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If the PAP government don't kill you, the hospitals will

tobelightlight

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Loyal
Bring in too many rubbish n worse with the clowns, gone
Just don't participate in whatever they suggest. Vaccine, mask, social dist, cpf, rat race, etc. Those that using your energy to make the economy good so they can stand out, but in the expense of your energy.

Spend your energy into nourishing yourself, start your own personal biz and so you can move away from such crap.
 

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Son of elderly woman who died at TTSH sues hospital and 3 doctors for negligence​

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Madam Tan Yaw Lan was admitted to TTSH on April 20, 2018. She died on May 13, 2018. ST PHOTO: LIM YAOHUI
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Selina Lum
Senior Law Correspondent

Aug 15, 2022

SINGAPORE - The son of a 74-year-old woman, who died three weeks after a heart attack while she was hospitalised at Tan Tock Seng Hospital (TTSH), has sued the hospital and three doctors, seeking $800,000.
Madam Tan Yaw Lan, who had medical issues including diabetes, hypertension, heart disease and kidney disease, had a heart attack while she was taking a shower - assisted by a nursing intern - on April 23, 2018.
She suffered brain damage following the heart attack and was placed in intensive care. She died on May 13, 2018.
In 2019, her son Chia Soo Kiang, 47, a public servant with the National Library Board, sued TTSH and the three doctors for negligence, alleging multiple breaches of their duty of care.
The purported breaches include the withholding of pre-existing medications for Madam Tan's heart condition and diabetes, failure to refer her to appropriate specialists, and allowing a medically untrained person to handle her.
A hearing into the suit opened in the High Court on Monday (Aug 15).
A total of 30 witnesses, including medical experts, are lined up to testify - six for Mr Chia and 24 for TTSH and the doctors.

Mr Chia's lawyer, Mr Clarence Lun, said in his opening statement: "Despite the deceased's medical history known to the defendants, the defendants had acted in a callous manner to a high-risk and vulnerable person, even to the extent of permitting an untrained intern nurse to treat the deceased, which resulted in her collapse and delay in responding to the emergency."
TTSH and the doctors - Dr Dorai Raj D. Appadorai, Dr Lee Wei Sheng and Dr Ranjana Acharaya - are represented by Ms Mar Seow Hwei.
They contended that all aspects of the treatment and management of the patient were appropriate and met the required standard of care.

Madam Tan was admitted to TTSH on April 20, 2018, after she went to the emergency department because of fever and lethargy.
She was initially diagnosed with widespread sepsis, a heart attack, diabetes, anaemia and worsening kidney function.
The initial treatment plan included stopping aspirin as well as medications furosemide and losartan she took for heart issues and starting her on antibiotics.

The next day, Dr Lee referred her to the hospital's cardiovascular medicine department and replaced her usual premixed insulin with a "sliding scale" insulin that varies the dose based on blood glucose level.
The planned referral was later cancelled by Dr Ranjana.
The defendants said it was appropriate to temporarily withhold aspirin, which carries a risk of bleeding, in view of Madam Tan's sepsis and drop in haemoglobin level.
They added that it is usual for hospitalised patients to be placed on sliding scale insulin.
They said no specific treatment was required for Madam Tan's heart attack as the underlying cause was sepsis, which is the body's life-threatening response to an infection.
They added that there was no delay in the resuscitative efforts - the intern called for help immediately and the medical team attended to the patient immediately.
They said Dr Dorai Raj, the consultant on call on the night of April 20, did not personally review Madam Tan and was not consulted on her case, and thus, did not owe her a duty of care.
The trial continues on Tuesday.
 

