‘Callousness’: Probe indicts Chamarajanagar hospital, officials for 24 deaths

Bengaluru: The findings of a report on the death of 24 people on May 2 due to lack of oxygen in Chamarajanagar have revealed that apart from the inefficiency from senior hospital staff and district administration, there was an attempt to tamper with documents after the tragedy.

The committee of the Karnataka State Legal Services Authority (KSLSA), headed by retired judge of the High Court Justice AN Venugopala Gowda, in its report pointed at the lack of leadership from the dean of Chamarajanagar Institute of Medical Sciences (CIMS), its district surgeon, and a microbiologist, resulted in the failure to efficiently marshal the available resource.

The report was submitted before the high court on Wednesday in a sealed document.

Apart from the 24 people who died on May 2, another 62 patients died at the hospital between May 4 and May 10 – at least 36 of whom were admitted at the hospital on May 2 night, when the oxygen supply was disrupted for several hours. “The death of these 36 inpatients could be attributed to non-availability of oxygen supply during the night of May 2 and early hours of May 3,” the report said.

According to the panel, the deaths could have been averted if authorities had acted on time. “Had the hospital administration been vigilant, it could have had enough oxygen by timely refilling of cylinders. With the bottling plant at a distance of about 70 km, not having sufficient filled oxygen cylinders at Chamarajanagar is an act of callousness and led to the loss of dozens of precious lives,” the report added.

The panel found that the truck transporting the oxygen cylinders should have reached Chamarajanagar by 2 am, but instead it stopped at a refilling agency to load another 30 cylinders. It reached the hospital at 6 am on May 3, the report said.

Talking about the district administration, the report said the deputy commissioner, Chamarajanagar has not exhibited the dynamism and the leadership qualities expected of a district head in a dire crisis situation. “The Deputy Commissioner of Chamarajanagar, as chairman of the District Disaster Management Committee, miserably failed to guide and supervise the crisis situation arising out of extreme demand for oxygen. On the contrary, he indulged in an unsavoury blame game accusing the District Commissioner of Mysuru of causing hindrance for oxygen supply without any basis,” the report stated.

The committee also noted that the district commissioner, Mysuru, did not get in the way of agencies in Mysuru refilling oxygen cylinders of any other districts, including Chamarajanagar.

“Cumulatively, the failure of the district administration in general and the hospital authorities in particular, including the Dean of CIMS, is apparent. A detailed probe alone can unearth the acts of omissions and commissions of the concerned individuals for fixing the responsibility,” the report added.

The committee in its report pointed out incidents of possible tampering with the records. One of the incidents of tampering was noticed by the committee during the examination of the Liquid Medical Oxygen (LMO) register. “The examination of LMO register maintained from 29.04.2021 and two oxygen consumption registers maintained by the Bio-Medical Engineer, prima facie reveals that there has been manipulation by tampering of the registers. In the LMO register page No. 3 and 4 are missing,” the report said.

Earlier, taking suo motu cognizance of the 24 deaths at two Covid-19 hospitals in a span of 24 hours on May 2 allegedly due to shortage of oxygen, the high court on May 4 had suggested a judicial probe by a retired judge into the matter. The state government had subsequently formed a one-member committee to probe into the matter.

The committee report also observed discrepancies in the preparation of the case sheets of the deceased. “The entries in the case sheets, 28 made by one particular doctor and one case sheet by another doctor, appeared to have been made in one go,” the report said. Some factual details were not entered in the case sheets with reference to even the time and date of death, while a number of printed forms were blank, without the particulars of the patient but contained only the signature of the medical officer, the report added.

Meanwhile, the Karnataka high court on Thursday sought a response from the state government on paying compensation to the families of those who died in the tragedy. Chief Justice Abhay Shreeniwas Oka and Justice Aravind Kumar said the state government was liable to compensate the families, and it has to answer two issues raised by the report.

First, how will the state government compensate families that have lost their dear ones due to its failure and second aspect of the report is on the government taking a decision on fixing responsibility on individual officers for their lapses, the court asked the state government.