The Punjab Institute of Cardiology has been slowly degenerating, after having been devolved to the provincial government. Presently, seven out of nine operation theatres in PIC are closed for sterilization, and all nine have been branded unsafe for use. This is alarming, considering the hospital serves almost the entire province and there are few alternatives. The bigger problem, outside of hospital administration, is the fragmentation of power and devolution gone wrong. The government, instead of removing the national health ministry, should have devolved most of its power while retaining some national roles. There are no national responsibilities at the moment, and there are divisions and incoherence between different sectors.Most planning and policy-making related to health is usually made at the federal level. Right now, the health sector is divided between various ministries, divisions and departments. Planning and synchronization is done by the Planning and Development Division. The coordination with other countries and international organizations is under the Economic Affairs Division.The once efficient and consolidated PIC, is a victim of this confusion and the diffusion of responsibility. Unlike political institutions, the health sector runs best with a powerful centre, a well structured health ministry, that knows what to do and when to do it, and can coordinate between provincial and national interests. Either the government should vest more power in the provincial health ministry and enable it to make sound decisions, or the National Institute of Health should take over the job of coordination between various departments, provinces and international bodies.The questions surrounding the horrific findings in the PIC operation theatres, demand some accountability. Who is responsible for PIC today? Should we blame the current administration or the Punjab government, which took up the reigns of the institute after devolution? Despite administrators attempting to underplay the problem, somebody must come up with answers soon. Too many lives are at stake.