by : Vinay Sultan
AFTER PARTITION, 3.5 million Hindu and Sikh refugees came to India from West Pakistan. All major cities, such as Amritsar, Jaipur, Ajmer, Alwar, Ludhiana, Jammu, Lucknow and Delhi, witnessed an influx of refugees. The Teen Murti residence of Jawaharlal Nehru—the prime minister of the interim Indian government—was also swarmed with refugees. The Kingsway Camp in the outskirts of Delhi, which had been reserved for the royal tents of the indigenous princes during the Delhi Durbar of 1911, now housed the tents of the refugees.
On 24 January 1948, the press information bureau issued a press note. “At no time has the necessity of giving relief to vast numbers of our suffering countrymen been so great and urgent as it is today,” Nehru said in the note. “I feel that it would be desirable to have a central relief fund which can be used for any type of emergency relief of distress but which must now be especially used for the relief and rehabilitation of refugees from Pakistan who have come to India. I’m, therefore, starting a fund called ‘The Prime Minister’s National Relief Fund’ and I invite donations to this fund.”
As the note mentioned, the fund would be managed by a committee. But, in 1985, the committee formed to manage the PMNRF passed on all the rights to use this fund to the prime minister. Since then, the fund is used at the prime minister’s discretion. A joint secretary in the prime minister’s office helps the prime minister manage the fund.
On 28 March 2020, four days after Narendra Modi announced a nationwide lockdown on account of the coronavirus pandemic, another press note was issued by the Press Information Bureau. The title of this note was, “Appeal to donate generously to the Prime Minister’s Citizen Assistance and Relief Fund in Emergency Situations (PM Cares Fund).”
“The pandemic of COVID-19 has engulfed the entire world and has posed serious challenges for the health and economic security of millions of people worldwide,” the note said. “In India too, the spread of coronavirus has been alarming and is posing severe health and economic ramifications for our country.”
In a similar way to the 1948 note, the press release talked about the need for a new fund, as if the PMNRF never existed. “Keeping in mind the need for having a dedicated national fund with the primary objective of dealing with any kind of emergency or distress situation, like posed by the COVID-19 pandemic, and to provide relief to the affected, a public charitable trust under the name of ‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’ (PM CARES Fund)’ has been set up,” the note said. “Prime Minister is the Chairman of this trust and its Members include Defence Minister, Home Minister and Finance Minister.”
Figures available in the public domain show that substantial money has been donated to the fund, but the government has steadfastly refused to reveal exactly how much money it has received. It has refused to provide information about the fund under right-to-information requests, maintaining a suspicious lack of transparency of dubious legality. Meanwhile, questions have been raised over tenders processed under the fund. While the fund was supposed to ensure that the health system did not feel a shortage of ventilators and oxygen, it failed miserably in the face of the pandemic’s second wave.
Hospitals ran out of ventilators, and shockingly large numbers of PM CARES ventilators turned out to be faulty. Where the ventilators were available, they went unused because there was a lack of technical staff for operating, installation, repair and maintenance of the machines. Media reports have shown how government neglect ensured oxygen plants promised under PM CARES remained pipedreams during the second wave. The resultant loss of lives necessitates a probe into how this money was spent.
ON 19 MAY 2020, the Times of India reported that, till May 2020, at least Rs10,600 crore been donated to the PM CARES Fund. This was not an official figure. The newspaper had come up with the number by compiling donation figures available in the public domain. According to this report, private-sector companies donated a total of Rs5,565 crore. A total of Rs3,249 crore came to PM CARES from the funds designated for corporate social responsibility by public-sector companies. A sum of Rs1,191.4 crore was purported to have come from the salary of central-government employees, and Rs413 crore was donated from the local-area development fund allotted to members of parliament. Three months later, the Indian Express reported that, of the 55 PSUs with which it had filed RTI applications asking for data on donations, 38 PSUs had responded. Of these, ten PSUs donated Rs100 crore or more, with ONGC depositing the maximum amount.
According to the Express report, many PSUs donated more money than their CSR budget to PM CARES. The estimated CSR budget of Power Finance Corporation for 2020–21 was Rs150 crore. But PFC’s donation to PM CARES exceeded the budget by Rs50 crore. In 2019–20, PFC’s CSR budget had been spent on 29 projects, including projects on tribal health, rural childcare centres, upgrading government schools, constructing operation theatres and digital classrooms in tribal schools. But almost the entire CSR budget for 2020–21 went to PM CARES.
Many other PSUs split their contributions to PM CARES into two instalments to fit them in their CSR budget. Power Grid contributed Rs200 crore, with one contribution of Rs130 crore and another of Rs70 crore. OIL India divided its contribution of Rs38 crore into instalments of Rs25 and Rs13 crore. Rural Electrification Corporation Ltd broke its contribution into two instalments of Rs100 and Rs50 crore.
According to the Indian Express, as of 18 December 2020, soldiers of the Indian Army have contributed an amount of Rs203.67 crore from their salaries to the PM CARES Fund. The Indian Air Force has deposited Rs29.18 crore, while the contribution from the Indian Navy was Rs12.41 crore. Indian Railways employees contributed Rs146.72 crore.
