Saturday, August 19, 2017

Gorakhpur Tragedy: Findings of the IMA Inquiry Committee

Dr KK Aggarwal
National President, IMA

The Gorakhpur tragedy, where many innocent lives were lost, has shaken the nation and stirred a debate in the country.

Taking cognizance of the seriousness of the situation, Indian Medical Association (IMA) HQs constituted an Inquiry Committee comprising of Prof KP Kushwaha, Former Principal & Head, Dept of Pediatrics, Medical College Gorakhpur; Dr Ashok Agarwal, National Vice President IMA and Dr BB Gupta, President IMA Gorakhpur Branch.

The committee also asked the following doctors to appear before it to present their case.

•  Prof Dr Rajiv Mishra, Principal BRD Medical College, Gorakhpur at the time of the incident
•  Prof Dr Satish Kumar, Head, Dept. of Anaesthesia, Medical College, Gorakhpur
•  Dr Mahima Mittal, Associate Prof, Dept. of Paediatrics, Medical College, Gorakhpur
•  Dr Kafeel Khan, Asst. Prof and Nodal Officer, Encephalitis Ward, Dept. of Paediatrics, Medical College, Gorakhpur
•  Dr AK Shrivastava, Superintendent in Chief, Nehru Hospital, Medical College, Gorakhpur

But, the above doctors failed to appear before the Inquiry Committee, which then decided to visit the Dept. of Pediatrics in the Medical College.

People there were hesitant to speak. The scope of the Committee was to only examine the working of the doctors as other issues such as lack of oxygen, inadequate staff and any structural deficiency were being investigated by the Chief Secy, UP Govt.

The committee also took note of the various reports published in the newspapers and other media. The following conclusions were arrived at:

•  Oxygen supply was interrupted for a short time on the night of August 10, 2017.
•  The liquid oxygen supplier had not been paid his dues since last 5-6 months.
•  Cleanliness of hospital and ward was unsatisfactory. Presence of dogs and rats in hospitals is not acceptable by any standards in the hospital premises.
•  The hospital was handling these cases and other critically ill patients much more than its capacity.
•  There is no facility in Gorakhpur and nearby districts to manage encephalitis.
•  There is a lack of staff – paediatricians, nurses and other paramedical staff – in PHCs/CHCs.
•  ICUs in 10 districts of Poorvanchal area are not functioning because of lack of staff and other resources.
•  No alert was issued by the hospital administration regarding shortage of oxygen, The traeting doctors should have been alerted seven days before the fresh oxygen supply was  not received.

According to the IMA, although there is no evidence of medical clinical negligence against Dr Rajiv Mishra and Dr Kafeel Khan, prima facie it appears that a case of administrative negligence against them cannot be ruled out. Hence, administrative inquiry and action may be taken against them.

The recent movie ‘Airlift’ was based on the true story of evacuation – airlifted - of several hundreds of Indians from Kuwait during the first Gulf war and brought back to the country.

Similarly, we read about ‘green corridors’ without any traffic disruptions being set up to transport harvested organs like heart to reach another hospital, where there is a patient waiting to receive the organ. It’s an emergency where time is of utmost importance.

Why can’t the same be done in situations such as the Gorakhpur tragedy, where an epidemic of encephalitis recurs every year and, many children lose their lives every year because of the illness?

In view of this tragedy, IMA has suggested the following to avoid similar situation in the future.

•  There should be a state policy to airlift such critically patients in a timely manner to nearby best facilities.
•  All patients denied treatment at government hospitals should be reimbursed for the cost of treatment in the private sector at pre-defined rates.
•  All hospitals should have back up of one-week supply of all essential drugs, investigations and oxygen.
•  IRDA has made it mandatory for all private hospitals to get NABH accreditation. The same should be extended to all government set ups.
•  Essential drugs and investigations, not non-essential drugs and tests, should constitute the bulk of the expenditure of the allocated budget to reduce the cost of treatment.
•  All payments for health care services should be made either in advance or in time.
•  Doctors are clinicians as well as administrators. It is important to make a distinction between clinical medical negligence and administrative negligence.

Disclaimer: The views expressed in this write up are entirely my own

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