Hospitals or death traps?

The Wednesday morning fire incident at a hospital in Thane, where at least four patients lost their lives, has served to highlight the appalling safety standards prevailing at most hospitals, both private and government-run. The cause of the fire may well be the proverbial ‘short circuit’ but the series of such disasters happening in close succession points to a deeper malaise in the system. Wednesday’s fire disaster in Thane is the third such incident in just one week. At least four critical patients under treatment for Covid died in a fire which broke out in a Surat hospital last Sunday. Just a couple of days prior to that, as many as 14 Covid patients were charred to death in a fire at a hospital in Virar. On April 10, at least four patients died in a hospital fire in Nagpur. At the beginning of the month, a major fire which broke out at Delhi’s Safdarjung Hospital, one of the largest in the NCR region, forced the emergency evacuation of 50 critically ill patients. These are just some of the major incidents which made it to the national media. No doubt, there have been any more incidents which have not been in the media glare. This is not counting the huge number of deaths of Covid patients in ICUs in hospitals, who have died gasping for breath because the hospitals had run out of medical oxygen.

We are a fatalistic nation and few will question this series of unfortunate events being labelled a ‘coincidence’ or ‘fate’. However, it would be an injustice to the families of those who lost loved ones in these incidents if we were to simply accept this and move on. That so many fires are breaking out in hospitals at this time, when every hospital in the country, public or private, is loaded beyond capacity, points to the failure of either poor quality equipment or poorly maintained infrastructure simply collapsing under the stress of continuous usage. It is evident that an unbiased inspection of hospital facilities in our country will show that a majority will not be able to meet the minimum standards prescribed in the rules, leave alone match up to global standards. We are all familiar with hospitals which have sprung up in buildings which were never designed to house the kind of complex machinery and infrastructure used and hazardous material, including explosive gases, radioactive and biomedical waste generated in a critical care hospital. In fact, 10 people were killed in a hospital fire in Bhandup where the hospital was located on the upper floors of a mall! It is shocking that a hospital, which was converted to a Covid care facility to boot, was permitted to operate in such a hazardous public place as a shopping mall in the first place.

The incidents point to a collapse of the oversight mechanism for healthcare infrastructure in our country. The routine building safety and fire safety inspections carried out by the authorities are clearly insufficient when it comes to hospitals, which need to meet higher safety standards and also operate at different ‘stress levels’ compared to ordinary residential or commercial buildings. The municipal authorities, who are tasked with providing such certification, in most cases lack the expertise to do so and indeed, may not be even aware of the requirements. There is also the all-pervasive corruption, which manages to circumvent whatever rules and regulations exist. In fact, it is doubtful whether the authorities have even paid attention to the minimum requirements for a building to be declared fit to be used as a hospital. The very fact that the PM CARES Fund has only now allotted money for building oxygen plants at as many as 551 hospitals located in district headquarters – the first line of tertiary care in our public healthcare system – points to a serious lacuna. How were all these hospitals allowed to come up, leave alone operate all this while, without the basic infrastructure of an on-site oxygen plant?

Let us be clear. The Covid pandemic is an act of nature and the authorities cannot be blamed for it, although they certainly can be blamed for negligence in allowing ‘super spreader’ events which made a bad situation worse. But they can, and should be blamed for the death of every patient who died because the hospital ran out of oxygen, or those charred to death in fire accidents. Once the immediate crisis of surging cases is over, the authorities need to take urgent action to ensure that such avoidable deaths do not recur. Standards must be fixed at the national level of hospital infrastructure, safety and operations. At the state and municipal level, capacity must be built up to ensure strict supervision and implementation of standards. Hospitals which do not meet the code – whether public or private – must be shut down till the infrastructure and safety gaps are addressed. Accountability must be fixed for allowing substandard set-ups to operate.