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Was Nanded hospital deaths the result of administrative failure than a medical one?

The 31 people who died included 16 infants

The death toll at Dr Shankarrao Chavan Government Medical College and Hospital in Maharashtra's Nanded has gone up to 31 after the death of seven more patients since Monday, in a span of close to 30 hours. This includes the death of 16 infants, who according to doctors, died due to different reasons—ranging from inadequate facilities and infrastructure to an acute shortage of staff and medicines—and within hours of each other.

In August, a similar tragedy occurred inside another government hospital in Thane district's Kalwa, in which 18 patients lost their lives. This was due to the overburdening of the hospital's infrastructure because of a sudden influx of patients from another hospital in the vicinity and an acute shortage of staff to cater to those patients.

The dean of Dr Shankarrao Chavan Hospital, Shyamrao Wakode, however, denied reports that the patients died due to the hospital's negligence or the shortage of essential supplies, including medicines. He reportedly said all the patients were given proper care but their bodies did not respond to treatment that was administered to them for conditions ranging from diabetes to liver failure to kidney failure.

Almost a decade earlier, in 2014, an associate professor Aswar Nandkeshav, medical officer Rewatkar Mangesh, and a postgraduate student Akanksha Jain, all from the department of preventive and social medicine at Dr Shankarrao Chavan Government Medical College and Hospital, where the tragedy has now occurred, published a research paper in which they concluded that each patient at the hospital required 75.5 minutes waiting time to avail the OPD services. Their report said various factors contributing to the long waiting time at the hospital included the registration clerk not attending duty on time, taking more time to register the patient, difficulties in locating rooms, rush, doctors coming late for duty, doctors and pharmacists talking on mobiles, and VIP patients jumping the queue.

This teaching hospital in Marathwada region of Maharashtra serves as a reference centre, has a 500-bed capacity, and runs outpatient clinics in various medical specialties. Close to a thousand people avail the OPD services every day. According to standard operating procedures of OPD for district-level hospitals, waiting time for collection of OPD ticket is one minute, waiting time for dispensing medicines is two-three minutes and the time taken for lab investigation is 10 minutes. In comparison, the findings of this study showed that at Dr SC Government Medical College and Hospital the waiting times are way longer, and at times patients do not even get the opportunity to approach a doctor. And this is why, Dr Amol Annadate, a doctor and activist based in Aurangabad, says the recent deaths at the hospital in question are a result of administrative failure than a medical failure.

"This issue has been a long-standing one and there is no guarantee that this won't be repeated. This is not the fault of health workers working at the grassroots in the hospital, they are extremely overburdened. The starkness of the statistic is such that there are only five to six doctors for every hundred patients there, which is shocking, to say the least. Health is a state subject and is the joint responsibility of the medical education department and the health department, and unfortunately, both these departments are the most corrupt. They already have meager budget allocations and to top it, there is so much corruption. What we need is an audit of the number of deaths occurring daily at these hospitals, the magnitude of human errors and infrastructure shortage and more. There is a total absence of accountability and any system of timely audits at these hospitals. This despite the fact that Nanded has given the state two strong chief ministers, Shankkarrao Chavan and Ashok Chavan."

Following the tragedy, the state government has reportedly formed an inquiry committee to probe the incident. The deaths triggered a massive political mudslinging as the opposition slammed Prime Minister Narendra Modi's silence on the matter. Opposition leaders, including Sharad Pawar, Rahul Gandhi, Supriya Sule and Priyanka Chaturvedi, lashed out at the Eknath Shinde government. Congress president Mallikarjun Kharge raised questions on the state government's health infrastructure and demanded a thorough investigation while Pawar said it was shocking to know how so many people could die in a span of 24 hours at a government hospital.

Former chief minister and local Congress MLA Ashok Chavan visited the Nanded government hospital to review the situation. He said, “This is extremely unfortunate. Government medical colleges are in a serious crisis. Inadequate staff and shortage of medicines are responsible for the condition of this hospital." Chavan added that when he discussed these issues with the dean, he was told that besides the 24 deaths in the last 24 hours, around 70 patients were in a serious condition. “Some of them have been referred to private hospitals,” he said, indicating that the death toll could rise.