Life saving surgery?

This report is based on an unpublished article written by a Maldivian doctor stationed overseas reporting on an incidence that happened at IGMH. We received the article from Minivan News reporter who wishes to remain anonymous. The article was refused publication by the Minivan News Editorial team for unknown reasons despite the Minivan News reporter confirming authenticity of the events.

In October 2007 a baby born at IGMH was diagnosed to have Congenital Diaphragmatic Hernia, a condition in which the muscular sheath (diaphragm) separating the abdominal cavity from the thoracic cavity has a defect in it that allows intestinal loops and other abdominal content to herniate into the thoracic cavity. The condition is potentially life-threatening as the intestinal loops in the thoracic cavity would occupy the space that would otherwise have been occupied by the lungs. Depending on the severity of the herniation, the lungs could be compressed preventing respiratory functions.

The baby was admitted to the Neonatal ICU where investigations confirmed the diagnosis. The child remained stable even with the potentially life threatening internal deformity.

Cases of Congenital Diaphragmatic Hernia have been diagnosed at IGMH in the past as well. Reportedly, in the past 3 years, none of the previous cases had died. The procedure that was followed over the 3 years referred was to stabilize the patient and have them transfered to Trivandrum or Colombo accompanied by Pediatric doctors. Reportedly, in 2007 a total of 4 babies were transfered for varying surgical and severe medical conditions (including one with Congenital Diaphragmatic Hernia) under medical care of a Pediatrician. They all survived.

IGMH does not have a Pediatric surgeon. Neither does it have a general surgeon with enough expertise and experience is surgeries of the newborn. This is not to say that a general surgeon would be unable to undertake any life-saving surgeries at IGMH for newborn surgical conditions.

The baby in this case was in a stable medical condition, Pediatric orders for referral abroad were made and discussed with parents when the case was seen by Dr Mohamed Firdous and his puppet team of surgeons. He clearly wanted to "have a go" to see if he could add "did a correction of CDH" to his resume'. To make this possible, the parents were misinformed by the surgeon and a new Pediatric Head of Department Dr A.C. Bhagwat that the child was in a critical state and that unless surgery was done urgently child would die!

Left with no choice, the parents consented to surgery. The relatives were made to sign a "high-risk" surgery consent form. Clearly; a common practice by all surgical specialties at IGMH, attempting to reduce liability.

Details of surgery are sketchy. Surgery was done by Dr Firdous himself. Documents were never given to parents; they were given just a Death Certificate. MMW was able to confirm from IGMH theater staff that the child arrested during the surgery and could not be revived. However, on the orders of Dr Firdous, death was not declared. The lifeless body of the baby was transfered back to Newborn ICU and connected to a mechanical ventilator.

To our shock, we were told that the lifeless baby (no cardiac activity, breaths given by machine) was kept on "life support" for several hours before declared dead. The parents were lied to and the truth of the events hidden. The surgeons shamelessly declared the surgery a success; claiming to have repaired the diaphragm!

The way patients condition was mis-informed and parents misled before the surgery, during surgery and following surgery (surgical death) the parents had no way of understanding the grave injustice that was done to them. They weren't even aware of the devious scheme. Dr Firdous's misadventure, on this occasion and certainly on several previous occasions, were covered up by IGMH.

The case, as was done for previous cases, should have been transfered abroad when the child was in a stable condition.

Note: MMW was informed by the Minivan News reporter that parents were advised on possible legal action that could be taken.