With news of five deaths at the Madurai Government Rajaji Hospital (GRH) in Tamil Nadu, on Tuesday, rocking the state, a doctor serving at the GRH, who did not wish to be identified, told The Federal that the battery back-ups to ventilators had failed and that likely led to three of the five deaths at the hospital on the night of Tuesday, May 7. He said that the battery back-ups have failed in the past and the hospital has a procedure in place to replace the mechanical ventilators with a hand-operated one. But on Tuesday night, the hospital was unable to carry this out.
Another member of the staff privy to the developments independently affirmed that this was the case. Relatives of patients had earlier in the day on May 8 talked about ventilators conking off.
A doctor who earlier had served at the GRH and was later transferred to another government hospital elsewhere in the state said this was indeed a problem in Madurai and confirmed that the procedure for hand-held ventilators was the practice there.
‘There are two forms of backup’
A retired government doctor who served for over 30 years in the sector said that even as many government hospitals have backups for high priority areas like the ICU, operation theatre and labour wards, the maintenance of the equipment is the question. The source said, “The backups have to be checked frequently and the inbuilt batteries in the ventilators have to be looked into to confirm their efficiency during times of emergency.” The source claimed that hand held ventilators were the practice almost 20 years in many set ups and that is not the case anymore. “Those days deaths happened during power cuts as they had to be pumped manually,” he added.
According to the doctor who is now serving in GRH, inbuilt batteries attached to the ventilators do not function properly. “Only very few ventilator batteries function properly here. So, the ventilators used for these three patients should be checked,” said the doctor.
The doctor also said that it is not possible to know from the autopsy report, if they died due to lack of oxygen. “In the autopsy report, it would just show the cause of death as the malfunctioning of the some vital parts of the body. Though it might be because of the lack of oxygen support to the parts of the body, it would not be directly attributed,” the doctor said.
‘They were responding well to treatment’
Of the five patients who died, three patients, Palaniamma of Dindigul; Ravichandran of Virudunagar; and Malliga from Madurai were being treated in the Intensive Care Unit of trauma ward of GRH. All three died between 6 pm and 7 pm, soon after the first power cut, caused by thunder, lightning and heavy rains. Of other two patients—one was brought dead and the other one was being wheeled in for treatment after 8pm, when power was being interrupted intermittently
Relatives of the deceased said that though all three were being treated for head injuries in the trauma ward, they were responding well to treatment.
One of the relatives of Malliga said that though she was critically ill, she was on life support and was responding. “Only after the power cut, she suffered fits and we alerted the nurses there. As there was no duty doctors by that time, nurses rushed in to take an ECG and confirmed that she died,” Chandrasekar, a nephew of Mallika, said.
Mallika was moved to GRH recently after being treated for several days in a private hospital in Madurai. Chandrasekar admitted that she was critically ill at the time of admitting her in the hospital.
Similarly, P Pandimuniyappa, brother-in-law of Ravichandran, said the latter had sustained head injuries and was admitted to GRH on May 5. “Around 4.30 pm, he underwent a surgery and around 5 pm, his blood was tested. We were told he was stable and a procedure was fixed for 8 pm. But before that, around 6.30 pm, he suffered fits,” Pandimuniyappa said.
Ravichandran was being wheeled in for an ECG. “Even in the ECG centre, there was no power and I used my mobile torch,” Pandimuniyappa said. Adding that he did not want to make it an issue, he added that no such untoward thing must happen in the hospital.
Just a coincidence?
Dr K Vanitha, dean of GRH, told The Federal that the deaths and the power cuts were just a a co-incidence, adding that the ventilators were functioning even during the power cut.
“Only three died during the first power cut. All the three were critical and they also had cardiac arrest earlier. But, they were revived and were being monitored before they died,” Vanitha said, adding that nine patients were in the ventilator out of which six are stable.
The doctor who said battery backups had conked off told The Federal that malfunctioning did not strike all the ventilators.
‘Multiple deaths in ICU on a single day possible’
Dr Suresh Rao, head of department, critical care unit, Fortis Malar Hospital explains that the rate of ICU deaths is inconsistent depending on the number of high risk cases. “If the hospital accepts high risk cases then it is possible that a chain of deaths can happen in a short span. At a given time, some patients have a high Sequential Organ Failure Assessment (SOFA) Score. So if the patients had a high SOFA score they can die in a few hours’ time, provided we know what their morning condition was,” he added.
A study has shown that in ICUs, among the total number of admissions, around 20 per cent die, he said. He also added that the number of deaths have to be seen in proportion to the number of beds in the facility. The 15-bedded facility in GRH had 10 patients on life support.
(With inputs from Janani Sampath)