Ministry of Death

To understand this story, you need to know what Arcsa does. It is the Agency for Health Regulation and Control, the Health Ministry office that checks that the medicines and supplies entering hospitals work and do no harm. When it finds a bad product, the law requires it to issue a public alert. Between 2017 and 2019 Arcsa found several, and the Ministry put the reports in a drawer. An internal source handed them to La Posta.

The first video came out on May 7, 2019, nine and a half minutes long. Since 2017 the Ministry had been buying fourth-generation rapid HIV test kits through special-regime tenders, with no open bidding, for about three million dollars. They are tests similar to pregnancy tests: a drop of blood, a reagent, a result in minutes. In October 2017 an internal memo reported false negatives in Los Ríos, Bolívar, Santa Elena and Guayas: patients who already had the virus were getting a clean result. Arcsa's laboratory confirmed it: 33 percent of the tests did not clearly identify HIV. The Ministry returned the batch to the Korean supplier and said nothing. The report recommended running confirmatory tests. The source who signed it also had doubts about the storage and transport handled by the Ministry, in uncertified warehouses; the Korean product had no Ecuadorian health registration.

In 2018 it bought again, with international funds and through an intermediary agency. A 1.6-million contract, signed by the minister herself, for 87,000 kits made in Japan; in 2017 and 2018 some 36,000 tests a year were bought for about one and a half million each time, while HIV cases rose 15 percent. This time the Ministry tested them before distributing them, and the result was worse: 26.6 percent false negatives and 20 percent false positives. People with HIV were told they did not have it, and healthy people were told they did. A Rutgers University researcher consulted by La Posta said a test with a 5 percent error rate would not be allowed to circulate in the United States or Europe; here the error rate was almost seven times higher. The report, ready in October 2018, recommended not using them. According to the person who signed it, the Ministry asked Arcsa, behind closed doors and verbally, to revise it so the tests could leave the warehouse, and seven months later someone from the Ministry called the head of the laboratories to ask her to add a couple of lines that would clear the way for distribution. Asked about it, the Ministry replied in writing that the 1.6 million in tests was still in the warehouse.

The minister replied the same day with a two-word denial: not true. The Ministry said the tests were certified by the World Health Organization, that Arcsa had run checks with certified plasma and that UNAIDS backed them. That third report, which whitewashed the matter, was issued on April 15, 2019, six days after La Posta asked questions, and it was signed by the same person who signed the first two; the minister could not say who paid for the certified plasma. A week later, on May 14, Espinosa came to Café la Posta to answer in person for an hour. The second installment had come out the day before.

The second installment was about a disinfectant. Chemscrub was used in operating rooms and emergency departments to clean the skin before surgery or wound care. On November 17, 2017, the Health Ministry reported, in memo 2910, an outbreak of respiratory infections at the Military Hospital in Quito that doctors attributed to the disinfectant. Arcsa analyzed it: the microorganism count was too numerous to count, with Achromobacter denitrificans and Comamonas testosteroni, identified thanks to a researcher at INSPI, the national public health research institute. The bacterial load was a thousand times higher than allowed. Three months passed between the hospital's warning and the resolution that pulled it. The product was contaminated at the factory, on the road to Daule, a plant certified for good manufacturing practices; there were two versions, at 4 and 2 percent, and the second did not even have a health registration. The Ministry said only four patients were infected and none died. As for the other hospitals, it replied that the product was no longer in stock. The penalty: a temporary suspension of the registration and withdrawal of the operating permit; no internal or criminal investigation.

The third was paracetamol. In 2016 the state bought injectable paracetamol, 10 milligrams per milliliter, from an Indian supplier for 355,000 dollars, through a reverse auction, the mechanism that requires choosing the cheapest option. On April 28, 2017, the San Francisco hospital in Quito reported foreign particles inside the vial. A nurse refused to administer it. On May 22 Arcsa provisionally suspended the batch, and on June 6, 2017, it declared it unstable: it did not meet sterility standards. Even so, four months later the Military Hospital found it again. La Posta documented that it reached eight hospitals: Abel Gilbert in Guayaquil, Luis Dávila in Tulcán, the Isidro Ayora maternity hospital in Quito, the IESS's José Carrasco Arteaga in Cuenca, the basic hospitals in Guaranda and Quevedo, San Francisco in Quito and the Military Hospital; four report directly to the Ministry. There was no public alert. Only on July 6, 2018, was the distributor Farmédica asked to recall and destroy the product; its health registration was returned in March 2019.

The fourth was a laboratory. Jaime José Gerardo Gutiérrez González made cancer drugs, hydroxyurea and imatinib, which are sold to the state through a distributor in which he himself has been a shareholder and manager. In June 2017 Arcsa inspectors found dust in the capsule-filling machine, dirty air vents, poorly handled waste and no cleaning logs. The laboratory said it had lost them. It requested a reinspection, which the regulations do not allow when there are serious irregularities: in October the logs reappeared and the dust disappeared. In January 2018, on the third visit, Arcsa declared it exemplary. In 2016 the state had bought eight million dollars' worth of medicines from it, through reverse auctions in ten procurement processes, more than three million in those two drugs alone, which kept circulating despite the 2017 inspections.

