Tuesday, April 14, 2020

Case Study of PKLI: How a Fine Initiative was Destroyed by Saqib Nisar, the Economic Hitman of Pakistan

With this treatment of Dr Saeed Akhtar and the treatment that they highly qualified professionals brought to Pakistan from their plush careers from abroad, no sane expatriate Pakistani will ever think of coming back to Pakistan to serve the country. This was the severest form of shock therapy from the Economic Hitman of Pakistan

[To understand the context of this post, please read At What Cost! Why Compute Economic Costs of Faulty Political Decisions]

Amer Yar Khan

March 29, 2019 ·

I had resigned from PKLI last month (letter attached) after, despite all efforts, the cabinet approved the PKLI Act 2019. This Act comprehensively takes away any autonomy we had which is a pre-requisite to run any facility in a modern and efficient way, let alone a future Harvard of Pakistan, which is what we had set out to make. I needed to put this post up to avoid the dozens of calls I’m getting and to help avoid confusion and rumours as well as saving myself from explaining the same thing to multiple people.

The well respected adhoc management committee placed by the SC convinced me to stay (letter attached) at least while they were functioning due to which I had to defer my resignation in their respect, however, without any liability to stay after they had gone. The adhoc committee was disbanded along with the ditching of the suo moto case against us by the new bench of the honourable SC.

What has happened at PKLI should be a case study for why Pakistan could not succeed like some other countries such as Malaysia, Turkey, Korea, Japan and Germany, despite having some of the best minds in the world in all fields. The PKLI Act 2019 practically gives complete control of the institution to a bloated government bureaucracy which has no clue how to run modern hospitals, while dumps responsibility on an executive which is not given the authority which would enable delivery. People who are professionals and motivated to deliver will never be able to accept such an appointment. Small people sitting on big chairs - the tragedy of Pakistan.

Another remarkable thing is that just 3 months into the partial inauguration of PKLI with rudimentary out-patient services only, a suo moto was taken by a biased CJP claiming that PKLI had wasted money and were ineffective in still not being able to conduct a liver transplant. He did not stop there, he humiliated and threatened us in the court and specifically told me by name that he would put me behind bars! The ridiculousness of all this is incomprehensible. The icing on the cake was that after that every institution or segment of society jumped on board singing along with the ex-CJP making PKLI the child everyone desired to kick and shame! Not only the courts, but the media, the vile and lowly forensic auditor with questionable credentials, the anti-corruption establishment, the auditor generals office, two individuals from the NAB, FIA, Punjab health care commission, our own colleagues from local hospitals, you name it, every single person went after PKLI with a battering ram for 11 months. Sad part was no one spoke up for justice. Even more tragic was that those cognisant of this torture, chose to remain quiet.




I just salute each and every member of my team who despite all this, continued to toil and brought the facility to a level where just this month we have conducted three successful liver transplants. Despite all the filth spewed against PKLI and dragging us down in litigation, I take pride in saying that within the last six to eight months we have developed the best ICU and dialysis services in the province, the only OPD in the public sector where consultants see and are held responsible for every patient and the only public sector facility where you can expect safe liver and kidney transplants. PKLI has also made HMIS, EMR, Infection Prevention and Control, Quality Assurance, Waste Managment, hepatitis elimination, hepatitis bill etc buzz words which are so essential to implement proper health care in Pakistan. This is no small achievement and kudos to the PKLI Family for all this and much much more.

I had hoped that after the conclusion of the suo moto the new government (now relieved from the pressure of the ex-CJ) would reverse the draft PKLI Act of 2019. That has not been the case. They are “know it alls” there. They are people who, for whatever reason, are so upset at the PKLI Managment that literally no one has ever even bothered to contact the PKLI Managment to even briefly discuss what we were about and how we planned to achieve what we had claimed. The contempt for PKLI has been obvious from not only their facial expressions but also from their complete lack of any meaningful communication with any one of us.

