Documents reveal panic within HSE to buy ventilators at start of Covid pandemic
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In a way, the saga involving an Irish festival management company and the abortive provision of medical ventilators from China sums up much of the sheer panic which engulfed the HSE, Ireland, and the world at the beginning of Covid-19.
Documents discussing the bizarre transaction in detail have finally been released to the , nearly two years after the HSE denied their release citing myriad issues — not least that the public interest would not be best served by their publication.
It was not ever thus. When we first began putting questions to the HSE in December 2020, as to how a company which specialised in staging music festivals in Eastern Europe and the Middle East managed to land a contract to provide as many as 3,000 medical ventilators to the Irish health service, the initial responses were relatively transparent.
An invoice for the transaction was even provided upon request, something which subsequently would be denied under freedom of information due to its commercial sensitivity, which is quite the argument: We can’t give you this thing that we already gave you because it’s too sensitive.
The appealed that refusal, and 20 months later the Information Commissioner agreed with us, ordering the HSE to not only provide all details which were previously refused, but also to go back and search once more for the various correspondences which traced the matter.
The resulting documents show the panic at the heart of the HSE in March 2020, the extent to which its procurement section went rogue in seeking to shore up Ireland’s defences for the coming storm, the transition from panic to introspection regarding the splurge that had taken place, and finally the executive’s attempts to belatedly account for same.
Most of the main parties to the Roqu transaction declined to respond to requests for comment for this piece. A senior source within the health service meanwhile suggested there was little consternation regarding the final release of the documents given so many senior personnel at the time Covid hit have now moved on to pastures new.
On March 16, 2020, the company in question, Roqu Media International, made direct contact with the then-chief medical officer Tony Holohan, offering its services for the procurement of vitally needed medical devices. This intervention was “how engagement with Roqu commenced”, Sean Bresnan, the HSE’s head of procurement at the time, subsequently wrote.
Robert Quirke, the company’s sole employee and CEO, made clear that he had made similar overtures to both the HSE and the Department of Health. Following Holohan’s referral, Mr Bresnan met Mr Quirke in person four days later.
An offer was put on the table for all the ventilators Ireland could possibly need, and more. The only problem was the scenario was one of ‘take it or leave it’. The HSE took it, leading to a series of redrafts of the contract between the two as the requirements of the febrile situation lurched from point to point.
The initial contract was for 1,000 machines, something Mr Quirke promised he could “absolutely have... in Ireland before Wednesday of next week (March 25)”, with the promise of 2,000 more, at €35,000 per unit. Mr Quirke promised his ability to match “all of these requests without hesitation”.
Within a day that figure had reduced to 300, while the nature of the products in question also began to fluctuate as global demand for the life-saving machines ramped up.
From the beginning, the specifics of Roqu’s communications on the subject of ventilators veered from position to position, with the HSE struggling to keep pace.
On the morning of Monday, March 23, 2020, Sean Bresnan requested that then HSE chief executive Paul Reid approve the Roqu contract, stressing that “it is critical that I get it to the vendor within the next 20 mins”.
This followed a communication from Mr Quirke himself, which underlined that a confirmation letter for the transaction was required “as a matter of extreme urgency”.
From the beginning, there were apparent exaggerations in Mr Quirke’s retelling of the state of play in China.
On March 18, he told Mr Bresnan that he had “transferred several million dollars to reserve stock and ensure Ireland gets its quota”. Roqu itself confirmed 10 days later that figure to be just $500,000.
“Given the market conditions it was the only way forward and I am happy to do it given the severity of the emergency,” he said, adding that if the HSE were to “miss out on options now we could be looking at May for the next manufacturing run”, a delay of two months.
One week later a number of things had happened — firstly, Roqu confirmed that it had in fact only been able to secure 59 ventilators, after one unnamed manufacturer “would not release vents to Roqu”, according to the company, due to the machines having been “sold to another party at 3 times the price agreed with the HSE”.
“It is not known if other stock is available” from the same manufacturer, Mr Bresnan told the Department of Health on March 29.
More encouragingly however for Ireland, the number of Irish patients in need of ventilation in intensive care settings had notably begun to hold steady, meaning the quantity of machines required by the HSE was likely to be significantly less than their worst-case scenario projections.
From here a new battle commenced, between the health service and the HSE’s procurement section, as the former tried desperately to rein in the latter’s efforts to acquire all and any products that Ireland might conceivably need to battle the pandemic.
As early as the end of March 2020, the HSE’s two chief medical device specialists Ger Flynn and Dr Michael Power agreed that there was a need “to establish the total volume ordered so far” while a HSE official noted at the same time that “it seems to be impossible to get a status on where we are with ventilators”.
By the beginning of April the two men further agreed that it was time to “pause” the purchasing of ventilators. In this they came up against staunch opposition from the procurement section, which was determined to reach a figure of 2,000 ventilators acquired.