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Widow wins appeal in medical lab negligence case, top court rules for reassessing $1.2 million award​

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The Appeal Court urged all parties to explore the possibility of arriving at a settlement on the damages issue in the interests of "effecting closure as well as the saving of costs". ST PHOTO: KUA CHEE SIONG
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K.C. Vijayan
Senior Law Correspondent


NOV 26, 2019

SINGAPORE - The Court of Appeal has ordered the High Court to redetermine an award of more than $1.2 million to a widow who sued a medical lab and its medical director for failing to detect cancer in her husband's skin sample.
The five-judge court allowed the appeal of Carol Ann Armstrong, 53, that the medical negligence caused her husband, Peter Traynor, to lose his full life expectancy instead of the four years held in the judgment of the High Court last year.
The Court of Appeal affirmed the High Court's finding that Quest Laboratories and its director, Dr Tan Hong Wui, had failed to spot the skin cancer in a skin sample from Mr Traynor in 2009. Mr Traynor, a Singapore-based information technology specialist, died in 2013 at the age of 49. The Canadian couple have two daughters aged 10 and 12.
Judge of Appeal Andrew Phang in decision grounds on Tuesday (Nov 26) said: "It is difficult to understate the significance of the Respondents' breach... lives depend upon accurate diagnoses by pathologists, and diagnoses had therefore to be undertaken with due diligence."
"In the present case, Dr Tan not only failed to state that he could not rule out melanoma, he also delivered a report indicating the exact opposite - that there was no malignancy. Put simply, Dr Tan intended to convey, and did convey, that the lesion was benign," wrote Justice Phang on the court's behalf.
Both parties' appeals on the calculation of damages were partially allowed and the case is to be remitted to the High Court to revise the sum payable based on the parameters provided by the Court of Appeal.
The High Court last year found that the defendants' breach was "straightforward and obvious" and rejected their claim that Mr Traynor's fate was biologically determined and he would have died from his cancer anyway. But the High Court judge had then also rejected Ms Armstrong's claim that her husband could have been cured, finding instead that he would have lived only for four more years.


The judge, in assessing the sums payable last year, awarded the widow $1,241,334 in damages, comprising $346,677 on the grounds of dependency and $894,657 for the loss of inheritance.
Ms Armstrong appealed to the apex court and the defendants also cross-appealed.
Her lawyers led by Edmund Kronenburg and Christopher Goh argued that the damages should have been awarded based on Mr Traynor's full life expectancy of up to the age of 82.

The respondents' team of lawyers led by Senior Counsel Kuah Boon Theng and lawyer Eric Tin submitted that the High Court erred in finding their clients liable for breach of duty. Among other things, they urged the court to reduce the damages payable in relation to Mr Traynor's estimated income.
The Appeal Court comprising Chief Justice Sundaresh Menon, Judges of Appeal Andrew Phang, Judith Prakash and Tay Yong Kwang as well as Justice Belinda Ang, heard the case in January and reserved judgment and affirmed the respondents' misdiagnosis was a straightforward breach.
The court found that the sole cause of Mr Traynor's death was the melanoma that had spread through his bloodstream from his infected lymph nodes after 2009, and the breach by Quest Lab and Dr Tan led to a delay in diagnosis which allowed the cancer to grow in his lymph nodes.
The Appeal Court revised the High Court's finding of Mr Traynor's annual income from $450,000 to $308,386 but affirmed the majority of the judge's assessments on the pre-trial dependency and the loss of inheritance claims.
It also allowed Ms Armstrong's appeal in relation to the post-trial loss of inheritance claim.
This would now depend on the judge's determination and the multiplier-multiplicand to be applied. The judge would also have to assess, among other things, Mr Traynor's retirement age, the educational expenses for his daughters beyond four years and savings in deriving the appropriate sum.
"Accordingly, we remit these issues to the judge for him to reach the appropriate sum for the post-trial loss of inheritance," said the Appeal Court.
The Appeal Court said that in the context of a dependency claim, the multiplier is the number of years for which a dependent can claim for his or her loss, with a discount for accelerated receipt of funds and the vicissitudes of life. The multiplicand is the annual value of the dependency.
However, in the context of a loss of inheritance claim, the multiplier must also be adjusted to reflect the post-retirement expenses of the deceased. The multiplicand is the savings of the deceased per annum.
The widow in her initial statement of claim in January last year sought more than $10 million.
The Appeal Court urged all parties to explore the possibility of arriving at a settlement on the damages issue in the interests of "effecting closure as well as the saving of costs".
Quest Lab and Dr Tan were ordered to pay $75,000 to Ms Armstrong for the cost of appeal.
 

