced to look abroad for a medicine she ultimately could not obtain.
Frustrated and disillusioned, she sought an alternative at another hospital in another city.
She found one, and her treatment continued under a different regimen.
Apparently, it is also producing results, she says – which is the best possible outcome of this story.
The questions remain
Why was a cancer patient forced to search for a potentially life-saving medicine herself when the state has a procedure specifically designed for situations like this?
And if such a procedure exists, whose responsibility is it to activate it – the patient’s or the medical institution providing the treatment?
And, finally, what happens when hospitals decide that it is easier not to search for a medicine for their patients and instead tell them: “Try Greece, try Turkey…” – as the woman featured in this report was advised?
By the end of June, the missing medicine was reportedly expected to be available in Bulgaria, judging by letters the woman provided to “Za Istinata”.
She nevertheless wanted her story to be told because, as she put it, “only when we insist can we get attention”, and because “while hospitals are looking for greater profits, we are fighting for our lives, and we would trust them more if we felt they were on our side.”
