In a bizarre move, the Maharashtra government has abruptly decided to 'ration' medical oxygen for patients in COVID-19 public and private hospital wards/ICUs, kicking up a row between the state and the medical fraternity.

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Doctors in the state have condemned the move as "unprecedented in the world", "terrible, horrible, abominable", something that could lead to "a sharp spike in COVID fatalities", with a veiled warning that they may be forced to abdicate the responsibility of treating Corona patients and "it will be better if the government runs all the private hospitals on its own".

As per a September 18 circular issued by the Principal Secretary (Health), the order was triggered by a very high consumption of Oxygen -- more than thrice the national average -- in comparison to the number of patients in COVID oxygen wards or intensive care units. The Principal Secretary (Health) said that the present consumption of medical Oxygen is above 600 tonne per day and at the rapid rate of growth, there are fears that this may outstrip the manufacturing capacity in the state after a few days. "The Government of India has expressed serious concern about the quantum of Oxygen being used in Maharashtra per day considering the number of patients who are on Oxygen," the Principal Secretary (Health) said grimly.

Adding to the woes is the fact that a figure of around 1,08,000 patients -- who have been discharged -- has not been updated on the government records owing to a discrepancy in manual tabulation. This implies that a lesser number of discharges and lower recovery rate is shown for Maharashtra, but if this figure was accounted for, then it would point to nearly 15 percent of all patients getting Oxygen treatment in the state - much higher than the national average of 5-6 percent, he pointed out. "So, it is clear that there is no judicious use of Oxygen," said the Principal Secretary (Health) unexpected rap, adding there was a tendency in private hospitals to put patients on Oxygen for duration more than necessary for 'commercial reasons' and such activities need to be scrupulously monitored.

Clamping down on hospitals, the government has now ordered that Oxygen consumption in wards must be limited to 7 litres per minutes and 12 litres per minute in ICUs. All hospitals have been directed to comply with these restrictions by conducting a consumption to prevent wastage of medical Oxygen due to leaks, etc. The Maharashtra Indian Medical Association (IMA) President minced no words by terming the order as "the biggest and most cruel assault" by the administration at the expense of a patient's life. "This is another direct battering on the professional autonomy of clinicians, an unwarranted questioning on the clinical acumen of doctors. It's an attempt to cover up bad governance of supply of Oxygen by such an unprofessional and unethical notification," the IMA President told IANS.

He said that there are some patients who would need 20 litres/minute and some even upto 80 litres/minute, known as high flow nasal oxygen (HFNO) and keeping such limits of 7-12 litres was "absolutely absurd", and the move was taken without even consulting the COVID Special Task Force set up by the Chief Minister. The IMA State Secretary said: "There can't be anything more ridiculous, insulting and derogatory to the entire medical profession which is fighting the deadly COVID pandemic and have dedicated their service to humanity."

An ex-office bearer and a IMA Member said all medicos are up in arms against this order since it could have a bearing on whether a patient survives or dies. The IMA president said that merely setting up jumbo COVID hospitals is not enough as it's the other medical infrastructure and doctors which ultimately help cure the patient, but "if anything happens to the patients, doctors get beaten up". Despite repeated attempts by IANS, the Health Minister and the Principal Secretary (Health) were not available for their comments on the matter.