Chicago, December 8,2017:
Compare the two situations in Delhi:
Case Number 1: Hospital Safdurjung, New Delhi (Under Central Government)
In June, 2017: Santi Devi – a 28 years pregnant woman delivered a preterm baby at Delhi’s Safdurjung Hospital. As per media reports, with a gestational age of 24 weeks. Birth Weight: 460 Grams. The hospital staff found no movement in the baby, made some attempts to revive and when these attempts failed, handed over the baby to the family to take it home.
At home,they found the baby alive and brought him back to the same hospital (safdurjung). The baby was readmitted.
As per the report published in the HT, father of the baby Rohit Kumar – a daily wage earner- said: “I wouldn’t have opened the polythene if it weren’t for the ladies of the family; they insisted on seeing the boy’s face. When we opened the cover we found he was moving his hands and feet.”
Safdurjung Hospital apparently set up an inquiry in this gross negligence. But, did any heads role in this case? Remember, Safdurjung Hospital does not come under Delhi Government.
Note: What happened to that inquiry that was set up? Details are not available.
Case Number 2: Max Hospital, Shalimar Bagh, N Delhi. A Private Hospital, but comes under jurisdiction of Delhi Government.
November 30,2017: Versha- a pregnant mother- checks into Max Hospital. She is pregnant with triplets (reduction was done, so she has in effect, Twin pregnancy). 23 weeks gestation. She delivered twins- one is still birth, another is live premature baby. According to Dr. AP Mehta- the consultant Neonatologist – the family was involved in the decision making right form beginning. Do Not Resuscitate (DNR) was signed by the family at the time of delivery. Comfort Care was started. The baby was later handed over to the family apparently in a plastic bag. While going to the cremation ground, the family noticed movements of the baby. They admitted the baby in a local Nursing home. (More details can be found at my article written at NewsGram: https://www.newsgram.com/hospitals-please-own-your-own-doctors-do-not-treat-doctors-as-scapegoats/ )
Max Hospital fired the Neonatologists- Dr AP Mehta and Dr Vishal Gupta.
Later on, Delhi Government canceled the license of the hospital
Now, let us look at some medical facts:
1. A fetus less than 22 weeks of gestation is considered Non Viable ( incapable of survival).
A fetus with a gestational age of 22-24 weeks: Borderline Viability. In Western world with advanced medical care, still the decision to resuscitate or not will depend upon many factors. Mortality is 98 % in a 22 weeker baby.
In such premature babies at the borderline of viability, it is not uncommon to see beating of heart (remember, heart has autonomicity), feeble and intermittent respirations and flickering of arms and legs for several minutes to many hours after birth, particularly when comfort care is being provided.
2. Why babies who were apparently dead and cold showed signs of life again? One possible reason is that in polythene bag, the babies get rewarmed and heart starts pumping again. This is just a plausible medical explanation and I can not vouch for the circumstances of the 2 babies cited above.
3. A family discovering the baby alive: This is an absolutely emotional and painful experience for the family. The babies should not be handed over to the family until declared dead by the doctor. However, such situations are equally agonizing for the caretakers too.
These kinds of disastrous situations are not an open and shut case of ‘criminal medical negligence’. Generally speaking, there is not an intent of the doctor to ‘kill’ the baby in such embarrassing medical situatioins . In Safdurjung Hospital case, it seems from media reporting that there was just not enough time spent on the baby to let ‘die’ peacefully and an opportunity for the family to spend and bond with a dying borderline non-viable baby (what we call Comfort Care in medical parlance).
However, by firing his doctors, Max Hospital’s administration shifted the onus on doctors, whereas the fiasco was a collective responsibility.
Why did Delhi Government led by incompetent Chief Minister cancel the license of the hospital based upon this case? The simple answer: Political Opportunism shown by Delhi’s Government on Ventilator.
Because, first Delhi government’s incompetence is well known. It was elected with a heavy mandate, but the govt has lost its sheen and is highly unpopular. It jumped upon this opportunity to score some brownie points and project itself of as a savior of people. Also, canceling a private hopsital’s license shows lack of policy understanding and typical communist mindset of early 1960s. Asking for damages from the hospital would have been a better step: it brings revenue to the sarkari coffer which the government could have spent on improving health standards. Right? Ouch! I am talking of health policy nuances which the CM may not understand! Afterall, its DDC is in absolute despair, just siphoning away tax payer money rather than coming up with some concrete policy suggestions.
Also, this happens because in India, governments are not considered accountable. There must be provision to sue the governing class also (municipality, state, center) and then you will see that Health Ministry in Delhi would have thought 100 times before taking this step. At this point, Health ministry is scoring points to cover up its own incompetence.
The families need healing touch. Doctors and the hospitals need to review their practices and do course correction.
Dr. Munish Raizada is a practicing Neonatologist in Chicago.