Gorakhpur tragedy: Show zero tolerance towards needless mortality in govt hospitals
It is paradoxical that the prices of tomatoes or onions can bring governments to their knees but not so the deaths of defenceless children. A lesson will only be learnt if the chief minister shows zero tolerance for needless mortality in government hospitals
The deaths of more than threescore children at the BRD Medical College Hospital in Gorakhpur, Uttar Pradesh, has horrified people across India. Not because other tragedies are less disturbing — but because children’s vulnerability calls for the highest standards of protection. Within that healthcare tops the list.
Once the children were admitted to the hospital it was the responsibility of the management to save their lives. The Gorakhpur Medical College Hospital is a tertiary level public health facility. It is said to be the only facility with wherewithal to treat encephalitis within a 300 km stretch. The disease has been endemic to Gorakhpur for four decades and the hospital serves not just Gorakhpur but Gonda, Basti, parts of Bihar and the terai regions of Nepal. Given all this one would have expected the highest levels of emergency preparedness and response. Instead, so many defenceless children had to die. Why?
This happened because in the pecking order, investment or a concern about healthcare does not bring visibility or active public endorsement — the way investment in infrastructure does. Health bureaucrats, like all public sector employees, take the cue from the seriousness with which governments view a subject. If a handful of hospital deaths are treated as normal and no questions are asked, the administration becomes careless. Monitoring of hospital management is rarely looked at by anyone besides the hospital. The contradictions and complexities that beset the health sector are several and the compulsions are unfathomable for newcomers.
The contending priorities of communicable vs non-communicable diseases, primary vs tertiary care, preventive management vs disease control can only be managed through measurement and monitoring. Health bureaucrats seldom give the bad news that affects peoples’ lives. No chief minister or health minister, least of all in a state the size of UP, can possibly keep track of trends, warning signals, local shortages of manpower, equipment or consumables; which is why they must administer by exception. This calls for data management to take stock of warning signals and to respond to those.
The tragedy and the truth is that government district hospitals are the last resort of the poor in times of emergency — whether caused by putrid water, poor sanitation, mosquito breeding or maltreatment by quacks, is irrelevant. The kids that were admitted to the Gorakhpur hospital were brought alive. Whatever caused their illness is of concern only to epidemiologists, now. Hospital emergency services were unequipped to handle the crises that led to the death of over 60 children. If they succumbed because of mismanagement of oxygen supply, it was atrocious; and, if it was because of delayed payments, it cannot be dismissed by holding one or two individuals responsible.
Why weren’t there checklists for oxygen supply as a top commodity in a hospital’s inventory? Only measurement and management by exception would have rung alarm bells in time. Every modern hospital is run like that and a medical college hospital should have performed better — not worse.
Indeed it is paradoxical that the prices of tomatoes or onions can bring governments to their knees but not so the deaths of defenceless children. A lesson will only be learnt if the chief minister shows zero tolerance for needless mortality in government hospitals. He must direct district hospitals and medical colleges to publish monthly and annual data on in-patient admissions and personally look at monthly reports of mortality trends by hospital-related causes and also share this data publicly. Other countries have mortality and morbidity reviews or clinical peer reviews. This leads to better processes and systems. Punishment of a few players does not improve systems or a willingness to improve. Only systemic changes will work; but for that continuous data collection and medical audits are a must.
This Independence Day one would like to hear the prime minister and all CM’s commit themselves to giving top priority to public health and hospital management. Through a commitment that hospital data of mortality would be declared by all district hospitals and uploaded every month along with the outcome of reviews conducted by third party peer review committees. If the CM shows no lenience towards medical or administrative apathy by simply glancing through the exception reports and peer reviews of hospital deaths, things could still change dramatically.
Shailaja Chandra is former chief secretary, Delhi
The views expressed are personal