Post-devolution emergency: Investigation report into deaths at JPMC submitted

Even now, the hospital says it doesn’t have credit to buy diesel.

KARACHI:

After two days of investigating the deaths of four patients at the neurosurgery intensive care unit at the Jinnah Postgraduate Medical Centre (JPMC), the five-member committee formed by the Sindh health secretary submitted its findings to the chief minister on Saturday.

On September 12, four people, all critical and on ventilators, died during the 13-hour long power outage at the recently devolved hospital. The neurosurgery ward sees an average of two people die a day because of the severity of the cases, hospital sources said. In fact, one of the two patients who died had come from the Liaquat Medical College hospital at Jamshoro. This patient had been attacked in the head with an axe and pus was oozing out from the woundthe wound was pouring pus, said the official, who did not want to be named because of the sensitivity of the matter. One other patient had come from Abbasi Shaheed Hospital and another was their own admission.

Three generators, 1,000 kVA each, were said to be bone dry as the hospital had mounted huge diesel bills, running into hundreds of thousands of rupees, and could no longer obtain additional fuel on credit. The following morning, when contacted, the health secretary arranged for 2,000 litres of diesel, good to last for about two hours should the hospital face a similar power outage. According to the administration at JPMC, the health secretary was on several previous occasions informed about the dire situation — the last written communication being on September 10.

Jinnah hospital maintains that it sent direct letters which were marked as received by the office of the health secretary. Just in case he did not actually see them or they were not delivered, several telephone calls were made, one of which was received by Additional Secretary Dr Sabir Memon who assured that he would pass on the message. When nothing came of that as well, more letters and telephone calls were made.

The investigation committee comprised vice chancellor of Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro Prof. Noshad Shaikh, principal for Sindh Medical College Prof. Umar Farooq, deputy health secretary Dr Jamal Shaikh, special health secretary Sikandar Panhwar and Prof. Azam Yousafani.

According to a member of the committee, who spoke on condition of anonymity, the findings indicate a degree of negligence on the part of JPMC’s administration. It raised questions on whether other hospital resources such as ambulances and cars assigned to the administration did also not have diesel. The hospital was asked whether Zakat could not have been used, but according to an official, there are strict rules governing this fund. Zakat meant to buy medicines for deserving patients cannot be used on diesel. According to reports from Daily Express, JPMC’s administration was asked whether they received an allocated amount for diesel from the federal government. JPMC said it did not. JPMC never had any separate fund for diesel for a long time, an official said. It used to have just one 1,000 kVA generator, acquired in 1988. When JPMC was under Islamabad’s control, the federal government’s public works department (PWD) deputed about 150 of its staff to tend to the hospital on a full-time basis. This included electricians, and staff who would fix the pumps, drainage and generators, among other infrastructure. As Karachi’s electricity supply situation worsened, the hospital expanded, and diesel became more expensive, the hospital developed an informal understanding with the PWD that it would somehow pay for the diesel. But this deal could not last for long and with devolution, the federally run PWD unit started to refuse to help the hospital. JPMC had made repeated requests in its budget assessments for a diesel allowance as well.

Devolution

Before Jinnah hospital was devolved about two and half months ago, it would receive its budget from the centre, about one billion rupees, on June 30 each year. However, with devolution, its financial worries started to crop up. The deaths are not the only crisis that erupted at the hospital after it was devolved to the Sindh government. Salaries, a delay in the release of funds for the payment of life-saving functions, such as oxygen supply, and a decision to relieve contractual workers have all taken a toll. A lack of clear communication and contact with the Sindh health department appears to have compounded the issue.

It is no secret that a tussle has been brewing between officials in the Sindh health department and members of the administration at JPMC. However, whether or not the blame of these four deaths can be pinned on any one individual or the entire administration of the hospital may require much more than a two-day investigation. On the premature leak of the initial findings to sections of the media on Friday, the steering steering committee comprising members of JPMC, the National Institute of Cardiovascular Diseases and the National Institute of Child Health, issued a statement. It read: “The premature conclusion reported in the media of an incomplete, biased inquiry which hasn’t even taken the statement of the executive director of JPMC clearly reflects the mala fide intentions of the secretary health of the Government of Sindh to destroy the institute to satisfy personal ego and vendetta.”

One of the terms of reference for the inquiry was to ascertain and affix blame on the “official guilty of negligence”. This assumes guilt and negligence and that one person is responsible, a hospital official said.

Given the nature of the inquiry’s terms of reference, the executive director declined to immediately give a statement to the team and said that she would first consult a lawyer. The initial inquiry report was thus allegedly prepared without her input and leaked to the media, sources said. Now an urgent application will be filed during the hearing scheduled for Monday to take up this matter.



Published in The Express Tribune, September 18^th, 2011.