Medical Kalabule: Inside Ridge Hospital’s system that exploits patients [Part One]

The cattle were the first to go. Then the small savings he had. Then his business.

“I suffered a lot. My business also suffered. I sold all my cows. About 20 of them. I was worried because I did not have money at that time,” he recalls, exhaustion in his voice.

The tumour had begun as a dull ache. Nothing serious – just a nagging throb at the back of his head. But month after month, the pain grew sharper, heavier, unrelenting. One afternoon, when the cattle herder from Ho blacked out while riding pillion on a motorbike, he knew something was seriously wrong.

Painkillers had failed him; so had the small clinics and hospitals in the Volta Region. Desperate for answers, he made the journey to Ghana’s largest referral centre, the Korle-Bu Teaching Hospital, where doctors told him the source of his agony. The brain tumour was lodged deep in the centre of his head, and the only solution was a delicate, minimally invasive surgery to cut it out.

He said surgeons at Korle-Bu told him the facility wasn’t equipped for the procedure. His only option, they said, was India.

“I was worried about the cost. Going to India meant buying an extra ticket for my caretaker,” Amadu said. “Someone told me to try Ridge Hospital instead.”

On July 31, 2023, Ridge handed him a “Specialized Request Form” for surgical equipment. The form is used by surgeons to list special gadgets or surgical consumables needed for surgery. The request form mentioned a brain tumour excision with neuronavigator, an intra-operative neuromonitor, a fluorescein dye (tumour agent), and a virtual reality system.

These aren’t items you take home. They are advanced surgical systems already available in Ridge Hospital, bought and installed by the Government of Ghana for about GHC13 million.

The neuronavigator maps a patient’s brain and guides surgeons with millimetre accuracy, helping them remove a tumour without damaging healthy tissue. With the virtual reality system, special headsets and software help surgeons “walk through” a patient’s brain in 3D before and during surgery for safer operations. It’s not a one-use item; it is designed for hundreds of surgeries. The intra-operative neuromonitor is a real-time alarm system for surgeons. It tracks nerve signals during surgery, warning if a movement could cause permanent paralysis or damage. The fluorescein dye is a special dye that makes tumours glow under surgical lights, so doctors can see exactly where to cut.

Apart from the tumour agent, the rest of the specialised equipment Mr Sambo was told he needed for his surgery was state property, already available at Ridge Hospital and meant to be used without extra billing. Patients, under normal circumstances, only pay for implants, consumables, and the disposable items which the hospital procures on their behalf if this is made known to the hospital by the surgeons to be put in the hospital’s procurement plan.

But The Fourth Estate’s checks show that no such request went through Ridge Hospital’s official procurement channels for Amadu’s surgery. Although he has no receipts to show, Amadu said he had spent over GHC 200,000 on his surgery and recovery. For someone like Amadu, already stripped of his savings, his cattle, and his business, there was no room to question prices, no chance to shop around.

Loopholes that some surgeons are exploiting

At Ridge Hospital, the standard procedure after diagnosis is clear. Once a patient requires surgery, for certain specialities, the surgical team compiles a list of implants and consumables. The hospital is supposed to take over from there, procuring the supplies and releasing them to the theatre for surgery.

But in practice, this process is mostly bypassed. Instead of routing these requests through the hospital, some surgeons bypass it entirely, sending patients with private pharmacy prescriptions (until recently) to private vendors for these “items”.

Medical Director Dr Leslie Adam Zakariah admits the practice is irregular. He says Ridge has drafted a policy to fix the problem. “We have developed an implant policy. We will try to get what we need in-house, with requests made to our procurement unit, so surgeons get exactly what they require,” he says.

Fifty-two-year-old Mr Sambo wept and thanked all the people who contributed to fund his surgery. He also thanked the surgeons for operating on him and reducing his headaches. However, he has not fully recovered and is waiting for another surgery.

He directed The Fourth Estate to secure the receipts from his sister in Accra. Although the sister agreed to provide the receipts, she eventually backed out, saying that her brother would still go to Ridge Hospital and hence did not want the doctors to victimise him.

But another family from Nigeria, which was compelled to bypass Ridge Hospital’s procurement system, told a story similar to Mr Sambo’s.

Perfect Sunday, a name altered to conceal her identity, travelled from Nigeria to Ghana with her ailing brother, Adebayo, in search of healing. After months of research, calling hospitals, contacting doctors, and eventually narrowing her options to two countries – Ghana and Morocco – she settled on Ghana because it was closer and the visa requirements were easier.

The family had desperately raised $10,000 for Adebayo’s brain surgery from strangers, friends, and family because doctors in Nigeria said they lacked a highly specialised machine for the procedure. On 24th July 2024, after months of crowdfunding and sleepless nights, she arrived in Accra with her brother by her side. They checked into Ridge Hospital, praying they would return to Nigeria with good news.

