No One Died of Lack of Oxygen, And No One Took Accountability

"To not acknowledge that failure, that is a huge problem. If we don't acknowledge, how are we going to fix it?"

Desperate SOS calls from hospitals on social media pleading for oxygen were one of the defining factors of the second wave of the COVID pandemic in India. For many, these pleas could not be met. Oxygen, essential to saving lives of serious COVID-19 patients, ran out.

Now the minister of state for Health, Dr Bharati Parvin Pawar, in a statement to Rajya Sabha on Tuesday, said, "no deaths due to lack of oxygen has been specifically reported by states."

While the statement has been met by disbelief by family members of those who died gasping for breath, there has also been a tug of war between center, states and hospitals on where the accountability lies.

No Mention of Lack of Oxygen in Death Records

On three occasions, hospitals in the national capital spoke about oxygen running out leading to deaths of the most vulnerable. In a previous fact-check by The Quint we have highlighted this:

• On May 1, Delhi's Batra Hospital said that they lost 11 patients and a doctor to lack of oxygen. The hospital's executive director Sudhanshu Bankata was quoted by a leading newspaper attributing the deaths to oxygen running out.

• Delhi's Jaipur Golden Hospital told the Delhi High Court that they lost 25 people due to oxygen shortage.

• Similar reports came in from Delhi's Gangaram Hospital where 25 people died, allegedly due to lack of oxygen supply. The hospital later denied that the deaths were caused directly as a result of oxygen shortage.

The Quint reached out to some of the families of those who died during the oxygen crisis to look at what the death summery issued by the hospital says. We received a summery from the family of one of the patients who died at Delhi's Jaipur Golden Hospital. The cause of death is listed as cardiac arrest and respiratory failure. Most deaths have been attributed to cardio-respiratory causes.

The doctors we spoke with said that in an autopsy it will be difficult to distinguish between disease and incident in patients already suffering from a serious health condition. If you really want to look at attributing the cause to oxygen dip, you would have to look at the data stored on ventilators, which the machine auto-sets within 72 hours.

Dr Sumit Ray, head of critical care at Holy Family Hospital, that also sent out SOS calls during the second wave, says accountability can be established, only if there is a will to do so.

"You will have to establish that oxygen levels fell for a number of patients at the same time, you will have to establish that there was a sudden drop in O2 levels, you'll have to match it with hospital logs of oxygen levels. Machines auto reset in 72 hours, so unless they extract that data quickly, it is lost."

You can still establish all the above with liquid oxygen, but it is difficult to ascertain any of this with cylinders, he adds.

In a detailed fact-check by Boomlive, the reporters reached out to the same set of hospitals that had earlier in statements attributed deaths to lack of oxygen. Many went back on their statements, with some saying they would no longer want to comment on this issue.

But patient didn't just die when oxygen ran out in hospitals. Many died desperately hunting for oxygen cylinders, some died in ambulances as they went from hospital to hospital in search of beds while the cylinders ran out. Several people died in car parks, outside emergency rooms, and on streets as the healthcare infrastructure crumbled in the face of a vicious wave.

So Where Does the Accountability Lie?

"In India we had the experience of the first wave, there was a recognition that this is a respiratory disease, and one of the challenges is saturation levels, so as part of the preparation for this wave, we should have had better forecasting of higher oxygen requirement, and then prepared for that accordingly at every stage," say Dr Anant Bhan, Researcher, Bioethics, Global Health, Health Policy.

When it comes to accountability it lies at various levels - at govt level, local administrators, hospitals systems etc. "One can accept this was a unique exceptional event, but we have to also seek accountability to establish the failure, to learn from it and to ensure we don't repeat the same mistakes again."

"To not acknowledge that failure, that is a huge problem even from an ethics perspective, because then you are whitewashing it all the way, and saying that this was a difficult chapter and closing it, but then what have we learned, how are we going to fix it? What systems have been put in to help us be better prepared?"

Dr Anant Bhan

That one place where this conversation needs to happen is our national parliament, but it is at this very venue that the government has failed to address the tragic deaths.

The response hides behind reporting parameters which might not necessarily capture underlying cause of death, say experts. For hospitals and individual doctors, there is a very real fear of legal action.

"Almost everyone died due to cardio respiratory causes, but what lead to it, unless you also tabulate that, then how do we ever know what is the true burden of oxygen shortage related deaths?," says Dr Bhan.

We have to establish adequate mechanism for collecting deaths data, and that itself has been lacking.