- Goemakrponn stands VINDICATED; Health Minister Vishwajit Rane’s move to give Oxygen Supply to just one contractor resulted in thousands of Goans losing life due to Oxygen shortage
Goemakrponn desk
PANAJI: In a shocking revelation, which vindicated Goemakrponn expose that the M/s Scoop Industries Ltd was unable to handle the surge in demand for Oxygen supply in Goa Medical College and Hospital, led to thousands of innocent losing their lives.
The government-appointed three-member Committee to look into the Oxygen shortage, headed by Director IIT Dr BK Mishra, former GMC Dean Dr VN Jindal and Secretary Urban Development Tariq Thomas, submitted its 35-page report to the government.
The Committee said that in June 2018, the decision of the Public Health department to extend the scope of work awarded to M/s Scoop to all across the State of Goa resulted in the creation of a single supplier for all the public health institutions.
“After this extension, the health institutions had no alternative source of oxygen in case of emergency. As GMC’s oxygen demand rose, M/s Scoop stopped supplying oxygen to the other public hospitals, except GMC, without any warning, letter or message,” the report says.
It said that even in June 2020, GMC tried to put the archaic trolley based system in the newly built Super Specialty Block where the LMO tank was already installed.
“However, even in this tender, only M/s Scoop was technically qualified, and other bidders were disqualified. Fortunately, now the tender has been cancelled,” it says.
The REPORT on Oxygen Shortage
On the shortage of oxygen, the first alarm was raised by the Goa Association of Resident Doctors on 1st May. Even after this, GMC did not raise any alarm bells or send any letter or communication on the shortage of oxygen.
The Committee was told that GMC took no action on the MoHFW guidelines on rational use of oxygen, except appointing a Nodal officer. Notably, during the same period of time, GMC’s doctors and healthcare workers were dealing with an overwhelming number of patients, at the peak of the 2nd wave of Covid in Goa.
5In any case, GMC did not have a readily available real-time database that has segregation of the number of patients on different kinds of oxygen therapy; therefore, any precise estimation was impossible. The number of patients itself was fluctuating (or increasing drastically at one stage). Officially, there was no shortage of oxygen虏1, as shown by the lack of any official communication.
Instead, as revealed from the official communications, GMC thought that the alleged lack of oxygen supply was due to improper pipelines (manifold and delivery systems) and not the lack of sufficient oxygen in the pipeline. GMC wrote to GSIDC (the agency that set up the oxygen manifold) to check the pipelines rather than writing to the oxygen supplier to increase the delivery of oxygen.
An online calculator of Cornell University was used to assess the adequacy of the supplied oxygen (assumed pressure 2200 PSI: http://www-users.med.cornell.edu/-spon/picu/calc/o2tankd.htm). However, the data was not sufficient to make a proper assessment.
The Goa Association of Resident Doctors first highlighted the issue of shortage of oxygen.
GMC did not have any specific person dealing with oxygen supply, except the account branch that passes supplier’s bills.
As per supply order, the maintenance of manifolds too was the responsibility of the supplier. GMC was just hopeful of getting sufficient oxygen from the supplier. However, the oxygen demand was limited with the supply of oxygen by M/s Scoop Industries Pvt Ltd. Therefore, the Committee went to his plant to understand its capacity.
Irrespective of the supply of oxygen or lack of it, the Committee did feel that the number of Covid patients at GMC were much beyond the infrastructure planned for or could handle.
Therefore, the families of the deceased might have been aggrieved for lack of proper care, insufficient attention, or absence of beds or lack of other health infrastructure at GMC. Yet, GMC remained the best bet for people in need of special care. Even private hospitals referred the patients to GMC once their situation deteriorated.
Conclusions
GMC and other public authorities performed at their highest capacity with dedication and sincerity. M/s Scoop and other oxygen suppliers too rose to the challenge and supplied a far higher number of oxygen trolleys, as compared to their contractual obligations. However, the following are the observation of the Committee:
- GMC did not timely raise any issue of lack of oxygen or sought augmentation of the oxygen, except putting their demand in an affidavit before the High Court. GMC did not take much action on the letter written by the Goa Association of Resident Doctors dated 1st May 2021. A prompt action on this letter would have enabled better management of the situation.
