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Can a baby born prematurely be called a foetus? Can a hospital rule out "medical negligence” when a premature baby showing “signs of life” is declared dead? Do doctors in India lack empathy in cases of premature deliveries?
The recent case of a premature baby being found alive after Safdarjung Hospital declared it dead raises some of these questions – and more.
On 12 June, Rohit Kumar Tandon took his six-month pregnant wife Shanti Devi to Safdarjung Hospital in New Delhi, after she complained of pain and bleeding. On examining Devi, the doctor on call said that she required two litres of blood, and admitted her to the hospital. What followed, according to the family, was the doctors in Safdarjung Hospital washing their hands off Devi’s ‘case’.
Five days later, Devi, still admitted, complained of “intense pain”. She thought she was going into labour, but the doctor allegedly dismissed her and told her “not to lie about pain that did not exist”.
On 18 June, Devi gave birth to a premature baby – a boy weighing 440 grams. While the hospital claims that the newborn was 20 weeks old, Tandon claims that his wife was pregnant for six months – or 26 weeks.
The newborn was declared dead on delivery by the hospital staff. The hospital personnel wrapped the baby in a polythene bag, labelled it, and handed it over to the father.
Relatives of the couple insisted on seeing the newborn’s face before he was taken to the crematorium. The relatives said that when they opened the polythene bag, the baby moved its limbs.
They rushed the baby to Apollo Hospital in south Delhi, where the doctors confirmed that the newborn was alive. The baby was then taken back to Safdarjung Hospital, as the parents, both daily wage labourers, could not afford private medical care.
The baby was gasping when it was brought back. We immediately put the baby on oxygen support.Nurse at Safdarjung Hospital who refused to be identified
‘Abortion’, Or Premature Delivery?
Dr AK Rai, the medical superintendent at Safdarjung, constituted an inquiry committee, including heads of the gynaecology and the paediatrics departments, to probe into the incident.
On 21 June, the committee ruled out “medical negligence” in the case.
We agree that this is an unfortunate incident. But there is no medical negligence on the part of the hospital. According to the Medical Termination of Pregnancy (MTP) Act, termination of foetus, which is 20 weeks old, is not non-viable. This is more a case of abortion than delivery.Safdarjung Hospital Committee
The child’s family has rejected the hospital’s stance.
“If we had not opened the sealed polythene cover, I would have never known that my son was alive and breathing,” says Rohit Tandon, the child’s father.
For the hospital, it is just another baby but for me, it was my child. How can they be so negligent? I want doctors and nurses who were responsible for this to be punished severely.
With the hospital authorities accepting that the premature baby showed signs of life when being admitted again, calling it an abortion and not a delivery raises a number of alarming legal and medical questions.
Is the Termination Act Relevant to the Case?
While Safdarjung Hospital’s inquiry committee insists that there isn’t medical negligence as per the MTP Act, it might not be relevant to the case, The Quint’s legal correspondent Vakasha Sachdev points out.
The MTP Act talks of cases where it is legally permissible to abort a foetus. It does not specify what doctors should do with premature deliveries, or even deliveries for that matter. The Act is not relevant at all to assessing whether the hospital has met its duty of care regarding the delivered baby, or even a miscarriage that was not intended to be an abortion. This would be assessed on the basis of standard medical practice.
The duty of care for doctors is higher as professionals, and not adhering to standard medical practice would be negligence.
What Could Have Been Done Clinically?
It the responsibility of the doctors to assess properly whether the child is alive or not, says Dr Satish Saluja, who has been practising neonatal care for 30 years.
When no signs of breathing or heartbeat is found in a premature baby, doctors try to induce it. In the recent Safdarjung case, it is possible that the heart would have started contracting after a few hours. This would resulted in blood circulation, thus explaining the visible movements. The hospital, ideally, should have kept the baby under observation for a few hours.Dr Satish Saluja
According to the WHO’s definition of Preterm births, Tandon and Devi’s newborn is an ‘Extreme Preterm’ baby – born alive before 28 weeks of pregnancy are completed.
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According to Born Too Soon: The Global Action Report on Preterm Birth, ‘Extreme Preterm’ babies require intensive care to have a chance at life.
Preterm birth is the second leading cause of deaths in infants in India, preceded only by pneumonia.
However, Dr Saluja says India has come a long way in reducing the number of these deaths. “In the 80s, babies that were born before 30 weeks of gestation in India always died. Now, there is a strong rate of survival of those newborns that are at least 26 weeks old. It is those delivers that are born with less than 26 weeks of gestation that have minimal chances of survival. India has come a long way but,” Dr Saluja says.
Dial Empathy For Emergency?
“While medically nothing might be possible, doctors should try and show empathy, and look at patients as people, beyond being a ‘case’,” says Dr Priya Shanker, a practising gynecologist at a leading private hospital in Delhi.
In most cases like the Safdarjung baby, doctors don’t believe that there can be a chance at life. We give up without even trying.
“Doctors need to be competent enough to judge whether there are any chances of saving a life,” says Dr Sumit Ray, specialist of internal medicine at Sir Ganga Ram Hospital.
Better standards are expected from large hospitals, especially those that are also medical colleges. It is no secret that India’s public health service has a long way to go, but doctors need to be competent enough.Dr Sumit Ray, Ganga Ram Hospital
Tandon, the child’s father, says that while he wants to take the hospital to court, he does not have the finances to do so. “Poor people like us cannot afford private medical care,” he says, as he raises two important questions:
If government hospitals do this to us, where will we go? People have taken notice of my situation because of the media. But what of those incidents that never see the light of day?
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