Bhubaneswar fire underscores how Indian hospitals fail to take even basic safety precautions

Kalyani Patra was a critical patient with kidney disease at the Institute of Medical Sciences and SUM Hospital in Bhubaneswar. On Monday evening, when a fire broke out at the hospital, Patra was one of 20 patients who died. "We were not informed when the fire broke out," said Kumar Patra, her brother who was at the hospital. "We saw the smoke but the hospital staff kept us in dark. After sometime they started process to shift to the patients of the ICU. There were not sufficient ambulances available in the hospital. There was a huge crowd. My sister was shifted to the AMRI hospital and declared dead."

Since the fire, as many as 106 injured have been shifted to government and private hospitals around Bhubaneswar.

The fire seems to have started because of an electric short circuit in the dialysis ward, said Binoy Behera, the director general of police in charge of fire services. The flames were so intense and the smoke so thick that firefighters reported difficulty in navigating hospital stairs. Said a fire service officer: "We had to carefully drop the patients by tying them with clothes."

The fire reportedly was first spotted in the Intensive Care Unit of the medicine ward and the dialysis ward next to it. "We ran to the hospital and found there were 11 patients in the ICU and 9 were in the dialysis room," said Madhabananda Sahu from Sham Pur village close to the hospital, who darted to the scene along with his neighbours when they saw smoke from the hospital building. “We tried to rescue them on priority basis with the help of the hospital staff so we broke the glasses and get them out. But there was no sufficient ambulance to take them to the other hospitals. There was a total chaos.”

Debendra Pal, an attendant of an orthopaedic patient at the hospital, recounted his experience trying to leave the hospital premises after the fire broke out "We tried to come out of the hospital but found that all the gates were closed," he said. Pal and a few other attendants of patients managed to break the gate and move patients out through a rear entry of the hospital.

Television journalist Jajati Mohanty who was reporting from scene said that ICU patients on life support were moved out of the hospital in a hurry and that proved fatal for some of them. The hospital staff and management did not seem to be prepared for such kind of incident nor did they have fire safety training, the journalist said.

In 2011, a fire at the private AMRI hospital in Kolkata killed in which 89 people. That fire allegedly began in the basement where highly inflammable material was stored. The directors of the hospital were booked for culpable homicide not amounting to murder. The trial is still underway.

Like in the Kolkata fire, most of the victims in Bhubaneswar on Monday died of smoke inhalation.

Fire safety only on paper

Fire safety qualifies as a municipal function but in some states like West Bengal, state governments have taken over responsibility for it.

"All the fire norms and guidelines have been made," said Om Parkash, a retired fire advisor with this department of civil defence, referring to the National Building Code of India drafted in 2005, which sets the minimum standards of fire safety in a building.

But, these norms are taken very lightly in India, he said. In other countries, "systems are all maintained well", he said. "People can fail in maintaining systems, but the system does not fail them."

A safe hospital, as simply defined by the World Health Organisation, is one that will not collapse in disasters, killing patients and staff, and can continue to function and provide its services as a critical community facility.

Many hospitals in India, both private and public, would fail on these counts.

After the AMRI tragedy, the Mumbai municipal corporation conducted a survey checking for fire safety of public and private hospitals in Mumbai and issued notices to 56 hospitals. Many did not have adequate fire-fighting systems. Some hospitals did not maintain basements for approved purpose approved but instead had turned them into storage facilities for inflammable materials. In many hospitals, staircases to be used for fire rescue were blocked and necessary open spaces were used for parking, an Indian Express report said.

"Some of the Delhi public hospitals are downright dangerous," said Parkash.

Hospital disasters in India

• In 1988, the Children's Hospital of the Jammu Medical College collapses allegedly due to substandard materials used in the construction killing 20 children.
• In 2001 Gujarat earthquake, a civil hospital had collapsed at Bhuj.
• In 2011, Kolkatta's AMRI Hospital had a major fire that killed 89 people.
• In 2015, 18 patients died in the Intensive Care Unit of Chennai's Madras Institute of Orthopaedics and Traumatology after a power failure during the Chennai floods that year.

Greater responsibility for safety

While all hospitals need to be safe, public health experts observe that private hospitals, which are scarcely monitored, could flout more regulations than public hospitals.

"Public institutions are in older buildings that have more space but private institutions are like matchbox buildings," said Amit Sengupta of Jan Swasthya Abhiyan, a network of institutions working for better public health. "There is a broader context of private institutions and the way they are able to flout regulations of all kinds, safety is only one aspect. Today it is the issue of safety that we are discussing but it is also the kind of facilities in private hospitals that is an issue."

In an editorial in the Indian Journal of Medical Ethics in 2012 about the Kolkata hospital disaster, Dr Sanjay Nagral points out that India as a nation has the distinction of having a "certain indifference to safety" in every sphere of life. For instance, India recorded 1.4 lakh road accidents fatality in 2015.

In the editorial Nagral writes:

It should be a given that since the core function of hospitals is to look after the sick and, in a sense, vulnerable population, those who run them need to have a heightened sensitivity to safety. Whether it is the food served, the ventilation, or the hygiene, hospitals need to ensure that these don't aggravate already existing illness and disease amongst its occupants. So, though it is important for all modern buildings and public places to have mechanisms for fire safety, for a hospital to ignore and flout them is particularly disturbing and deplorable.

"A disaster is even more dangerous in a hospital," said Parkash. "A healthy man will get scared of the fire, what will a sick person do. You have to evacuate them."

More checks before fire, not after

In February 2016, the National Disaster Management Authority issued guidelines in relation to hospital safety, which speaks of inadequate compliance or complete non-compliance of hospitals to building codes and other safety norms, the absence of a hospital disaster management plan, and lack of planning and preparedness to respond to disasters, inadequate or complete lack of internal and external communication. The guidelines emphasise the need for hospitals to create systems by improving staff capacity, and by improving structural requirements for safety to preparedness for a disaster.

"We should authorise fire officers to inspect buildings every three months and certify them safe," said Parkash. He added that the fire department needs to employ more retired officers, or have additional staff to look into this.

But the laws need to have teeth for it to be effective. "We need to be able to take stringent action before a fire breaks out, and not after the fire," said Parkash.

With inputs from Scroll.in contributor Sarada Lahangir.