Shri A.P. Joshi
Chairman: Empowered Committee on BMHRC
Department of Atomic Energy
Government of India
Anushakti Bhawan, CSM Marg, Mumbai
Sub: Case for effective administration of Bhopal Memorial Hospital Research Centre by the Department of Atomic Energy and rejection of proposal by the MP Government regarding setting up of an Autonomous Society for administration of BMHRC.
On behalf of five survivors’ organizations working for the medical care and rehabilitation of the survivors of the Bhopal disaster, we wish to present the following grounds for taking over the BMHRC, as directed by the Supreme Court of India on 19th July 2010.
- Madhya Pradesh government is not a competent agency for provision of health care to gas victims and has demonstrated its inability to improve its effectiveness.
Concerned by the poor quality of medical care available to gas victims in the hospital run by the Madhya Pradesh government, one of the undersigned organizations filed a Writ Petition in the Supreme Court of India in 1998. In response to this application and the thoroughly unsatisfactory replies of the Madhya Pradesh government, on 17th August 2004, the Supreme Court directed the setting up of the Monitoring Committee for Medical Rehabilitation of Bhopal gas victims. From 2005-2008 this Monitoring Committee, comprised of retired bureaucrats, physicians and others, submitted 6 reports on the basis of 50 surprise visits they made to various hospitals run by the Madhya Pradesh government.
These reports highlighted terrible inadequacies in terms of lack of specialists and doctors, absence of treatment protocols, unavailability of quality medicines, inadequacy of patient recording system, unhygienic and insanitary conditions and other lacunae. The Monitoring Committee also presented specific recommendations for improving the administration of health care in these hospitals.
A summary of the problems identified by the Monitoring Committee and the specific recommendations submitted to the Supreme Court is appended as Annexure – 1. On 16 June 2008 the Monitoring Committee wrote in its 7th Report to the Supreme Court “In spite of these reports there has been no appreciable change in the working of these hospitals commensurate with the efforts of the Committee. Hence the members unanimously feel, looking at the realistic situation on the ground, the onerous responsibility entrusted to the Monitoring Committee does not get discharged satisfactorily. Hence it is up to the Hon’ble Supreme Court that they may consider giving this responsibility to such an empowered committee that may ensure the fulfillment of the needs of the gas patients. ”
The Supreme Court has now through its order dated 7 January 2011 directed the Monitoring Committee to present the powers that would need to be vested upon it by the Supreme Court to ensure that their recommendations for the improvement of the health care of the gas victims be actually implemented.
The facts and opinions mentioned above that were presented by a Supreme Court appointed committee that includes experienced medical professionals, should be considered a strong indictment of the Madhya Pradesh government for its failure to provide health care to the victims of the world’s worst industrial disaster even after the passage of 26 years.
- The future plans of Madhya Pradesh government towards medical rehabilitation of gas victims show both incompetence and corruption.
Further verifiable evidence of the state government’s corruption and incompetence lie in the current Action Plan being followed by the Madhya Pradesh Government for providing health care and other services to the victims of the Union Carbide gas disaster in Bhopal.
The Plans for Medical Rehabilitation, for which Rs. 33.5 Crores has been budgeted, do not address any of the major recommendations made by the Monitoring Committee for Medical Rehabilitation of Bhopal Gas Victims set up by the Supreme Court of India.
95% of the budget for Medical Rehabilitation is for building infrastructure or purchasing equipment. Just purchasing equipment is 79% of the total budget for health care delivery to the gas victims. Further, 70 % of the amount budgeted for purchase of equipment (some such as “Automatic Microorganism Detection Instrument and “Identification and Sensitivity of Microorganisms” indeed being fictitious) is meant to be spent on purchasing equipment for just one hospital.
We draw your attention to a detailed critique of the Memorandum on Plan of Action for Relief and Rehabilitation of Bhopal Gas Tragedy Victims submitted by the Department of Bhopal Gas Tragedy Relief & Rehabilitation, Government of Madhya Pradesh [Annexure – 2].
These lacunae in the Action Plan drew strong criticism from the Ministry of Chemicals and Fertilizers (Nodal Ministry on Bhopal), Ministry of Health and Family Welfare and Planning Commission.
Below we present extract of comments expressed by these agencies [details of responses are appended as Annexure–3.
17th April 2009: Comments of Ministry of Chemicals & Petrochemicals to M.P. Government Medical Rehabilitation
- The mechanism for monitoring & implementation of action should be mentioned in the Plan of Action.
- Steps in overcoming under staffing in various gas Relief hospitals and dispensaries need to be overcome.
- After scrutiny of the proposed plan of action we find that there is a diverse nature of different rehabilitation activities & the skills required for implementation may not be adequately available with the Department of Bhopal Gas Tragedy Relief & Rehabilitation, Madhya Pradesh.
13th Mar 2009: Comments of Planning Commission & its divisions
- It is advised that the Empowered Commission for rehabilitation of the victims of Bhopal Gas Leak Disaster be set up at the earliest (as an alternative to the MP Government).
- The current administration of BMHRC is far from satisfactory and it is possible that the situation will get far worse following greater involvement of the state government agencies.