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Estate of patient who died from cancer due to negligence by CGH awarded $326,000​

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Ms Noor Azlin Abdul Rahman had gone for treatment at CGH in 2010 and 2011, but did not receive follow-up consultations despite getting recommendations. PHOTO: ST FILE
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Salma Khalik
Senior Health Correspondent


JAN 19, 2021

SINGAPORE - Changi General Hospital (CGH) has been ordered to pay the estate of Ms Noor Azlin Abdul Rahman $326,620, as well as interest at 5.33 per cent, plus legal costs of $105,000 for the delay in diagnosis which caused her relapse and death from lung cancer at the age of 39 in 2019.
She died five weeks after the Court of Appeal found in her favour against CGH.
Her estate sought $13.46 million in damages while the hospital said the evidence provided only justified $20,800..
Ms Noor Azlin had gone for treatment at CGH, where X-rays of her lungs were taken in 2010 and 2011. Both times, the radiologist recommended follow-up consultation. But this did not happen.
By the time she was again referred to the hospital by a doctor from the Raffles Medical Clinic, her tumour had grown. In spite of treatment, her cancer progressed and she died on April 1, 2019.
The Court of Appeal's judgment in February that year said: "But for CGH's failure to diagnose her in July 2011... we find it unlikely that the lung cancer would have progressed to Stage IIA before resection.
"It was more likely than not that she would not have suffered from nodal metastasis and any consequences that may follow."

By the time her appeal was heard, the cancer had already spread to her brain.
Before the assessment of damages released by the High Court on Tuesday (Jan 19), her estate was awarded an interim payment of $200,000 in September 2019.
In deciding on the amount, Justice Belinda Ang said shortcomings in the estate's claims "have impacted the damages recoverable".
As examples, she said: "No evidence has been led on Ms Azlin's expected full life expectancy. In addition, no justification has been given for the calculation of Ms Azlin's medical expenses post-trial." She also said that "a pleaded claim for loss of earnings has been retained when it should have been changed to a claim for loss of inheritance".
The amount sought by her estate was also far higher than the $6.7 million Ms Azlin had originally claimed.

Justice Ang said that since Ms Noor Azlin has died - the claims for loss of future medical expenses, transport expenses, take-home earnings and CPF, and cost of nursing care have all dwindled.
The higher claim "is ostensibly making up for this shortfall", the judge said, describing it "as simply contrived in the absence of supporting evidence, amongst other things".
Before her death, Ms Noor Azlin, in an interview with The Straits Times, spoke about why she had pursued the case in court in spite of her terminal cancer.
She had said: "I really had to. I don't want the same thing to happen to anyone else. I am sad it has happened to me, but I hope this can change the system so more lives can be saved."
 

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Death of foreign worker: Doctor fined $1,500 for negligence after issuing prescription without performing tests​

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Haridass Ramdass was fined $1,500 after pleading guilty to one count of endangering the personal safety of his patient by a negligent act. ST PHOTO: KELVIN CHNG
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Wong Shiying

FEB 10, 2022

SINGAPORE - A doctor exposed his patient to potentially more serious side effects when he issued him a particular drug to treat his psoriasis without performing the necessary tests that would have alerted him to the patient's renal impairment.
Haridass Ramdass, 77, was on Thursday (Feb 10) fined $1,500 after pleading guilty to one count of endangering the personal safety of his patient, Savarimuthu Arul Xavier, by a negligent act.
Xavier, an Indian national working as a construction worker here, died in December 2014 after developing an invasive fungal infection following treatment.
Haridass, a general practitioner (GP), was originally charged with causing Xavier's death by a rash act, but the charge was later reduced by the prosecution.
The court heard that Xavier, then 28, visited three different GPs between October and November 2014 after developing rashes over his body, face and limbs.
Each clinic diagnosed him with psoriasis and prescribed medications including antihistamines and steroid cream.
Psoriasis is an autoimmune disease that causes red, itchy and scaly patches on the skin. It has no known cure.

