THAT a severe shortage of oxygen exacerbated the Covid crisis in the second wave and contributed to mortality is beyond doubt. But lack of a definition of an oxygen-shortage death, no classification of Covid casualties as such as per established protocol and hospitals wary of linking death with oxygen supply given the many variables in mortality are behind the fact that zero deaths were officially attributed to the lack of oxygen.Delhis Deputy Chief Minister Manish Sisodia Wednesday sought to lay the blame squarely on the Centre, saying that the Delhi government has no records of such deaths because the Centre did not allow it to form a committee to look into claims by patients families and doctors.His response came a day after the Union Minister of State for Health and Family Welfare, Bharati Pravin Pawar, told Rajya Sabha: Detailed guidelines for reporting of deaths have been issued by the Union Health Ministry to all states/UTs.
Accordingly, all states/UTs report cases and deaths to the Union Health Ministry on a regular basis. However, no death due to lack of oxygen has been specifically reported by the states/UTs.There were at least two major cases of oxygen shortage in prominent Delhi hospitals contributing to deaths there at Jaipur Golden Hospital where 21 people died on April 23 and at Batra Hospital, where 12 people died on May 1.The findings of a four-member committee, formed to look into the Jaipur Golden deaths, underline the challenges in categorising a casualty as an oxygen death. The committee concluded that since hospital records do not indicate any shortage of oxygen, it could not be ascertained as the cause of death.
Not in a single document that was furnished, nor in the patients case records, did the hospital say that there was a lack of oxygen. For anyone to say that a person died because of lack of oxygen, a few basic conditions must be fulfilled. First, there have to be signs of hypoxia and the oxygen monitors that measure oxygen saturation must show a dip. Along with this, there has to be documented evidence that the hospital was running short of oxygen. This can be done through documents made available by the hospital.
In the case of Jaipur Golden Hospital, this was absent, said a source.This contradicts what Dr D K Baluja, the hospitals medical superintendent, had told The Indian Express soon after the deaths came to light: The Delhi government had written to us saying they will provide 3.6 metric tonnes of oxygen. Though we required more, we agreed to work with this.
Last night, the tanker didnt arrive. We made several calls to authorities and suppliers. Our stocks depleted. After a delay of seven hours, we got 1,000 litres of oxygen. But by then, patients in critical care were affected. This happened after midnight. Some deaths werent because of oxygen shortage but other complications too.
Dr Baluja had also said oxygen pressure was definitely low. A normal patient would have coped but not those with high requirements, he had said.Dr Baluja did not respond to calls and texts Wednesday.The Indian Express also spoke to Dr SCL Gupta, medical director of Batra Hospital, Wednesday. He said he stands by his May 1 statement that 12 people died due to a lack of oxygen at the hospital.The question in response to which the Central Government had made the statement (in Rajya Sabha) was how many deaths have specifically been reported to be due to lack of oxygen and the answer reflects a problem in the system.
We send daily reports about deaths in the hospital to the state government, but this information is only given under the category Covid deaths. This specific point about oxygen death is not part of the information being recorded, he said.Asked if death by lack of oxygen is recorded in the patients medical report, he said, That is not how it is done, the medical report will not mention that. It will only be mentioned that the cause of death is, for instance, due to cardiac arrest.
However, it will be documented with the individual consultants under whose care the death took place.Dr Sumit Ray, medical superintendent at Holy Family Hospital, which was on the frontlines of the capitals Covid fight, also said that concluding that lack of oxygen is the cause of death is difficult. It is difficult to ascertain this through an autopsy. To differentiate between whether a person has died due to a dip in oxygen saturation related to disease versus not being supplied oxygen would be tough. The only way is to see whether there was a shortfall in the hospitals oxygen supply. One has to see whether the oxygen levels went down on each patients monitor at the same time.
This data is available on patient oxygen monitors for 2-3 days, he said.A senior doctor, on condition of anonymity, also said no doctors or hospital would mention in a patients death summary that he or she died because the hospital had run out of oxygen. This would open the hospital up to claims of medical negligence and their medical license could be cancelled. It is for the government to look at their oxygen availability and delivery logs, and the calls (regarding oxygen shortage) made by the hospitals, and messages sent on the status of oxygen availability. To say that there was no death in Delhi because of the lack of oxygen is like saying that doctors, nurses, patients and their families are all lying, said the doctor.
The report of the committee looking into the Jaipur Golden deaths, signed May 2, also states that in no document did the hospital claim a lack of oxygen. As per the case records, all patients were given supplemental oxygen till resuscitation/death. There was no mention of shortage of oxygen in any of the case sheets and patients were given oxygen supplementation till last, based on the clinical requirement, as per records made available to the committee, the report said.It was on the basis of this report that the Delhi government told the Delhi High Court that the 21 patients died due to respiratory failure and not lack of medical oxygen.During a webcast on Wednesday, Sisodia acknowledged that his government believes people had died of oxygen shortage in the capital.
Asked why Delhi had not provided the Centre with information regarding these deaths, Sisodia said: When Delhi government said yes, it seems like people died due to the lack of oxygen and decided to set up a committee to look into the deaths and give them Rs 5 lakh as compensation, the Centre did not let us do it The Centre wants to hide the truth about the mismanagement it brought on and doesnt want the figures to come out. You didnt want the government to send you updates, you didnt want the government to collect these figures. If you ask me today how many such deaths have happened in Delhi, I have no data. This is what the committee was supposed to have done. The Centre did not allow the committee to be formed.
Sources said it was the L-Gs view that since the Supreme Court committee was already looking into the issue of oxygen shortage, there was no need for another panel.In other states, too, there is lack of clarity on how to categorise a death due to oxygen shortage. According to a senior official in the Madhya Pradesh government, all deaths that occurred during the second wave, irrespective of cause, have been noted as Covid deaths and no details were sought on deaths that occurred owing to shortage of oxygen.The states Health Minister Prabhuram Choudhary said, There have been no deaths due to shortage of oxygen.
There was some difficulty in making oxygen arrangements but it was made available by the government and there was no shortage.In Goa, Health Minister Vishwajit Rane had stirred up a storm when he claimed on May 11 that 26 Covid patients had died in Goa Medical College in the early hours of the day when supply of oxygen was interrupted.On June 28, the High Court of Bombay at Goa observed that there were serious issues relating to the supply of oxygen at the Goa Medical College in May and said: Some lessons will have to be learned from the unfortunate events of May 2021, so that the numerous causalities that arose, especially at GMC, may not have been in vain.Goa health secretary Ravi Dhawan declined to comment on the data related to Covid-19 deaths due to oxygen shortage, since the report of a committee appointed by the state government to inquire into the issues of oxygen supply in GMC is awaited.
(Inputs from Mayura Janwalkar and Iram Siddique)