Between August 9 and 11, 54 people – 36 children and 18 adults – died at the Baba Raghav Das Medical College in Gorakhpur, Uttar Pradesh, because the hospital ran out of oxygen.

As news of the deaths broke, the state administration, in a knee-jerk reaction, announced on Twitter that the cause of death was not shortage of oxygen but some other “medical” reason. A magisterial inquiry has since been ordered. We set out to find if the hospital did run out of oxygen or was it something else that went horribly wrong?

When the oxygen supply was stopped at 7.30 pm on August 11, there were only 52 jumbo cylinders at BRD Medical College on which the authorities relied to manage supply from 1.30 pm the same day. Till 7 pm, 60 oxygen cylinders could be supplied in two attempts. This was when the largest number of deaths happened in the Encephalitis ward, the Neo-natal ward and ward number 14. The central oxygen pipeline operators had earlier taken a reading of the Liquid Medical Oxygen (LMO) Plant at 11.20 am on August 10.  At that time, the LMO Plant showed a reading of 900 which meant the plant, which had a capacity of 20,000 litres oxygen, was carrying 900 kg oxygen. The four operators immediately wrote to the head of the paediatrics department. A copy of the same was despatched to the principal, chief medical superintendent of the Nehru Hospital which is associated with the college, head of the anaesthesia department and nodal officer, NRHM Medical College.

The letter stated:

“We had earlier informed about the stock of liquid oxygen being no more there. Today the reading at 11.20 am is 900. The supply is possible only till this night. The Liquid Oxygen system set up by Pushpa Sales Company in Nehru Hospital provided oxygen supply to the whole hospital such as Trauma Centre, Ward numbers 100, 12, 6, 14, anaesthesia and labour room.

After repeatedly contacting the official from Pushpa Sales Company, we are told that the company has stopped supplying liquid oxygen due to non-payment of dues. If arrangements are not made for immediate supply of oxygen, patients in all wards are at risk of losing lives.”

Earlier, Deepankar Sharma of Pushpa Sales had written to the medical college principal asking him to clear the dues of Rs 63 lakh and in case of non-payment, the company would be compelled to discontinue supply of liquid oxygen. Sharma’s logic was that their company takes supply from INOX and the latter had refused supply unless previous dues were cleared.

Pushpa Sales set up the LMO Plant in 2014 at the hospital. Initially, the liquid oxygen was supplied to Ward 100 for Encephalitis patients. The daily consumption then was around 600-700 kg. Later, the whole of Nehru Hospital was connected to this plant, doubling oxygen consumption to 1,200 kg per day. The company provides four oxygen tankers each with a capacity of 6000 kg. The oxygen consumption patterns thus make it clear that the company supplied liquid oxygen for around Rs 1-Rs 1.5 crore to the hospital of this medical college every month.

According to an agreement between the BRD Medical College and Pushpa Sales, the college has to pay the company after every four billings. A maximum of Rs 10 lakh can be due. But payments to the company became irregular after November 2016. In March this year, Rs 30 lakh were paid in two instalments but no payments have been made to the company after that. Thus in August 2017, at the time of discontinuation of supply of liquefied oxygen by the company, the overdue amount had reached Rs 72 lakh.

There was regular correspondence between the medical college administration and the company during this period but the college didn’t clear the dues. Then the company sent a legal notice. The medical college has not responded to this notice also. It is also said that after this, there was a verbal spat between an official of the company and the college principal but nothing happened on the payment front. The result was the discontinuation of the supply of liquid oxygen to the college and the hospital by the company in August.

Even after this, the college administration and the district administration did not take corrective measures.

Uttar Pradesh Chief Minister Yogi Adityanath had been in the college premises for two-and-a-half hours on August 9. He had chaired a meeting of senior officials where the issue of Encephalitis and death of children due to other reasons were discussed. But the issue of oxygen supply was overlooked. The state Principal Secretary (Medical Education) was also present in this meeting.