While PKLI was independent I never got a single call from any corridor of power asking to treat, hire or promote someone. Just two weeks or less into the PKLI Act 2019 and the government takeover, I am inundated with requests which I (now damaged with a year of government agencies’ unjust investigations) now cannot ignore without some stress of consequences. Is this the environment in which professionals can perform?

We are told by the government that PKLI will be an independent organisation like Shaukat Khanum. Let’s not take the Pakistani people for a ride again, like all previous governments have. Read the PKLI Act 2019 and please explain to me how anyone can possibly believe that!

PKLI has been a love and a passion for me. It has consumed me completely for more than 2 years. It has often come before my family and always before my health. It is so painful to leave that I will likely detox for the next 6 weeks. However, when there isn’t even a sliver of hope for achieving what I had signed up for, one has to take a stand on principles.

I wish from the depths of my heart that better sense prevails in the future and PKLI blossoms. Ameen.














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PKLI: from hope to despair (Why Pakistan could not succeed)


ISLAMABAD: “What has happened at PKLI should be a case study for why Pakistan could not succeed like some other countries such as Malaysia, Turkey, Korea, Japan and Germany, despite having some of the best minds in the world in all fields,” this is what Dr Aamir Yar Khan, Medical Director and Chief Operating Office, PKLI, wrote as his reason to quit.

“Small people sitting on big chairs -- the tragedy of Pakistan,” is how Dr Aamir was made to explain on his Facebook the state of affairs in Pakistan after the Pakistan Kidney & Liver Institute, oncethe great hope, has been turned into a despair initially by the suo motu notice of the former chief justice and later by the controversial actions of the Punjab government.

Dr Aamir is one of the several foreign qualified doctors who had come to Pakistan leaving their lucrative and well-paid jobs in the US, Europe and Middle East to join the PKLI as Dr Saeed Akhtar’s team to serve Pakistan with the mission of providing free kidney and liver treatment including transplant to the poor and needy besides attaining the objective of getting the country rid of Hepatitis B&C by 2030. But the treatment meted out to the globally acclaimed Dr Saeed and the consequent damage done to PKLI by the SC’s suo motu and Punjab government’s action, have frustrated these doctors to leave the institute and the country as well.

Dr Aamir, who was brought in by Dr Saeed, has served as Clinical Associate Professor of Medicine, University of South Dakota, Division of Health Sciences, School of Medicine, USA. He also worked as Director of Hospital Medicine at Saint Alexius Medical Center in Bismarck, North Dakota as well as BroMenn Regional Medical Center in Bloomington, Illinois, USA.

Others who too have left the PKLI include Dr Bashir Azher, a top notch Urologist trained in USA to do complex cancer surgeries; Ahmad Awab, critical care Specialist from USA, who was very disheartened by suo motu and rude behaviour of forensic auditor working on order from former CJP; Dr Shah Gul trained in USA and was director of PKLI’s pathology lab who put her heart and soul in building a state-of-the-art lab; Dr Mazhar Butt, child specialist who joined from Saudia; Dr Nauman Zafar, a top urologist and robotic and laparoscopic surgeon, who wanted to build and teach latest techniques in cancer surgeries went back to the UK; Dr Abdul Rauf Mazhar, a nephrologist trained in USA, who worked with a lot of passion and also was a good teacher also resigned.

While the future is uncertain about highly reputed Dr Saeed Akhtar, his wife Dr Masooma Saeed, will also leave if the PKLI is not revived to its original mission. Dr Masooma did her residency in anesthesia and pain management at Texas Tech University Health Sciences Center, Lubbock, Texas. Trained in all aspects of anesthesia with special interest in transplant anesthesia and anesthesia for major cancer surgeries, she has given anesthesia to more than 1,000 kidney transplants and cancer surgeries.

