Max fiasco: There's no defence for a hospital not knowing if a patient is dead or alive

Doctors alone should not be made scapegoats, responsibility lies with the hospital too.

 |  6-minute read |   07-12-2017
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The newborn who had been erroneously declared dead by Delhi’s Max Super Speciality Hospital on November 30 died at a nursing home in the capital on Wednesday, December 6.

The infant's family has refused to collect his body, demanding that the doctors responsible for his treatment at Max hospital be arrested. According to a report, his mother, 20-year-old Varsha, has demanded that the hospital be shut down, alleging that she, too, did not get proper treatment there.

Meanwhile, Max has sacked the doctors who were treating the child. A preliminary report by a panel set up by the Delhi government has found lapses on the hospital’s part. After the death of the baby, the case has been handed over to the crime branch.

Twin tragedy

The case came to light last week after Varsha gave birth to premature twins (23 weeks) — a boy and a girl — at Max hospital. While the girl was stillborn, the boy was breathing. According to the family, the hospital asked them for Rs 50 lakh to treat the child.

While the family was still discussing this, the hospital informed them that the boy had died, and handed them over the twins’ bodies in “polythene bags”. While on the way to conduct the children’s last rites, the family realised the boy was alive, and took him to another nursing home.

Viable foetus and medical negligence

Ever since reports of the case emerged, there have been discussions on whether the baby had any chance whatsoever to make it, or if he should be called a “baby” at all. At 23 weeks, it has been argued, he was just a foetus, not yet a fully-formed baby.

Photo:India TodayPhoto:India Today

Another point under discussion has been “foetal viability” – the ability of a foetus to survive outside the uterus. In the United States and other developed countries, foetal viability is limited at 22 weeks, which means that efforts are not made to resuscitate a foetus less than 22 weeks old, because there are next to no chances of it surviving.

In India, the law is less clear, and 22 weeks to 24 weeks are considered a “grey area” of sorts. The baby who died at Max was severely underweight, and it has been argued that had the hospital continued charging the parents to keep the baby alive for a few more days, that would have been unethical.

However, none of the above is defence for the criminal, unbelievable neglect on part of the hospital – that of declaring a living baby dead.

No one had expected Max hospital to miraculously keep the child alive, but the very basic thing one expects from a hospital is to know if a patient is dead or alive.

Report found violations

According to the preliminary report by the committee set up to probe the incident, the hospital did not perform Electrocardiography (ECG) to check if the infant’s heart was beating after the surgery. 

According to a report, “after scrutinising hospital records and meeting relevant staff, it [the committee] found that no ECG tracing was done to ascertain whether the child was alive”. An ECG test is done to measure the heart’s electrical activity to check if it is working normally.

The same says that the baby’s body “was handed over without written instruction”, “dead and alive children were not kept separately” and that “the hospital is guilty of not having followed prescribed norms”.

The child’s father, Ashish Kumar, has alleged that after he took his son to a nursing home, doctors there said he had contracted an infection as Max hospital put him in a plastic bag.

These mistakes or oversights on part of the hospital led to an indescribably horrifying experience for a young couple, who had to go through the agony of losing their child. Twice.

The few hours that the baby had to spend without medical care might have been crucial to his survival. Between the time Max handed him over "in a plastic bag" and his family managed to get him to another hospital, the critically unwell baby was without life support. While a baby born so premature needs to be kept in a temperature controlled environment, he was outdoors in the Delhi pollution.   

His parents might never be free of the feeling that had the baby not been taken out of hospital for those hours, he might have survived.

In any case, whether or not the baby would have made it does not exonerate Max hospital for the unconscionable negligence.

Breach of trust between hospital and patient

Ashish Kumar, 26, first got his wife admitted in a nearby nursing home. After she developed complications, he rushed her to a “super specialty” hospital. Private hospitals charge astronomical amounts, and people pay them in any way they can in the hope of getting the best care for their loved ones.

Even if the baby had almost nil chances of survival, was this explained to the family? Were they given the option to decide if they wished to keep paying to keep their baby alive with artificial support?

One does not go to a private hospital with the expectation that they will give up on a patient as a lost cause and not even monitor his vital stats. When a family pays through its nose, the least it expects is the hospital to be invested in their loved one’s treatment.

Delhi does have many government hospitals, but they are overburdened, and people choose private hospitals despite the prohibitive costs in the hope of more focused attention on the patient.

Neglect cannot get bigger than failing to notice if the patient is alive or dead.   

Not just doctors, hospital responsible too

Max hospital has already fired the two doctors responsible for the baby’s case, and before the child died, they had been booked for attempt to culpable homicide under Section 308 of the Indian Penal Code.

While the doctors are indeed responsible for negligence, the hospital cannot be allowed to get away by making scapegoats out of them.

When a person goes to a particular hospital, he is persuaded more often by the brand name of the hospital, not individual doctors. Under the Consumer Protection Act, not just the doctors, but even the hospital is the service provider to a patient.

It is the hospital’s duty to employ doctors competent enough to decide if a patient is alive or dead.

In the Max case, after the doctors were fired, the hospital came out with a statement saying: “While the inquiry by the expert group which includes external experts from IMA is still in process, we have decided to terminate the services of the two treating doctors…This strict action has been taken on the basis of our initial discussions with the expert group and as a reflection of our commitment to higher standards of care. We wish to clarify that this action should not presuppose finding of any lapse by the expert group and should not be construed in any way to be anything other than an expression of our continued commitment to providing quality healthcare.”

While whether action is taken against the hospital or not remains to be seen, the statement can be read like an attempt to distance itself from the issue while throwing the doctors into the fire.

Government’s role

Every time a case of a patient allegedly fleeced or mistreated by a private hospital comes to light, the obvious takeaway is that the family may not have had to seek medical treatment from a profit-making entity of the government provided adequate facilities.

Improved public healthcare facilities will at least provide people more choice and not let them get so helpless in front of private hospitals’ demands.

Also, concrete guidelines need to be formulated for cases of medical negligence, so that both patients and hospitals are clear on what practices are ethical and legal.

It is hoped that a fair enquiry is conducted into the Max case, and those guilty are not allowed to get away using clout or legal technicalities.

Also read: Max fiasco: A doctor makes sense of why a hospital declared a living baby dead

Writer

Yashee Yashee @yasheesingh

Senior sub editor

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