Mumbai: In the first 12 days of this month, 417 Covid-19 patients died at the premier state-run Goa Medical College and Hospital (GMCH), several of them due to a lack of oxygen. Many of the deaths occurred in the early hours of the morning, after 1 am.
The Goa Association of Resident Doctors had on 1 May written to the GMCH dean about issues with the supply of oxygen to Covid-19 wards in the hospital.
“Oxygen cylinders being used for patients get over in the middle of the night and it takes 2-3 hours for replacement cylinders to come,” the letter said. “Patients are kept without oxygen with saturations dropping to less than 60 per cent.”
In this week alone, there have been about 62 deaths between Monday and Thursday, suspected to have been due to issues with oxygen supply. On the intervening night of Thursday and Friday, there were reports of 13 more Covid deaths in the hospital due to fluctuations in oxygen supply. The state government is, however, yet to confirm this figure.
Lawyers, activists and doctors ThePrint spoke to said there have been more of such incidents.
“We have lost colleagues, a lot of them have suffered losses of their family members. All this has been due to mismanagement by the government and the lack of oxygen,” Antonio Clovis Da Costa, president of the South Goa Advocates Association, told ThePrint. “We will be asking for an audit of all the deaths. Someone needs to be held accountable.”
The association is one of the petitioners in a case that the Goa bench of the Bombay High Court is hearing about the state government’s alleged mismanagement of health infrastructure amid the Covid pandemic.
Nowhere is it more evident than at the GMCH in Bambolim.
Behind the shocking numbers is the tragic story of a hospital stretched beyond its capacity; basic logistical issues such as lack of drivers to supply oxygen trolleys; inconsistent responses by different factions of the ruling Bharatiya Janata Party (BJP) government in Goa; and an overburdened oxygen manufacturer struggling to keep up with the demand.
CM says no shortage, health minister says CM ‘misinformed’
The GMCH has a capacity of 708, but has currently admitted 953 patients. Of the 708 beds, 160 are in the ICU unit. Patients without beds, however, have been accommodated on trolleys and on the floor, and have to be administered oxygen through loose cylinders.
There have, however, been disruptions in oxygen supply, with different arms of the state government — the dean of the hospital Dr S.M. Bandekar, the state health department and the Chief Minister’s Office — inconsistent in their responses to explain the discrepancies.
Chief Minister Pramod Sawant has maintained that there is no shortage of oxygen, and that the crisis is due to the “mismanagement” in getting the oxygen to the hospital. State Health Minister Vishwajit Rane, who has been at loggerheads with the CM in the management of the pandemic, called Sawant “misinformed.”
The state health department, in its affidavit to the Bombay High Court, maintained that the government is meeting Goa’s oxygen requirements but Dr Bandekar’s affidavit, a copy of which is with ThePrint, painted a more dire picture. It said there was a deficit of 6.5 metric tonnes (MT) of oxygen as of 11 May when 330 of the 953 patients admitted to the hospital were on oxygen supply.
On Thursday, Dr Bandekar told the Bombay High Court the hospital realistically needs at least 72 trolleys of oxygen if patients have to be effectively treated. Currently, the supply of trolleys is in the 50s.
ThePrint reached State Health Minister Vishwajit Rane, Dr Bandekar and Health Secretary Ravi Dhawan via phone calls but did receive a response till the time of publishing this report.
The midnight hours at GMCH
Every night, social media and volunteer WhatsApp groups in Goa are flooded with desperate messages from relatives of patients at the GMCH about dropping oxygen levels.
The hospital relies on oxygen trolleys, which have to be transported by tractors from the manufacturer, Scoop Industries’ production plant at Corlim, about 15 km away. These are then loaded on the hospital’s manifold.
The process of loading the oxygen cylinders usually causes fluctuations in oxygen supply for a short span of about 15 minutes, multiple sources involved in the process told ThePrint.
Amit Palekar, an advocate who is among the petitioners in the Bombay High Court and a member of several volunteer groups helping amid the pandemic, said, “There is a transition while shifting from one trolley to another during which there are fluctuations in oxygen supply. The doctors are not informed about it, so they are unprepared. At night, the oxygen saturation levels of patients are anyway lower, so even a drop for a short period leaves critical patients breathless. There is panic and anxiety.”
