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Doctors question move to shift girl to Singapore

By Prithvijit Mitra & Durgesh Nandan Jha, TNN, NEW DELHI-KOLKATA: The decision to shift her to Singapore was not a medical decision and was based on “direction from the top (government)”, said a senior doctor at Safdarjung Hospital, where Nirbhaya was being treated. Nirbhaya had suffered irreversible brain damage in the early hours of Wednesday, 22 hours before she was airlifted to Singapore, the doctor told TOI.

According to the doctor, damage to the brain was caused by a thromboembolic attack — a clot in the blood vessel — which also triggered two consequent cardiac arrests. “While the heart function could be revived by giving DC shock, the brain function was damaged irreversibly during the process. A neurologist was called to examine the pup-ils which showed sluggish reaction on shining a torchlight,” the doctor said. He also said there was no possibility of the patient undergoing any transplant in that condition.

Sources said inotropic drugs (which alter the strength of heartbeats) were used to keep Nirbhaya’s heart beating while she was being airlifted to Singapore. But she still went into near collapse in the air ambulance when her blood pressure dipped alarmingly. The doctors on board created an arterial line to monitor the blood pressure real-time.

“The shifting of the victim who had suffered irreversible brain damage, after two consequent cardiac arrests and septicemia was ethically and morally wrong,” said Dr Deepak Agarwal, senior neurosurgeon at the AIIMS trauma centre. He dismissed the government claims that Mount Elizabeth hospital was selected as it has state-of-the-art organ transplant facility. “The fact is a patient with two cardiac arrests and septicemia cannot undergo transplant. She was at best an organ donor not a recipient,” said Agarwal. He added, “I would suspect she was brain dead already.”

However, Dr Yatin Mehta, chairman of the Medanta Institute of Critical Care and Anesthesiology, who was part of the team that accompanied her to Singapore, said the doctors were fully aware the girl wasn’t fit to withstand an intestine transplant. She was flown to Singapore in a last-ditch attempt to try and revive her in a set-up that was far better than Safdarjung Hospital. “Let me be honest. Despite the best efforts and arrangements that we made for her here, they can’t be compared to Mount Elizabeth Hospital. It has a far better set-up, with an environment and facilities that are not available in India. The priority was to save her life. We were not even thinking of an intestine transplant,” added Mehta.

Mehta said he would have been “pleasantly surprised” if she survived. He, however, refused to comment on whether the decision to fly her to Singapore was logical. “I am not saying she was not in a condition to be flown. But she was in no state to undergo a transplant. When she was taken out of Safdarjung Hospital, Nirbhaya was on a ventilator. She had a serious infection, had already undergone three surgeries and suffered a cardiac arrest. Her blood was not clotting well. Her blood pressure had stabilized but she was not breathing properly,” he said.

“On the flight, her blood pressure dropped to 80 from 120, but she responded to the measures that were taken immediately. It was clear that she would struggle to survive even in Singapore,” Mehta told TOI in Kolkata on his way back from Singapore.

Dr Samiran Nundy, gastro-intestinal surgeon at Sir Ganga Ram hospital, said, “The patient could have been served better in India. The girl was not in a condition to undergo transplant immediately and infection control was being done successfully by the doctors at Safdarjung hospital.” Nundy, who has worked for 21 years at AIIMS, said the government could also shift the patient to the institute which would have helped in avoiding unnecessary travel.

When contacted, the chairman and managing director of Medanta Medicity Dr Naresh Trehan said the decision to shift the patient was taken by the treating doctors, not him. “I was contacted to assess if the patient could be airlifted. We have air ambulance facility and a team of experts who regularly ferry international patients suffering from serious medical problems,” Trehan said.

“I did not take the call. I cannot comment on this issue,” said Dr Anil Aggarwal, chief of the department of gastro-intestinal surgery at G B Pant hospital, who was a part of the team of doctors treating the victim whose intestines and blood vessels were ruptured when she was brutalized.

Dr Devi Shetty, renowned cardiac surgeon, said he supported the government decision. “They made an effort which, I would believe, was taken in the best interest of the patient. She was a young and brave girl and could have come out of the trauma,” he said.

Experts say that a patient has to be hemodynamically stable and there should be no infection to undergo the transplant procedure. “If the brain is damaged, the transplant cannot be carried out,” said Dr Sanjeev Bagai, CEO and Dean Radiant Life Care which manages the BLK hospital.

Published Date: Saturday, December 29th, 2012 | 03:09 PM

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