Max fiasco: A doctor makes sense of why a hospital declared a living baby dead
The recent news of a hospital in Delhi that declared dead a newborn baby who was alive, and packed it off in a plastic sheet, has enraged people all over. As a doctor, with some experience, and a responsible citizen of the country, I would like to make a few observations that were not mentioned by the media while reporting the incident. I assume it may be because of the ignorance, or to keep the "sensational news alive", which is seemingly an essential component of "selling" news. Nevertheless, if it harms the image of a particular community, such sensationalism is best avoided. The Max Hospital incident is deplorable, and on the face of it (as reported by media outlets), appears to be a case of gross negligence by a doctor.
We are already grappling with one of the worst infant mortality rates in the world (37 per 1,000 live births). India tops the ignominious list of countries with the highest under-five mortality rate in the world (50 per 1,000 live births).
No wonder any complicated case is rushed to a private set-up. While the government has already failed us, the private set-ups are looked upon as the only hope, especially when they claim to have state-of-the-art facilities, and charge patients accordingly.
But had the news reporters done some unbiased and dispassionate research on this story, which actually required just to reach out to any of the paediatricians/neonatologists in town, or Googled the topic of "foetal viability", the coverage would have been more balanced. Therefore, for readers of this article, it is necessary for me to put out some very relevant facts that may affect the overall outlook in this case.
1) The unfortunate "baby" (I am calling it a child with lot of reservations, as it was at the cusp, deserves to be called a foetus technically) was 22 weeks, part of a twin "delivery" (technically termed abortion) while the other was a stillborn and the weight is not mentioned. But if its weight was less than 400gm - which is very likely in an extremely premature twin baby - it is technically considered "non-viable" (not fit for survival) even as per American standards, and it is best not resuscitated. Any baby whose weight is less than 500gm has rarely made it.
2) I would like to mention here that about two months back, a miracle was performed and history was made by a private hospital in Santa Cruz, Mumbai, where a 22-week-old was miraculously saved after a painfully prolonged four-month journey during which the child, aptly named Nirvaan, suffered a litany of complications.
It was a first in India, but could be made possible because of the extraordinary favourable points during the birth - he weighed 650grams, was a single foetus and from a healthy mother - all good pointers for the doctors to take the wafer-thin chance of 0.5 per cent survival in such cases after insistence by the parents.
Unfortunately, it never made big time news because it was not sensational enough, I guess.
3) In simple words, the ill-fated foetus in question was not fit for survival and even by undertaking desperate saving measures, which is against medical ethics, it stood a slim chance as low as 0.5 per cent of survival.
Such a foetus may have signs of life - twitching movements or heartbeat - for a few hours and in very rare cases for one or two days, or if kept on ventilator, for a few days.
4) Just to inform everybody, activists in India are running a strong campaign to declare 24 weeks as the higher limit of MTP (medical termination of pregnancy, or abortion of foetus), which at present is only 20 weeks, following enough scientific evidence.
5) Recently, the Supreme Court permitted a rape survivor to terminate her pregnancy at 24 weeks, which is beyond the permissible 20-week limit prescribed under the Medical Termination of Pregnancy Act, 1971.
So, as far as the scenarios vis-a-vis the Max Hospital case are concerned, insinuations of “judicial murder of a child" are not just ill-informed, but also unjust.
6) In an ideal situation, the circumstances should have been explained to the family and told that if they want, they can take the baby or wait in the hospital until the eventual "death". The cost of continuing with the resuscitation measures and the long-term bad prognosticators was done. The FIR states that the doctors mentioned that it may cost Rs 50 lakh, which is not an entirely wrong figure by realistic considerations.
7) Without mincing words, if the "aggrieved party" was not explained all that in writing and handed over the babies (which is highly improbable), it shows a very callous attitude on the doctors' part. But does it still fulfil the legal parametres of negligence or malpractice? I am not sure.
8) It is very much possible that all the things must have been explained to them because delivery of such non-viable babies is not so uncommon. Therefore, such a goof-up is highly irresponsible as it is impossible.
But, verbally explaining things is not enough. Patients at times later claim ignorance of any such consent given.
Also, sometimes such babies start breathing late, or breathe sparsely. So, it is tricky to decide how much life is there in the foetus. Especially, because such foetus may suffer from hypothermia, which can temporarily arrest all life activities, only to come back again when the temperature is raised.
But it does not alter the bleak prognosis of the foetus. Doctors do not take much trouble in such cases since anyway it is non-viable, especially when everything is explained and the patient/family has consented, which is usually the case. While I say that I don’t mean to defend the mistake of having sent the baby while there were signs of life telling them that it was dead, but the matter was not reported fairly by the media. Ask any neonatologist, and he/she can tell you better.
9) Now, I will give you another scenario, (especially in light of the recent Fortis FMRI fiasco) where the same foetus/baby would have been kept in the hospital, and the patient/family would have kicked a ruckus over “malpractice by Max Hospital for keeping a non-viable baby on ventilator or life support for money".
The same relatives would have turned the story on its head, and quoted the medical rules of "foetal viability" and blamed Max Hospital of “malpractice and over-billing by keeping a baby who was practically dead. While I'm not saying medical negligence doesn't take place, it does and is highly condemnable, half-truths and ill-informed media reporting can sow seeds of suspicion and give rise to fear psychosis among the common people about the conduct of doctors. Also, I would say that doctors too are humans who are prone to errors. However, strengthening the processes at the hospitals and improving the standards of training, especially the documentation and counselling part, is the solution.
10 ) Lastly, is it not gross "injustice" when the doctors are booked under harsh sections of IPC like Section 308 (attempt to commit culpable homicide) without even getting the other side of the story? Or consulting medico-legal experts? That too in a case of "abortion" that led to the expulsion of a non-viable foetus, and where the parents also must have anyway refused any resuscitation?
The doctors have been summarily terminated without any tangible inquiry.
My only hope is that all aspects will be taken into consideration by Delhi Police during investigation, and that it will take into consideration expert opinion and not buckle under public pressure and media trial.
Also read: Why India's public healthcare system is gasping for oxygen