Thus, we know that substantial contributions have been made to the fund, but the government is inexplicably keeping secret the official figure of total contributions.
On 18 June 2020, the activist Anjali Bhardwaj filed an RTI application in the prime minister’s office seeking a copy of all the available documents related to the PM CARES Fund. “PM CARES is not a public authority under Section 2(h) of the RTI Act 2005,” the PMO responded, eight days later. “However, relevant information related to the PM CARES Fund can be accessed at pmcares.gov.in.”
On 19 January 2021, 100 retired bureaucrats wrote an open letter to the prime minister expressing their concern over the lack of transparency in PM CARES. “The immediate cause of this letter is the refusal of the Government of India on 24 December 2020, to divulge details under the Right to Information (RTI) Act on the grounds that the PM Cares Fund is not a Public Authority under the ambit of Section 2(h) of the RTI Act, 2005,” the letter said. “If it is not a public authority, how have the Prime Minister, Home Minister, Defense Minister and Finance Minister, as members of the government, lent their designations and official positions to it? Why are they Trustees in their official capacity and not as private citizens?”
According to a 2019 Supreme Court decision, trusts, societies and even non-governmental organisations should be treated as public authorities if they have sufficient government funding. When money from the salaries of PSU and central-government employees was put in PM CARES, why should it not be seen as a public authority?
On 28 March 2020, a day after the formation of PM CARES, the ministry of corporate affairs issued a circular. The ministry said that the donation given to the fund will qualify as CSR expenditure. “Item no. (viii) of the Schedule VII of the Companies Act, 2013, which enumerates activities that may be undertaken by companies in discharge of their CSR obligations, inter alia provides that contribution to any fund set up by the Central Government for socio-economic development and relief qualifies as CSR expenditure,” the circular said. “The PM-CARES Fund has been set up to provide relief to those affected by any kind of emergency or distress situation. Accordingly, it is clarified that any contribution made to the PM CARES Fund shall qualify as CSR expenditure under the Companies Act 2013.”
The cited provision of the Companies Act, 2013 details which types of donations will be counted as CSR expenditure. “Contribution to the Prime Minister’s National Relief Fund or any other fund set up by the Central Government for socio-economic development and relief and welfare of the Scheduled Castes, the Scheduled Tribes, other backward classes, minorities and women,” the provision says.
Thus, apart from the PMNRF, only contributions to central funds set up for social and economic development of SCs, STs, OBCs, minorities and women can be counted as CSR. Since PM CARES is not targeted towards the development of these marginalised communities, donations to the fund could not have been counted as CSR.
In order to avoid this legal hurdle, the government rescinded the order and, on 26 May 2020, issued a notification amending the Companies Act to also include the PM CARES Fund.
On 1 May 2020, Samyak Gangwal, a young lawyer, filed an RTI application in the PMO seeking information about the PM CARES Fund. A month later, he received the same reply that Anjali Bhardwaj did: that PM CARES was not a public authority. Challenging the response, Gangwal filed a public-interest litigation in the Delhi High Court.
“The prime minister’s office says that the PM CARES Fund is not a public authority,” Gangwal’s lawyer, Debopriyo Maulik, told me. “But you can see that the office address of the PMO is given in the PM CARES Fund. The website of the PM CARES Fund has a .gov domain which is reserved for the government website. PM CARES Fund uses the national emblem Ashoka Pillar on its website, so can you say that the government has nothing to do with it? PM CARES Fund can be a well-intentioned fund. But every citizen has the right to know where the money is coming from and where it is going. If the intention is good, then what is the harm in bringing it under RTI?”
The solicitor general, Tushar Mehta, has been representing the PMO in the case. On 10 June 2020, Mehta told the court that he would soon file his reply in the matter and clarify why this type of PIL should not be given attention. The next day, an update appeared on the official website of the PM CARES Fund. SARC & Associates, a consultancy firm, had been appointed as an “Independent Auditor” of the fund.
But instead of allaying fears, the appointment raised doubts of its own. Sunil Kumar Gupta, the head of SARC & Associates, has close ties to the Modi government. According to the firm’s website, Gupta is a currently the auditor of ONGC, Indian Overseas Bank, SBI General Insurance and the Reserve Bank of India. His clientele includes many more government authorities, such as the Northern Railway, the Delhi Development Authority and the Directorate General of Hydrocarbons—controlled by the ministry of petroleum and natural gas—among many others. Gupta’s firm is also a consultant on matters related to income tax and the goods-and-services tax for the government.
Gupta is the author of nine books, including one titled Make in India. He has links with several BJP leaders, such as the union minister of state for Panchayati Raj, Purshottam Rupala. His website shows pictures of the Gujarat chief minister, Vijender Singh, releasing his books. The former chief minister Anandiben Patel, the BJP member of parliament Rakesh Singh and the union ministers Arjun Meghwal and Anurag Thakur have attended his book releases. The website also shows two pictures with Modi. SARC has put up an audit report of the PM CARES fund on its website for the financial year 2019-20. Since the fund was formed on 28 March 2020, the data covers just four days—till 31 March 2020. Needless to say, the data tells us very little about the fund. No report has been published for the financial year of 2020-21.
