Introduction

On the fateful night of 15th November, a heartrending incident took place in the Neonatal Intensive Care Unit (NICU) of state-run Maharani Laxmi Bai Medical College in Jhansi district of Uttar Pradesh in which a sudden fire broke out affecting 47 newborn babies. Out of them, 10 babies died instantly and 37 were rescued. Till date, the casualty amounts to 18 babies. The probable cause of the tragedy has been ascribed to be short circuit in the unit. The NICU has two sections - the outer unit for babies in a stable condition and the inner unit for those in a critical condition. It is suspected that the fire broke out in the inner unit. Other babies are undergoing treatment under intensive medical care.

The Jhansi incident is a grim reminder of the fire in a private clinic in east Delhi in May this year, in which seven infants lost their lives. ‘Similar incidents were reported from hospitals in Gorakhpur, Bhubaneswar, Kolkata and many other cities and towns in recent years.1

Government of Uttar Pradesh has instituted three separate enquiries into the incident, including a Magisterial Enquiry, an investigation by a panel of experts headed by the Director General of Medical Education (DGME) and another probe at the local level by the Divisional Commissioner and Deputy Inspector General of Police, Jhansi Range. According to the Principal Secretary, Medical & Health, govt. of U.P., “The probe will focus on what caused the fire, identification of the guilty or the laxity that led to the incident and recommendations to avoid incidents in future.”

National Crime Records Bureau (NCRB) Data on Electric Short Circuit-related Incidents

As per the NCRB data, Uttar Pradesh ranks fourth in terms of fatalities due to electrical short circuits, with 101 deaths in 2022. Odisha tops the list with 446 deaths, including 403 men and 43 women, followed by Maharashtra with 143 deaths, including 109 men and 34 women, and Bihar with 118 deaths (97 men and 21 women). Nationwide, 3,375 fire incidents caused by electrical short circuits were reported in 2021 (1808) and 2022 (1,567), according to the latest NCRB data.2

Report of the Electricity Safety Audit Remained Unheeded

Five months ago, a government-appointed panel conducted an electricity safety audit at this government hospital and made several recommendations. The audit was conducted as part of statewide drive in the wake of the fire incident in a unit of the SGPGI in Lucknow. The report dated June 20, 2024, had highlighted the following glaring lapses in this hospital:

Exposed wires with joints;

Many wiring connections were exposed and had joints, and junction boxes were left open, increasing fire risks. Aluminium wiring was reported to be improperly secured in numerous areas.

1. It was found that an overhead LT line was going only two metres above the gallery and the tin shade of the department of gynaecology and Obstetrics department. As per the rules, the distance from the ground should not be less than 15 metres.
2. Emergency electrical systems were found inadequate, and critical backups such as earthing mechanisms were absent. Cooling systems and fans in panels were missing or dysfunctional.
3. Basic safety precautions like securing live wires and replacing damaged components were not undertaken.
4. As per the report, two panels for the emergency system were found to be damaged, the main electrical panel's PDB (Power Distribution Board) earth strip was broken and the air socket not properly earthed. Besides, the main wiring was not found to be connected with the PDB/DB, leading to the possibility of electrical fires.
5. Lack of earthing and miniature circuit breakers (MCBs); According to the report, “What is most important is that even MCBs/MCCBs that prevent any damage to an electrical circuit in the event of an excess current were also found missing from most of the places in the hospital.”
6. Missing firefighting systems; The audit also found that there was no arrangement for firefighting systems like fire extinguishers and smoke alarms in most units of the medical college.
7. Distribution of circuits not match the power load. No compliance report was filed by the Jhansi Medical College authorities.3

The Panel Report and Action Taken

After receiving the Panel Report (a four-member committee) the Uttar Pradesh government removed on 27.11..2024, the Principal of Jhansi Medical College, Dr.Narendra Singh Sengar and suspended three staff members including the college's junior engineer (electrical )Sanjeet Kumar, NICU ward's nursing sister in-charge Sandhya Rai and chief superintendent Dr.Sunita Rathore. The panel report has not been made public yet.

