Oxygen firms accused of intimidating Mexican hospitals during pandemic

Benjamin Espinoza Zavala, a central Mexican physician, saw his entire Guanajuato hospital converted into Covid-19 wards in March 2020. The hospital's need for oxygen rose dramatically.
CryoInfra deliveries, which are part of Grupo Infra's group, sometimes slowed to one delivery per day. He had to purchase extra supplies to make up the shortfalls in supply. The prices went up.

The hospital purchased an onsite oxygen generator plant, also known as Pressure Swing Adsorption plants (PSA), at a cost totaling 3.5 million pesos (125,000). The plant could supply the hospital's entire staff and has already been paid for in savings. The PSA equipment produces 93% pure oxygen from oxygen, as opposed to 99.5% from liquid oxygen suppliers.

Hospitals in low- and medium-income countries have had the opportunity to benefit from the assistance of Unicef, World Bank and World Health Organization.

Grupo Infra saw that orders were falling. Grupo Infra's top executives, directors, administrators and doctors visited the hospital to inspect the plant, Espinoza, the general manager of the Celaya SA de CV Medical Specialties Centre, Guanajuato. The administrators who came to visit were polite and kind. We got along well.

Grupo Infras lawyers informed Espinozas hospital in June that it had violated its contract by installing this plant. They also threatened a severe penalty. We were fined 1,300,000.00 pesos (47,000) if we stopped buying from them.

Espinoza objected by pointing out that the hospital never stopped buying oxygen from the company, but had reduced its order. He said that the contract does not specify how much we have to purchase. Grupo Infra wrote later to him, raising the penalty to over 10,000,000 pesos (nearly 400,000.). Since June, he has been in negotiations with Grupo Infra but has not reached an agreement.

A Grupo factory in San Miguel Xoxtla (Puebla) carries an oxygen tanker. The company issued warnings and threats to hospitals that were producing their own oxygen supplies. Photograph by Pedro Pardo/AFP/Getty Images

Grupo Infra, along with Praxair Mexico, a third oxygen supplier in Mexico, were accused of spreading fear and doubt, deterring hospitals to switch to more cost-effective PSA plants, and threat of legal action if they did.

According to the Bureau of Investigative Journalism, the letters were sent by the companies to Mexican hospitals and contained misleading statements about the safety of the plants.

Grupo Infra stated that its actions were based upon Mexican regulations and industry documents regarding the use of PSAs and oxygen quality, as well as transport requirements. According to the company, it is not aware of any legal action against hospitals for installing PSA equipment.

Praxair and Linde, its German owner, didn't respond to our requests for comment. They had $27bn in 2020 sales.

Mexico is home to the fourth-highest Covid death rate, with 253,000 people. Research suggests that the actual figure could be three times higher, since testing numbers are very low.

The demand for oxygen has increased dramatically. The demand for oxygen has risen to such an extent that in December 2020, the number of cases in Mexico City exceeded hospitals' capacity. To protect the oxygen delivery lorries, the national guard was activated.

Dr Marta Hernndez Vzquez* is the director of Michoacn's hospital. She installed a PSA plant for her patients in October 2020. She treated patients with respiratory problems at her facility and required up to 40 cylinders per month. It cost her 30,000 pesos (1,00). She stated that she had grown tired of Grupo Infra's dependence and was looking for a more convenient and affordable supply. Grupo Infra provided fewer cylinders per month to the PSA plant, which meant that the hospital required fewer cylinders.

A medicinal oxygen plant. Grupo Infra warned hospitals that their onsite production was not in compliance with regulations and could put patients' lives at risk. Photograph: Jorge Abrego/EFE/Alamy

Grupo Infras sent Hernndez a letter on 6 October warning him that it would remove its cylinders if the hospital used them alongside onsite-produced oxygen. The letter also stated that such plants could put human lives at risk and that PSA plants, which were not in compliance with regulations, produce lower quality oxygen than Grupo Incra and can cause fires or explosions.

Hernndez wrote the letter to Ignacio Andrade (a biomedical engineer at HC Promedical), who had imported the plant from the US. When I first read the letter, I thought it was a joke. They were telling the truth and would kill people. AirSep, a US manufacturer, assured Andrade that the arguments in the letters were not true.

Jim Stunkel is vice-president at Assist International, a NGO that builds oxygen plants around the world. He stated: It seems obvious that the points in the letter are meant to prevent the implementation of PSA plants.

Dr Paul Sonenthal, a physician from Partners In Health added that it would be a risk to human life if a supplier of compressed gas were to suddenly remove its equipment from a hospital during a pandemic.

Praxair Mexico made similar claims to at least one hospital in a letter. According to Praxair Mexico, the hospital contract and the law prohibit the use of an onsite oxygen plant. Praxair would cease supplying oxygen if it continued. According to the letter, oxygen from PSA plants could worsen respiratory conditions and possibly cause death.

Grupo Infra informed the bureau that it does not recommend PSA equipment in hospitals with anaesthesia equipment, hyperbaric chambers or high-flow ventilation. We believe that PSA equipment is appropriate for hospitals in difficult-to-reach locations where cryogenic oxygen supply is complicated. These hospitals tend to be focused on primary care, and don't have the intensive care equipment required by 99.5% purity oxygen.

It is important that you mention that the current regulations stipulate that only respiratory therapies can use oxygen 93% grade (FEUM Pharmacycopoeia). It is not allowed to be used in anaesthesia procedures and equipment, high flow ventilation for patients or hyperbaric chambers.

Hernndez continues to use the generator plant. She stated that she believed the contents of the letters were not based and was being manipulated to scare or pressure me. She said that the plant's results were very pleasing to her. It's a relief that we can generate oxygen here.

Andrade believes at least five of the other hospital clients who received the exact same letter may have decided to stop installing PSA plants.

Leith Greenslade is the coordinator of Every Breath Counts Coalition. She stated: To receive a lengthy letter filled with legal jargon and serious medical claims as well as highly technical engineering terms and infrastructure terms, is intended to confuse the reader.

People line up to buy oxygen at Tehuantepec in Oaxaca. People caring for relatives with terminal illnesses are finding it difficult to pay for the gas, which has led to a rise in prices. Photo by Luis Villalobos/EPA

The coalition has written to Mexican hospitals and government officials to clarify that generator plants and the oxygen they produce are safe.

Mexico requires more than 100,000 cylinders per day just to treat Covid-19 patients.

Grupo Infra's situation worried me more than drugs, Espinoza said. Espinoza regrets not installing the oxygen plant. The cost of the oxygen plant was changed by the pandemic.

* Name change

Rosa Furneaux also reports