Photos on Gupta’s website also show that he attended the 2018 World Hindu Congress in Chicago, where the chief of the Rashtriya Swayamsevak Sangh, Mohan Bhagwat, was the keynote speaker. Citing Gupta’s relationship with BJP leaders, the RTI activist Saket Gokhale questioned the impartiality of SARC & Associates in an article for The Wire. “In my opinion, Gupta’s photos with ruling party leaders and his public media advocacy of the policies of Modi, who is the ex-officio chairman of the PM CARES Fund, could colour the public perception of SARC & Associates’ ability to conduct an independent audit within the guidelines of the ICAI,” Gokhale wrote.
ON 13 MAY 2020, the Press Information Bureau put out a press release, saying that a total of Rs3,100 crore has been allocated from the PM CARES Fund. It said that fifty thousand new ventilators would be purchased for Rs2,000 crore. Of the remaining funds, Rs1,000 crore will be spent on the welfare of migrant labourers and Rs100 crore on manufacturing vaccines.
Five days later, Bhaskar Khulbe, an advisor to the prime minister, wrote a letter to the health ministry. He asked the health ministry to send a detailed proposal for the ventilators that were to be purchased under PM CARES. He also wrote in the letter that the manufacturers must be told to mention clearly on the ventilators that these were funded by PM CARES.
In August, in a response to an RTI application filed by Anjali Bhardwaj, the ministry said that it gave contracts to manufacture a total of 58,850 ventilators to six different companies. The largest of these contracts was awarded to Bharat Electronics Limited. This public-sector company had to make a total of 30,000 ventilators. The other five contracts were awarded to five private-sector companies through another PSU called Hindustan Lifecare Ltd. Allied Medical was supposed to provide 350 ventilators; AMTZ Basic was supposed to provide 9,500; AMTZ High End was supposed to provide 4,000; Agva Healthcare was supposed to provide 10,000; and Jyoti CNC was supposed to provide 5,000 ventilators.
The total cost of these contracts was stated to be Rs2,332.22 crore. HLL issued its first tender to buy ventilators from the private sector on 5 March 2020, before PM CARES had even been formed. On 18 May 2020, this purchase got financial support from the fund. But the tender process was suspicious from the beginning. Between 5 March and 18 April, HLL made nine changes regarding the specifications for ventilators. Eventually, two types of ventilators were ordered: low-end and high-end ventilators.
On 7 September 2020, in response to an RTI application by the activist Venkatesh Nair, HLL said that a “Joint Technical Committee” was formed for the testing of ventilators, under the leadership of the Directorate General of Health Services and included two members who worked with the Defence Research and Development Organisation. The JTC tested ventilators made by Bharat Electronics Limited, Agva Health Care, AMTZ and Allied. HLL declined to give information about the JTC’s evaluation of the ventilators. In its reply, HLL wrote that it could not share any information regarding this, since the report on this matter was prepared by the JTC.
In May 2020, questions started being raised for the first time on the quality of ventilators bought through PM CARES. A ventilator manufactured by the Noida-based company Agva was brought to Delhi’s Ram Manohar Lohia Hospital for a trial. Many problems were found during the trial, and a committee formed for this test said in its report that it was not able to maintain Positive End-Expiratory Pressure—a mode of therapy that maintains the patient’s airway pressure at a safe level after exhalation. “This requires further technical validation,” the committee wrote in its report.
Ten days later, another committee examined an Agva ventilator and submitted its report on 1 June. This committee gave the green signal to Agva’s ventilator. But the observations of this committee were creating conflict with its decision. The committee wrote in its note, “considering the COVID situation it is necessary to have ventilators available in adequate numbers throughout the country. … It should not be considered as a replacement for high-end ventilators in tertiary care ICUs.”
This committee instructed that the Agva ventilator should be purchased in several phases instead of in one go, and that feedback should be taken from users before purchasing the next phase. Also, when using this ventilator, other ventilators should be kept for backup.
Following the recommendation of the committee, five thousand of the slated ten thousand Agva ventilators were purchased. During a conversation with BBC Hindi, Divakar Vaish, a co-founder of Agva, said that they had delivered the first batch of ventilators in the first week of July 2020. At present, they have been asked to deliver the remaining five thousand ventilators.
On 18 June 2020, in response to an RTI application by Anjali Bhardwaj, the health ministry said that the 58,850 ventilators were tendered to five different manufacturers. But the JTC, after clinical examination, had found the machines of only three manufacturers to be fine. The ventilators made by them have been installed in different states. These three manufacturers were Bharat Electronics Limited, Agva Health Care, and Allied. The names of AMTZ and Jyoti CNC were missing from this list. It was clear that the ventilators of both these companies were rejected by JTC. Since AMTZ had received a tender to make a total of 13,500 ventilators and Jyoti CNC 5,000 ventilators, the number of ventilators officially procured under PM CARES came down from 58,850 to 40,350.