- GMC did not undertake any assessment of rational use of oxygen except appointing a Nodal officer, as suggested by the Government of India.
- In June 2018, the decision of the Public Health department to extend the scope of work awarded to M/s Scoop to all across the State of Goa resulted in the creation of a single supplier for all the public health institutions.
- After this extension, the health institutions had no alternative source of oxygen, in case of emergency.
- As GMC’s oxygen demand rose, M/s Scoop stopped supplying oxygen to the other public hospitals, except GMC, without any warning, letter or message.
- Even in June 2020, GMC tried to put the archaic trolley based system in the newly built Super Specialty Block where the LMO tank was already installed.
- However, even in this tender, only M/s Scoop was technically qualified, and other bidders were disqualified. Fortunately, now the tender has been cancelled.
- GMC and its oxygen supplier did enhance their capacity to deal with this unprecedented crisis. However, the Committee feels that the crisis was much beyond the capacity of GMC. Still, GMC and its oxygen supplier, instead of seeking help, tried to handle the issue itself to the best of their capabilities and limitations. Seeking timely assistance would have helped GMC.
- GMC assessed its requirement to be about 1500 trolleys/year in its June 2018 oxygen supply order. However, the data shows that GMC’s monthly consumption, before Covid, was about 240 trolleys per month and 2890 trolleys per year
Recommendations:
The Committee suggested the following actions to improve the oxygen supply in the State:
- Setting up LMO generating plants in the State is not recommended because of its prohibitive cost and due to the meagre demand.
- The Committee believes that installing LMO tanks is more advisable for the major health institutions to allow holding oxygen stock for multiple days. The Administration has already set up five new PSA plants and two LMO tanks in different public hospitals in the last few weeks. A large tank is now being installed at the Old Block, GMC.
- GMC should make use of biomedical engineers or suitable experts for managing the 24X7 availability of oxygen and other gases, as required. For getting a suitable expert, GMC can also tie up with any engineering education institutions established in Goa. This expert should properly examine, monitor and ensure serviceability of the equipment/devices and other engineering services and recommend regular updating of technology as and when required.
- The current system of projecting a consumption trend as the future demand will be of little use. Implementation of HMIS is an urgent requirement for any serious demand projection, not only for oxygen but also for medicines and other medical supplies.
- At high-demand times, the trolley system based supply might have failed to supply adequate oxygen, especially at the tail end of the supply chain, even if it did not cause any death.
- The Committee is of the view that the oxygen distribution system at GMC needs to be studied by experts from the Fluid Dynamics perspective with relevant instruments. Anecdotal evidence for the low-pressure siren mostly came from the 4th Floor of the New Block. The 4th floor houses the most critical patients and lies at the tail end of the supply chain. GMC is already planning an upgrade of its manifold system. This planned overhauling of the pipelines should be completed at the earliest.
- The Committee concludes that sufficient oxygen supply has been available in GMC since the installation of LMO tanks. Prior to installation of the LMO tank, the Committee observed that during the peak demand, three trolleys were required to remain connected at the manifold.
- Incidents of pressure drops were quite likely to occur during the changeover of empty trolleys, especially due to the late arrival of the next trolley. Any drop in pressure activates an alarm in the wards.
- The Committee concludes that such incidents did occur and caused panic amongst patients and healthcare workers. However, the Committee could not conclude that such intermittent incidents of drop in pressure were long enough to cause loss of life.
- The Committee also wants to highlight the notable efforts of the Administration, which independently identified a not-in-use cryogenic gas storage tank (due to some contractual issues between two private parties) that can be used for storing liquid medical oxygen, in early May. After an analysis, on 08th May 2021, SEC approved the proposal for shifting and installation of this tank as a LMO tank at the New Block, GMC.
- All public authorities contributed in ensuring that the tank was installed and made functional within the next seven days, and that involves getting the tank transferred in the name of the Government of Goa, obtaining licenses and permissions, getting the site ready (including 7 days of curing of concrete foundation), and signing an agreement with the main LMO supplier. The Committee profoundly appreciates this timely intervention in providing an alternative source of oxygen supply.