The Real Truth of Rashmi BT Story at Wockhardt Hospitals
Sunday, June 14, 2009
However in case anyone of you does not have the time to go through the same in detail we would like to let you know that Wockhardt Hospitals had followed all the necessary medical protocols that any reputed institution across the globe would have followed. We have always tried to question the limits to which medical science can progress and have been also largely responsible for the positive changes that the Indian healthcare industry has been witnessing in recent years. It is but unfortunate that certain risks in medicine cannot be completely mitigated how much ever one might strive.
Please do read our version and if you find it convincing forward the same to whoever you might think appropriate.
Reputations take a lifetime to build, is it right to destroy them without understanding true facts and make a hospital and its doctors look inhuman?
Ms. Rashmi B.T. was under the care of a senior gynaecologist in Bangalore for her second pregnancy. She made a conscious decision to shift under Dr. Latha Venkatram’s care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an option and wanted to select that option for her second delivery. She had collected information that Dr. Latha Venkatram was one of the senior gynecologists in the city who offered this option to her patients. From the OPD records filed by Dr Latha Venkatram it is evident that Rashmi was counseled and given ample information about the procedure and the risks associated with it and she took an informed choice to select this procedure.
Vaginal Birth after Caesarian Section (VBAC) is the term used when a woman gives birth vaginally, having had a caesarian delivery in the past. Worldwide VBAC, if possible, is being recommended and preferred over repeat C-Sections as its advantages substantially outweigh the disadvantages. According to the Royal College of Obstetricians and Gynaecologists patient information guideline 2008 “Birth after previous Caesarian Section”, overall three out of four women with an uncomplicated pregnancy would give birth vaginally following one caesarian section delivery. The short-term and long term complications inherent in a C-Section make it preferable that a woman is offered the choice of a VBAC. The US Federal Government in its healthy people report 2010 proposed a target for VBAC of 37%.
Repeat Caesarian Sections are associated with:
o A possibly more difficult operation
o Longer recovery period
o Possibility of injury to bladder or bowel
o Possibility of blood clots developing in legs and pulmonary thrombosis
o Breathing problems for the baby. Higher in C-Section than in VBAC
o Serious risks increase with every Caesarian delivery
o Higher chance of infection
o Future complications for the mother who has had repeated opening of the abdomen
o Higher costs
VBAC has a shorter stay in the hospital, faster recovery as well as lower cost for the patient. There is a risk of uterine rupture but this risk is approximately 0.5%. In spite of this risk the benefits of VBAC far outweigh the risks.
As in all medical procedures there is no way to predict which patient would fall under the 0.5% risk of uterine rupture or any way by which this rupture can be prevented. A VBAC delivery is more demanding of the gynaecologist, as it takes 6-8 hours as compared to a C-Section, which in a planned fashion would be over in less than 40-45 minutes. Also the mother and child need close monitoring it is estimated that one will have to do as many as 200+ unnecessary C-Sections to prevent the occurrence of 1 uterine rupture. In most cases a uterine rupture is not fatal. However in the best interest of Ms Rashmi, Latha Venkatram gave her both the choices and Ms Rashmi chose to opt for the VBAC option.
Ms. Rashmi B.T. was a fit candidate for a VBAC. She had a breech presentation (where the legs of the baby present itself first instead of the head at the time of delivery) in the earlier pregnancy which required a C-Section. A breech presentation in the earlier pregnancy which necessitated a C-Section is in fact an indication to offer a VBAC to the patient in the subsequent pregnancies.
An age of 35 is not a contraindication to a VBAC. The fact that she was 5 days past her due date was also not a contraindication to a VBAC because less than 5% of patients deliver on their due date.
During her antenatal visits to Dr. Latha Venkatram, Ms Rashmi B.T. was explained in detail about the pros and cons of VBAC and she agreed to undergo the procedure. The OPD case records have these notations. She was also clearly informed by Dr. Latha Venkatraman that she works along with Dr. Prabha Ramakrishna as a team and either of them would be present during her delivery. Doctors particularly in the area of obstetrics frequently prefer to work as a team since many times an emergency may hold one of them which would make it possible for the other team member to attend to the delivery as the date and time of delivery cannot be predicted. In a VBAC considering that a consultant needs to be around for most of the labor period it is prudent that a team takes care of the patient. Both Consultants of the team Dr. Latha Venkatram and Dr. Prabha Ramakrishna are Fellows and Members of the Royal College of Obstetricians UK respectively.
Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. She was connected to monitors for a close monitoring of both maternal and fetal parameters. She was visited by Dr. Latha Venkatram soon after admission. An experienced nurse and a fully qualified gynaecology registrar were monitoring her constantly. The Consultant Dr. Prabha Ramakrishna was also available on the same floor and repeatedly examined her. She was kept informed about the progress of the labour.
The labour progressed normally until 1.50 p.m when a sudden decrease in the fetal heart rate was noted (fetal bradycardia). The tracings before 1.50 p.m were normal. The moment fetal bradycardia occurred, the consultant Dr. Prabha Ramakrishna who was on the same floor was called in by the gynecology registrar. When Dr. Prabha Ramkrishna examined Ms Rashmi, the baby’s head position was a little high. She was asked to push to see if the baby’s head would come to +2 position in which case she could do a forceps in the labor room itself and deliver the child. When the baby’s head did not descend as required she asked for the patient to be shifted to the Operating room. After this Ms.Rashmi was not asked to bear down any further.
Shift to the OT was rapid since the dedicated Operation Theatre for Caesarian sections is situated within the labour room complex and this theatre is not used for any other procedure. Within 7-8 mins the patient was in the theatre. The anesthetist had a choice of going in for an emergency general anesthesia which has inherent risks for a pregnant woman or to go in for epidural anesthesia. Since the patient was already receiving pain medication (epidural analgesia) it was decided that for the safety of the mother increasing this analgesia to achieve anesthesia was the preferred option. In the OT the fetal heart rate was recorded as 180 b.p.m on the Doppler. On the OT table an examination was done and it was found that the head had receded and a forceps delivery was not attempted. An immediate emergency C-section was then performed.
The anesthetists, Neo-natologists and the surgical nursing team had assembled in the theatre within a few minutes of the emergency being declared. The hospital has full- time anesthetists, Neo-natologists and a surgical nursing team working round the clock to attend to all kinds of medical emergencies.
At the time of birth the baby did not have a heart beat or respiration. Resuscitation was started and the heart beat started about half a minute later. The child was immediately shifted to the Neonatal ICU and put on the ventilator. The baby’s weight at birth has been recorded in the NICU as about 3 Kg. The only reason an exact weight could not be taken in the NICU was that the child was already attached to various lifesaving equipments and the neonatologist had to make the closest estimate. However it must be noted here that a birth weight of 4 Kg is not a contraindication for a VBAC.
In the neonatal ICU the clinical team met the family on a daily basis and kept them informed about the status of the baby and the prognosis. The poor prognosis was explained to the parents on the 2nd day itself. An opinion from an external eminent neonatologist was also sought who concurred with the poor prognosis. All decisions regarding further care were made only after extensive discussions with the parents of the baby. Dr.Prakash Vemgal our Neo-natologist is not only highly experienced but has also gone through some of the highest training in Neo- natology in high patient volume and reputed international centres.
The doctors and the management (including senior management personnel) of the Wockhardt Hospitals group spent long hours with the parents understanding and trying to address their concerns. As is the normal practice in such a case a complete internal review was done. The family sent to us a detailed list of areas they wanted us to look into during our investigation. We did go into each of these areas and sent them a detailed reply addressing most of these issues including taking the opinion of two leading and senior external gynecologists of the city who do substantial VBAC work. It is unfortunate to note that inspite of providing her all clarifications Ms Rashmi has been projecting an extremely poor image of Dr. Latha Venkatram and the hospital.