But, a month later, HLL shared contradictory information in another RTI response. The RTI activist Venkatesh Nayak had sought information about the names companies that have been issued purchase orders for ventilators. The list of names HLL provided included AMTZ and Jyoti CNC. AMTZ is owned by the government of Andhra Pradesh.
At this point, a new player entered the game of ventilator manufacturing: the Chennai-based company Trivitron Healthcare. The company got an order to manufacture ventilators in April 2020 from AMTZ instead of HLL, although it had no experience in making ventilators. On three different occasions, the company has provided three different figures on how many ventilators they got the order for.
The first figure came in a Huffington Post report, published on 23 September 2020. According to the report, Trivitron signed a contract with AMTZ to manufacture 10,000 ventilators for Rs373 crores. This included 7,000 low-end and 3,000 high-end ventilators. By the time the contract was made, the report said, Trivitron Healthcare had not even prepared a prototype. The company told the Huffington Post at that time that it had manufactured the 10,000 ventilators that were ordered, but had not been able to deliver a single ventilator because it had not received a dispatch order from HLL.
Seven months later, on 26 April 2021, GSK Velu, the managing director of Trivitron Healthcare, told BBC Hindi that he had received an order of 6,000 ventilators—not 10,000—and that the order comprised 4,000 low-end and 2,000 high-end ventilators. “We had a lot of stock lying around but didn’t get a single purchase order from HLL,” Velu said. “It was told from HLL that the government is pushing for vaccination and there is no need for so many ventilators, but two weeks before the second wave came, we have got the order and we have sent 1,000 ventilators to some state governments including Gujarat.”
Then, on 4 May, in an official statement to The Caravan, the company clarified that it received an order from AMTZ to manufacture only 2,000 low-flow oxygen ventilators. In this agreement, the price of one unit was fixed at Rs1,48,550. The company claimed that its ventilator was approved by the health ministry on 22 December 2020, and that it had delivered 650 ventilators till 4 May. It said that the remaining 1,350 ventilators would soon be delivered. The company also said that it had received advance payment for these 2,000 ventilators.
I reached out to the public-information officer at AMTZ over e-mail, but have not received a response.
In September 2020, in another RTI response, HLL said that it had issued purchase orders for 58,850 ventilators. Out of this, only 29,882 ventilators have been delivered to different states. Out of these, BEL has supplied 24,332, Agva supplied 5,000 and Allied supplied 350.
Thus, because of a lax approach in procurement, the government had only acquired half of the ventilators that it ordered by September 2020. In the second wave, it was the public that paid dearly because of a ventilator shortage.
ON 26 APRIL 2021, the union Jal Shakti minister, Gajendra Singh Shekhawat, visited hospitals in his parliamentary constituency of Jodhpur. At around 1.30 pm, he visited Mathuradas Mathur Hospital. On seeing Shekhawat, a young man told the minister that his mother was on a stretcher, and no doctor was seeing her. Shekhawat summoned the medical superintendent, and the hospital administration swung into action. But by then it was too late, and the woman died because of lack of treatment.
Shekhawat went ahead with his rounds. When he came upon an inconsolable family of a critical COVID-19 patient, he told them, “Offer a coconut to Balaji. Balaji Maharaj will do all his work right.”
The following day, there were 22 COVID-19 deaths in one day in Jodhpur. Shekhawat’s advice to the woman to offer a coconut to Balaji should be seen in the context that there were few other options for critically ill patients in the hospital, which received ventilators of terrible quality under PM CARES.
A total of 120 ventilators came to Mathuradas Mathur Hospital through the fund. BEL suppled 100 ventilators and Agva 20. “We understood from the beginning that the ventilators of Agva are not of very good quality,” a doctor working in the hospital’s anaesthesia department told me in May. “We installed some ventilators, but they were not able to maintain the pressure required. We had high hopes from the BEL ventilators. But the ventilators of BEL would suddenly stop functioning. There is an issue in starting them too. Two out of five will not start even after you try to start them. Even if started, no one can say when they will stop. Another big problem is the accessories of these ventilators. We do not have a single adapter or supply pipe in spare, so when any accessories get damaged, the ventilator has to be switched off.”
According to the doctor, BEL’s ventilators also had several problems. “There was also some issue of software in BEL’s ventilator even after being updated twice,” the doctor said. “But still it is not working properly. When the ventilators were new, the team of engineers of BEL was coming for inspection in every 15 days. We would tell the problem, the engineer would leave after promising to fix it the next time. Now, his last visit was in March, around Holi. We have been calling since one and a half months, but no one has come to check.”
The doctor said that BEL provided good service in the beginning, and engineers visited often when there were issues. “We expected that, sooner or later, these ventilators would start working,” the doctor said. “So, we did not raise any demand for ventilators in the department. Now, we have no time left for this. If we had got these 120 ventilators in running condition, then we could have handled the second wave of COVID with better ease.”
