The nation’s medical reforms could screech to a halt and possibly go into reverse if Acting Health Minister Ulana Suprun is removed from her post, according to the Cabinet of Ministers and multiple civil society organizations.
Kyiv District Administrative Court on Feb. 5 banned Suprun from exercising her powers, following a lawsuit by Ihor Mosiychuk, a lawmaker from the Radical Party of Oleh Lyashko.
The lawsuit accused Suprun of incompetence, of unlawfully occupying her post for longer than one month, and of holding dual Ukrainian and U.S. citizenships — Ukraine does not recognize dual citizenship. A hearing is set for Feb. 15.
The result was a backlash from Suprun’s supporters, who told the Kyiv Post that Suprun was the only health minister to achieve real reforms since Ukraine became independent in 1991. While many of these reforms were controversial, supporters worry that without Suprun, the health care system will slide back into corruption and waste.
“For many decades, no one challenged the health care system, that’s why Ukrainians have huge problems with the quality of medicine,” Prime Minister Volodymyr Groysman said at a cabinet session on Feb. 6. “This court ruling is an attempt to turn us back.”
President Petro Poroshenko also said that Suprun has “the full support of the president of Ukraine.”
Claims of sabotage
Mosiychuk released a statement on Facebook accusing Suprun of “causing irreparable harm” to Ukraine’s “badly damaged” health care system. He claimed that first aid is unavailable to people who need it, and that basic medicine is “impossible to find.”
“We’re fighting for the life and health of Ukraine,” Mosiychuk wrote. Suprun posted a rebuttal on Feb. 4, pointing to Mosiychuk’s own legal troubles — the lawmaker once pled guilty to taking bribes.
This is not Suprun’s first run-in with Lyashko’s party. In April 2018, the National Anti-Corruption Bureau of Ukraine said that one of Lyashko’s aides had tried to bribe Suprun — he offered her a new apartment in exchange for medical allocations to a hospital in Vyshneve. Suprun promptly turned the aide in to the police. Shortly after, Lyashko demanded that the Rada dismiss Suprun due to her alleged dual citizenship.
Also in April 2018, the Rada’s health committee approved a draft decree to dismiss Suprun due to “disruptions,” caused by her attempts to reform Ukraine’s drug procurement system.
At the time, Olga Bogomolets, the health committee head, lawmaker from the Poroshenko bloc and a major opponent of Suprun’s proposed reforms, called on the government to decide whether Suprun’s “professional ineptitude” was behind Ukraine’s procurement troubles.
Problems surface
According to the Ministry of Health’s statement on Feb. 6, the court injunction is already blocking a shipment of vital medicine worth a total of Hr 633 million, or about $23 million. Before this shipment can go to regional hospitals, it requires a minister’s or acting minister’s signature.
“Currently, Ukrvaktsina and Ukrmedpostach are in the warehouses of state enterprises preparing to dispatch vital products in the regions through 33 public procurement programs,” the ministry wrote, in a statement.
“Among them are vaccines against measles, mumps and rubella (almost 390,000 doses) and polio (954,000 doses),” the ministry wrote. “With the ongoing measles outbreak, any delay in delivering these vaccines to the regions is unacceptable.”
Suprun expressed alarm at these developments. “Thousands of people might be left without treatments,” she wrote in her Facebook statement.
Fragile reforms
Nongovernmental organizations, including Patients of Ukraine, Transparency International and the HIV charity 100% Life, say Suprun made powerful enemies by trying to reform Ukraine’s medical procurement system, which previously funneled revenue to a handful of companies and corrupt officials.
The health ministry used to procure all drugs for Ukraine’s state hospitals. The job of procurement often went to a handful of companies that could buy drugs abroad and inflate their price through a chain of subsidiaries. The new system caps the final price and delegates much of the procurement to international organizations, including branches of the United Nations. Reform backers claimed that this made drugs and medical supplies 40 percent cheaper.
“The ministry (under Suprun) helped fight against a feudal system,” Maksym Rovinskyi, the director of communications at 100% Life, which supports Ukrainians living with HIV, told Kyiv Post. “Before her, there were people who could sit on these money streams and skim off a big percentage of government funds meant for medical procurements.”
Suprun also oversaw the creation of a system to reimburse patients for the purchase of drugs for treating cardiovascular disease, asthma and Type 2 diabetes. However, the reimbursement only covers the cost of the cheapest generics. Patients who want brand name drugs must pay the difference out of their own pockets. Also under Suprun’s watch, the health ministry adopted a World Health Organization standard by which hospitals are obliged to buy medicines with allocated funds.
NGOs that spoke to the Kyiv Post are worried that all these reforms might be on the chopping block without Suprun in control.
“Right now, all our strength must be thrown into keeping Ulana in place,” said Inna Ivanenko, the executive director of Patients of Ukraine. “We’re all ready to go out into the streets to picket and support her in any way we can.”
Representatives of several foreign powers echoed these concerns. British Ambassador Judith Gough tweeted that the court case may endanger Ukraine’s “vital” health care reforms.
Legal questions
Constitutional questions hang over Suprun’s pending court case — where her power comes from and how it can be stripped away.
Legal expert Andriy Guck told the Kyiv Post that Suprun can continue working as acting minister despite the injunction. He said the court ban on Suprun’s powers would be effective if she was installed by a minister of health. But Suprun was installed by the Cabinet of Ministers.
“In such a legal conflict, in my opinion, it is impossible for Suprun to be criminally liable for not complying with the court order,” Guck told Kyiv Post. “She has a binding order (from the government) that is still valid.”
Andrii Borovik, the executive director of Transparency International Ukraine, told the Kyiv Post that Suprun enjoys broad support from the president and the Cabinet of Ministers, which might simply try to re-appoint her. However, he acknowledged that there may not be enough votes in parliament to confirm her as a full-fledged minister.
“It would be very undesirable if she was removed,” he said.
Since Suprun was brought in as a replacement in the absence of a health minister, it’s unclear under Ukrainian law whether the cabinet can endow a deputy minister with the full power of a minister. According to an article by Guck, the law isn’t clear on what happens when parliament refuses to confirm an “acting minister” whose functions are then interrupted, like Suprun’s.
According to Guck, there are two possible ways out for Suprun. One is to appeal against the court ruling and continue trying to do her job without full ministerial powers. The other is to provide a formal rationale as to why the court ruling cannot be legally implemented.
Kyiv Post staff writers Anastasia Shepeleva and Artur Korniienko contributed to this report.
