The interim report of the Supreme Court-appointed sub group to conduct an oxygen audit for Delhi has set off fresh recriminations between the Centre and the AAP government, with news reports focusing on the headline grabbing claim that Delhi inflated its oxygen needs by four times at the peak of the second wave of COVID.
However, a closer reading of the 163-page report, part of an affidavit filed by the Union Ministry of Health and Family Welfare in the SC on June 22, reveals that the committee members were divided over the methodologies used to arrive at the oxygen demand, with one dissenting member accusing the panel of functioning with a “pre-conceived and predetermined conclusion and narrative”.
What’s more, the report makes it clear that the headline figure of 1,140MT (four times) was the result of misreporting by hospitals, which was later rectified.
The Federal takes a closer look at the latest controversy…
The SC Order
The Supreme Court constituted a 12-member National Task Force (NTF) on May 6 “to facilitate a public health response to the pandemic based on scientific and specialised domain knowledge”.
“It is necessary that an effective and transparent mechanism is set up within the Union government for the purpose of allocating medical oxygen to all states and UTs for being used during the COVID-19 pandemic. The Union government has agreed to set up a National Task Force to streamline the process,” a Bench of Justices DY Chandrachud and MR Shah said in its order.
The order came on a plea by the Centre challenging the contempt notice issued to it by the Delhi High Court over medical oxygen supply to Delhi.
Members of the Committee
As per the order, the NTF would facilitate audits by sub-groups in each state and UT. In Delhi’s case, the panel consisted of:
- AIIMS director Dr Randeep Guleria
- Max Healthcare Clinical Director (Internal Medicine) Sandeep Budhiraja
- Delhi Principal Secretary (Home) BS Bhalla
- Ministry of Jal Shakti Joint Secretary Subodh Yadav
- Controller of Explosives, Petroleum and Explosives Safety Organisation, Dr Sanjay Kumar Singh
Differences over Methodologies
The report reveals that the differences in the liquid medical oxygen (LMO) demand for Delhi during the peak of the second wave, from the last week of April to early May, were due to separate formulas used by the Centre and the Delhi government. Under the Centre’s formula, 50 per cent of non-ICU oxygen beds are calculated as using LMO. The Delhi formula says all non-ICU oxygen beds use oxygen. The two formulas were discussed during the seven meetings of the committee between May 10 and May 21.
The sub-group observed that the Delhi formula would lead to “overestimation” going by the experience of major hospitals including AIIMS.
Delhi Principal Secretary (Home) BS Bhalla and Max Healthcare Clinical Director (Internal Medicine) Sandeep Budhiraja were the primary dissenters, even skipping one of the committee’s sittings. They flagged their objections in two separate notes.
Bhalla appended a detailed list of objections and comments to the draft interim report. One of the paragraphs said: “The assumption that only 50% of non-ICU beds use oxygen is not correct in the context of a respiratory disease like COVID-19. In fact all hospitalised patients need a regular supply of oxygen. Fall in oxygen saturation is the first and primary reason that patients get admitted to a hospital…”
Bhalla and Budhiraja pointed out that the sub-group had not factored in the requirement of LMO for home isolation patients, refillers, ambulances and small nursing homes.
Members of the panel affiliated with the central government bodies recommended that Delhi be provided 300MT daily on assured basis and an additional 100MT by 4pm every day based on requirement. The Delhi government insisted on assured daily allocation of 568 MT. A “compromise” was worked out on May 15 to allocate 500MT daily to Delhi, the interim report noted.
The report noted that on May 13, “it was discussed that there is a gross discrepancy (about 4 times) in that the actual oxygen consumption claimed (1,140MT) was about 4 times higher than the versus calculated consumption by formula for bed capacity (289MT). It was noted that four hospitals in Delhi i.e. Singhal Hospital, Aruna Asaf Ali Hospital, ESIC Model Hospital, and Liferay Hospital have claimed extremely high oxygen consumption with very few beds and the claims appeared to be clearly erroneous, leading to extremely skewed information and significantly higher oxygen requirement for the entire state of Delhi. Actual consumptions were estimated by recalculation after replacing the claimed use figures for these 4 hospitals with expected use figures using the calculation formula.”
In his dissent note, Bhalla said: “Requirement of oxygen for oxygen cylinders with home isolation patients, refillers and certain other establishments has also to be taken into account. Also, oxygen for non-COVID requirements and some buffer components need to be factored in while calculating the total oxygen requirement of Delhi. It is further an indisputable fact that 214 is not the sum total of hospitals/medical establishments catering to patients suffering from COVID-19. In fact, the figure is more than 260. Therefore, the entire basis of the assessment/quantification of the LMO requirement in Delhi has been made on incomplete data.”
It must be reiterated here that the committee discussed the possibility that the 1,140MT figure had emerged erroneously, and that this figure was later rectified. The figures were provided by four hospitals – the government did not inflate the figures. Nor did it at any stage ask for 1,140MT.
‘Unfortunate and Unacceptable’
In a file noting of the Delhi Home Department, Bhalla on Friday said that the “interim report seems to have been sent to Government of India without making the requisite changes, without sharing again with the members of the sub-group, and without their formal approval”.
“Detailed objections/comments have been added at the end of the interim report just for posterity, leaving it to the reader to make the effort, if he/she so decides, to interpret the entire report together and make his/her conclusions. This is unfortunate and unacceptable.
“The interim report, as submitted, does not have the approval of all the members of the sub-group,” he wrote.