In a circular issued on Friday, principal health secretary Dr Pradeep Vyas has asked local authorities to carry out audits of oxygen consumption in private hospitals, taking the requirement of 7 litres/minute for a ward patient and 12 litres/minute for an ICU patient as the base numbers. Terming it “unscientific”, the medical fraternity said in Covid ICUs, patients on ventilators need up to 50-60 litres of oxygen per minute. Doctors said the state’s insinuation that oxygen was being “wasted” was merely to shift the blame and an attempt to cap usage.
Government must ensure that resources are not wasted or mismanaged. It is precious taxpayer money that is funding expenditure towards containment of Covid-19. If there is evidence to show that Maharashtra’s use of a precious commodity is not in line with national trends, it does call for greater scrutiny. At the same time, hospitals and doctors must not be made to feel that they are being reined in or not being given a free hand to decide the best line of treatment a patient needs.
Active cases in Maharashtra jumped from over 1.9 lakh cases on August 31 to nearly three lakh on September 1, increasing the demand for oxygen. The department’s analysis, however, showed that Maharashtra had 10%-15% active Covid patients on oxygen compared to the national average of 5%-6% . “So, it’s clear that there is no judicious use of oxygen,” the circular stated and asked district and local body officials to submit a record of patients on oxygen to the central control room.
Officials refuted that it was an attempt to cap oxygen use. Dr Vyas told TOI, “When you want to know about wastage in usage, pipeline and loose valve, you have to compare actual consumption vis-a-vis some normative number. These normative numbers are average consensus numbers compiled by experts.”
The circular said that Maharashtra had the highest number of oxygen-supported beds in the country and the daily oxygen consumption has rapidly crossed 600 metric tonnes (MT). “This consumption is not commensurate with the reported number of patients on oxygen in that particular district/civic body. There is gross mismatch particularly in private and civic hospitals in terms of patients on oxygen and quantity of oxygen consumed in metric tonnes per day,” it said. Though Maharashtra produces 1,200 MT of oxygen per day, a consumption at this rate would deplete the state’s stocks fast, it added.
But, doctors pointed out that there is no mechanism to get data of actual consumption. “Their fear of oxygen getting over is true, but that cannot put a clause to clinicians to stop oxygen to patients,” said Dr Deepak Baid, president, Association of Medical Consultants. He said the claim that oxygen was being exploited for commercial gains was “invalid” as it’s part of the package capped by the state. “Moderately ill patients can need 2 litres/minute to up to 8 litres/per minute, but in an ICU, patients could need up to 70 litres. The newer high-flow oxygen delivery devices need constant and good supply,” said Dr Dhruva Chaudhry, president, Indian Society of Critical Care Medicine and Covid nodal officer in Haryana.