BY GO TEAM

THERE are so many controversies regarding medical shortages of drugs, vaccines and oxygen in the wake of the Covid-19 pandemic and lockdowns in the last two years, especially during the second phase of the pandemic to do with deaths due to the shortage of oxygen at the GMC that there were demands from various political and non-political for an official investigation.
The Goa government was forced to form an independent committee to review the situation and suggest remedial action. Accordingly a committee was set up consisting of three members, namely Dr BK Mishra (Director, IIT, chairperson); Dr VN Jindal (ex-dean, GMC, member) and Dr Tariq Thomas (Secretary-UD, member & convenor). The Secretary (Health) was also directed to provide necessary support to the committee to complete its report in a week.
Here are the Committee’s conclusions and recommendations for public knowledge.
Excerpted from the report…
7 Conclusion and Recommendations
7.1 GMC and other public authorities performed at their highest capacity with dedication and sincerity. M/s Scoop and other oxygen suppliers too rose to the challenge and supplied a far higher number of oxygen trolleys, as compared to their contractual obligations. However, the following are the observation of the committee.

• GMC did not timely raise any issue of lack of oxygen or sought augmentation of the oxygen, except putting their demand in affidavit before the High Court.
• GMC did not take much action on the letter written by the Goa Association of Resident Doctors dated 1st May 2021. A prompt action on this letter would have enabled better management of the situation.
• GMC did not undertake any assessment of rational use of oxygen except appointing a nodal officer as suggested by the Government of India.
• On June 2018 the decision of the Public Health department to extend the scope of work awarded to M/s Scoop to all across the state of Goa, resulted in creation of a single supplier for all the public health institutions. (After this extension the health institutions had no alternative source of oxygen in case of emergency.)
• As GMC’s oxygen demand rose, M/s Scoop stopped supplying oxygen to the other public hospitals, except GMC, without any warning, letter or message.
• Even in June 2020 GMC tried to put the archaic trolley based system in the newly built super Specialty Block where the LMO tank was already installed. However, even in this tender, only M/s Scoop technically qualified and other bidders were disqualified. Fortunately, now the tender has been cancelled.
• GMC and its oxygen supplier did enhance their capacity to deal with this unprecedented crisis. However, the Committee feels that the crisis was much beyond the capacity of GMC. Still, GMC and its oxygen supplier instead of seeking help tried to handle the issue itself to the best of their capacity and limitations. Seeking timely assistance would have helped GMC.
• GMC assessed its requirement to be about 1,500 trolleys/year in its June 2018 oxygen supply order. However, the data shows that GMC’s monthly consumption, before Covid, was about 240 trolleys per month and 2,890 trolleys per year.

Recommendations
• Setting up of LMO generating plants in the State is not recommended, not only because of its prohibitive cost, but also due to the meagre demand.
• Installation of LMO tanks is more advisable for the major health institutions to allow holding oxygen stock for multiple days. In the last few weeks, the Administration has already set up 5 new PSA plants and two LMO tanks in different public hospitals. A large tank is now being installed at the Old Block, GMC.
• GMC should make use of biomedical engineers or suitable experts for managing the 24×7 availability of oxygen and other gases, as required. For getting a suitable expert, GMC can also tie-up with any engineering education institutions established in Goa. This expert should properly examine, monitor and ensure serviceability of the equipment/devices and other engineering services and recommend regular updation of technology as and when required.
• The current system of projecting a consumption trend as the future demand will be of little use. Implementation of HMIS is an urgent requirement for any serious demand projection, not only for oxygen, but also for medicines and other medical supplies.
• At high-demand times, the trolley system based supply might have failed to supply adequate oxygen, especially at the tail end of the supply chain, even if it did not cause any death. The committee is of the view that the oxygen distribution system at GMC needs to be studied by experts from the Fluid Dynamics perspective with relevant instruments. Anecdotal evidence for the low pressure siren mostly came from the 4th Floor of the New Block. The 4th floor houses the most critical patients and lies at the tail end of the supply chain. GMC is already planning an upgrade of its manifold system. This planned overhauling of the pipelines should be completed at the earliest.
• The Committee concludes that sufficient oxygen supply has been available in GMC since the installation of LMO tanks. Prior to installation of the LMO tank, the committee observed, that during the peak demand, three trolleys were required to remain connected at the manifold. Incidents of pressure drops were quite likely to occur during changeover of empty trolleys, especially due to the late arrival of the next trolley. Any drop in the pressure activates an alarm in the awards. The Committee concludes that such incidents did occur and cause panic amongst patients and healthcare workers. However, the Committee could not conclude that such intermittent incidents of drop in pressure were long enough to cause loss of life.
• The committee also wants to highlight the notable efforts of the Administration, which independently identified a not-in-use cryogenic gas storage tank (due to some contractual issues between two private parties) that can be used tot for storing liquid medical oxygen, in early May. After an analysis, on 8 May, 2021, SEC approved the proposal for shifting installation of this tank as a LMO tank at the New Block, GMC.
• All public authorities contributed in ensuring the tank was installed and made functional within the next seven days, and that involves getting the tank transferred in the name of government of Goa obtaining licenses and permissions, getting the site ready (including 7 days of curing of concrete foundation), and signing an agreement with the main LMO supplier. The committee deeply appreciates this timely intervention in providing an alternative source of oxygen supply.