Hospitals requiring oxygen referral raise concerns over bureaucracy
There is a widespread rush for bottled oxygen across the country.
With the surge in Covid-19 cases, hospitals are facing an oxygen shortage, prompting many to declare that they will no longer take Covid-19 patients without an increase in oxygen.
The authorities intervened but this was not widely welcomed.
Blaming the current crisis on mismanagement of oxygen delivery, the Ministry of Health and Population on Saturday issued a circular on behalf of 10 oxygen manufacturers, most of them based in the Kathmandu Valley, urging them to not to provide oxygen to hospitals whether public, private or community-run without its letter of recommendation.
Private hospitals have condemned the government’s move, saying the move would be harsh on private and community hospitals and add bureaucratic hassles just to get the life-saving gas.
âAt a time when the country needs a unified response from government, the private sector and all other sectors in the current Covid-19 crisis, the government’s unilateral move aims to harass community-run hospitals and the private sector, âthe Association of Private Health Institution of Nepal, a group of private hospitals, said in a statement.
Kathmandu-based oxygen factories produce around 8,000 cylinders per day, but manufacturers say current demand far exceeds capacity.
But the oxygen manufacturers follow the directive.
âSince Sunday, we have stopped providing oxygen to anyone without a recommendation from the ministry,â said Gaurav Sharda, president of the Oxygen Industries Association.
Private hospitals have also criticized the manufacturers’ decision. They claim that the oxygen makers breached their contractual obligation to provide oxygen to private hospitals after the âunwantedâ government intervention.
âPublic hospitals have no beds. Private hospitals, where beds are available, have been unable to provide services due to lack of oxygen due to the government’s decision, âthe association said.
Kumar Thapa, senior vice president of the association of private hospitals, said they were forced to tour government authorities when oxygen was urgently needed.
âWe’ve been lining up at the oxygen factories so far. With the government’s decision, we were forced to queue at the ministry for the recommendation letter, âsaid Thapa, who is also a promoter at Alka hospital.
But the government argued that the recommendation from the health ministry was made mandatory to address the oxygen shortage in a coordinated manner.
âWho knows how many patients are in each hospital, how many are in intensive care units, on ventilators and in wards?â Jageshwar Gautam asked, indicating that only the government has this data. âTherefore, oxygen must also be distributed according to the number and condition of patients in each hospital. For this, the government is committed to ensuring that oxygen is properly distributed. “
Despite Gautam’s claims, the government publishes data every day on the number of patients with Covid-19 in hospitals. However, the data is not complete. For example, there were 50 Covid-19 patients at Kist hospital on Saturday, according to the hospital, but Saturday’s situation report does not show Kist hospital as having Covid-19 patients.
The hospital ran out of oxygen on Saturday afternoon and was able to get it from a government hospital to save the lives of its oxygen patients.
In addition, according to Gautam, the shift to the need for recommendations for oxygen use is also intended to discourage the delivery of oxygen to individual households amid the lack of oxygen in hospitals.
The oxygen makers say they have also dispensed oxygen to individuals as prescribed by hospitals or doctors.
Public health experts have also questioned whether the government’s decision would be practical.
“Hospitals that are overwhelmed with Covid-19 patients might need oxygen even at midnight,” Dr Baburam Marasini, former director of the Division of Epidemiology and Disease Control, told The Post, adding: ” Will the ministry prepare a letter of recommendation at midnight? “
Authorities say, however, that the process of finding letters of recommendation would not hamper the ability of hospitals to receive oxygen on time.
“The hospital management stays on top of its oxygen supply and they shouldn’t wait to receive a letter of recommendation until the hospital is on the verge of running out of oxygen,” said the Gautam spokesperson.
But oxygen continues to be a scarce commodity along with the bottles that contain it.
Nepalese police have started collecting oxygen cylinders from businesses and factories and distributing them to hospitals.
According to data provided by Nepalese police, as of Saturday evening, they have collected 2,781 oxygen cylinders across the country.
“Nine hundred oxygen cylinders were donated to hospitals in need of emergency supplies, while 1,881 cylinders were distributed to oxygen manufacturers,” said Chief Superintendent Basanta Bahadur Kunwar, also a spokesperson. Nepalese police.
According to the SSP Kunwar, oxygen cylinders used by businesses for non-medical purposes were taken by the police after requesting them from the owners.
âMany people also kept oxygen in stock, while some sold oxygen cylinders on the black market and also hid cylinders in stores and warehouses for future use. These were confiscated by the police, âKunwar told the Post.
But despite efforts, supply may not meet demand.
There is more than 80,000 people infected in isolation at home, according to the Ministry of Health.
âEven though 20 percent of them need treatment, we are unable to provide treatment,â a Department of Health Services official told The Post, asking not to be named.
As of Sunday, 88 Covid-19-related deaths were recorded across the country. The health ministry said 52 of them had died in the past 24 hours.
âThe other 36 people had died at different times and places,â Gautam, the spokesperson. “Some died on the way to hospital, some at home, and some tested positive only after death.”
The country has registered 8,777 new cases in polymerase chain reaction tests.
The number of active cases stands at 88,160.
As the Covid-19 pandemic continues unabated, doctors warn of an increase in the number of deaths if patients with breathing difficulties do not receive oxygen support.
âIf we have 2,000 beds and an adequate supply of oxygen, it will make a big difference,â Dr. Kiran Pandey, a doctor at Hams Hospital, told the Post. “The major problems lie in the management and coordination between the agencies concerned.”
(Arjun Poudel and Shuvam Dhungana contributed reporting.)