When Xavier's condition did not improve, he visited Tekka Clinic in Little India on Nov 24, 2014.
Haridass was the sole doctor in the clinic.
He noted that Xavier had extensive reddish and round lesions all over his body, including his scalp.


The patient informed him that his skin condition had persisted for 20 days and that he had seen three other doctors before him.
Haridass diagnosed him with psoriasis and gave him an injection of dexamethasone, a steroid used to treat ailments such as arthritis and breathing problems.
He also prescribed 10 tablets of methotrexate (MTX), 10 tablets of prednisolone and 10 tablets of chlorpheniramine.
MTX is a drug often used in the treatment of cancer and can also be used in the treatment of severe psoriasis. Possible side effects include life-threatening toxic reactions.


Said Deputy Public Prosecutor Timotheus Koh: "MTX may produce marked depression of the bone marrow and lead to a deficiency in red blood cells, white blood cells and platelets, as well as bleeding.
"Deaths have been reported to follow the use of MTX in the treatment of psoriasis... Potentially fatal opportunistic infections, for instance by fungi, may also occur with MTX therapy."
MTX therapy for patients with impaired renal function should be undertaken with extreme caution because the impairment will increase the potential for MTX toxicity.
Haridass did not arrange for Xavier to undergo tests and thus failed to discover the patient's renal impairment.
Haridass was previously charged with causing the patient's death by a rash act.
The charge he admitted to on Thursday was for endangering personal safety by a negligent act.
The DPPs sought the maximum fine of $1,500, noting that the sentence must adequately deter negligence by medical professionals.

Haridass' lawyer, Senior Counsel Davinder Singh of Davinder Singh Chambers, said in mitigation that there was no risk of Haridass committing the offence again as he had retired and did not renew his practising certificate.
"He is genuinely remorseful and accepts that he was wrong," Mr Singh added.
For endangering the personal safety of the patient, Haridass could have been given a maximum penalty of three years' jail and a $1,500 fine.
 

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Doctor rapped over patient's death after knee surgery​

He failed to make detailed notes or hand over case, coroner finds​

The coroner said Dr Sean Ng Yung Chuan's (above) treatment of his patient goes beyond mere human error. The doctor was found to have failed to make detailed notes or hand his patient over to another specialist when he planned to travel after operat

The coroner said Dr Sean Ng Yung Chuan's (above) treatment of his patient "goes beyond mere human error". The doctor was found to have failed to make detailed notes or hand his patient over to another specialist when he planned to travel after operating on her.
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Salma Khalik
Senior Health Correspondent

SEP 19, 2019

The way a doctor treated a patient who died following total knee replacement "goes beyond mere human error", said a coroner at the conclusion of a seven-day hearing.
The coroner criticised Dr Sean Ng Yung Chuan for failing to make detailed notes or hand the patient over to another specialist when he planned to travel after operating on her.
If he had done so, tell-tale signs that something was wrong might have been noticed, and action could have been taken earlier.
State Coroner Kamala Ponnampalam said on Monday that a coroner "does not make a determination of guilt or negligence, or attribute legal or moral culpability".
Nevertheless, she flagged Dr Ng's behaviour which "demonstrated a clear departure from the standards expected of a physician who had primary care of a post-surgery patient".
To reduce preventable deaths in the future, the coroner suggested it should be made mandatory that "if a doctor delivering primary care to a post-surgery patient is going to be unavailable, he must arrange for another doctor to cover him".
"There should also be guidelines for a proper handover," she added.