Steps Ahead

Following the Jhansi Medical College incident, the state government has issued orders for conducting comprehensive fire safety audits across all hospitals and medical colleges in the state. According to the deputy Chief minister who also holds charge of Health and Medical Education portfolio, Brajesh Pathak, the wiring in ICUs (Intensive Care Unit) and operating theatres will be thoroughly inspected. He stressed that overloading inwards, which can increase the risk of short circuits and subsequent fire incidents, would not be permitted.4 The state government has also issued a stringent safety guidelines as follows:

• Conduct fire safety audit in each hospital, and medical college particularly focusing on ICU, and operating theatres;
• Keep multiple exit ways and clear of any obstruction;
• Install emergency lights that work when the power supply is switched off in case of fire;
• Senior doctor to take rounds with electrician and plumber to correct even small irregularities;
• At least one staff trained in evacuation process will remain on duty in each ICUs, among other staff.
• Remove all types of scrap vehicles, and furniture that might catch fire;
• Ask private hospitals too, for getting fire audit on their campus;
• If an electrical load of equipment has to go beyond the sanctioned load it will be done only with electrical engineer's approval;
• No electrical equipment will run via extension socket;
• Mechanical controlled ventilation load will be equal to sanctioned load, not more.5

The Union Health Secretary also directed States to constitute district-level committees to conduct physical inspections of all health facilities regarding fire safety compliance. The State authorities are also asked to take suitable action against the defaulters. The statement read as such:” States/UTs are also requested to constitute district level committees headed by District Collectors comprising of relevant officials from health, fire services and public works departments to undertake physical inspection of all health facilities. Such committees may also be directed to undertake suitable actions against the defaulters, as deemed necessary under the law.”6

The Local Hero

One Ram Kripal Singh, a local lawyer, had just moved ahead to guide his daughter-in-law Rajini, inside to feed her newborn grandson, who had been admitted to the NICU for breathing issues since November 8. ‘He stepped forward, gesturing for Rajini to hurry inside. But within moments, he saw a nurse running towards him, her salwar burning as she screamed. “Fire has broken out! Behind her, smoke was rapidly filling the area.” He ran inside, his eyes were burning. He was gasping for air. But Ram Kripal didn't think and just acted. He picked up as many babies as he could-15, maybe more, and handed them to people who could carry them out. He later described the scenario inside-"It was like a bomb had gone off-silent but deadly. Babies were charred. Some were still crying weakly. The flames were everywhere.” It is truly said that unusual circumstances bring about unseen heroes whose courage and bravery often go unsung.7

Conclusion

The fire incidents at Hospitals keep on increasing despite innumerable government advisories and instructions. In most of the cases, a short circuit is the primary cause. The recent incident at Jhansi Medical College is as painful as it was during the past incidents occurring at different places. The irreparable loss of 18 innocent lives is beyond redemption. Though the state government has instituted three-tier enquiries, and such a panel has submitted its report even. Action has been taken accordingly. But the glaring question remains as to what should be the level of proper implementation of the government diktats, and the role of supervisory authorities. For instance, the report of the fire safety audit remained lying with the Jhansi Medical College administration without paying any heed to its recommendations for five months. Had proper attention been given to the report and corrective measures been ensured, this gruesome tragedy could have been averted. This time again, the government has ordered a fire safety audit of government hospitals and medical colleges and issued stringent fire safety guidelines. But if the lacunae remain at the implementation level, things will remain the same, and the chain of such accidents will continue to thrive as usual. This is the time for the governments to show their strong willpower to combat the menace. At the same time, the civil society is also required to raise its voice stridently to ameliorate the prevailing situation in the country, particularly in the hospitals and medical colleges. Prevention is always better than cure, as the saying goes. This is, undoubtedly, time to act than to deliberate further.

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References:

1. Editorial, Hindustan Times, Nov 10, 2024.
2. Rohit Kumar Sing, Regular load audits crucial to prevent short circuits: experts, Hindustan Times, Nov 17, 2024.
3. Brajendra K Parashar, Audit exposed lapses, but hospital sat on warnings, Hindustan Times, Nov 20, 2024.
4. HT Correspondent, Hindustan Times, Nov 19, 2024.
5. Ibid.
6. HT Correspondent, Health secretary urges states to review fire prevention, Hindustan Times, Nov 19, 2024.
7. Haidar Naqvi, ‘I didn't think, I just acted’, says lawyer who rescued 15 babies, Hindustan Times, Nov 17, 2024.