An FIR has been registered against nine people, including sacked principal of Baba Raghav Das (BRD) Medical College, in connection with the deaths of over 70 children, due to alleged lack of oxygen supply, the police said today.
The BRD Medical College is a major centre for treating encephalitis. Patients from several neighbouring districts, as well as Bihar and Nepal, come to the hospital. According to a 2017 estimate, it treats over 60% of the encephalitis cases in India, and receives 2500-3000 encephalitis patients every year. Most of the encephalitis cases arrive during August-October, when the number of patients in the hospital ranges from 400-700
A majority of the children who died between August 7 to the noon of August 11, had been struck by Japanese encephalitis, a mosquito-borne, potentially fatal viral brain infection that periodically ravages the Indian state of Uttar Pradesh.
But the immediate reason for at least half the deaths appeared to be the cessation of piped oxygen into the intensive care ward. Japanese encephalitis has no known cure, and as it progresses, patients require oxygen to survive.
Japanese encephalitis is a viral disease that is transmitted by the infective bite of the Culex species of mosquitoes. The infection can lead to high fever, headache, stiffness in muscles, seizures, coma, and in worst cases, death. It primarily affects children because of their weaker immune systems.
According to Balwant Gupta, the man in-charge of oxygen supplies at BRD on the fateful night on August 10 and 11, he said, “We had 52 oxygen cylinders. When piped air supplies dropped at 7.30 pm, some other staff replaced them with back-up cylinders. “When I took over (the shift), the entire stock was exhausted by 11.30 pm.”
Gupta informed all the staff on duty that the hospital would run out of all oxygen cylinders in a couple of hours. They were told to prepare self-inflating bags for emergency. (Self-inflating bag is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately).
But no one shared information about the crisis with the parents. “I don’t know what would have happened, if I had disclosed this to the patients (attendants/parents),” he admitted. Anxious parents, Gupta said, pumped air from the hand-operated device for the next two hours till a new lot of oxygen cylinders arrived.
“The vehicle carrying the oxygen cylinders was running late. It came in at 1.22 am (August 11) and the supply of oxygen resumed at 1.30 am,” he recounted.
The parents had little clue about the imminent disaster when nurses unhooked the ventilators and handed manual air bags to the parents to pump oxygen into their children.
Despite 11 reminders over six months, the Uttar Pradesh government did not pay the company that supplied oxygen to the Baba Raghav Das Medical College hospital. The company acknowledged it had threatened to stop supplies but denied it had actually done so.
However the company responsible for the supply of liquid oxygen, M/s Pushpa Sales, has also been named in the FIR, while the state government has transferred Additional Chief Secretary, Medical Education Anita Bhatnagar Jain, an official spokesperson said.
Earlier on Wednesday, Uttar Pradesh Chief Minister Yogi Adityanath had ordered for a strict action against the hospital staff and Pushpa Sales Pvt. Ltd., the firm that had allegedly cut off oxygen supply over non-payment of dues, after he was briefed about the Gorakhpur tragedy by a committee that he formed for looking into the matter.
The report of the Chief Secretary’s Committee, including Ashok Kumar – Secretary of Health and welfare, Mukesh Mittal – Joint Secretary, and Dr. Hem Chandra, the Medical Superintendent.was presented to Adityanath, and catered towards suggestions and improvements for the better working conditions in hospitals in Gorakhpur and other districts.
It further said that the committee has recommended registration of criminal cases against former principal of BRD Medical College, Dr. Rajeev Mishra; Dr. Satish, in-charge of oxygen supply and head of anesthesia department; Dr. Khan, in-charge of the 100-bed Acute Encephalitis Syndrome (AES) ward; and Pushpa Sales.
In its report, the committee has also recommended a special audit by the CAG in supply of medicines and chemicals in the medical college for last three years. It has recommended action under the Prevention of Corruption Act against Dr. Mishra, his wife Dr. Purnima Shukla, and Gajanan Jaiswal, the medical college’s chief pharmacist.
Adityanath had also ordered a disciplinary action against Dr. Mishra, Dr. Satish, Dr. Khan, Gajanan and an accountant for dereliction in duty and behaviour against rules laid down for the staff.
According to the government, directions have also been issued to register another case of criminal investigation against Dr. Khan for allegedly hiding facts in the affidavit he submitted to the Chief Medical Officer of Gorakhpur, and for working in violation of rules of the Indian Medical Council.
Scientists during their extensive research have found that 28 degrees Celsius temperature with 50-55% relative humidity is the most appropriate condition for increase in mosquito density.
Gorakhpur has a climate that makes it vulnerable to Vector-borne diseases like Japanese encephalitis. The temperatures in Gorakhpur range from 8.9 degrees Celsius to 38.3 degrees Celsius. The district receives rainfall between June and August with an average of 52.2 days in a year.
Vector-borne diseases are determined by a set of complex interrelated social, economic, and environmental factors. This means that health cannot be left to the health sector alone: it requires intersectoral coordination, cooperation and action. Traditionally, much of the government works in silos.
Intersectoral action for health would require government departments to work with each other horizontally (inter-ministry cooperation) as well as vertically (at national, regional and local levels). Without intersectoral action, health outcomes will remain underachieved.
Addressing basic issues like agro-climatic concerns, husbandry practices, urban development and public health issues and organizing adequate intersectoral coordination should be the steps to be taken going forward.