Our internal review involved discussions with our own team of gynaecologists, meetings with two external gynaecologists who practice VBAC and the entire clinical care team. Our findings after this detailed internal review are summarized below.
a. Ms Rashmi BT was a fit candidate for a VBAC. She would have been offered this procedure as a first choice by any gynecologist or hospital which practices advanced obstetrics anywhere in the world. Her age or the week of pregnancy were not contraindications to go in for a VBAC.
b. She had made a conscious and informed decision about going in for a VBAC. She had changed her senior gynecologist whom she was consulting until the 35th week of her pregnancy primarily because that gynaecologist was not in a position to offer VBAC.
c. The OPD case notes of which she was given the duplicate copy recorded that she was willing for VBAC and she was informed about all risks of her decision.
d. Both the mother and the child had been monitored carefully right through the labour
e. All medications used for progressing labor were prescribed agents and safe for use in VBAC
f. She did have a uterine rupture which in VBAC carries a risk of 0.5%. This rupture could in no way be predicted or prevented. In spite of the rupture the gynecology team was able to save the uterus for future child bearing.
g. The Operation theatre was ready at the time it was required.
h. All the staff were present in the Operation Theatre within a few minutes of the emergency being declared
i. While the baby was in the NICU Dr.Prakash Vemgal the head of Neo-Natology met up with the parents at regular intervals and kept the family clearly informed about the status and prognosis. All major decisions were taken only after discussion with the parents.
j. Senior management of the organization met up with the family on multiple occasions to understand and address their concerns
A minute by minute account of her story as is being spread through the various emails circulated by various people who were neither physically present during her admission to the hospital nor were involved in her care process exhibits to us a determined effort to harm the reputation of the gynecologist and the hospital without having any understanding of the clinical facts of the case.
Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?
We do understand the pain and suffering of Ms Rashmi BT. As a hospital every life is precious to us but we are also are in the world of medicine where unfortunate rare complications can be counteracted but every procedure cannot be made risk free. There are many lives which we save each day when all has been given up and each such case teaches us that to pursue medicine is to pursue the limits of the unknown but does that mean that we become victims of public misinformation
We have taken all necessary care and followed every medical protocol that any reputed institution across the globe would have followed. However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails to use a redressal system that is purposely harming the reputation of Dr Latha Venkatram, Dr.Prabha Ramakrisha and our institution.We will not stand to be mute spectators to this form of intentional disreputation.
The case can be subjected to analysis by any competent authority.
Labels: BT Rashmi false story of wockhardt, Rashmi BT Story, Rashmi BT true facts, Wockhardt Hospitals response, wockhardt Hospitals true facts
24 comments:
I did not comment yesterday bcs i thot comment moderation will automatically weed out comments of dissent.
Here are some more questions:
1. If the fetal heart rate was being consistently monitored, at what point did it go to 0 from 180?
2. If the doctor was there all the time, how come the abdominal rupture was not noticed?
3. If this was Dr. Latha Venkatraman's case, how could she abandon a VBAC case and hand it over to a "team member" who has never met the patient before, and with whom the patient has no comfort/awareness level? How come she was not present even once throught the ordeal?
Wockhardt, we are not in the business of a word duel with you.
You are in the business of earning money and we are the ones who decide where it gets spent when we need medical care. Yes, we are the fat cheque TPA processing cases who pay 1 lakh and above to bring a child into the world. We dont need to exchange a word with you. We just need to make a decision that this money will NOT come to Wockhardt. Just like you have decided that no harm will come to the guilty in this case.
Unless you come clean on this, with A LOT OF INTROSPECTION and some tough action on all the guilty parties, there will be a rather long term impact.
Remember that it was 25 years before someone hurled a shoe at the Congress for the 1984 riots, but the fact of the matter is that people remember. And people will not take even a 1% risk with their children. You only need one bad case to set you apart for all time to come. This is that one case. You can either make amends and win back some of that respect (and patients) or you can stick to this story and shield the guilty.