On 5 April 2021, the chief minister of Rajasthan, Ashok Gehlot, held a virtual review meeting on the COVID-19 situation with various administrative officers and officials of the medical department. Dr Lakhan Poswal, the principal of Rabindra Nath Tagore Medical College, Udaipur, first raised the issue of poor ventilator in this video conference.
“We got 85 ventilators from PM CARES,” Poswal told the chief minister. “Apart from ours, other medical colleges also have the same feedback. Our anaesthetists and ICU doctors have absolutely no faith in the ventilators with PM CARES. It works alright for one or two hours and then stops working. I also spoke to the principals of other medical colleges. Government of India’s CV-200 and Agva ventilators are not effective.”
Gehlot called for a detailed report on the matter. The next day, Vaibhav Galaria wrote a letter to the union health ministry asking for a solution.
The health department submitted a detailed report on PM CARES ventilators from all districts of the state. According to the information received by The Caravan, the report claimed that, out of 1,900 ventilators received by Rajasthan, 592 were not working. According to the report, 215 ventilators have not even been installed so far. Eleven ventilators are not being used because some of their parts are not available. The report says that another 366 ventilators have technical problems, such as pressure drop, compressor failure and sensor failure. The state government has so far made 188 written complaints to the companies making ventilators.
But Rajasthan is not the only state where complaints have been received about PM CARES ventilators. The Guru Gobind Singh Medical College and Hospital, in Punjab’s Faridkot, received 113 ventilators from PM CARES. Out of these, 90 were not working. The doctors of the anaesthesia department complained that the ventilators are unable to maintain pressure. Many ventilators shut down on the go. Because of this, doctors have not been able to muster the courage to use these ventilators.
Punjab received a total of 320 ventilators from the PM CARES Fund. According to a report published in The Hindu, 237 ventilators turned out to be defective. Out of 98 ventilators received by the Medical College of Patiala, 50 were defective. Out of 109 ventilators allotted to Amritsar Medical College, only 12 are working.
“We have raised these issues with the government,” Dr Raj Bahadur, the vice chancellor of Baba Farid University of Health Sciences, said in his statement to The Tribune. “We have even conveyed that the quality of the ventilators provided under the PM Cares Fund is significantly inferior. Besides, the functional machines, too, are constantly hit by snags, so we cannot use these for patients until we have a repair mechanism in place.”
The prestigious Post Graduate Institute of Medical Education & Research, Chandigarh, had expressed doubts about the capabilities of these ventilators as far back as July last year. The government allotted 20 PM CARES ventilators to the city’s Government Medical College and Hospital, but the hospital was not operational at the time. Therefore, ten ventilators were sent to PGIMER for trial. On 25 July 2020, PGIMER refused to use the ventilators that came through the PM CARES Fund.
Hospitals in Madhya Pradesh, too, reported similar problems about the ventilators. Dr Pradeep Kasar, the dean of Jabalpur Medical College, told The Caravan that the institute had received a total of 130 ventilators, out of which eighty percent are working.
A committee of six experts at the Government Medical College, Aurangabad submitted its report about the Dhaman-3 ventilator of the Rajkot-based company Jyoti CNC. According to the report, none of the 25 ventilators received could be used for the treatment of COVID-19 patients. This committee, led by the head of the medicine department, Dr Meenakshi Bhattacharya, concluded that the ventilators did not serve purpose of ventilating COVID-19 patients. It said that the patients got desaturated on these ventilators, and that these could not be utilised as ventilators in intensive-care units.
In May 2020, Dr JV Modi, the superintendent of Ahmedabad Civil Hospital, questioned the quality of ventilators by Jyoti CNC. On 15 May 2020, Dr Modi wrote a letter to the Gujarat Medical Services Corporation Limited, in which he described the ventilators of Jyoti CNC and Agva as useless.
The government needs to clarify why Jyoti CNC’s ventilators have been sent to hospitals despite the fact that the health ministry has said in an RTI response that Jyoti CNC’s ventilator was not approved by the JTC. On 28 August 2020, a month after the government’s RTI response, according to a report published in the Times of India, Jyoti CNC got an order to deliver 5,000 Dhaman-3 ventilators. Parakramsinh Jadeja, the company’s chairman and managing director, said that the Dhaman-3 model had been cleared by the JTC in another trial, held on 8 August 2020.
Another aspect of Jyoti CNC casts doubts on the whole process. The Virani family of Surat, which runs a jewellery company, is a big stakeholder in the Rajkot company. Jadeja told The Wire last year that the Virani family has a 46.76-percent stake in the company. The Wire’s journalist then inquired if this was the same Virani family that had gifted Narendra Modi a monogrammed suit with a fine embroidery of “Narendra Damodardas Modi” that purportedly cost close to Rs10 lakh. At this, Jadeja changed his statement and said some shares had been offloaded and that he would get back to them on the current status.
“As of today Virani family do not hold any shares,” he later told The Wire over email. He said the latest shareholding pattern filings made by Jyoti CNC in February 2020, which showed the Virani stake, pertained to the previous financial year. But, when Jadeja was asked who had the shares now, he did not give a direct answer.