A local news portal Gorakhpur Newsline had published a story on the “lack of supply of liquefied oxygen” on the evening of August 10 itself, a day before the tragedy. Finally, it was at 7.30 pm on August 10 the pressure of liquefied oxygen became quite low. This was an indication that the authorities needed to look at alternative arrangements.

The report submitted by the medical college and the health department to senior officials said that when the pressure got low, then the 52 cylinders available in stock were connected to the supply. The next instalment of oxygen cylinders reached the medical college from Faizabad at 1.30 pm the next day. Then two more lots of 22 and 28 cylinders were received from Gorakhpur which helped to continue with the oxygen supply till evening. It was expected that 100 more cylinders would reach by 7 pm.

The maximum number of deaths occurred on the night August 10 when supply of liquefied oxygen had stopped and the oxygen was provided through cylinders. Of the 36 children who died in the neo-natal intensive care unit, the Encephalitis and paediatrics wards between the morning of August 10 and evening of August 11, around 30 children lost their lives when oxygen was supplied through cylinders.

When children and adults started dying in large numbers due to oxygen shortage, the medical college administration quickly paid Rs 21 lakh to Pushpa Sales on the afternoon of August 11. After receiving the payment, the company immediately bought a tanker of liquefied oxygen from Nagpur and sent it to Gorakhpur. An official of the company confirmed this.

It should be noted here that in a jumbo cylinder, there is around 150 kg of oxygen and around 50 kg of oxygen gets wasted during supply. The quality of oxygen provided through cylinders is much lower than the liquefied oxygen. The oxygen supplied through cylinders costs twice as much as liquefied oxygen.

While outside the Encephalitis ward yesterday afternoon, this reporter saw ward in-charge Dr Kafeel Khan making desperate pleas on phone seeking oxygen cylinders. So much so that oxygen cylinders were ordered even from private nursing homes. There was panic in the ward. The news about lack of oxygen supply had spread like wildfire and the near and dear ones of the patients were extremely worried and restless. Meanwhile, another child died and the body was immediately sent out of the ward in a hurry.

At 7.45 in the night when the DM Rajeev Rautela was talking to media persons, Sangeeta and her daughter from Ramkola were crying. Sangeeta’s daughter’s 7-day-old son had passed away. The child had not even been christened. But to hide the number of deaths, the body of the child had not been handed over to Sangeeta. It was kept in the ward. On condition of anonymity, an employee at the neo-natal ward told this reporter that three more infants had died while the DM was briefing media persons but due to the presence of the media, their bodies were not handed over to the families.

In his briefing, the DM admitted that 30 children had died from the midnight of August 9 to the evening of August 11. He also accepted that 17 infants, eight patients from General Paediatric and five patients suffering from Encephalitis had died. He said BRD Medical College is a big hospital and a large number of children are admitted here and, on an average, 10 children die from acute encephalitis syndrome every day here and 10 infants die due to other reasons. But the statistics belie these claims. The maximum number of deaths caused by Encephalitis in a span of 24 hours here were five. Similarly, the neo-natal ward has also registered around five deaths every day.

The district administration has set up an inquiry committee headed by ADM (City) to look into the death of 54 people within 48 hours. This committee would investigate if the deaths of these children were abnormal. On one hand, the DM is claiming that no death has been caused by oxygen shortage and, on the other, he has set up an inquiry committee. The UP government is claiming that oxygen shortage has not caused these deaths as has the state health minister. The question is that if the state government and the administration have already decided that oxygen shortage is not the cause of death, then what is the point of setting up an inquiry committee? Any inquiry on any other issue would mean that the authorities have already started looking for a scapegoat to blame because everyone knew that payment was overdue to the company supplying liquid oxygen.  Why were payments not made in time? Why was oxygen supply  stopped?  Everyone wants to escape the responsibility for this.

If this had happened elsewhere (imagine a non-BJP state of your choice), the governing dispensation would have been torn apart by the national media and invited stern and dire warnings from Union ministers. Not in this case though.