//We stick to Rashmi’s version. We believe her.//
So you are suggesting that there shall be no more normal deliveries for mothers who has had a previous LSCS
And then there is a hue and cry that doctors are doing caesarean section and not allowing normal deliveries “for money sake”
The tendency to blame each and everything that a doctor does is very sad
//During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt’s Bannerghatta Road maternity facility to see me through the rest of my pregnancy.//
So who was this lady consulting till that time
Why did she change the doctor
Was it because the previous doctor said “Caesarean only” and she changed because this doctor agreed for a VBAC
Questions to Rashmi
1. Was she aware of the risks of VBAC
2. Did she ever opt for LSCS
3. If so why she did not consult a doctor who could have done LSCS
It is a common thing we see on the roads when a two wheeler and a pedestrian dash, the illiterate rowdy mob just thrash the two wheeler driver
When a two wheeler and a four wheeler dash, the four wheeler is immediately thrashed, even without trying to find who is at fault
Similarly in this case as Rashmi has lost her baby, everyone is training the guns on the hospital, conveniently forgetting other facts
//During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt’s Bannerghatta Road maternity facility to see me through the rest of my pregnancy.//
So who was this lady consulting till that time
Why did she change the doctor
Was it because the previous doctor said “Caesarean only” and she changed because this doctor agreed for a VBAC
//We stick to Rashmi’s version. We believe her.//
So you are suggesting that there shall be no more normal deliveries for mothers who has had a previous LSCS
And then there is a hue and cry that doctors are doing caesarean section and not allowing normal deliveries “for money sake”
The tendency to blame each and everything that a doctor does is very sad
//During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt’s Bannerghatta Road maternity facility to see me through the rest of my pregnancy.//
So who was this lady consulting till that time
Why did she change the doctor
Was it because the previous doctor said “Caesarean only” and she changed because this doctor agreed for a VBAC
Questions to Rashmi
1. Was she aware of the risks of VBAC
2. Did she ever opt for LSCS
3. If so why she did not consult a doctor who could have done LSCS
It is a common thing we see on the roads when a two wheeler and a pedestrian dash, the illiterate rowdy mob just thrash the two wheeler driver
When a two wheeler and a four wheeler dash, the four wheeler is immediately thrashed, even without trying to find who is at fault
Similarly in this case as Rashmi has lost her baby, everyone is training the guns on the hospital, conveniently forgetting other facts
how come Dr Prabha never met the patient before the incident if she was part of "the team"?
what were the circumstances that made it impossible for Dr Latha to attend to the patient(she was there at the the time of admission) ?
Wockhardt, what happened to Rashmi is sad but what is worse is the way you hide behind words like "protocols" and "SLAs" and the like. i only only you havent fooled yourselves into believing what you say.
The 10 questions I'd like you to answer in a public forum:
1. Why is Dr. Latha’s notation in the OPD record regarding Dr. Prabha as her “co-consultant” made only on the 28th of Feb., AFTER Rashmi’s predicted due date? Would that be a good time for a patient who is past her due date to switch her obstetrician, or even make enquiries about the qualifications and credentials of the co-consultant?
2. Since Dr. Latha is such an experienced VBAC practitioner who follows ROCG and other foreign-body guidelines, please publish the guidelines she followed, and match Rashmi’s records against them.
3. Rashmi’s key question: “If I have paid for doctors who were fellows and members of the Royal College of Obstetricians, why was the registrar attempting to deliver me?”
4. Another key question from Rashmi: “Why did an experienced doctor like Dr. Prabha not recognize signs of uterine rupture? I was yelling with pain in the labour ward and kept pointing at my stomach and telling her that there was a ripping pain in my stomach. I complained of shoulder pain and chest pain in the OT she still did not recognize the rupture. She admitted that she knew of the rupture only when she opened me? Why?”
5. Registrar Dr. Shirley had announced that Rashmi would deliver by 1.30 p.m. What was Dr. Prabha doing in OPD at that time? Uterine rupture does not happen suddenly but over a period of time… during which Rashmi was attended by a registrar who is NOT an ROCG-qualified doctor.
6. Why did it take 43 mins to conduct an emergency C-section? Baby fetal heart rate was down to 58 bpm at 1.50 p.m. and baby was extracted at 2.33 p.m.
7. Why was the fetal monitor not connected in the OT? Is this what VBAC guidelines specify?
8. If the baby had a heartbeat of 180 bmp, how is it possible for the outcome to be a baby without heartbeat and respiration at birth?
