Probe team says heatstroke not direct cause of Ballia deaths; finds lapses in patient management
Micro-level management includes taking a call on which patients need immediate attention/medical care and which ones can be attended to later.
LUCKNOW The team sent by the Uttar Pradesh government to Ballia to investigate the cause of recent deaths in the district has concluded that ‘heatstroke’ was not the direct cause of any death. However, the team, upon inspecting the district hospital, did find glaring lapses in the ‘micro-level’ management of patients. The development comes after 68 people died reportedly due to heat-aggravated pre-existing diseases.
During its visit to the hospital, the probe team found that the ‘queue system’ was being followed in the Emergency ward as opposed to the mandated ‘Triage’ protocol. “The ‘Triage’ protocol demands that the most serious be given maximum and first attention. It appears this assessment of most serious patients was poorly done at the hospital,” said senior health officials privy to the matter.
Given the ‘poor management’, the members of the team got the Triage system implemented in the hospital. They also ensured other arrangements such as coolers, air conditioners, and water coolers in the Emergency wing. Notably, the hospital has five doctors -- including three physicians. Therefore, any lack of manpower was not pointed out by the team.
Another point raised by health department team members was of power cuts in Ballia. Dr AK Singh, one of the members of the committee sent to the district, said the deaths at the hospital were primarily due to comorbidity and old age and not heatstroke. He, however, added, “Power supply in rural pockets of the district was disrupted. Transformers were burnt out. The condition of the people worsened by the time they reached hospital due to non-availability of electricity, among other factors. Also travel time to reach hospital is a factor due to which the condition of patients worsened.”
Dr Singh, director of infectious disease, said, “It takes more than four hours to reach Varanasi or Azamgarh, the nearest districts, if referred from Balia. In this scenario, it becomes difficult for patient to travel to another district.”
In the blood samples of 18 patients, the Total Leukocyte Count (TLC) was found high, indicating that they suffered from some illness. However, this was due to the illness mentioned in their medical history and not due to heatstroke, the team found. The blood samples tested negative for any viral load.
When asked about the status of the final report, one of the team members said, “Once the report of water samples taken from affected areas and blood samples of patients admitted to the hospital arrive, the team will summarise and file the final report.”
Separately, in the demographic study conducted in the areas that reported maximum cases/deaths, the team members pointed out the delay in paying attention to early symptoms of illness.
Micro-level management includes taking a call on which patients need immediate attention/medical care and which ones can be attended to later. For instance, if there are two patients with high fever, it is upon the hospital to give priority to the patient who has a low pulse and is unconscious while the other patient, who is able to drink water and is talking too, can be treated next. Micro level management is done when the staff is overwhelmed by the number of patients -- like if there are three nurses for five patients in the Emergency ward.
‘Avoid media interaction’
Health officials have been asked to avoid giving statements to the media. In a recent letter by the principal secretary (health), Partha Sarthi Sen Sharma, to all additional directors, chief medical officers (CMOs), and the chief medical superintendents (CMSs) of the health department, it was said that “in case of health emergency, no unauthorised person will issue a statement. In case of crucial situations, the concerned CMO/CMS will, in coordination with the district magistrate, issue authorised information as per need.”