Shortcomings in management and ventilation in the post-operative room of Ad-din Medical College Hospital may have contributed to the deaths of six newborns last Wednesday, health officials and the families of the victims said.
The post-operative room, where two babies died and four others’ conditions deteriorated before they ultimately died, lacked any alternative ventilation system besides air conditioners. Apparent management deficiencies also raised concerns, health officials said after visiting the hospital several times in recent days.
They further said the 700-bed private hospital has infrastructural weaknesses in several areas, including narrow corridors and poor ventilation, creating a suffocating environment and increasing its vulnerability to fire and other disasters.
The issues came to light as a government probe committee continued investigating the unusual deaths of six newborns, aged between one and four days.
The committee, led by a joint secretary of the health ministry, has almost completed its investigation but decided to interview the victims’ families to verify its findings, as no post-mortem examinations or inquest reports were conducted.
Committee members yesterday recorded the statement of the mother of twin babies in Dhaka and were on their way to Keraniganj to meet another victim’s family around 4:30pm, said Md Mohsin, head of the probe committee.
“We will try to reach all the families and hope to submit our report on June 3,” he told The Daily Star yesterday.
The babies died within a few hours of each other from 6:00am on Wednesday at the hospital in the capital’s Moghbazar, with health officials suspecting that a technical failure in the hospital’s post-operative room may have caused the tragedy.
Two babies were brought dead to the neaonatal intensive care unit (NICU), while four of them died while being treated there, according to hospital authorities.
The exact cause of the deaths has yet to be confirmed, but officials of the Directorate General of Health Services have shed light on possible reasons behind the tragedy.
Speaking to reporters on the day of the incident, Prof Zahid Raihan, additional director general (administration) of the DGHS, said, “We do not think the sudden deaths of six children occurred due to treatment complications. We suspect some technical issue or fault may have been responsible.”
This correspondent spoke with three senior DGHS officials, two members of the probe committee, three family members of the victims and also visited the hospital.
One DGHS official said the post-operative room felt suffocating as there was no alternative ventilation system or windows besides air conditioners.
It was learned that the air conditioner was switched off for about an hour around 2:00am after a guardian in the post-operative room complained that the babies were feeling cold.
At the time, all six babies and their mothers were in the room. Five other mothers were also there while their babies were admitted to the NICU.
“There should have been a protocol for managing the post-operative room, and any decision to switch off the air conditioner should have been made in accordance with that protocol, not at the request of a guardian. It is linked to the breathing conditions of newborns. I think this was a lapse,” a DGHS official told this correspondent, requesting anonymity due to the ongoing investigation.
Another official said the condition of one newborn deteriorated around 4:00am, and the baby was shifted to the NICU. About half an hour later, the infant was returned to the post-operative room after showing signs of improvement.
From 6:00am onwards, the babies started dying.
“So, there was a considerable gap between the time the babies’ conditions deteriorated and their deaths. Had there been proper management and an adequate workforce, the children might not have faced such an outcome.”
Mohammad Hasan Sardar, who lost twin babies in the tragedy, said his wife had told him that the atmosphere inside the post-operative room became unusually hot and stuffy after 2:00am.
“There was a warm, suffocating feeling in the room. The environment did not seem normal. There was also a strange smell, which some thought might have come from medical gases,” he told The Daily Star yesterday.
According to him, the babies began crying, vomiting, and struggling shortly afterwards. “After vomiting, all the babies started shaking.”
Hasan alleged that no doctor or nurse was present in the room when the babies’ conditions began to deteriorate.
“My wife and other attendants looked for doctors and nurses but could not find anyone. Only an aaya [caregiver] was there.”
Janu Begum, the grandmother of another baby who died that day, said her three-day-old grandchild had been fine earlier.
“Around Fajr, all the children in the room started crying and were later taken to the NICU.”
She alleged that the mothers lost their babies due to mismanagement by the hospital authorities.
A DGHS official said the hospital had been built by combining four buildings, but its corridors were so narrow that “people would die of suffocation in the event of a fire before they could even be evacuated”.
“There should be an investigation into how the hospital obtained its fire safety and environmental clearance certificates,” he said.
Another official said, “The infrastructure is not what it should be for a hospital. This is problematic.”
Speaking to The Daily Star on Wednesday, DGHS Director General Prof Pravath Chandra Biswas said the post-operative room is located on the first floor of the hospital, while the NICU is on the fifth floor.
“The rooms should have been closer to each other. We found it [the distance between them] problematic.”
During a visit to the hospital on Saturday, Health Minister Sardar Md Sakhawat Husain found a bread factory on the top floor of one of the buildings attached to the hospital, as well as stagnant water on the premises.
“We will test the stagnant water and examine whether any substance from the bread factory, or any gas that may have exceeded the babies’ tolerance levels, was being emitted. Since we detected an odour inside the room, we will investigate it thoroughly,” he told reporters.
A member of the probe committee, seeking anonymity, said the investigation was almost complete and that there would be “no big difference” between its findings and those of DGHS officials.
Contacted by The Daily Star yesterday, Tariqul Islam Mukul, director of HR and Company Affairs at Ad-din Foundation, which runs the hospital, refuted the allegations.
“It is true that there was no doctor stationed in that particular post-operative room, but a doctor was available in nearby units. No hospital assigns a dedicated doctor to a post-operative room,” he said, claiming that a nurse was present.
Regarding the alleged delay in responding to the babies’ deteriorating conditions, he said hospital staff transferred the newborns to the NICU as soon as complaints were received.
He also claimed that the hospital has a protocol for operating the post-operative room.
“However, something might have gone wrong. We have many things to learn and correct from this incident.”
Regarding the infrastructural shortcomings, Tariqul said the hospital’s licence had been renewed by the DGHS with the existing structure and that it would make necessary changes if ordered to do so.
DGHS Director General Prof Pravath yesterday said three members from Bangladesh Shishu Hospital and Institute, the Public Works Department, and the National Electro-Medical Equipment Maintenance Workshop & Training Center were co-opted into the probe committee to ensure the investigation is accurate and impartial, as the issue is highly sensitive.
