Gorakhpur hospital deaths: Doctor explains why oxygen payments were delayed

A day after Uttar Pradesh government held him responsible for the delay in payment to the oxygen supply company, the former principal of Baba Raghav Das Medical College and Hospital in Gorakhpur on Sunday blamed the delay on bureaucratic procedures and the Chief Minister’s visit.

Thirty children died in 48 hours after liquid oxygen supply to the pediatric intensive care unit and the neonatal wards ran out on the evening of August 10. Pushpa Sales, the company contracted to supply liquid oxygen, had cut off the supply after repeatedly reminders to the state-run hospital that its dues of approximately Rs 65 lakhs needed to be paid.

The state government has strenuously denied that the deaths were caused by shortage of oxygen, even though parents of the children who died say they were asked by doctors to manually pump oxygen for several hours.

Dr Rajeev Mishra, the principal of the college, took responsibility for the deaths and resigned on August 12. The state government claimed he had been suspended. The state minister for medical education, Ashutosh Tandon, said the government had released funds for the oxygen supply company on August 5, and blamed the principal for not making payments in time.

Speaking to Scroll.in on Sunday, Mishra defended himself. “The cut in supply of oxygen is not my fault,” he said.

How delays mounted

Mishra claimed that he had written at least three or four letters to the state medical education department in July, asking for the release of about Rs 2 crore allocated to the college in the state budget. The funds were released on August 5. “But, you must understand, August 5 was a Saturday,” he said. “The dispatch from the state reached us only on August 7.”

The process of paying a bill involves clearance from the treasury department, said Mishra. The college sends a bill voucher to the treasury, which is verified by officials, who send back a token. The college sent the voucher on August 7. “On August 8, the token from the treasury was released,” he said.

But, on August 9, Chief Minister Adityanath came on a visit to the hospital, which kept the hospital administration busy, claimed the former principal. It was only on August 10 that that the hospital could send the token to the bank for the transfer of Rs 52 lakh to Pushpa Sales’ account. “We do not do a direct bank transfer via RTGS [real time gross settlement],” said Mishra. He explained that because Pushpa Sales and the hospital have accounts in different banks, the inter-bank transfer took a day.

Mishra left for Rishikesh on the night of August 9 as a member of a technical committee overseeing the establishment of a laboratory. In the afternoon of August 10, he got a call from Pushpa Sales that the next truck with the liquid oxygen would not be sent.

“He [the owner of Pushpa Sales] has been sending letters threatening to cut the oxygen supply so many times,” said Mishra. “Payments have been delayed, but we have always paid him. I explained to him that it was the bank’s delay and that he would get his payment.”

Mishra said the hospital did not expect the company to cut off supplies.

Defending the company’s decision to stop supplies, Manish Bhandari from Pushpa Sales said that as per the agreement with the state, his dues should never be more than Rs 10 lakhs. “How is the principal able to justify this delay?” he asked. Bhandari said he did not want to speak further on the subject. “I have all the documents to make my case,” he said.

Mishra expressed helplessness. “There is always delay in the payment when you deal with the government,” he said. “That is a fact. It is because of the [delayed] budget allocation.”

The medical college budget is transferred in installments, he said. The first installment arrived in May, when they paid Rs 32 lakhs to Pushpa Sales. The college and the hospital, he claimed, has no emergency funds to tide over any crisis. In fact, for nearly four months, the employees had not been paid their salaries.

Why did he not inform the chief minister about the money crunch? “We would have told the chief minister if the budget was not cleared,” said Mishra.

Disruption in the wards

The money was transferred on August 11. By then, several wards of the hospital had spent the night struggling to ensure oxygen supply to patients, including newborn babies in the neonatal Intensive Care Unit. A statement released by the hospital said after the supply ran out at 7.30 pm on August 10, 52 reserve cylinders were pressed into service.

The state health minister Siddharth Nath Singh admitted that between 11.30 pm and 1.30 am, there were not enough cylinders in the children’s wards. But he said very few children had died in those intervening hours. Listing the causes for all the deaths, he claimed that 23 deaths of children in a single day were normal for the 950-bed hospital. But hospital administrators elsewhere in India say regardless of whether a disruption in oxygen supply caused the deaths, the fact that such a large hospital was negligent in maintaining its oxygen supply was a matter of serious concern.

It finally took the hospital more than 72 hours to restore the liquid oxygen supply. The trucks carrying liquid oxygen arrived in the early hours of Sunday morning, refilling the tank. In the hospital’s oxygen supply department, the dial marks began to indicate oxygen was available, and wards began to switch from cylinders back to piped oxygen.

Each time a truck comes with approximately 6,000 litres of liquid oxygen, which lasts about six days, said an operator in the oxygen supply department. When the reading is shows approximately 4,000 litres, the next truck is ordered. The truck takes about two days to come.

The last truck had come sometime last week, after Pushpa Sales wrote a letter threatening to cut off supply, said Mishra. He could not recollect the exact date. Until a few years ago, he said, the hospital used to pay Pushpa Sales each time the truck arrived. The payment for one truck was approximately Rs 12 lakhs to Rs 16 lakhs, he added.