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Expired medicine, no oxygen: audits flag gaps in Bihar’s ambulance service

On May 19, 2021, during the devastating Delta wave, then Leader of Opposition in the Bihar Assembly, Tejashwi Prasad Yadav, converted his official residence at 1, Polo Road into a Covid care centre. With beds, oxygen cylinders, private doctors and free food, the centre ran almost for a month. Yadav, now the state Health Minister, was flagging what then was a national challenge: a strained health infrastructure struggling to cope with a record number of cases.

The infrastructure included Dial 102, the call-an-ambulance service run by the consortium of Pashupatinath Distributors Private Limited (PDPL) and Samman Foundation between 2017 and 2022.

From expired medicines to missing oxygen cylinders, lack of sufficient staff to poor hygiene, as many as 12 audit reports between 2019 and 2021, which cover the two fateful Covid years, raised question marks on the service offered by PDPL and Samman, an investigation by The Indian Express has revealed.

The Indian Express accessed these audit reports prepared by State Resource Unit (SRU), a wing of CARE, under the National Health Mission (NHM):

The key illustrative examples:

October 4, 2019: In seven ambulances inspected in Bhagalpur and Munger districts, expired consumables, including micro-drip sets, were found on board ambulances (no number mentioned). No oxygen cylinder was found in any ambulance in Jamalpur, Munger.

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February 13, 2020: In seven ambulances inspected in Vaishali and Muzaffarpur, expired medicines found in “some of ambulances”, air-conditioning was non-functional in almost all ambulances and the minimum set of drugs stipulated were not kept in any ambulance.

A fleet of ambulances on the campus of the State Health Society of Bihar in Patna. The contract, given to PDPL on May 31, was for running 2,125 ambulances as part of the Dial 102 service. Express photo A fleet of ambulances on the campus of the State Health Society of Bihar in Patna. The contract, given to PDPL on May 31, was for running 2,125 ambulances as part of the Dial 102 service. Express photo

February 24, 2020: In Nalanda and Nawada, expired medicines and consumables were found in two of four ambulances inspected, minimum quantity of drugs was not kept in any ambulance inspected; AC was non-functional in two of four ambulances and standard hygiene was not followed in any ambulance.

February 24, 2020: Expired medicines were found in five of the nine ambulances inspected in Supaul, Samastipur and Darbhanga; air conditioners were non-functional in four vehicles and non-availability of minimum drugs in all ambulances.

July 6, 2020: On 14 ambulances inspected in Vaishali, Muzaffarpur, Samastipur, Supaul and Darbhanga districts, the audit found expired medicines in four and empty oxygen cylinders in three.

This is the second stint for PDPL running Dial 102 ambulances but this time as sole bidder. This is the second stint for PDPL running Dial 102 ambulances but this time as sole bidder.

December 15, 2020: Of five ambulances inspected in Arwal, Bhojpur and Buxar, expired medicines were found in three and oxygen cylinders were missing in two ambulances.

February 10, 2021: Of the 11 ambulances inspected in Jehanabad, Sheohar, East Champaran and West Champaran, expired medicines were found in five, an empty oxygen cylinder in one ambulance – and non-functional blood pressure checking machines in eight ambulances; all ambulances were found unhygienic.

Another instance of how Dial 102 ambulances services performed during Covid was a letter written by State Health Society of Bihar (SHSB), the state agency that monitors the Dial 102 service, to the consortium of PDPL and Samman Foundation on September 24, 2020 on poor services of five ambulances attached with the then dedicated Covid hospital, Nalanda Medical College and Hospital, Patna.

Incidentally, in 2017, PDPL and Samman Foundation, as a consortium, got the Rs 400-crore Dial 102 contract to run about 650 ambulances. Incidentally, in 2017, PDPL and Samman Foundation, as a consortium, got the Rs 400-crore Dial 102 contract to run about 650 ambulances.

The SHSB official flagged several issues with ambulances, right from empty oxygen cylinders to non-working AC and no power in cabin to no ventilator, non-functioning suction machine to no oxygen masks or nebulisers.

PDPL directors Brajesh Ranjan and Sunil Kumar did not respond to The Indian Express query on SRU’s adverse audit reports.

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Asked about the audit report’s findings, Samman Foundation director Irfan Alam claimed that its “responsibility was very limited to technical knowledge sharing.” All audit observations, he said, “are related to operations and management which was the sole responsibility of PDPL”.

While a representative with SRU declined to comment, a state health department source said: “After SRU audit reports, SHSB would write to the contracting company as a standard procedure.”

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As The Indian Express reported Monday, the Bihar government decided on May 31 to award the fresh Rs 1600-crore contract solely to PDPL for five years with an additional clause to extend the contract by another three.

This despite the court’s note of caution to wait until a petition challenging the contract was disposed of. PDPL’s directors are relatives and family members of JD(U) MP Chandeshwar Prasad Chandravanshi who has denied any favouritism.

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When contacted, SHBS executive director Sanjay Kumar Singh had said: “The state was running an estimated loss of over Rs 2.5 crore per month on account of the delay… so we went ahead with PDPL, the lowest bidder. As for the SC order asking the Patna High Court to dispose of the matter, the order does not look clear. The SC order did not stay the HC order but asked to consider other aspects. Under these circumstances, we sought the opinion of the A-G and decided to award the provisional contract to PDPL. If the HC orders otherwise, we will comply accordingly.”

© The Indian Express (P) Ltd

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