KOLKATA: As the toll from the country's worst hospital blaze rose to 91 on Saturday, the mystery of why the fire department wasn't immediately called began to unravel.

On October 8, a minor fire had broken out on the ground floor of the same AMRI Hospital. Security guard Haradhan Chakraborty did the right thing by calling the fire station without waiting to alert his superior. The staff doused the fire before two fire tenders reached the spot but the firemen wanted to inquire. That, hospital sources said, angered the management and Chakraborty was reprimanded and suspended for two weeks.

On Thursday night, four security guards were posted around the hospital building that caught fire. But all they did for the first 90 minutes was apparently try to control the blaze themselves. By then, the smoke had climbed four floors.

By the time firemen arrived at AMRI Hospital on Friday morning, the battle was over. Fire officials who reached first confirmed that when they arrived, the entire building was covered with thick smoke. "The basement was too hot for us to enter and reach the seat of fire. That usually happens when the fire has been burning for quite some time," said a fire official.

Joint CP (crime) Damayanti Sen said the Lalbazar control room received the first information of the fire at 4.08am and in two minutes, informed the fire brigade. But by then, hospital guards who tried to douse the fire and wasted precious time, had allowed the fire to go out of control. Meanwhile, deadly carbon monoxide had wafted into all rooms in the hospital through the air-conditioning ducts.

As per the protocol set by AMRI management, employees and security staff informed night administrator Sajid Hossain, who was to then alert all wings of the hospital. "We can't inform police or fire brigade individually. Only the night administrator can take such a decision," said Prasanta, a hospital employee.

According to hospital maintenance staff, the fire was first spotted close to the building's basement pharmacy that is part of the hospital's central store. It was the pharmacy staff who spotted the fire first and alerted the security staff. "After the pharmacy staff spotted the fire, they gave a "code brown" alert which means there is a fire. The code is used to prevent panic among other sections of the staff as well as patients and their relatives," an employee explained.

Since small fires aren't uncommon in an establishment as big as a hospital, he didn't panic. He saw maintenance staff rush into the basement. After a few minutes, one of them emerged and sought assistance to douse the fire. "All four of us went to the basement and found the fire was widespread, covering a lot of area before the central store. Heaps of empty packing boxes and stock of cotton and bandage were on fire," said another security guard.

The staff used all 10 portable extinguishers at hand but could not arrest the flames. An employee said they had initially managed to contain the fire but a single flame suddenly leapt out and licked a stock of chemicals. That lead to spreading of the fire.