The Telegraph
Friday , December 28 , 2012
Since 1st March, 1999
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Doctors see infection as a reason for shift
- Not an easy decision, says specialist on team looking after girl

New Delhi, Dec 27: The government’s decision to move the Delhi gang-rape victim to Singapore could be justified on both medical and non-medical grounds, senior doctors have said, although many say they are baffled by the decision.

The 23-year-old woman, who was battling to survive life-threatening injuries and infection at the government-run Safdarjung Hospital here since her sexual assault on December 16, was admitted to a super-speciality hospital in Singapore this morning.

“The patient arrived at the Mount Elizabeth Hospital’s intensive care unit this morning in an extremely critical condition,” a spokesperson at the hospital told PTI.

The decision to move her was taken by a team of doctors after consultations and consent from her family, two senior doctors who have been monitoring her over the past week said today.

“This was not an easy decision for us,” said Mahesh Misra, the head of the trauma centre at the All India Institute of Medical Sciences, New Delhi, who was among the team of doctors managing the victim at Safdarjung Hospital.

Her move to Singapore may yield both short-term gains in her current fragile and precarious condition and long-term gains if she survives, Misra and other doctors familiar with her condition said.

Specialists in critical care medicine point out that the risk of hospital-acquired infections is likely to be lower in Singapore than at Safdarjung Hospital or other government or private hospitals in India.

“Minimising the risk of hospital-acquired infection is important when dealing with sepsis and infection,” said Amit Gupta, a trauma care specialist and secretary of the Indian Society of Trauma and Acute Care, who has not treated the victim.

The condition of the victim — who had lost her intestine in the assault and subsequent surgery and developed infection and sepsis — further deteriorated on Monday night, a senior doctor in the medical team said.

Misra said the woman had suffered a cardiac arrest, but doctors had revived her. She was sedated and unconscious and on ventilator when she was flown to Singapore on an air ambulance. A cardiac arrest carries the risk of brain damage triggered by the loss of oxygen supply when the heart stops pumping blood. But the extent of brain damage, if any, remains unknown, Misra said.

“We’ll be able to assess brain functions only over the next few days,” he said.

“If and when she pulls through, the (Singapore) hospital’s transplantation experience could help her — but this is a big ‘if’ and a big ‘when’,” Misra told The Telegraph this evening.

Some doctors not associated with her treatment are speculating that non-medical reasons have also influenced the government’s decision to support her treatment in Singapore.

“I think this was a non-medical decision, possibly influenced by the government,” said Sri Prakash Misra, professor of gastroenterology at the Motilal Nehru Medical College in Allahabad, and secretary of the Indian Society of Gastroenterology.

“The (Safdarjung) doctors have done all that can be done in such cases — surgery, antibiotics, drains to clear pus, and supportive therapy,” Sri Prakash Misra said.

A senior doctor who requested not to be named told The Telegraph that given the poor prognosis for the woman and the intense scrutiny that this case has generated, it is possible the government also wishes to demonstrate that it has provided the best possible treatment available to her.

Safdarjung Hospital medical superintendent Badrinath Athani today declined to respond to a question whether the decision had in any way been influenced by the government.

He said a medical team had taken the decision. Asked if Safdarjung Hospital had the appropriate equipment and expertise to continue treating the victim, Athani said “the facts speak for themselves ... we have managed her for the past 10 days.”

“I can’t understand why she was sent away,” said Samiran Nundy, a senior surgeon at the Sir Ganga Ram Hospital, New Delhi. “I think this sends a misleading signal that the government has little confidence in doctors in India.”Nundy and others point out that the issue of an intestine tranplant will come up only if she recovers from the infection.