It is said that seven other doctors, who have requested not to disclose their names, are also planning to resign. According to a source, for the last 28 days no cheque has been signed because the PKLI has no Chief Executive Officer. “How can anyone leave a running hospital without CEO for a month, where active patient services including kidney and liver transplant are being offered? Mind boggling,” a PKLI source commented on the indifference of the Punjab government.

It is generally believed and said that the treatment meted out to Dr Saeed and PKLI, would serve very negatively in government efforts to allure top Pakistani minds serving in foreign countries to come and serve Pakistan.

Dr Aamir Yar Khan comprehensively explains what happened to PKLI and how the dream of making PKLI an institution of international repute became a nightmare.

Dr Aamir note reads as: “I had resigned from PKLI last month (letter attached) after, despite all efforts, the (Punjab) cabinet approved the PKLI Act 2019. This Act comprehensively takes away any autonomy we had which is a pre-requisite to run any facility in a modern and efficient way, let alone a future Harvard of Pakistan, which is what we had set out to make. I needed to put this post up to avoid the dozens of calls I’m getting and to help avoid confusion and rumours as well as saving me from explaining the same thing to multiple people.”

“The well-respected ad-hoc management committee placed by the SC convinced me to stay at least while they were functioning to which I had to defer my resignation in their respect, however, without any liability to stay after they had gone. The ad-hoc committee was disbanded along with ditching of the suo motu case against us by the new bench of the honourable SC.”

“What has happened at PKLI should be a case study for why Pakistan could not succeed like some other countries such as Malaysia, Turkey, Korea, Japan and Germany, despite having some of the best minds in the world in all fields. The PKLI Act 2019 practically gives complete control of the institution to a bloated government bureaucracy which has no clue how to run modern hospitals, while dumps responsibility on an executive which is not given the authority which would enable delivery. People who are professionals and motivated to deliver will never be able to accept such an appointment. Small people sitting on big chairs - the tragedy of Pakistan.”

“Another remarkable thing is that just 3 months into the partial inauguration of PKLI with rudimentary out-patient services only, a suo motu was taken by a biased CJP claiming that PKLI had wasted money and were ineffective in still not being able to conduct a liver transplant. He did not stop there, he humiliated and threatened us in the court and specifically told me by name that he would put me behind the bars! The ridiculousness of all this is incomprehensible. The icing on the cake was that after that every institution or segment of society jumped on board singing along with the ex-CJP making PKLI the child everyone desired to kick and shame! Not only the courts, but the media, the vile and lowly forensic auditor with questionable credentials, the anti-corruption establishment, the auditor general office, two individuals from the NAB, FIA, Punjab Health Care Commission, our own colleagues from local hospitals, you name it, every single person went after PKLI with a battering ram for 11 months. Sad part was no one spoke up for justice. Even more tragic was that those cognizant of this torture, chose to remain quiet.”

“I just salute each and every member of my team who despite all this, continued to toil and brought the facility to a level where just this month we have conducted three successful liver transplants. Despite all the filth spewed against PKLI and dragging us down in litigation, I take pride in saying that within the last six to eight months, we have developed the best ICU and dialysis services in the province, the only OPD in the public sector where consultants see and are held responsible for every patient and the only public sector facility where you can expect safe liver and kidney transplants. PKLI has also made HMIS, EMR, Infection Prevention and Control, Quality Assurance, Waste Management, hepatitis elimination, hepatitis bill etc buzz words, which are so essential to implement proper health care in Pakistan. This is no small achievement and kudos to the PKLI Family for all this and much, much more.”

“I had hoped that after the conclusion of the suo motu the new government (now relieved from the pressure of the ex-CJ) would reverse the draft PKLI Act of 2019. That has not been the case. They are “know it all” there. They are people who, for whatever reason, are so upset at the PKLI management that literally no one has ever even bothered to contact the PKLI management to even briefly discuss what we were about and how we planned to achieve what we had claimed. The contempt for PKLI has been obvious from not only their facial expressions but also from their complete lack of any meaningful communication with anyone of us.”

“While PKLI was independent I never got a single call from any corridor of power asking to treat, hire or promote someone. Just two weeks or less into the PKLI Act 2019 and the government takeover, I am inundated with requests, which I (now damaged with a year of government agencies’ unjust investigations) now cannot ignore without some stress of consequences. Is this the environment in which professionals can perform?”

“We are told by the government that PKLI will be an independent organisation like Shaukat Khanum. Let’s not take the Pakistani people for a ride again, like all previous governments have. Read the PKLI Act 2019 and please explain to me how anyone can possibly believe that!”

“PKLI has been a love and a passion for me. It has consumed me completely for more than 2 years. It has often come before my family and always before my health. It is so painful to leave that I will likely detox for the next 6 weeks. However, when there isn’t even a sliver of hope for achieving what I had signed up for, one has to take a stand on principles.”

“I wish from the depths of my heart that better sense prevails in future and PKLI blossoms. Ameen.”

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From Omer Dossani:
Dr. Saeed Akhtar of PKLIC is great man who has sacrificed a lot for the betterment of others and for the less fortunate. I have been glad to host a fundraiser for him in Austin, TX. He would fly all around the US in his own small plane and at his own expense to raise a small amount of money for his charitable work.
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Supreme Court Reverses Saqib Nisar's Judgement agains PKLI


https://www.dawn.com/news/1466809/apex-court-reverses-ex-cjps-orders-against-pkli-management


Apex court reverses ex-CJP’s orders against PKLI management


Wajih Ahmad SheikhUpdated March 01, 2019


The court discards ad hoc committee, allows Dr Akhtar to go abroad, directs the govt to run the PKLI under its Act.— AFP/File

LAHORE: A three-judge Supreme Court bench on Thursday reversed all previous orders passed by former chief justice Mian Saqib Nisar in a suo motu case against alleged corruption in the Pakistan Kidney and Liver Institute (PKLI) and huge salaries of its president and other staff.

The former chief justice had ordered the Anti-Corruption Establishment (ACE) to hold an inquiry into alleged misappropriation of funds at the PKLI after a court-appointed forensic audit expert doubted transparency in the institutes’ financial affairs.

The former chief justice had also appointed an ad hoc committee headed by a retired judge to run the institute on behalf of the apex court and ordered amendment to Pakistan Kidney & Liver Institute and Research Centre Act 2014.

The court had also barred its president Dr Saeed Akhtar from leaving the country.

The suo motu case was taken up by the three-judge bench headed by Justice Manzoor Ahmad Malik at the Lahore registry. Justice Syed Mansoor Ali Shah and Justice Yahya Afridi were other members of the bench.

ACE acting director general, health secretary and other officials of the Punjab government were present in the court with the assistance of law officers.

Revoking previous orders, the bench directed the provincial government to run the PKLI under its Act and also allowed Dr Akhtar to go abroad. The bench also discarded the ad hoc committee.

Asked about the legitimacy of the inquiry conducted by the ACE into the PKLI affairs, a law officer told the judges that a bench headed by the former chief justice had ordered that probe.

Justice Malik observed that every institution was supposed to work within its limits. He told the law officer that the bench was withdrawing the order for the inquiry as being unnecessary and a judicial overreach. With these directions, the bench disposed of the suo motu.

In its report filed on Jan 12 last before a bench headed by former chief justice, the ACE had recommended registration of an FIR against the management of the PKLI and others.

The report stated that the project of the PKLI was supposed to complete by December 2017. However, it was still under construction. It said the government officials were involved in misappropriation of funds and a detailed investigation could be held after registration of a case. The report pointed out that no action had been taken against the contractors for delaying the project.

Published in Dawn, March 1st, 2019

PKLI carries out only 50 kidney transplants in one year


PKLI carries out only 50 kidney transplants in one year


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ISLAMABAD: As per vision of its founding members, Pakistan Kidney and Liver Institute (PKLI) had a target of 200 kidney transplants for this year. However, it has hardly achieved 25 percent of the target— thanks to the new management running under the umbrella of Punjab government.

