Via The Lancet: Over 60 children die in a hospital in north India. Excerpt:
Although investigations are still ongoing to assess the chain of responsibility, the Gorakhpur tragedy exposes the malaise of India's health system. Dinesh C Sharma reports.
About 60 critically ill children have died in the neonatal and encephalitis wards of the Baba Raghav Das (BRD) Medical College Hospital in Gorakhpur, Uttar Pradesh (UP), India, between Aug 10–11. The deaths were allegedly due to disruption in oxygen supply stopped by the supplier over unpaid bills.
The medical education department of the UP Government has suspended Rajiv Mishra, the BRD Medical College Hospital's Principal, but denies that deaths occurred due to disruption in oxygen supply. Mishra and other officials of the hospital have been charged for negligence and corruption. Enquiries instituted by the central Ministry of Health and the UP Government, the contents of which are yet to be made public, have found that the deaths occurred due to illness, including sepsis and Japanese encephalitis.
Amnesty International India has raised “serious discrepancies” in the findings of the investigations. A criminal complaint was also filed against the oxygen supplier. A fact-finding team deputed by the Indian Medical Association (IMA) found that “oxygen supply was interrupted for a short time on the night of August 10, as the liquid oxygen supplier had not been paid dues for the past six months”.
In light of this, the IMA has concluded that it was a case of administrative negligence and not medical negligence. Clinical autopsies, which could reveal whether the deaths were linked to lack of oxygen, have not been conducted.
A failing system
“These tragic deaths…reflect on the state of India's public health system, and are an urgent wake up call to evaluate the functioning of public health facilities everywhere in the country”, said Asmita Basu, Programmes Director of Amnesty International India.
Critically-ill children are often refered to the BRD Medical College Hospital which is in a region endemic for acute encephalitis syndrome and Japanese encephalitis. The government-run facility often experiences a high burden of patients. Poonam Muttreja, Executive Director of the Population Foundation of India, New Delhi, told The Lancet that this can be traced back to the tendency of “private hospitals, in spite of having comparatively better facilities, not [taking] responsibility of children at acute stage, since they fear loss of reputation in case deaths occur, and refer these children to government tertiary care centres”.
“When sick children from poor families are admitted to an overcrowded hospital, requisite critical care is not assured in constancy or quality”, K Srinath Reddy, President of the Public Health Foundation of India, New Delhi, told The Lancet. “On top of this chronic problem of suboptimal care, an interruption of oxygen supply may have reversed recovery and hastened death in some children.”
“Since these children were very sick to begin with, it is difficult to assign oxygen shortage as the precipitating cause of death but a contributory role cannot be ruled out”, he added.