A female hospital staff member approached her quietly, handing over an Axis Pharmacy Specialised Prescription Form at Ridge Hospital signed by Dr Hassan Andani, a resident in training, but issued on behalf of the surgical team’s lead, Dr Samuel Kaba Akoriyea.

The female staff member instructed her to contact Axis Pharmacy, where she was to buy all the necessary items for her brother’s procedure.

On the specialised request form, there is “pineal regional,” but a simple search showed the pineal region is part of the deep brain. The “pineal regional” request was coded 001.

The second list on the form included “Brain Stem Neuronavigator” and “Endoscopic Assisted,” also coded 031 and 032, respectively.

At Axis Pharmacy, the cost of the “Brain Stem Neuronavigation set” was initially quoted at GHC7,000. However, when Perfect returned to pay, the price had mysteriously changed to $7,000. She protested immediately. The staff at the pharmacy brushed it off, claiming it was a mistake.

Perfect said she was desperate and filled with thoughts of her brother’s surgery, so she did not ask any questions. “I just did what I was told because my brother’s life was on the line.” She bought what they asked her to buy for the doctors to proceed with the surgery.

After the surgery, he was placed on a ventilator. Then he died. Doctors later told Perfect that he had succumbed to an infection in the theatre.

What continues to gnaw at Perfect is not just the loss but the growing suspicion that she may have been exploited in the process.

Seeking Answers

The Fourth Estate handed over Amadu’s form to Dr Divine Banyubala, the registrar of the Ghana Medical and Dental Council, and he was stunned.

Dr Banyubala, who heads the statutory body regulating medical practice in Ghana, said the requisition was “irregular and unacceptable.” He explained that doctors must use Ministry of Health prescription pads and work with hospital pharmacies and procurement units for surgical supplies.

“This practice is very, very irregular. It is inconsistent with professional expectations and may constitute a classic case of ‘infamous’ [nefarious] conduct,” he said.

Looking at Amadu’s prescription pad, he pointed to the oddity of a public hospital’s name scribbled in pen on a private pharmacy form.

Taking a critical look at the doctors’ written request for “brain tumour excision with neuronavigator and virtual reality system,” he described it as vague.

“The system referenced here is something meant for repeated use on several patients. Even if no specific amount is quoted, is it for the use of the system in a public facility, or are they buying an accessory from a private source for a public hospital? It is all muddled up.”

For Amadu Sambo, the muddle was never just about paperwork. It was about a fight for his life, one made harder by a system that seemed ready to take from him even when he had almost nothing left to give.

On the Adebayo case, Dr Banyubala said the coding of the prescription raises red flags.

“When a prescription includes specific product codes tied to a single pharmacy, it strongly suggests the possibility of collusion between the doctor and the pharmacy,” he explained.

The Fourth Estate reached out to Dr. Hassan Andani for an interview. We wanted to know who asked him to use the Axis Pharmacy form. He stated that he was merely a trainee neurosurgeon and directed us to contact the appropriate authorities at the hospital.

We subsequently wrote to the Medical Director, Dr. Leslie Adam Zachariah, requesting that Dr. Hassan Andani and the neurosurgical team be made available for an interview. Despite repeated follow-ups, our requests were ignored.

Why would a pharmacy in Ghana quote prices in U.S. dollars to a West African patient walking in from a Ghanaian public hospital? And how could a pricing error involving thousands of dollars be so casually made? “If I walk into a shop to buy bread, does it tell whether this is a non-Ghanaian face so the bread is suddenly 10 dollars instead of 10 cedis?” Dr Banyubala queried.

Even more unsettling was the fact that the transaction was priced in foreign currency when the Foreign Exchange Act, 2006 (Act 723) prohibits the pricing of goods and services in a foreign currency in Ghana. In fact, Axis Pharmacy issued an officially stamped receipt of $5,000 and $2,000 for neurosurgical supplies on 27th July 2024. According to the law, such violations are punishable on summary conviction by a fine of up to seven hundred penalty units, or a prison term of not more than 18 months, or both.

But Perfect eventually paid and handed the receipt to the neurosurgeons.

Grief-stricken and out of funds, Perfect only wanted to retrieve her brother’s body for burial. But the shock wasn’t over. The hospital handed her an additional bill of GHC55,000.

“I was shocked and exhausted,” she says. “I had already paid $7,000, plus countless other medications. I couldn’t believe my ears.”

It was only at this point that she was informed that the $7,000 payment had only covered a neuronavigation set and an endoscopic set.

“By that time, I had run out of money. A nurse was the one giving me food to eat,” she says.