Uttar Pradesh was one of the worst-hit states, even going by its highly dubious official statistics. Health systems in Lucknow, Prayagraj and Varanasi were battered. On 24 April 2021, at the height of the second wave, the state’s chief minister, Adityanath, had a virtual conversation with editors of various media institutions. He claimed that there was no shortage of medicine, beds and ventilators in the state.
Five days earlier, Vijay Kumar, a Kanpur resident, took his 27-year-old son Saurabh to the city’s largest hospital, a part of the Ganesh Shankar Vidyarthi Medical College. Despite Saurabh’s RT-PCR report being negative, he had been down with fever for three consecutive days. When Vijay came to GSVMC, there was no ventilator free. After his father pleaded with the hospital staff for about an hour, Saurabh was put on oxygen on the normal bed. But there was still no arrangement for a ventilator. Eventually, Vijay was told to take Saurabh to another hospital. He took his son to a private hospital in Swaroop Nagar. After a lot of pleading, the hospital agreed to put Saurabh on ventilator if the family paid Rs50,000 in advance. But, by then, it was too late. Saurabh died soon after he was put on the ventilator.
According to government figures, on 6 May 2020, 56 people lost their lives in Kanpur due to COVID-19. However, according to a report by Amar Ujala, on the same date, 297 people were cremated at various crematoriums in Kanpur. The principal of the city’s Ganesh Shankar Vidyarthi Medical College, Dr RB Kamal, told me that last year that a total of 120 ventilators from the PM CARES Fund had come to the Hallett Hospital attached to the medical college. Out of this, 34 ventilators were not working.
“We had 94 ventilators from BEL and 26 ventilators from Agva,” Kamal said. “Out of this, the ventilators of Agva were never installed. There is also a problem with the ventilators of BEL. First there was a problem of pressure. Later, after installing the humidifier gave issues, this problem was solved to some extent. But, due to continuous running of ventilators, problems have started coming in them too. Many ventilators have power problem. In many, the airflow sensor blows after working for a few days. On 1 May, BEL’s technical team came for eight ventilators [that] were faulty. Only six defective ventilators were repaired. But, within a few hours, they got damaged again.”
The problem with BEL, Kamal said, is that its assembling was being done by the company’s staff but its maintenance was run by third parties. “They have a shortage of staff,” he said. “When we report a problem, it takes four to fifteen days for the maintenance team to come. Due to the second wave of COVID, there is a lot of pressure on us from the patients. When the ventilators run continuously, they will need constant maintenance. But due to less staff, BEL is not able to provide maintenance on time.”
The situation in the neighbouring district of Etawah was even worse. According to a report in the Navbharat Times, five people died between 22 and 23 April 2021 in Etawah’s Dr Bhimrao Ambedkar District Combined Hospital. The reason was unavailability of ventilator treatment. When the chief medical superintendent of the district, Ashok Kumar Jatav, visited the hospital, Dr Abdul Qadir told him that, while the hospital had 20 ventilators, they could not be used due to lack of trained staff. Jatav asked Qadir to teach the sweepers of the hospital how oxygen is administered to patients.
Dr Bhimrao Ambedkar Memorial Hospital, attached to Pandit Jawaharlal Nehru Memorial Medical College in Raipur, is the largest hospital for the treatment of COVID-19 in the Chhattisgarh capital. A total of 46 ventilators were available in the hospital under the PM CARES Fund in May.
“Out of 46 ventilators we got, 38 are from BEL and 8 are Agva,” a senior doctor of the COVID-19 ward told me in May, on the condition of anonymity. “Five ventilators out of eight of Agva are not working at present. Five ventilators of BEL are also facing problem. There are several problems with Agva’s ventilator. They are hanging over and over again. Tried to turn on several times but would not turn on. We have kept them in backup. We don’t use them unless absolutely necessary. BEL is also having problems. Six ventilators were faulty. On 1 and 2 May, BEL’s engineers came to fix it. But they broke down again.”
On 11 April, the BJP MP from Raipur, Sunil Soni, while addressing the reporters at his parliamentary office, accused the Congress-run state government of allowing 230 PM CARES ventilators to lie idle for ten months. In response, the Congress spokesperson Shailesh Nitin Trivedi alleged that 58 ventilators out of 69 received from the PM CARES Fund were defective.
“Last year, we got a total of 230 ventilators from the centre. A hundred and sixty are from BEL and 70 are from Agva,” the state’s health minister, TS Singh Deo, told me. “There is a lot of problem in maintaining these ventilators. Engineers are not available on time. Many machines supplied for NIV”—Non Invasive Ventilation—“don’t work … We have written to the central government about the problems being faced regarding the breakdown and maintenance of these machines.”
On 11 May 2020, a top health department official told me, “At present 38 ventilators out of 160 BEL ventilators were unopened. At the same time, only 50 ventilators out of 70 of Agva are working. Only one BEL engineer has been provided to repair these 160 ventilators, and the engineer himself is corona-positive. Due to this, the repair of ventilator is stuck.”