Dr Ng had done a total knee replacement for Mrs Yuen Ingeborg, then 78, in November 2016.
It is a fairly common operation, for worn-out knees, that thousands of patients undergo each year. Unfortunately, Mrs Yuen died within a week of the operation.
Dr Ng travelled to Tokyo the day after the operation.

The coroner's inquiry revealed a series of mishaps and errors.
During the surgery, Dr Ng accidentally cut a ligament. He called another orthopaedic surgeon for help to repair the cut ligament.
The patient appeared fine after the operation.
The next morning, her haemoglobin count was low, so Dr Ng prescribed her the transfusion of a pint of blood.
What Dr Ng did not realise was that both Mrs Yuen's popliteal artery and vein (in the knee) had also been cut. This led to internal bleeding and restricted blood flow that cost the patient, first her leg which had to be amputated, and later her life as the delay in treatment allowed poisons into her body.
She died of multi-organ failure.
The coroner noted that Mrs Yuen's son and daughter had asked how Dr Ng "had managed to sever both the popliteal artery and vein and then fail to recognise that he had done so."
Two expert witnesses said complications with the artery in the knee area are very rare - in the vicinity of 0.03 per cent to 0.17 per cent.
Dr Tang Jun Yip, a vascular surgeon at Singapore General Hospital (SGH), which does more than 2,000 knee transplants a year, said there have been no reported cases of both artery and vein being cut.
Professor Yeo Seng Jin, a senior orthopaedic surgeon at SGH said he had never seen something like this happen. He added that Mrs Yuen would have complained of numbness and pain when the anaesthesia wore off.
Mrs Yuen's daughter had pointed out to the nurses at Mount Elizabeth Hospital that her mother's leg felt icy cold, but was told that was normal.
According to the coroner's report, Prof Yeo questioned if Dr Ng "did actually physically examine Mrs Yuen's lower limb post-operatively. If he did not, then he is negligent for failing to do so".
Dr Tang said the drop in haemoglobin was unusual and Dr Ng should have explored further and not just prescribed a blood transfusion.
Another expert, Mr Nicholas Goddard of the Royal Free Hospital in London, who was brought in by the patient's family, said the cutting of both the artery and vein was "the result of poor surgical technique".
Because of the "paucity of note-keeping and large gaps in the medical notes", the experts had difficulty ascertaining if proper post-operative care was provided.
That Dr Ng travelled to Tokyo without handing over the patient to another specialist was "injudicious". It may have led to the delay in diagnosing that the blood flow to the lower leg had been affected.
Dr Ng later added to the notes, without indicating that this was done after he returned from Tokyo.
Prof Yeo said this clearly contravened the Singapore Medical Council (SMC) guidelines.
Mount Elizabeth Hospital has filed a complaint with the SMC against Dr Ng on this matter.
"Stern and appropriate action was taken against the doctor immediately after the hospital concluded its internal investigations, and he was served with an eight-month suspension," said Dr Noel Yeo, the hospital's chief executive.
Another complaint - on a separate matter - was made against Dr Ng in 2017. It was dismissed, but the appeal against it is pending.
The two complaints were revealed by Dr Ng's Ardmore Medical Group in its prospectus when it planned an initial public offering (IPO) on the Catalyst Board in June.
Dr Ng is the executive director and chief executive of the group and accounts for more than 40 per cent of its revenue. The group put its IPO plans on hold last month.
 

