In the context of the recent incident, involving preterm babies, at Max hospital in New Delhi, India, we Dr. Munish Kumar Raizada, a Board Certified practicing Neonatologist and Dr. Bharti Raizada will like to bring following points to your attention. We must mention that we studied this coverage in media and also spoke to Dr. AP Mehta, the Neonatologist who handled the twins.
1. These Newborns were born preterm at approximatley 22-23 weeks gestational age. Even in the Western medical community, it is a well established fact that chances of survival are very dim at this gestational age. A fetus between the age of 22-24 gestational age is considered to be of borderline viability. Survival is 2 % in babies born at 22 weeks and such babies carry 85 to 90 % risk of neuro-developmental sequelae.
2.From the very beginning, the family was involved in decision making. Likelihood of survival, long-term sequelae, and treatment options were discussed with the family both before and after delivery. Every time family decided not to go for resuscitation. The family even signed the DNR (Do Not Resuscitate) papers.
According to Dr. AP Mehta: “I reviewed the baby with my associate consultants Dr Vishal and Dr Gaurav at 10,00 AM (about 2 1/2 hours after the delivery) and told the father that the baby had feeble heart beats. The father again said that they do not want any active treatment or intervention.”
3.Comfort care, which is a standard of care, was provided to newborns.
4.As per Neonatologist Dr. A. P. Mehta, he did not declare the newborn dead.
5. Neonate was handed over to the family by nurses, apparently in a plastic bag, without informing the doctors involved in care. We are assuming that this was not the first preterm delivery in Max hospital. The hospital must be having a policy in place regarding discharge and handing over the preterm neonate(s) to the family. If nurses followed the existing hospital policy then it is time for the hospital to change the system and policy.
6.The family reported that newborn was moving after discharge from the hospital. It is not uncommon for such premature babies to show involuntary movements, for hours, after birth at this gestational age. However, baby should not have been handed over to the family before the doctor declaring the baby dead.
However, following can be the medical explanations:
a] It is possible that the baby started moving his body parts after getting rewarmed in the plastic bag.
b] Was it a rare case of Lazarus Syndrome?
7.When this fact was brought to the notice of Max hospital, the physicians, nurses, hospital administration, high-risk committee, and ethics committee should have communicated with one another and should have explained to the family, again, that this even though a traumatic experience, however, does not change the course or management of the baby. Survival chances are still dim and chances of neurological sequelae are very high.
8. There is nothing which suggests negligence and lack of proper communication with family on part of Dr. Mehta.
As per Dr. AP Mehta: “After this interaction and discussion with father, I did not see or clinically examine the baby. Dr Vishal examined the baby at 12-12.30 PM and did not find any heart sounds. He informed the sisters (nurses) about the same and asked them to wait. I did not declare the baby dead. The Babies were handed over without my knowledge and approval.”
9.Media -without looking critically at the case- gave the verdict that doctors are guilty and negligent, before the full investigation.
10. Doctors are not devils. This entire event is traumatic for family as well health care providers. Hospital did not provide any support to the doctors.
Our appeal is:
a. Doctors should come forward in support of Dr. A. P. Mehta and his associate Dr Vishal Gupta who have been terminated.
b. Max hospital should establish a support group for physicians and reinstate the terminated Neonatologists.
c. Ministry of health should act responsibly and not rush to issue statements before the full impartial inquiry and talking to the involved doctors, nurses, family, and the medical facility where new born was re-admitted.
d.. Media should investigate, and present facts. Delivery of judgement is not media’s work.
e. Terminating doctors is not a solution. Analyzing, learning and changing the system and policies/guidelines is.
Dr. Munish Raizada and Dr. Bharti Raizada practice in Chicago.
To read further, how 2 premature borderline viable babies died in Delhi, but the trajectory was different:
Llink to the video: