VANCOUVER — Sextuplets born at B.C. Children’s Hospital in January were in trouble right from the outset.
Two died shortly after delivery and soon the health of the remaining four was deteriorating so quickly that the government had no choice but to save them with urgent blood transfusions – despite the religious objections of their Jehovah’s Witness parents – the Supreme Court of British Columbia was told yesterday.
The parents, who can’t be named because of a publication ban, have applied to the court seeking a ruling that the provincial government deprived them of their Charter rights by failing to allow them to contest the transfusions in a judicial hearing.
They argue that the Ministry of Children and Family Development acted with undue haste because there was no imminent medical emergency when the babies were apprehended and given blood transfusions.
But Kris Chen, a lawyer for the ministry, told the court that the babies, who were born at 25 weeks gestation, were in jeopardy from the start and when hemoglobin counts began to fall, action was needed quickly.
“This case is about risk. Risk to the children of severe morbidity or mortality,” she said, as the babies’ father watched from the public gallery.
The infants weighed between 700 and 800 grams at birth and it was understood from the start that they would likely need blood transfusions to stay alive, Ms. Chen said, adding that it was equally clear that the parents would not consent.
But, she said, the government couldn’t seek an order to apprehend the children until a medical emergency had manifested itself.
That happened when the hemoglobin counts dropped to the low level of a broad range within which transfusions are needed, she said.
Lawyers for the parents have argued there is considerable medical debate about what the safe lower limit actually is and they say doctors could have waited for the counts to drop more.
However, Ms. Chen said doctors were being asked “to go below the known safe limits,” and that was not acceptable.
She said that when two treating physicians provided letters stating their concerns and recommending blood transfusions, the government had no choice but to act quickly.
She said the rush to apprehend the babies was not done to rob the parents of an opportunity for a judicial hearing, but to respond to a medical emergency that was increasing, and to make sure the infants were safe.
“Does it matter what was done and what wasn’t done?” she asked Chief Justice Donald Brenner, addressing the issue of medical treatment up to the crisis point.
“At a point in time we received information that these children were at risk. That’s what’s important, not how we got there.”
She said ministry officials could have delayed, to see if hemoglobin counts continued to fall or became stable, but medically that would have put the babies “in a grey area where no one knows exactly what’s going to happen.”
She asked rhetorically if the director of children and family development should put a child at risk just so parents could have a hearing.
– Four Dangers of the Jehovah’s Witness Organization
“Clearly the director has an obligation if a child is at risk. The question is: what process?” interjected Chief Justice Brenner.
“I think the answer to all of this is whether or not it was a medical emergency,” Ms. Chen replied.
She said that after the births, on the night of Jan. 6 and morning of Jan. 7, the ministry was alerted by hospital officials that at some time in the coming weeks, an apprehension order was likely to be needed in order to allow for transfusions.
The government opened a watching brief. But although the babies had extremely low birth weights, ministry officials were not told a “medical emergency” was developing until Jan. 16.
On Jan. 26, government officials were advised there was “extreme concern,” and blood transfusions would be needed “today or tomorrow.”
That prompted the ministry to go to court to get an order to apprehend the babies.
Ms. Chen said that order was issued at about 4 p.m. on a Friday afternoon. A request by the family to adjourn the matter so they could appeal was rejected.
Ms. Chen said that unlike the Supreme Court of B.C., which has judges available at any time, Provincial Court, which hears family matters, had no on-call judge available to sit on a Saturday.
She said the government did not try to “manoeuvre” the parents out of a hearing, but rather was forced to act when it did because any delay meant increased risk.
“All this is happening within a very tight window,” Ms. Chen said.
“Given the series of events and the time pressure on the director and the medical debate [about safe hemoglobin levels], there clearly was a medical emergency.”
She said the health of the babies was deteriorating rapidly and officials didn’t want to let things go “to the point where you can’t rescue them.”
Each of the four babies received one blood transfusion. Without treatment, Ms. Chen said, they might have died. They are now at home with their parents who report the infants are doing well.
The case is to continue on Sept. 10.