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High Court dismisses man's $800k negligence suit against TTSH over mum's death​

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The man alleged in his lawsuit that the doctors were negligent in not diagnosing his mother correctly. ST PHOTO: KUA CHEE SIONG
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Selina Lum
Senior Law Correspondent


OCT 13, 2022

SINGAPORE - A man who sued Tan Tock Seng Hospital (TTSH) and three doctors in the High Court, seeking $800,000 for the death of his 74-year-old mother, has lost his case.
Justice Choo Han Teck said the allegations against the defendants were "woefully short of evidence, and have been methodically refuted by not just the treating doctors and nurses, but also the defendants' expert witnesses".
Madam Tan Yaw Lan, who had multiple ailments, including diabetes, hypertension, chronic heart disease and chronic kidney disease, was admitted to TTSH on April 20, 2018, after she had gone to the emergency department with a fever.
Her heart stopped while she was in the shower, assisted by a nursing intern, on the fourth day of her stay.
She died three weeks later, on May 13, 2018, without regaining consciousness.
Her son, Mr Chia Soo Kiang, 47, a public servant with the National Library Board, alleged in his lawsuit that the doctors were negligent in not diagnosing Madam Tan correctly.
Mr Chia contended that his mother had suffered from an acute heart attack which was not picked up at the emergency department and on her admission. He said she should have been referred to a cardiologist.

Mr Chia also alleged that TTSH was negligent in taking Madam Tan for a shower against her family's instructions and in being too slow in its efforts to resuscitate her after she collapsed.
He also criticised the defendants for withholding medications in the first two days, namely aspirin, furosemide and losartan, that Madam Tan had been taking for her existing ailments.
The defendants and their experts maintained that Madam Tan had been correctly diagnosed as having sepsis, an infection, from an unknown source.

In his judgment, Justice Choo accepted the evidence of the defendants' expert, Dr Yeo Khung Keong from the National Heart Centre, that a heart attack would not have been the only possible cause of Madam Tan's death.
Dr Yeo said Madam Tan's entire clinical history, electrocardiograms (ECGs) and various laboratory results did not lead to a clinical finding that she had had an acute heart attack.
He said another possible cause for cardiac arrest would be a blood clot in the lung.
However, there was no definitive answer in Madam Tan's case, as her family declined to have an autopsy performed, said the judge.

Justice Choo said the TTSH doctors were right to focus on treating the sepsis. Madam Tan showed signs of recovery, and by April 23, was able to sit, have her breakfast, chat with the nurses and walk unassisted to the shower room.
"It is important to understand that a cardiac arrest is unpredictable, and that Madam Tan's collapse, had it been caused by a heart attack... could have occurred at any time, anywhere - even in an ICU or HDU," he said, referring to an intensive care unit or high dependency unit.
Mr Chia, who was represented by lawyer Clarence Lun, had relied on the expert evidence of Dr Eric Chong, a cardiologist in private practice.
Justice Choo said Dr Chong's evidence that Madam Tan had an acute heart attack was "perplexing" as she did not show signs of chest pain or shortness of breath and there were no significant changes in her ECG readings.
Justice Choo said the medications were stopped to avert acute complications, and could have been reinstated should the situation change.
The judge said there was no basis for the claim that TTSH was negligent in allowing a medically untrained person to handle Madam Tan, as assisting a patient with a shower does not require any specialised skills.
As for the alleged slow response, Mr Chia had contended that Madam Tan should not have been moved back to her bed before resuscitation efforts commenced.
The judge said it made better sense to move Madam Tan back to her bed, which was next to the shower room and connected to resuscitation equipment, rather than resuscitate her on the wet floor of the shower room.
"Mr Lun produced no evidence, only an assumption on his part, that the brief period that Madam Tan was in coma and suffered brain and spinal injuries was the result of the acts of the defendants. The law requires evidence, not assumptions," said the judge.
 

musclepower

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In his judgment, Justice Choo accepted the evidence of the defendants' expert, Dr Yeo Khung Keong from the National Heart Centre, that a heart attack would not have been the only possible cause of Madam Tan's death.

Does that mean it's possible vaccination may have also been the cause ?

I don't see how this kind of motherhood statement can be useful to the Court. Yes, heart attack may not be the only possible cause, and the implication is heart attack is a possible cause.
 

