On August 10, the website Gorakhpur Newsline reported a possible crisis due to an oxygen supply shortage at Baba Raghav Das Medical College and Hospital at Gorakhpur in Uttar Pradesh. The report said that Pushpa Sales, the company that supplied liquid oxygen to the medical college, had cut off supply because the medical college had not paid its arrears, warning that this could put patients’ lives at risk.

This is precisely what seems to have happened.

A statement released by the hospital on the evening of August 11 said that 30 children died after the liquid oxygen supply was disrupted.

The Gorakhpur Newsline report on August 10 cites two letters showing that the medical college authorities had been aware of a possible oxygen supply shortage since the beginning of August.

On August 1, Pushpa Sales wrote to the principal of BRD Medical College saying that the college owed the company Rs 63.65 lakh, which the medical college had not paid despite repeated requests from the company. In this letter, the company has also warned that oxygen supply could be disrupted if the payment was not made. Despite this warning, the medical college did not make the payment to Pushpa Sales, according to the news report.

On August 10, the central oxygen pipeline operators of BRD Medical College wrote to the principal of the college, the chief medical superintendent and the nodal officer of the National Health Mission reiterating that Pushpa Sales had stopped supplying liquid oxygen citing payment arrears. The letter also pointed out that the medical college had only enough oxygen to last till that night.

These were not the only two letters.

A letter released by news agency ANI said the department handling oxygen supply at BRD Medical College wrote a letter about the impending oxygen shortage to the principal, district medical authorities and National Health Mission officer on August 3 as well.

According to the Gorakhpur Newsline report, Pushpa Sales had set up a liquid oxygen supply plant on at BRD Medical College from which it supplies oxygen to the trauma centre and several wards at the Nehru Hospital affiliated to the college. Three of the wards that get this oxygen supply have patients with encephalitis.

The first and most important question that the Uttar Pradesh government and the medical college need to answer is why, despite several intimations and warnings, did they allow oxygen supply to be disrupted in the second week of August?

Causes of death?

The authorities seem to be avoiding that question by simply saying that the deaths were not caused by the oxygen supply disruption.

On August 11, the website reported that the Gorpakhpur district magistrate attempted to play down the fact that the oxygen supply had failed. He said that none of the 17 newborns, eight children in the general ward and five encephalitis patients had died due to lack of oxygen supply. He said that BRD Medical College is a large hospital where many children are admitted. He also said that 10 children and 10 newborns die everyday on average due to acute encephalitis syndrome. Gorakhpur is located in eastern Uttar Pradesh, a region where encephalitis is endemic.

However, data released by the hospital belies these claims and shows few deaths on account of encephalitis and the most number of deaths in the neonatal ward.

NICU: Neonatal Intensive Care Unit; AES: Acute Encephalitis Syndrome

The number of deaths spiked on August 10 – the day the oxygen supply failed. Gorakhpur Newsline also reported the average number of deaths in the neonatal ward is no more than five per day. Accounting for all causes, the number of deaths in the children’s ward does not normally exceed 15.

All this data raises the the question of what was responsible for the death of 23 children, including 17 newborns, in a single day.

If the hospital and the Uttar Pradesh government continue to claim that that the oxygen supply disruption did not lead to the deaths, and the hospital routinely sees such a high number of deaths in a day, then they must release data of fatalities at the hospital for previous months and years, and not just for five days prior to August 11.

The hospital will also need to account for the deaths by releasing detailed medical records of the victims and whether postmortems were conducted to determine the exact causes of death.

The Gorakhpur Newsline also reported that 18 adults have died and their deaths were not mentioned in the hospital’s statement. In ward number 14, which comes under the medicine department, eight people died on August 10 and 10 people died on August 11, according to the news report.

Scroll.in has not been able to independently confirm these deaths. It remains unclear what caused these deaths and whether they were related to the oxygen supply disruption – one more thing that the medical college and the state government need to explain.

Delayed payments?

The oxygen supply disruption seems to have been caused due to the non-payment of Rs 63 lakh to the company Pushpa Sales. The company spokesperson told ANI that the deaths have not occurred due to oxygen supply failure and that the company knows the consequences of stopping oxygen supply to a hospital. However, the spokesperson reiterated that the company had repeatedly written to the medical college about pending payments but never got a response.

The lack of payment by BRD Medical College does not seem to be restricted to the oxygen supply company. The salaries of at least 400 medical personnel who are involved in the treatment of encephalitis at the medical college have not been paid for many months, the Gorakhpur Newsline reported. Doctors at the physical and medicine and rehabilitation unit have not been paid for 27 months and neonatal unit staff have not received their salaries in six months, it said.

The reason for the lack of payments is unclear. In 2014, the BRD Medical College received Rs 150 crore – Rs 120 crore from the Centre and Rs 30 crore from the state government – under a scheme to upgrade medical college institutions under the Pradhan Mantri Swasthya Suraksha Yojana.

In October 2016, The Times of India reported that BRD Medical College was among several hospitals in the state that had not fully utilised funds allotted to them under the state government’s Asadhya Rog scheme. BRD Medical College had used just Rs 15.56 lakh of the Rs 4.5 crore that was allocated to it three years earlier in 2013.

On the other hand, the Hindustan Times reported that in May 2017 the college administration asked for Rs 37 crore to improve facilities, including maintenance of wards and the intensive care unit, procuring medicines and ventilators and maintaining its laboratories. The state government forwarded the request to the central government and an official told the newspaper that they were still waiting for the funds to be released.

Whether it is a lack of funds or simply under-ultilisation of existing funds, the government must answer why an important hospital serving the whole of eastern Uttar Pradesh and parts of neighbouring Bihar could not pay an oxygen supply company on time.