Cancellation of the Max Hospital License and the Concept of Fetal Viability: Public Outcry vs Doctors in Defense

This has been a matter that has made headlines for tragic reasons: The personal loss suffered by a family, the charge of medical negligence upon a hospital, and the expectation of the termination of the hospital’s license. Max Hospital was in the news for falsely declaring a surviving twin as dead. We look at what happened next and also examine the concept of fetal viability.

Death of the surviving baby

One of the twin babies born at Max Super Specialty Hospital Shalimar Bagh, New Delhi, died soon after birth. However, the other baby was still alive, when declared dead and handed over to the family in a plastic bag. At that time, the authorities had declared that the hospital's license would be cancelled if negligence was proven.

When one of the babies was found to be alive, the baby was rushed to a local nursing home. However, after battling for its life for a week, the surviving twin also died. The government had asked a three-person committee to investigate the incident. After the death of the surviving twin, the hospital's license has now been cancelled by the Director General of Health Services.

Reactions to cancellation of hospital license

Though the reasons cited for the revocation of the license are several; the precipitating factor appears to be precisely this incident. Other reasons cited were the flouting of norms relating to the treatment of economically weaker patients and because beds meant for dengue patients were used for other purposes during the outbreak. It is also alleged that there were insufficient documentation and other irregularities from the hospital in the twin baby case.

The hospital authorities protesting the revocation of the license; saying that the ruling is harsh and has been taken arbitrarily without being given the opportunity to be heard is another matter altogether.  

Top city doctors have criticised the decision of the authorities to cancel the hospital’s license. According to several top specialists, this decision is against existing medical protocols. Dr Alka Kriplani, head of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) was quoted as saying that a baby being born at 22 weeks is still only a fetus. The birth of a child weighing less than 500 grams can only be termed spontaneous abortion, and its chances of survival are so slim that there is no requirement to resuscitate.  As per medical guidelines, this could be agreeable. But this is not something that will ever go down well with the sentiments of parents, who would want to save a child at any cost. 

Was this really a case of medical negligence?

If an expert committee has opined that this was a case of negligence; there must be some merit in their findings. However, it is important to consider whether their findings were influenced by the huge public outcry in the matter or not. The concept of ‘fetal viability’ also must be considered. This is a concept that has changed in the recent past, after improved facilities made it possible for a fetus born at 22 weeks gestation and weighing less than 500 grams to survive in extremely favourable conditions in the United States. Previously only babies born at 28 weeks and after were considered viable.

According to Dr Kriplani, even at the best Indian hospitals, such as AIIMS, it is only possible to save babies born at 26 weeks. A baby born at 22 weeks is extremely difficult to save even if put on a ventilator for a prolonged period. According to experts, babies born so early may display some signs of life for a few hours or even a few days; but their chances of survival are as low as .5%.

There have been very few instances of such babies actually surviving. In a private Mumbai hospital, baby Nirvaan was born at 22 weeks and managed to survive after months of treatment and many complications. This was termed as a medical miracle. Even this was made possible because this was a single baby from a healthy mother who weighed 650 grams when he was born. Less favourable circumstances – as in the case of the recent Max hospital case – would almost certainly have resulted in the baby's death.

While the attitude of the doctors and staff at Max may well have been callous and negligent – looking at the medical issues involved, it is difficult to pin blame or to say that things may have turned out different if the hospital acted differently. 

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