BJP-ruled Karnataka has its own peculiar problems. Karnataka received the first consignment of 640 ventilators under the PM CARES Fund in July last year. A section of doctors in Karnataka refused to use these ventilators. Giving clarification to the media, Javed Akhtar, the state’s health secretary, said, “One set of doctors said that ventilators supplied under the central scheme cannot be used for patients. We have tested them and found them capable of delivering the oxygen needs. We will go ahead and use the ventilators.”
In the next batch, 2,025 ventilators were sent to Karnataka through PM CARES. But Karnataka did not need them, apparently. “We have saturated our intake capacity in government hospitals,” the state’s health-services director, Om Prakash Patil, told the Indian Express. “We are assessing the oxygen and other capacities at private hospitals and allotting the excess ventilators to them.” On 23 September 2020, the Karnataka government announced that any private hospital could take these ventilators on loan. But the private sector did not show any particular interest in the PM CARES ventilators.
The second week of April 2021 was devastating for Bihar. On 8 April, there were only 1,911 official COVID-19 cases in the state. By 15 April, this figure had reached 15,853. Media reports from the time illustrate how the healthcare system was faring. On 1 May, according to the New Indian Express, the Bihar government decided to rent 207 ventilators provided under the PM CARES Fund to private hospitals. These ventilators had been lying idle for the last ten months. But, due to a lack of technicians, the ventilators could not be used.
Barely ten days back, on 20 April, 22 COVID-19 patients died in Banka, Bihar due to lack of ventilators. After these deaths, the local administration decided to try and install four ventilators, which had not even been unpacked till then. But this exercise was in vain—the uninterruptible-power-source systems of these ventilators were not working.
According to a report published on 26 April by BBC Hindi, out of 40 ventilators received by Darbhanga Medical College, not a single one had been operational. The same was the case with Gaya. Anugrah Narayan Magadh Medical College here had got 30 ventilators. Not one of them was operational.
On 22 April 2021, Sanjay Jaiswal, the president of the state BJP and an MP from Paschim Champaran, visited the Government Medical College in Bettiah. Jaiswal, a doctor by profession, was shocked to learn that the 26 PM CARES ventilators received by the medical college had not even been unpacked. Apart from this, the hospital had received 25 ventilators from the Defence Research and Development Organisation. These 51 ventilators could not even be installed.
Later, in a statement to the media, Dr Pramod Tiwari, the superintendent of the medical college, revealed a bizzare fact about the 51 ventilators. “The connectors of these 51 ventilators and the sockets installed by the hospital manufacturer L&T do not match each other,” Tiwari said. “We luckily found a local vendor who had five adapters. With the help of that, we were able to install five ventilators that are currently in running condition.”
On 15 May 2021, the PMO said that the ventilators purchased under the PM CARES Fund will be audited. But, given the commitment that the PMO has shown towards keeping the fund confidential, it seems unlikely that the report will be made public. The responsibility for the error in the procurement process needs be fixed.
In this time of gross negligence, it was ordinary people who stepped up to help each other. In Indore, a man named Pankaj Kshirsagar received a call from his friend’s daughter. She told him that his friend had been admitted to a hospital due to shortness of breath. After meeting his friend, Kshirsagar posted on Facebook: “People are in dire straits. We are not able to help anything despite our efforts.” Chirag Shah, a friend of Kshirsagar, commented on the post: “Then let’s do something. Can’t we come together and donate oxygen concentrators to government hospitals?”
The next day, the two visited Maharaja Yashwantrao Chikitsalaya, the biggest hospital in the city. At the hospital, Dr PS Thakur, the medical superintendent, told them that he needed Bi-PAP ventilators—a non-invasive mode of therapy—for coronavirus patients. Thakur then asked them if they knew anyone who could install a ventilator. Kshirsagar was a journalist by profession and an engineer by education. Shah was an engineering student. They said that they could try installing it themselves. Thakur took them to Maharaja Tukojirao Hospital, and Kshirsagar also invited another engineer friend. Far from installing, all three were unpacking a ventilator for the first time.
The trio pasted the diagram that came with the machine on the wall. These were ventilators of BEL that had come via PM CARES. It took about four hours for all three to install the first ventilator. But the attempt was successful. By midnight, the three had installed nine ventilators. The next day, Kshirsagar got a call from the super-specialty hospital, where the team installed 12 ventilators. After this, the team installed three ventilators in the nearby district of Dhar and two ventilators in Shajapur.
IN APRIL 2020, after the call of the prime minister to generously donate to the PM CARES fund, Shakti Pandey, an 18-year-old resident of Ghaziabad, broke her piggy bank and deposited Rs5,100 in the PM CARES Fund. Almost a year later, during the second wave of pandemic, Shakti tested positive for COVID-19. The disease started with mild fever and then took a serious turn in three days. Shakti’s father, Shailesh, reached a nearby government hospital, but there was no empty bed. Shailesh took an unconscious Shakti to a private hospital in Ghaziabad.