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Anaesthetist who left patient during operation to take phone calls suspended 2½ years​

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According to CCTV footage, the anaesthetist left the operating theatre “multiple times”, with the longest period being nine minutes. PHOTO ILLUSTRATION: UNSPLASH
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Salma Khalik
Senior Health Correspondent

Jan 10, 2023

SINGAPORE – An anaesthetist who walked out of the operating theatre several times to take calls from other patients while another in his care was undergoing surgery has been suspended for 2½ years, the Singapore Medical Council said on Tuesday.
During the operation in 2016, the patient suffered a complication when a blood clot blocked oxygen from his lungs, an event known as a pulmonary embolism. He was successfully resuscitated by a team of doctors, but died the following day.
The Singapore Medical Council’s disciplinary tribunal said the patient’s chances of surviving the embolism was very low. But that chance may have been further lowered by Dr Islam Md Towfique’s delay in recognising the changes in the patient’s vital signs and consequent delay in taking action.
Dr Islam told the tribunal it was common practice for anaesthetists to leave the operating theatre for short periods of time.
The patient, 64, had surgery performed at Gleneagles Hospital on a fracture caused by his bone marrow cancer on Sept 1, 2016. Given his age, obesity, prior heart problems and cancer, he was “considered a high anaesthetic risk patient”, said the tribunal.
During the operation, his oxygen reading fell below 90 per cent, “into the 80s and 70s”. In a normal person, the SpO2 or the amount of oxygen the blood can carry should be in the range of 96-99 per cent. Despite that, the oxygen given to the patient was not increased.
The hospital’s parent company, Parkway Pantai ltd, pointed out in a letter to Dr Islam, “Increasing the oxygen delivery is one of the first few actions that an anaesthetist should initiate when a patient’s SpO2 falls, and yet for almost 50 minutes, with the SpO2 either un-recordable or in an unacceptable range, this remedial action was not taken.”

In his defence, Dr Islam, a veteran doctor, said: “I was with the patient and did apply my expertise to keep the Haemodynamics but I forgot to increase the oxygen to 100 per cent.”
Parkway suspended him for six months in 2017, and reported the incident to the SMC.
The expert for the SMC, which was the prosecuting body, said things can go wrong very quickly “so we need to be there … there’s not at any point … that it’s safe for an anaesthetist to leave the patient.”

He added that “all you need is less than a minute for things to go wrong”.
The tribunal agreed with the prosecution that the potential harm to the patient from Dr Islam’s multiple departures from the operating theatre “would be serious injury or even death”.
According to the hospital CCTV in the corridor outside the operating theatre, Dr Islam left the operating theatre “multiple times”. The longest period he was gone was nine minutes.
Aside from those times, Dr Islam also went several times to the adjoining induction room, but these were not recorded by the CCTV.
Dr Islam had argued that there was nothing wrong with his leaving the operating theatre for short periods as this “behaviour would not be that different from that of his other anaesthetic colleagues”.
The surgeon who had carried out the operation and who gave evidence on behalf of Dr Islam at the hearing, said the anaesthetist has continued to leave the operating theatre to take phone calls.

The tribunal rejected Dr Islam’s contention that the harm caused by his behaviour was minimal, as the prospect of surviving the blockage to the lung was minimal.
It said such a defence “would lead to an illogical outcome where a doctor treating a patient whose condition makes the prospects of survival low, is able to take less care, because the chances of survival were small in any event”.
The tribunal also agreed with the SMC that such misconduct “causes significant harm to public confidence in the medical profession and the healthcare system.
“The respondent’s conduct in repeatedly leaving the operating theatre to attend to phone calls which he acknowledged were not urgent, would shock the public and harm public confidence in the medical profession.”
It also disagreed with Dr Islam’s claim that his conduct was not motivated by financial gain.
Most of the calls were from patients both overseas and local, wanting to know when they could come for treatment, so he “was simply servicing other patients who would be paying his fees after coming to Singapore for treatment”.
Dr Islam also asked for a one-third reduction of his sentence, given the long time it has taken for the case to be heard.
But given that he has continued the practice of accepting calls in the midst of surgery, the tribunal said a one-sixth reduction was more appropriate.
It reduced his 36-month suspension to 30 months. He also has to pay the costs and expenses of the proceedings, including the cost of SMC’s lawyers, and undertake to refrain from such conduct in the future.
 

