CAG report had revealed irregularities in Baba Raghav Das (BRD) Medical College, Uttar Pradesh
A recent tragedy saw 63 children, including 17 infants, lose their life at the Baba Raghav Das (BRD) Medical College Hospital in Gorakhpur. It once again showcased the deplorable state of public healthcare in India. Initially, the death of children was cited due to lack of oxygen supply as the hospital hadn’t paid its dues to the supplier, but the Uttar Pradesh government denied it and attributed the cause of the deaths to Acute Encephalitis Syndrome (AES).
In the days that ensued the tragedy, as families mourned the untimely deaths of their children, the irregularities of the four government-run medical colleges in Uttar Pradesh and the callous approach of the state government in mitigating them also came to light. Especially, in the backdrop wherein it was revealed that the Comptroller and Auditor General (CAG) of India’s General Social Sector for the government of Uttar Pradesh report had already red-flagged the flaws in the running of these hospitals.
Decoding the CAG report
The CAG audited four colleges of the 19 government medical colleges (GMC) in UP – King George Medical University, Lucknow (KGMU, Lucknow); Lala Lajpat Rai Memorial Medical College, Meerut (LLRM, Meerut); Baba Raghav Das Medical College, Gorakhpur (BRD, Gorakhpur) and Maharani Laxmi Bai, Medical College, Jhansi (MLB, Jhansi).
The CAG social sector report states, “Uttar Pradesh is the most populous state in the country and has public health indicators far below the national average. Inadequacy of infrastructure available in medical colleges and their associated teaching hospitals are areas of serious concern in the state which need to be addressed on priority. The Medical Education Department is responsible for establishment and maintenance of well-equipped medical colleges, including teaching institutions, which are the premier referral centres for peripheral hospitals.”
It further informs, “The GMCs violated the provisions of General Financial Rules while procuring equipment. By extending undue favour to suppliers and purchasing equipment at a higher rate, financial management of the GMCs was not adequate as there were instances of retention funds for long periods in personal ledger account, diversion of funds, etc. This not only violated the provisions of financial rules but also deprived the patients of adequate healthcare as essential equipment were not procured in time.”
The CAG informed that the four hospitals, including BRD, parked their funds in Lucknow’s Kasturba Gandhi Medical Unit (KGMU) in violation of rules, resulting in delay in realisation of funds. The BRD hospital had parked ` 27.38 crores.
“The parking of funds not only violated the financial rules but also deprived the patients of adequate healthcare as essential equipment could not be procured in time. Government should enforce effective control systems to discourage parking of funds and to ensure that funds are utilised for the purposes for which it was sanctioned,” the government auditor stated.
A diseased state
The report also stated that gaping shortage of clinical equipment in BRD hospital was 27.21 per cent and non-clinical equipment was 56.33 per cent, which was against the minimum requirement prescribed by the Medical Council of India (MCI). The supply of oxygen comes under the non-clinical equipment segment.
The audit also cautioned the state, “Large shortages of clinical equipment not only had an adverse impact on the quality of education imparted to students but also affected health care service delivery to general public in these areas.”
Giving a grim picture of the GMC in Uttar Pradesh, the CAG report observed that the state did not procure clinical and teaching equipment though adequate funds were provided by the Government, resulting in shortages of equipment.
“The GMCs failed to provide adequate treatment to cancer/ heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being operated in hospitals due to lack of doctors/ technical personnel/ infrastructure. The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted. GMCs violated the provisions of General Financial Rules while procuring equipment by extending undue favour to suppliers and purchasing equipment at a higher rate. Financial management of the GMCs was not adequate as there were instances of retention funds for long periods in PLA, diversion of funds, etc. This not only violated the provisions of financial rules but also deprived the patients of adequate healthcare as essential equipment were not procured in time,” reveals the CAG report.
The audit report also mentioned that in March 2012, the UP government instructed that interest accrued out of its funds must be deposited in the government account.
The audit observes that records of KGMU from 2011-16 reveal an amount of Rs 210 crores was provided by the government for procurement of equipment. But an unspent amount of Rs 58.53 crores pertaining to the period 2011-16 was parked in savings bank account as of March 2016. The minimum interest accrued on the amount kept in the bank was Rs 2.83 crores. Against the aforementioned accrued interest of Rs 2.83 crores, KGMU deposited only Rs 0.95 crore in the Government account as of March 2016 and Rs 1.88 crores was yet to be deposited by KGMU in the Government account.
The encephalitis angle
Meanwhile the state government has informed that the cause of death was due to AES, including Japanese Encephalitis (JE). After the death of 63 children, the Ministry of Health and Family Welfare (MoH&FW) has announced a research facility for JE, which has been pending since 2014.
Year-on-year, the cases of AES and JE are long-time scourge in Uttar Pradesh. The major outbreak of JE was reported from eastern UP during 2005 which recorded more than 6000 cases and 1500 deaths. This led to a major decision to introduce vaccines in high endemic areas. As per National Vector Borne Disease Control Programme (NVBDCP), 26,686 cases of encephalitis were reported between 2010 and August 2017. Of this, 24,668 cases were of AES and 2,018 of JE. Out of those 4,093 died due to AES and 308 JE deaths were registered in the state.
Talking to Express Healthcare, a senior MoHFW official pleading anonymity said, “So many cannot die of encephalitis in two days, the cause of death can be different.”
Meanwhile, a public interest litigation (PIL) has been filed in the Allahabad High Court seeking a judicial inquiry into the BRD Hospital deaths. PIL has blamed the carelessness of the doctors at the hospital, questions the lack of effective measures to contain the outbreak of the vector-borne disease despite encephalitis claiming many young lives every year.
Reference:
CAG report – http://www.cag.gov.in/sites/default/files/audit_report_files/Report_No_2_of_2017_General_and_Social_Sector_Government_of_Uttar_Pradesh_0.pdf