She said her parents decided to bury Adebayo, her brother, in Ghana because it would be too expensive to fly his remains back to Nigeria for burial. “There wasn’t money to bring his body back home, so we were going to bury him in Ghana. I didn’t want to stay extra time in Ghana. We wanted to do everything in Ghana so that we could go back and mourn in peace,” she said.

In July 2024, Axis Pharmacy pocketed US$7,000 from Adebayo — the equivalent of GHC103,227 at the Bank of Ghana’s interbank rate of GHC14.7467 to US$1 at the time. By contrast, Ridge Hospital, the facility that actually performed the surgery with its state-of-the-art equipment, received only GHC30,000. It even had to waive an additional GHC25,145 on humanitarian grounds. The inescapable question is: how does a private pharmacy walk away with over GHC103,000 for consumables, while the public hospital at the heart of the life-saving operation gets barely a third of that amount?

Records show Ridge Hospital already had neuronavigation and endoscopic sets acquired by the state for the separation of conjoined twins. If the hospital charged Perfect for additional consumables rather than the equipment itself, no one explained it to her. She said she was never shown what she paid for. “Axis Pharmacy never provided a breakdown,” she said. And, according to her, the surgeons offered no clarity.

Another serious aspect is that the receipt she received from Axis Pharmacy was not a VAT receipt. Other tax components were absent (loss of revenue to the state/tax evasion).

Pattern of pricing inconsistencies

The Fourth Estate reviewed other patient records that revealed a troubling pattern of inconsistency in pricing for the same surgical tools: while a patient (name withheld) was charged GHC15,000 for a neuronavigation set, Adebayo was charged US$7,000 (GHC103,227) for supposedly the same equipment, and a 15-year-old (name withheld) was charged GHC8,000 for neuronavigation components. How could the same equipment, prescribed by the same group of neurosurgeons and sourced from the same pharmacy, vary so widely in cost?

The Fourth Estate wrote to the Food and Drugs Authority (FDA) requesting a list of licensed pharmacies and facilities authorised to import implants, medical accessories, and devices between 2021 and 2025. Axis Pharmacy was not on that list. So, on what grounds did neurosurgeons at Ridge Hospital repeatedly direct patients to purchase equipment and accessories from Axis Pharmacy?

The virtual reality mystery

At Ridge Hospital, technology is making surgeries more advanced. Surgeons use a system that creates 3D images of a patient’s body, which they can see through special virtual or augmented reality headsets. This helps them operate with more precision. A software programme called RadiAnt also allows doctors to plan surgeries in detail, often without the need for extra machines. These tools mean doctors can “see inside” the body before and during surgery, improving accuracy. Still, some parts of the hospital’s processes and procedures leading up to surgery are hard to fathom, seemingly harder to see through than it is for the hospital’s surgeons to look into a patient’s brain.

A consultant neurosurgeon, Dr Emmanuel Voado, signed an Axis Pharmacy “Specialised Requisition” form for a “Virtual Reality System.” Based on this, a 30-year-old patient (name withheld) was billed GHC25,000. Another patient (name withheld) received a separate invoice charging GHC13,000 for “Virtual Reality Components.”

This raises more questions: What exactly was sold as a “VR system”? Was it RadiAnt, which typically requires no attachments? Why the massive price differences for what should be a hospital-based tool?

Internal audit uncovers malpractices

Ridge Hospital’s own Third Quarter Internal Audit Report for 2023 found that some surgeons were dealing with Axis Pharmacy and Staraid Care Limited without authorisation.

The report noted that implants and instruments were kept at the hospital and used on patients who paid without approval from management. The audit recommended that the hospital itself procure implants so patients could be billed directly through the hospital’s system.

But despite this recommendation, some neurosurgeons and orthopaedic surgeons continued the practice of engaging unapproved vendors, like Axis Pharmacy and Staraid Care Limited.

Across multiple cases, the pattern is consistent: private pharmacy special request forms, inconsistent pricing, no transparency, and little accountability. In a place where patients seek healing, they are instead exposed to financial exploitation.

Dr Samuel Kaba Akoriyea calls national security

The Fourth Estate reached out to Dr Samuel Kaba for a response because he worked as a neurosurgeon (second stint) at Ridge Hospital and also because his name was on the Axis Pharmacy Specialised Prescription Form. He once served as the Director of the Institutional Care Division of the Ghana Health Service. Currently, he heads the Ghana Health Service.

He initially agreed to grant an interview at his office located at the headquarters of the Ghana Health Service but later changed the venue to Ridge Hospital, explaining that he wanted to practically demonstrate the use of surgical equipment to support his account. However, while our reporter was at the hospital, he instructed a staff member to contact National Security.

Shortly after, the Director of Special Operations at National Security, Mr Jakpa, called the reporters of The Fourth Estate to question their presence at Ridge Hospital. “You want to interview him (Dr Kaba) about what?” he asked. When the reporter declined to disclose details of the interview, Mr Jakpa barked, “He will not do the interview. Go and send an RTI request. Leave the hospital immediately.”