9. Would an internal review with your own gynecologists and external gynecologists who are close aides of Dr. Latha be unbiased? Why have you refused to conduct a transparent review that includes the inputs of Dr. Prakash Kini and Dr. Narayanan, two practitioners widely recognized as Bangalore’s seniormost obstetricians, as requested by Rashmi?
10. Finally: Please have this case put up for review in the next conference of BSOG and FOGSI and have the proceedings covered by the press.
Rashmi
You accuse wockhardt of copy and paste. BTW you too do the same thing.In some posts i felt that You sound not only arrogant and revengeful but it seems you have a personal agenda behind the whole thing.
In this whole thing of your tirade against wockhardt . The real reason for this whole thing seems to be forgotten. By now i am not convinced about your real intention. Is it to malign Wockhardt Hospitals ,their doctors and everything " Wockhardt"or 2) to help Rashmi get over this
By your tirade against the hospital and your scorn against wockhardt, You are only lending credence to the the fact that you are more interested in getting mileage out of this whole issue rather than seek justice for Rashmi
Also you seem to have problem with fradulent billing sometimes and sometimes the BP instruments and some other aparatus does not seem to work.
I wonder why you paid the extra bill if it was indeed fradulent .
what happened to Rashmi was tragic.. what you guys are doing by this blame game is not doing Rashmi any favor. For heavens sake stop making Rashmi a " issue" She is already traumatised.
It is extremely tragic that such an issue is being "sensationalized" in a public forum of this sort. I opine that these are matters to be left solely to the patient and the concerning authorities to sort out as the public is nowhere present/involved with Rashmi or people of Wockhardt in any manner.
If supporters of Rashmi feel that justice has not been served and accuse doctors of medical negligence, they have complete freedom to fight for their rights legally.
I think it wrong to challenge reputations of well known doctors and public authorities without the knowledge or competency in these matters. I find it wrong on Rashmi's part to have publicized her own grief for motives that are questionable.
It was acceptable, had this post been made to debate issues and concerns regarding VBAC or Rashmi's condition, rather than targeting doctors and authorities for doing what they thought was right for the patient in the condition that she was in.
I am not a medical practitioner, nor in anyway concerned with medicine. It came as a shock to find such a mail addressed to me recently. I am only writing this to inform all of you contributing to this blog that this mail is reaching public who are not even aware of what a C section or VBAC is,let alone what procedures are being followed.
it is just as wrong to question Rashmi's motive...from what i see she is only expressing her concerns so that others do not suffer her fate....dont see any hidden agenda in this.
and just as Rashmi and her supporters have the choice for legal recourse so do Wockhardt and named doctors. if they so stongly feel that they did the right thing and are being defamed why dont they slap Rashmi with a defamation lawsuit ?
They might!
All I say is that this issue is going out of bounds. If it is debated solely within the medical circle, well and good, but it is spreading out to people who are ignorant about these matters..
What would be the plight of patients in the near future? Who would they go to if they cannot trust anybody? This not only concerns the doctors in question but the entire medical community itself.
the purpose of blog is to reach wider audience(ignorant and otherwise). confining discussion to the medical community alone does not solve Rashmi's issue with Wockhardt...she is claiming negligence. Also, i do not understand why doctors cannot be questioned? i hope you have read todays bangalore mirror where a family trusted the doctor blindly with tragic consequences. while, such blogs surely confuse patients it also serves as a warning where patients will now take opinion of more than one doctor before arriving at a more informed decision instead of blindly going by what a doctor suggests.
Kosmo
Nowhere did we say or mention that Doctors cannot be questioned or to be trusted blindly. Our clarification was only meant to establish the medical facts before everyone, so that they would not be privy to just one sided information.
wockhardt,
my post was directed at Madhuri who in her posts suggests that we should not be challenging reputations of well know doctors.(is madhuri an alias for wockhardt?)
wochardt, itwould have been better if you had replied to the 10 questions put forward by one SumanBolar in this forum...that will help clarifying facts.
I do not understand why the questions asked above by Suman is unanswered where as all the questions seems very reasonable and valid in the context.