The loading and unloading of trolleys on the manifold happens during the day as well, but doctors say it might not impact the patient during the day as much as it does at night.
A senior pulmonologist in South Goa, who did not wish to be named, said, “Generally too, if a patient needs a litre of oxygen during the day, doctors will budget for 1.5 litres at night.”
“When you are awake and the oxygen level drops, the body responds by extending the respiratory range,” he added. “But, while sleeping, the demand for oxygen goes up, and if there is any fluctuation, the chemoreceptors in the body, including the brain, do not respond as quickly.”
This problem is compounded by logistical issues in the supply of these oxygen trolleys.
Dr Bandekar’s affidavit to the Bombay High Court dated 12 May reads, “…At times, there has been a problem with the supply of these trolleys and loose cylinders as a result of which there have been instances of a drop in supply of oxygen to the patients, which has resulted in casualties.”
The state government has cited the lack of tractor drivers as a reason for the fatal blip in oxygen supply.
On Thursday, after 15 patients died late Wednesday night, the state government told the Bombay High Court there was an issue with the movement of tractors to bring the trolleys to the hospital.
In its order Thursday, the court said, “… we were explained that there were logistical issues involved in manoeuvring the tractor that carries the trolleys of oxygen and in connecting the cylinders to the manifold. We were explained that during this process there was some interruption, which resulted in a fall of pressure in the supply lines of oxygen to the patients.”
Govt’s responsibility to transport oxygen: Manufacturer
Vivek Rodrigues, the advocate for Scoop Industries, told ThePrint that the company’s responsibility ends at production, and the accountability for transporting the oxygen to the hospital lies fully with the state government.
He cited a letter dated 20 April sent by Dr Bandekar to the North Goa collector, which says the hospital is deputing officials at the Corlim premises of Scoop Industries to monitor the oxygen trolleys “so that there is no delay in supply of oxygen, which can cause threat to the life of patients”. ThePrint has a copy of the letter.
“Our job ends at production. From the Scoop Industries premises to GMCH, the oxygen tanks are followed by two police cars so that they can reach without any obstruction,” Rodrigues said. “The entire supply has been completely taken over by the government. The onus of getting drivers and all logistical issues lies with the government.”
He added that according to its contractual obligations, the company has to supply just four oxygen trolleys but is currently supplying 57. “The company has borne the cost of manufacturing the additional trolleys,” he said. “The quota from the Centre of 10-11 metric tonnes also comes to us, we pay for it, and distribute it to all hospitals along with the 30 metric tonnes that we produce.”
Rodrigues further claimed that while private hospitals are prompt with the payment, the state government owes the company dues of Rs 3.75 crore, accumulated over the past two months.
State scrambling to take measures
Following stringent criticism from the Goa bench of the Bombay High Court, the opposition, activists and volunteer groups, the BJP government in Goa is now scrambling to take measures that can reduce the crisis at GMCH.
The load on beds eased slightly after the state government on 5 May commissioned the GMCH’s new super speciality block, initially with 150 oxygen beds to be eventually scaled up to over 500.
The Super Speciality Block at Goa Medical College is being commissioned today. The facility has been equipped with an oxygen tank of 20,000 litres. 150 oxygen beds will be utilized initially for #COVID19 patients and the same shall be scaled up as per the requirement. pic.twitter.com/HtwvrBFjBd
— Dr. Pramod Sawant (@DrPramodPSawant) May 5, 2021
The Centre Thursday also decided to increase oxygen supply to Goa by another 20 MT to 46 MT. Earlier, the government had raised Goa’s oxygen allocation to 26 MT from about 11 MT last week.
The state government has also set up a three-member committee under IIT-Goa Director B.K. Mishra to probe oxygen supply issues at GMCH. It has also started construction of a medical oxygen tank with a capacity of 20,000 litres at the hospital to reduce its dependence on the trolley system.
(Edited by Arun Prashanth)