“On the behest of the prime minister, we also donated money to the fund, played the thali, lit the lamps. But I wandered from door to door for oxygen,” Shailesh recalled, choking with emotion. “The hospital first put Shakti on the oxygen concentrator. When her condition did not improve, they simply gave up. They said either arrange oxygen on your own, otherwise take the patient. I started crying in front of them. Then after telling friends, I arranged two oxygen cylinders anyway. Only then was my daughter’s life saved.”
Ventilators and oxygen were going to be the most important weapons in the fight against the pandemic. While PM CARES promised to shore up supply for both, even after a year, the second wave of COVID-19 exposed the government on both ends.
On 14 March 2020, the central government declared COVID-19 a national disaster. About seven months later, the Central Medical Services Society, an agency of the ministry of health, issued the first tender for 150 Pressure Swing Absorption plants. PSA is a technique through which medical oxygen can be produced from a mix of gases in the atmosphere. The CMSS issued a tender for setting up 150 such plants in October. The first tender, for 150 plants, was issued on 21 October 2020. The last date for submission of tender was 10 November 2020. The tenders were allotted only in December. This means that the process of setting up PSA plants could start only about ten months into the pandemic.
In January 2021, the project became part of the PM CARES initiative, and 12 plants were added. On 5 January, the PMO website promised Rs201.58 crore for setting up 162 PSA plants in different states of the country. Out of this, Rs137.33 crore was going to be spent in setting up these plants, while Rs64.25 crore was to be spent on maintenance. A total of 154.19 metric tonnes of medical oxygen was to be generated through these plants.
On 18 April, an investigation by Scroll took stock of the 162 PSA plants to be set up in 14 states. Till then, only 11 oxygen plants had been installed. Of these, only five were working. Immediately after the publication of this news, the health ministry tweeted that a total of 33 plants had been installed. But it did not mention how many of them are working.
The same day, the ministry claimed in its tweet that, out of the seven PSA plants to be received by Himachal Pradesh, four had been installed. But, according to a report published in The Tribune on 23 April, only one of them was working. PSA plants were claimed to be installed at Zonal Hospital in Dharamshala, Deendayal Upadhyay Hospital in Shimla, Government Medical College in Mandi and YS Parmar Medical College in Nahan. Of these, only the Dharamshala plant was operational.
According to a condition in the CMSS tender, the agency was to supply all the parts related to the plants within 45 days. Meanwhile, the hospitals had to keep ready the civil and electrical work required for the plants. The installation work was to start after the “Certificate of Readiness” was issued by the hospital.
Scroll’s investigation revealed malpractice at several levels. It identified at least three companies that were awarded the contract to set up PSA plants: Uttam Air Products, Airox Technologies and Absstem Technologies.
Uttar Pradesh got 14 PSA plants, more than any other state, from PM CARES. On 18 April, the ministry of health tweeted that only one oxygen plant had been installed in the state. LLRM Medical College in Meerut, the largest district of western Uttar Pradesh, was supposed to get a PSA plant under the PM CARES Fund. In a statement given to Scroll, Gyaneshwar Kumar of the college said, “We allocated a site for the plant, but the machine is yet to come. I have phoned the company several times, but there is no response.”Absstem Technologies was responsible for setting up oxygen plants in Meerut.
On 24 April, the home minister, Amit Shah, was in his parliamentary constituency of Gandhi Nagar. He had come to inaugurate the PSA oxygen plant at an ayurvedic hospital in Kolavada. Here, he announced that Gujarat would soon get 11 more such plants under the PM CARES Fund.
However, just nine kilometres from Kolavada, Gandhi Nagar’s General Hospital is still waiting for its PSA plant. The Delhi-based Uttam Air Products got the contract to set up a PSA plant in this hospital attached to GMERS Medical College in Gandhi Nagar. Dr Niyati Lakhani of GMERS Medical College told Scroll that she had sent an email to Uttam Air Products on 13 January that the site was ready for setting up a plant in her hospital. After this, despite calling several times, there was no response from the company.
The CMSS blacklisted Uttam Air Products by issuing a letter on 13 April 2021. The agency wrote in its letter that the company could not submit the security deposit and necessary documents after getting the contract. In such a situation, it is not clear who is going to set up the PSA plant of GMERS Medical College, Gandhi Nagar.
To this day, the purpose of the PM CARES fund is not clear, given that the PMNRF already exists. By keeping it out of the purview of RTI, and through the suspicious use of its funds, the government has created a mess that can only be untangled with an independent investigation.
One possible purpose behind creating the fund could be a desire to do something historic. But lessons from history should not be forgotten in the desire to achieve historical fame. The most infamous Roman emperor, Nero, built a new palace in the centre of Rome, which was destroyed in the fire of 64 CE. It was named Domus Aurea—the palace of gold. But this palace was never completed. In later times, it became a cause of embarrassment for Nero’s successors. Rather than strive to etch his name in history through constructing big, beautiful buildings, a ruler should learn from history so that he is not remembered like Nero.