The fifth was the hardest. Newborn deaths in Ecuador had fallen between 1990 and 2014, and had been rising since: from 1,554 in 2014 to 1,859 in 2017, from 4.6 to 5.6 per thousand live births. At the Hospital Universitario in Guayaquil, an internal report counted 46 preventable newborn deaths between weeks 1 and 18 of 2018, 76 percent of them in the first eight days of life, compared with 71 in the whole previous year. A La Posta team, Ana Gabriela Oquendo, Mónica Velásquez and Gabriel Andrade, went undercover into the Isidro Ayora maternity hospital in Quito and filmed what a March 2018 technical report had already described: structures about to collapse, operating-room ventilation open to the elements, rusted boilers whose pollution contaminates linens that should come out sterilized, feces on the terrace, stray cats that staff fed and that bit employees next to the placentas, a kitchen tank that had exploded, gas cylinders without chains, an auditorium turned into a clothing store. The Ministry did not respond.

The Ministry responded to each installment with the same logic: the documents exist, but others are to blame. It said it does not buy medicines, that they are handled by 66 hospitals and 140 district offices; La Posta replied that the technical committee that recommends each award to SERCOP includes Ministry members, under Article 68 of the procurement regulations. It said it had issued a suspension resolution; La Posta showed there was none on Arcsa's alerts page. It cited the replacement clause in the framework agreements, but did not say whether the state recovered the money for the contaminated paracetamol. On May 21 La Posta published the Ministry's written answers, which had arrived late, and responded point by point.

On May 23, 2019, the piece that held the series together came out: fifty-five minutes with the source. David Salomón, a biotechnology process engineer trained in Germany and technical director of Arcsa's reference laboratory, had signed the HIV, disinfectant and paracetamol reports by hand. He spoke on camera. He explained how purchases were made, how products were tested and how things were hushed up; that the minister's press conference was coordinated, and that he gave his statement to GK under pressure, in front of his superiors. He said that after the first installments someone slashed one of his tires with a knife, and that he feared they would send a guy on a motorbike to his house. If that makes me a snitch, he said, then I'm the mother of all snitches. He became a protected source of the Attorney General's Office. On June 4, along with the fifth installment, La Posta published the complaint of Rosario Albán, an employee of the Isidro Ayora maternity hospital since 1985: she had written to the minister in May 2018, to President Moreno in June 2018 and April 2019, and to Attorney General Salazar on April 15, 2019, reporting irregularities and a rape by the maternity hospital's manager, her boss, with whom she still worked door to door.

The minister agreed to come on Café La Posta to answer questions. She defended the four quality control reports: rapid tests are not diagnostic, the first reports were done without the right reagent, a patient on treatment tests negative, the supplier is the UN Population Fund and not just any contractor, and now we know the tests worked perfectly. She argued that the Attorney General's Office was not investigating a personal act but the work of an entire institution, and that if they wanted someone responsible, they could pin it on her: I am not the ministry, the ministry is 47,000 professionals. Boscán closed: I hope you stay in office until justice comes knocking at your door. A week later President Moreno kept her in the post. Three months later the National Assembly censured her.

Three days after the first installment, the Comptroller General's Office opened a special audit of the Ministry and the Attorney General's Office opened a preliminary investigation into the HIV tests; in June 2019 the Attorney General's Office raided three Ministry and Arcsa sites and seized fourth-generation kits of the Standard Diagnostics and Alere brands. Espinosa left the post that same month; the government thanked her for her service, although she herself later said on the Assembly floor that she had been dismissed. Independent assembly member Mae Montaño gathered 35 signatures for an impeachment trial for dereliction of duty: purchases of spoiled medicines and supplies, misuse of public funds, allegedly fraudulent contracts, and maneuvers to avoid updating the essential medicines list.

On July 17 the Oversight Committee voted 13 to 0 to recommend censure. It accepted the grounds concerning the HIV kits and Arcsa's contradictory reports; it found no merit in the paracetamol or the disinfectant. On August 13 the full Assembly voted: 89 in favor, with 21 absent. It was two votes short of the 91 needed. Montaño explained the next day on Café la Posta who saved the minister that night: assembly members who had signed the request and did not vote, a bloc that offered its votes and did not cast them, surprise absences, an Assembly president, César Litardo, who froze the report for weeks and called recesses so more legislators could come in, and Minister María Paula Romo lobbying right in front of him. On the floor, the former minister said the trial was based on five lies by irresponsible journalists and that she had 14,000 news stories backing her record. Montaño requested reconsideration. The next day, August 14, 92 of 120 assembly members censured the former minister: two years barred from public office and the case file sent to the Comptroller General's Office and the Attorney General's Office.

Weeks later, Humberto Navas López, manager of the Isidro Ayora maternity hospital, whom Rosario Albán had accused of rape in the series, filed a criminal complaint against much of the La Posta team for disclosing a secret, on Ministry letterhead. It did not say the report was false; it said the physical document had gone missing. The team was summoned to testify. Nothing came of it.

In February 2020, five months after the censure, Primicias looked into what had happened to the criminal investigations in the health sector: nothing. The preliminary investigation into the HIV tests, opened in June 2019, remained confidential, with no defendants or charges. The 15 reports with signs of criminal liability that the Comptroller General's Office sent to the Attorney General's Office that year had not moved past that stage either. The results of the forensic analysis of the seized kits were never made public.

The Comptroller General's Office did reach a conclusion: it assigned administrative liability to Espinosa and her predecessor, Margarita Guevara, for failing to issue the rules governing health controls on imported medical devices. In an official response from July 2018, the nine zonal coordination offices reported 55 problem kits out of 893,732 used, a figure very different from the one produced by Arcsa's laboratories.

Verónica Espinosa never returned to public service. Her case became a reference point for what came next: the 2020 pandemic found the same procurement and control system in place, and in 2021 the VIP vaccinations scandal brought down two more health ministers. Nobody has faced criminal charges over the kits, the disinfectant, the paracetamol or the laboratory.