The state needs to address the electrical maintenance issue at hospitals to ensure no such future tragedies take place
What can be a greater tragedy than the loss of human lives in the very place where the ill have gone to heal and come back to health? In the first week of November 2021, a fire broke out in the intensive care unit (ICU) of the 500-bedded civil hospital of Ahmednagar, snuffing out lives of 11 patients. What made the tragedy even more sombre was that these patients were hospitalised for COVID-19 treatment and struggling to recover. However, what killed them was not the virus, but suffocation and burn injuries. A few days later, a special newborn care unit (SNCU) in a government hospital in Bhopal was engulfed in fire and four babies lost their lives as soon as they had begun living. Earlier, on 9 January 2021, the district hospital of Bhandara witnessed the death of 10 infants in the neonatal intensive care unit. Each of these hospitals was a government unit performing the respective state’s obligatory function of healthcare. In each case, the fire struck the specialised units of the hospital. All three fires were diagnosed to be on account of electrical malfunctioning, primarily short-circuits.
In Maharashtra, the state government reacted by suspending the chief medical officer—the civil surgeon—and the healthcare providing staff lower down—the nurses. Later, the senior-most doctor on duty on that fateful day and three nurses were arrested. This did not go down well with the medical personnel manning these hospitals and the medical fraternity in the city, who did not consider it part of their duty to be responsible for an electrical engineering function. Neither were they equipped to understand its shortfalls. There were strikes, protests, and a general unwillingness to perform in such unfair stress. The President of the Indian Medical Association, Ahmednagar, expressed shock that clauses of sections 304 and 304AA were applied against the medical officer and the nurses. “Instead of accusing the medical staff on ground, why is not anyone questioning the officials of the public works department and electrical department regarding wiring and maintenance works which caused the fire in the first place”, he asked. However, action against the medical staff was common in all three cited instances. In Bhopal, three medical officers, including the director of the hospital were removed from their posts. The medical staff was also the first target of disciplinary action in Bhandara.
It is farcical to hold the medical staff responsible for electrical failures in hospitals. Their job is to look after patients and their treatment. The responsibility for overlooking the need for adequate finance and manpower for the hospitals primarily rests with the state and municipal governments
In Ahmednagar, despite a warning from the fire brigade department, the hospital was not equipped with fire extinguishers nor had fire sprinklers, hydrants, or smoke detectors. A belated announcement was made by the state’s health minister on providing separate funds for safety audit of district hospitals. He also said that a new post of fire safety officer in all district hospitals would be created. This was clearly an admission that the aspect of fire in the hospitals of the state had not been paid enough attention in the past. A similar statement was made by the concerned minister in Madhya Pradesh, assuring that the electrical wing of hospitals would be upgraded and a separate civil engineering wing will be constituted under the medical education department. In Bhandara, an amount of INR 1 crore had been sanctioned to construct an extension to the special newborn care unit. The construction happened but no fire clearance was sought and the installation of electrical fittings was not overseen by an electrical engineer.
It has been reported that a total of 93 people died in 24 hospital fire incidents between April 2021 and August 2020. More than half of these happened during the second COVID-19 wave in the months of March and April 2021. Further, in a study carried out of 33 hospital fire incidents in major hospitals with more than 100 beds between 2010 and 2019, it was found that the overwhelming cause of such fires was electrical and 78 percent of these were on account of short-circuit. The air conditioners of the hospitals were the most common source.
Several reasons can be cited for such tragedies recurring in city hospitals. Firstly, there is no doubt that public hospitals in India are overstressed on account of patient overload. This is true even in normal times. However, the pandemic rendered this pressure worse. Beds, equipment, and staff had to be added to cater to the larger number of patients, but time was too short to buttress the electrical systems. As a consequence, the electrical wiring systems of the hospitals were stressed beyond capacity. Their overuse led to overheating causing the fires. The addition of more beds into special care units meant not only more reason for electrical overheating but increasing the risk of fire. Just as medical staff needs rest to recoup, the air-conditioning system too needs a break. However, such respite was not available to the hospitals and their systems.
While some leeway could be allowed in terms of failures during the deadly second wave, there have been hospital fires in other periods as well. We have been repeatedly pointing out that while governmental organisations have been concentrating on building physical assets, their attention to the periodical maintenance of the asset has been found woefully wanting. Similarly, governments at their level have been miserly in providing both money and technical manpower for adequate and quality electrical provisioning in hospitals and their upkeep. It is farcical to hold the medical staff responsible for electrical failures in hospitals. Their job is to look after patients and their treatment. The responsibility for overlooking the need for adequate finance and manpower for the hospitals primarily rests with the state and municipal governments.
What needs to be done is that hospitals must upgrade and expand their electrical systems. Furthermore, governments should fix a maximum load of patients that hospitals can carry at a given time, given the infrastructure—physical and electrical—that they have. Any transgression beyond that in times of crisis is a serious cause of worry and would require very close monitoring of the hospital’s electrical systems. Each hospital also needs to be equipped with personnel drawn from the civil as well as electrical wings of the public works department to undertake periodical check-ups of the hospital’s electrical arrangements. Experts have also suggested simple measures such as sensible placement of electrical devices and monitoring equipment in oxygen-rich areas. Oxygen monitoring devices in intensive care areas has also been recommended. Storage of flammable materials and placement of central gas supply points should be away from the vicinity of patient care area and always in conjunction with robust fire detection and control methods. Safety audits as well as electrical audits need to be carried out periodically to check the performance of the fire-fighting equipment.
Training of all staff in handling fire-fighting equipment and fire preparedness is equally essential. Experts suggest that air handling units (AHU) ought to be installed in ICUs to circulate the air. Air handling units take air from the atmosphere, recondition it and circulate it within a building or a section of the building through ducts. Learning from these past incidents, public authorities must posthaste render hospitals safe from fires and allow them to run as decent providers of healthcare.
In this regard, it would be wise to mandatorily put all hospitals, including those run by the government, under the ambit of National Accreditation for Hospitals and Healthcare Providers (NABH). This is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organisations in collaboration with stakeholders. This would focus due attention on patient safety and quality of healthcare based upon set standards, through a process of self and external evaluation.
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Dr. Ramanath Jha is Distinguished Fellow at Observer Research Foundation, Mumbai. He works on urbanisation — urban sustainability, urban governance and urban planning. Dr. Jha belongs ...
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