And the way answers are posted form wockhardt side is very much supporting the Rasmi's description that they are very defensive and scared of loosing there reputation.
This big medical houses/medical practitioners should not only think about money, they should be responsive,supportive and and above all take responsibilities not show their back and went in to rabbit hole to defend themselves.
Liereaper:
All of Suman's questions were answered many times by our senior doctors and our senior management when we had a detailed discussion with her at our Hospital.
We also have already posted our clarification officially. There is no question of being defensive about anything.
The very fact that we have used a public forum to repudiate all allegations bears testimony to the fact that we are very clear regarding the clinical procedures our doctors have taken regarding Rashmi BT case.
That we have chosen to respond to the chain emails and blogs and we have also allowed every kind of questions to be asked through our blogs itself shows that we fully believe in the power and transparency of the social media.
Wockhardt Hospitals
Kosmo
Suman Bollar and her Friend had met us many times after this incident and our senior management team had explained every clinical procedure
There is no "Madhuri" at Wockhardt Hospitals. We only have one official blog and one online official spokesmen for the social media.
All of Suman's questions were answered in detail by our management team
DkM.. I am sorry if your post was not published earlier. But we generally post all comments although we can’t respond to every comment.
We review comments before they’re posted, and those that are off-topic or personal allegation against an individual without checking facts generally won’t make the cut. We also expect a basic level of civility; disagreements are fine, but mutual respect is a must, and profanity or abusive language are out-of-bounds.
As far as Patient records are concerned we have always upheld them and shall continue to uphold them . However as mentioned in our clarification Blog Post, we cannot be mute spectators when one sided comments and postings along with chain emails are being posted . We are only responding to the allegations which are not only wrong but misleading.
We clearly stand by our medical and clinical facts in Rashmi BT case as as mentioned earlier.
To everyone wishing to comment here. Please follow these guidelines
1) Please Do no ask questions that have already been replied to and our official position been clearly stated.
2)Our Blog's objective is not just to give specific queries on an individuals, but is meant to decimate information regarding our Clinical Specialties,healthcare Guides and patient education series and to provide our healthcare community a platform to share ,create and syndicate information
3)people whose comments have already been posted and their point of view heard,please remember to give others a chance.
4)Keep your comments brief,see if someone else has already asked the same question. Please desist from commenting something which others have already stated.
5)Anyone wishing to clarify anything or discuss any specific cases are welcome to meet us in person and follow our standard protocol for redressal.
6)Just to repeat and set the record straight,There is ONLY ONE OFFICIAl spokesman for the Hospital. No other blogger represent Wockhardt Hospitals official view apart from our official Blog.
7)Finally while we will certainly agree to disagree,we expect a certain level of civility when two individuals talk.Please keep in mind while commenting at our blog
In relation to the comment guidelines that you have put up, I think you wanted to use the word "disseminate" rather than "decimate information" in no. 2.
You needn't publish this if you don't like it, but make the correction, will you? "Decimate information" sounds awfully odd. "Decimate" actually conveys a meaning that is the opposite of what you are intending to say.
Have a good day.
mummyjaan Thanks for pointing out the error in spelling
It should indeed be 'dessiminate and not decimate..
We Apologise for the error in spelling and meaning.
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Some questions if you please:
1. If the heart rate of the child at 1:50 were less than normal, how did the baby get to be born at 2:30? That does not sound like 7-8 minutes. Or is Wockhardt going to refute the birth time too?
2. Even a layperson knows that VBAC cases are not induced nor is the labor speeded up. The stronger than normal contractions caused by Syntocinon increases the chances for a rupture. How come Wockhardt does not talk about this?
Past due date , 4 kg birthweight + vaginal bleeding + induced labour + fetal bradycardia a couple of times before the actual rupture, how could all these have been ignored? No I am not a Dr, but I have pushed my own Dr for a VBAC and even tried laboring for a few hours. The moment the heart rate began to fall occasionally to 100, I was sent to the OT. Now that's what I call being cautious.
I wish you would understand the purpose behind Rashmi "spreading" this story.