Below we present the main issues concerning the administration of BMHRC that have led to denial of adequate health care and further led to re-victimization of victims.
Discrimination against gas victims:
While the BMHRC was set up exclusively for the victims of the Union Carbide disaster as per the October 3, 1991 order of the Supreme Court, gas victims have always faced discrimination in this hospital. Compared to private (paying) patients (including corporations and their employees) gas victims (entitled to free medical care at BMHRC) have far less access to services and facilities such as Consultation from specialists, Investigations, Admissions, Procedures, Surgeries and quality medicine.
- Private patients do not have to wait to get investigations like TMT, Angiography, Angioplasty, MRI & CT scan whereas the waiting period for these investigations for gas victims are usually several weeks to several months.
- Data from the Dialysis Unit of BMHRC shows that in 2010, 900 gas victims (who form the majority of the patients) were able to avail facilities for dialysis whereas the number of private patients who received dialysis in the same period was 3000. Several gas victims suffering from renal failure have died (we have the names of a few of them) because BMHRC would not admit them in the hospital for dialysis as all the beds were occupied by the private patients
Lack of facilities specific to gas victims:
Consequences of the toxic exposure on women’s health are well documented by ICMR’s research, yet there is no department of gynecology at the BMHRC. There is one gynecologist each at only 2 out of its 8 community units. While the Supreme Court categorically mentioned the likelihood of high morbidity among children born to the gas exposed parents, the BMHRC does not have a department of pediatrics.
Converting non gas victims to gas victims:
As the same hospital caters to both non paying gas victims and paying non-gas victims, it has given rise to a fairly organized system of corruption involving officials who routinely assign gas victim’s ID’s to non-gas victims in exchange of payment of several thousand rupees. A recent case of Mr Pawan Sharma has come to light where a private patient was assigned Mr Sharma’s gas victim ID and all Cardiological tests were conducted on the private patient free of cost. The official implicated in this case is Mr. Mazharullah, the Public Relations Officer of BMHRC.
No treatment protocols:
Since its inception BMHRC has not developed any standardized treatment protocols specific to health problems associated with toxic exposure. Examination of drug utilization patterns at BMHRC and its community units have indicated usage of needless and potentially harmful drugs.
No Benefits of Computerization:
Well over Rs 15 crores have been spent by BMHRC towards computerization of medical data and issuing smart cards to individual gas victims. None of this data contributes to treatment & follow up of victims. Computers are only used for inventory of medicines and for accounting purposes.
Charging Gas Victims for Services:
Thousands of gas victims, who are entitled to free medical care, have had to pay thousands of Rupees to obtain CD’s of Cathlab procedure records, X-rays, MRI/CT scan films, reports of other investigations and cardiac ambulance.
Consultants Cut on Private Patients:
The Specialist Consultants employed at BMHRC mostly cater to private patients as they make considerable monetary gains through this. The cardiology OPD sees 50%-60% private patients on a regular basis. In 2010 some of these consultants have earned up to Rs 28 lakhs by administering care to private patients at BMHRC
Absence of research:
While research into long term consequences of toxic exposure is prominently mentioned in its objectives, the BMHRC has not carried out or published any research since its inception. According to the organization’s website – www.bmhrc.org, BMHRC has only person in the research department who is qualified in bio technology.
Unethical drug trials:
Recent media reports and information obtained by us through RTI Act show that Senior Consultants of BMHRC including Drs. S K Trivedi, Subodh Varshney, Rajni Chatterjee and others carried out clinical trials of at least 9 drugs on gas victims who came to them for treatment. We are attaching an editorial published in the respected journal Monthly Index of Medical Specialties for your information about these unethical trials. We are also attaching a report published in Live Mint that mentions the death of 10 of the subjects who were part of this trial.
We wish we had hard data to back our observations on BMHRC presented above (as suggested by Mr. C B Venkataramana during our meeting with him on February 9, 2010) but please let us assure you that it is not due to lack of trying. On 26 June 2009, one of us filed an application for information under RTI Act with the BMHRC. In our application we had explained that since BMHRC had received the land for the main hospital and the 8 mini units from the State Government it came under the purview of the RTI Act. In July 2009, BMHRC’s PRO responded by denying that BMHRC could come under the purview of the RTI Act. Since then our application is pending before the State Information Commission. We are attaching our applications and BMHRC’s reply as Annexures 4 and 5
In conclusion we urge you to undertake a thorough review of the manner in which the M P State Government has administered medical rehabilitation of Bhopal gas victims in the last several years. We are confident that an objective review will lead you to conclude that the medical care of the Bhopal gas victims (and their children) is too important a task to be left to the M P Government.
|Safreen KhanChildren Against Dow-Carbide
|Balkrishna NamdeoBhopal Gas Peedit Nirashrit Pension Bhogi Sangharsh Morcha
|Syed M IrfanBhopal Gas Peedit Mahila Purush Sangharsh Morcha
|Rashida Bee, Champa Devi ShuklaBhopal Gas Peedit Mahila Stationery Karmchari Sangh
|Rachna Dhingra, Satinath SarangiBhopal Group for Information and Action