Since the Punjab government has taken over the control of PKLI, liver transplantation service has been closed down. The new management has carried out not a single liver transplant after March 2019. Only three patients have successfully received a liver transplant and that too by the previous administration.

The PKLI had a target of 200 kidney transplants for the current year but only 50 patients have received kidney transplants. The Punjab government was supposed to provide funds to run the hospital. However, according to well-placed sources, a majority of these kidney transplant operations have been carried out through donations and other resources instead of Punjab government’s funds.

The previous management mainly Prof Dr Saeed, brought 25 highly skilled physicians and surgeons from United States, United Kingdom and other countries to deliver state of the art health facilities to the people of Pakistan. These liver and kidney transplantation experts left their luxurious lifestyle and joined PKLI on bare minimum salaries with restrictions on private practices outside PKLI, in order to serve their country. However, half of these 25 highly skilled doctors have left PKLI and the remaining ones are also mulling to resign as the purpose of their joining the PKLI is not served in letter and spirit.

Launched on December 25, 2017, the PKLI served 303423 patients till March 2019 and provided free or subsidized treatment to 89 percent of the total patients. It was running Hepatitis Prevention and Treatment Program (HPTP) clinics in 23 districts of Punjab. From December 2017 till March 2019, a total of 279,940 patients were registered and 400,000 people have been engaged in awareness campaign.

As per the data, the HPTP clinics screened 515848 patients from December 2017 to March 2019. Similarly, 394468 patients were vaccinated through the hepatitis prevention and treatment program being run by PKLI. However, since the Punjab government took over the control of PKLI, the HPTP program has been closed down or merged with the Punjab government’s Hepatitis Control Program and no more patients are being treated through this program.

The PKLI data further shows that HPTP clinics in 23 districts and Hepatitis Prevention Control Clinic in Lahore screened a total of 914872 patients in 15 months. Similarly, the PKLI carried out 15775 ultrasound, 4942 Fibro scan and 2243 Endoscopy. However, after March 2019 almost all these facilities have been closed down by Punjab government.

The previous management was successfully running the telemedicine program and it was collecting an authentic medical data of the people of Punjab through HPTP and HPTC programs. While taking interest in this data collection program, Gilead Sciences, Inc. —an American biotechnology company that researches, develops and commercializes drugs had approached the previous management and expressed its desire to collaborate with PKLI for research purposes. However, this could not be materialized.

The PKLI as per the vision of previous management was supposed to generate its own funds for 75% of its cost after three years. The funds would have been generated through business initiatives like PKLI-owned shopping malls, pharmaceutical companies, hotels, bazaars and donations. However, it is on the verge of closure after the policies of current provincial government. The construction of this project has been stopped as the Centre was supposed to build a 470 bed hospital. However, only 60 beds facility has been constructed so far.

When contacted Dr Hafiz Ijaz Ahmed, acting head (Dean) of PKLI said only a couple of doctors have left PKLI. A majority of the doctors are still associated with PKLI. The hospital is still in the phase of construction therefore it is not functioning in its full capacity.

When asked if PKLI has met the target of 200 kidney transplant and whether it is true that only 50 kidney transplant operations have been carried out during last one year, the PKLI’s acting Dean said he doesn’t have the exact data. “The PKLI is not fully functional as there is only 60 beds capacity in the hospital and this is one of the major reasons of not meeting the target”.

He confirmed that no liver transplant operation has been carried out after March 2019. When asked the reason of closing down the HPTP and HPTC clinics, Dr Ijaz said the Punjab government already has a hepatitis control programme, therefore, the HPTP clinics were not needed; hence they have been merged with the Punjab Hepatitis Control Programme.

When asked whether PKLI has faced reduction in number of patients after the Punjab government took over the charge, the acting Dean said he doesn’t have the patients’ data therefore, he cannot comment on it.

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