Later, Dr Kaba followed up with a text message, declining a recorded interview and instead requesting that the questions be sent to him so he could provide written responses.

The Fourth Estate inquired why requisitions for tools were written on private pharmacy pads. He answered, “It is normal practice in hospitals for pharmaceutical companies to donate souvenirs in the form of writing pads to hospitals.”

He further added that “typical medications are written on prescription forms, lab investigations are written on lab request forms, and consumables.” Further, he said, “The consumables you referred to as tools are not medication to be prescribed on official prescription forms.”

Dr Kaba said it was normal practice in hospitals for doctors to use writing pads supplied by pharmaceutical companies to take notes or for other purposes without any undue influence.

“Nonetheless, the practice was immediately stopped when the attention of the team was drawn,” he added.

Dr Samuel Kaba said he sent a memo on 15 January 2024, drawing the attention of the management of Ridge Hospital to the challenges associated with the lack of neurosurgical consumables and the need for the hospital to procure and store consumables for future surgeries. He added that his memo was received and approved by the former director of the hospital (Dr Emmanuel Srofenyoh) for patients to buy their consumables until the hospital’s stocks were ready.

Ridge Hospital responds

Responding to questions on whether it was normal practice to issue requests on private pharmacy forms, Medical Director Dr Leslie Adam Zakariah said it is inappropriate. “Normally, we use the hospital-approved prescription. Since I came here, I have never seen any other kind of prescription. All I see are hospital-approved ones. It is not expected of a doctor to use a private pharmacy’s prescription within the facility. It is inappropriate.”

He acknowledged that implants and consumables have become issues, but the former medical director developed an implant policy.

When asked whether Ridge Hospital was short of prescription pads or stationery and hence a justification for doctors using private pads, he answered, “No, no, it’s no excuse. As for that, it’s no excuse at all. And I mean, even if we have run out of prescription forms, you can use a plain sheet. Why should you use a private form? It is like premeditation. If you come to your consulting room with a private form, then it is premeditated. No, that’s inappropriate; you should rather use the Ghana Health Service prescribed prescriptions.”

Axis Pharmacy responds

The Fourth Estate requested an interview with Axis Pharmacy, but a shop attendant said the owner had instructed him not to accept any letter from us. Calls to the phone numbers displayed at the pharmacy eventually reached Mr Kofi Dzifa Semenyo Dzakpata, who confirmed receipt of our letter and explained that the pharmacy would consult its lawyers before responding. Soon after, his lawyer, Papa Coffie Negble, wrote to The Fourth Estate, stating that Axis Pharmacy would only respond in writing, not in a recorded interview.

On the issue of charging Perfect in U.S. dollars, a violation of Ghana’s Foreign Exchange Act, Axis Pharmacy claimed the patient “elected to transact in U.S. dollars rather than Ghana cedis.” Perfect disputes this claim. She shared a signed Axis Pharmacy document showing the cost of surgical items pegged at GHC7,000. When she attempted to pay in cedis, she was told the amount was instead in U.S. dollars.

When asked to provide a breakdown of the consumables that added up to USD 7,000, Axis Pharmacy declined, saying it was under no legal obligation to share transactional documents with The Fourth Estate. Lawyer Negble added that disclosures would only be made to competent state investigative or regulatory bodies if allegations of criminality arose. But Perfect stated in an interview that she was not even allowed to see the items that cost USD 7,000 because the pharmacy said they had to be sterile for surgery.

Axis Pharmacy further claimed it had no contractual ties with Ridge Hospital, insisting patients purchased voluntarily and were not compelled to buy from them. Yet a key question remains: why did some Ridge surgeons write prescriptions on Axis Pharmacy’s specialised forms?

When pressed on why the pharmacy had no licence to import medical equipment and consumables, the lawyer replied that his “client is a retailer, not an importer, and thus does not require an FDA importation licence.”

But this raises an even more troubling question: why are surgeons directing patients to Axis Pharmacy for surgical equipment when the pharmacy itself has no licence to import such supplies?

Another issue that begs for more answers is where Axis Pharmacy sources these items for surgery and whether they are properly regulated for safety.

For Amadu, the fight for his life continues not just against the tumour in his head, but against a system that stripped him of his cows, his savings, and his dignity.

For Adebayo, the fight is already lost. But Perfect, his sister, who returned to Nigeria without his remains, carries not only grief and debt but also a gnawing suspicion that the very hospital meant to save him profited from his death.

Until the Ministry of Health, the Medical and Dental Council, and law enforcement demand answers, the exploitation will continue quietly and cruelly inside the very institutions meant to heal.