This was greeted with incredulity by Dr Power, who messaged the head of the HSE’s Medical Devices Criticality Assessment Group (MDCAG) to say: “I think you mean 200 ventilators. We don’t need 2,000 ventilators at this time.”
“The figure 2,000 was never agreed,” he added. The reply came back that 2,000 machines was what the procurement section intended to acquire regardless.
On April 20, the HSE’s director of sourcing Brendan White lauded the “magnificent achievement” of having sourced 2,000 ventilators in order that “no person requiring ventilation was unable to receive same in Ireland during this unprecedented crisis”.
He added that terminating some of the orders for ventilators already paid for would not be possible “without paying significant compensation”.
Dr Power replied that buying even more ventilators “cannot be justified at a time of Covid solidarity” when shortages were being seen in other EU
countries and the US. He said:
"There was no MDCAG agreement to ‘target 2,000 ventilators’ at any time. It is simply an inaccurate note. Please delete at this time."
In response, Dr Power was told in no uncertain terms that procurement was outside MDCAG’s remit, and "so the decision to keep ordering, cancelling orders, and or redeployment” was one to be made by HSE procurement alone.
These notes give interesting context to a subsequent HSE internal audit investigation into the procurement of ventilators for Covid, which concluded that 2,755 machines were bought and paid for in advance at a cost of €102m. Some 1,729 of the machines ordered from China were never received at all.
The internal audit noted that no basis was ever presented to the Department of Health as to why 1,900 ventilators were required in March 2020. The newly released correspondence might suggest that enormous overspend may have been attributable to something as simple as a typo.
Regardless, as the internal audit investigation began in June 2020 a briefing note assessment prepared by Procurement noted that not only did the 1,900 machines sanctioned for purchase in March vastly outstrip the 746 ventilators which were actually required, but at one stage orders had been placed for a whopping 3,447 units, at a cost of €137m — five times the required worst-case scenario number.
Little justification is given for the size of that order.
Meanwhile, the HSE’s relationship with Roqu was beginning to turn distinctly sour. On April 21, Mr Quirke informed the executive he would be flying 127 further machines into Shannon in five days’ time.
At this point, the few machines he had delivered had set off alarm bells in repeatedly failing quality control. He was told to stop the flight.
Ger Flynn told Sean Bresnan two days later that the Roqu machines represented “unreality” given the wide scope of model types, and the fact that more than half of the 72 delivered had failed testing.
He said that ventilators are life support equipment, and: "The failure rate experienced so far is very concerning, and cannot be ignored."
Mr Quirke for his part repeatedly insisted that any issues with the machines could be attributed to “calibration issues”. By May, HSE procurement was beginning to come under “significant pressure” in the words of Mr Bresnan, to account for the issues which had been experienced with the Chinese ventilators.
Further to this problem, a fresh bone of contention appeared in the correspondence between the HSE and Mr Quirke – that Roqu had allegedly used the overspend money it received from the HSE on the provision of millions of pieces of PPE without authorisation to do so.
With the internal audit investigation into the ventilators beginning to ramp up in June 2020, Mr Quirke was repeatedly contacted by the HSE seeking the approvals he had been given in the context of €6m of the money paid to Roqu.
Initially, Mr Quirke professed himself “deeply saddened” to hear that the ventilators had performed so poorly in testing. However, the HSE’s tone soon took a more aggressive slant, with Brendan White telling the Roqu chief in August that the information he had provided was “totally insufficient” and that more would need to be provided in order “to avoid the necessity of extensive public scrutiny”.
In July as part of the audit sweep, Mr Quirke was told that not answering questions would “reflect badly on Roqu”, with the conclusion to be that insufficient evidence had been provided to support the €6m spend on PPE.
The nature of the ongoing legal dispute between Roqu and the HSE would now appear clear. In responding to the previous message, Mr Quirke declared himself “confused and stressed” and firmly stated that Roqu had “operated under direct instruction” from the HSE and Sean Bresnan “at all times”.
He stated separately that his team was “currently travelling internationally for government-level meetings”, hence the sparse nature of Roqu’s replies, and took issue with the “tone” of the HSE’s questioning.
Interestingly, one of the delivery descriptions the HSE sought clarity for was cargo labelled ‘Conor McGregor’. Mr Quirke said that this related to freight he had been requested to transport for Cork-based ‘Dr Paul O’Brien’, an Irish man with knowledge of Chinese supply lines and markets who came to prominence in the Irish media at the beginning of the pandemic.
Whether or not the dispute between the HSE and Roqu will ever be resolved is a matter of conjecture, given it has dragged on for more than two years already.
The whole farrago appears to be a combination of a zealous purchaser under pressure as the pandemic broke out and a vendor who secured a fortuitous meeting and made promises which couldn’t be delivered.
It was a relationship that was always destined to fail.