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Doctor accused of causing patient’s death after aesthetic treatment faces more charges​

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Shaffiq Alkhatib
Court Correspondent

DEC 7, 2022

SINGAPORE – A doctor accused of causing a patient’s death after an aesthetic treatment was handed three more charges under the Health Products Act on Tuesday, including two involving expired medication.
Chan Bingyi, 34, was first charged in court on Oct 11, 2022, over his alleged negligence for administering ethylenediaminetetraacetic acid (EDTA) intravenously to Ms Lau Li Ting, 31, in March 2019, when there was no need to do so.
On Tuesday, Chan was accused of possessing expired injection ampoules of adrenaline and a heartburn relief drug at the Revival Medical & Aesthetics Centre at Esplanade Xchange in Bras Basah Road, in March 2019.
On March 18 that year, the Singaporean doctor also allegedly had three 500g bottles of J-Cain lidocaine cream at 10.56 per cent. The cream was an unregistered health product, court documents stated.
According to the Health Sciences Authority (HSA), lidocaine is a medicine used to decrease or eliminate the feeling of pain. The authority said the inappropriate use of products with high concentrations of lidocaine can cause low blood pressure and dizziness.
On March 18, 2019, Chan allegedly had 21 1ml ampoules of adrenaline injection that expired on Jan 30 that year.
The Australia-based Healthdirect website states that adrenaline injections are used to treat severe allergic reactions. It says: “Adrenaline makes your heart beat faster, and your lungs breathe more efficiently. It causes the blood vessels to send more blood to the brain and muscles, increases your blood pressure, makes your brain more alert, and raises sugar levels in the blood to give you energy.”

On March 25, 2019, Chan is said to have had in his possession one 2ml injection ampoule of Shintamet – 150mg/ml cimetidine, that expired in October 2018.
HSA states on its website that cimetidine is used for the short-term relief of heartburn. Its side effects include headache, diarrhoea and dizziness.
Chan’s alleged use of EDTA on Ms Lau on March 8, 2019, caused her to develop EDTA toxicity, which led to her cardiac arrest and eventual death.

EDTA is sometimes used as a medication for heavy metal toxicity. It is also a common ingredient in skin and body care products.
According to court documents, Chan allegedly administered the substance “at too high a concentration and too quickly”.

Ms Lau was on life support for five days before she died on March 13. Doctors had told her family that her heart had stopped for some time and there was little activity in her brain.
Her family made a police report and reported the matter to the Ministry of Health. In an earlier statement, Dr David Loh, president of the Society of Aesthetic Medicine (Singapore), said: “Chelation therapy, where EDTA is administered intravenously, is not a field within aesthetic medicine.”
In chelation therapy, a chemical is injected into the bloodstream to remove heavy metals and minerals in the body.
The Singapore Medical Council’s database shows Chan is still registered as a medical practitioner.
A search with the Accounting and Corporate Regulatory Authority reveals that he used to be a director at two companies – Revival Medical (International) and Revival Medical (Singapore).
He is represented by lawyer Adrian Wee from Characterist law firm, and his pre-trial conference will take place on Jan 11, 2023.
If convicted of causing Ms Lau’s death by a negligent act not amounting to homicide, Chan can be jailed for up to two years and fined. For each charge under the Health Products Act, an offender can be jailed for up to two years and fined up to $50,000.
 

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Doctor who failed to refer patient for TB treatment suspended 15 months​

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The doctor certified the patient, a domestic worker, as fit after her X-ray showed possible infection in her lungs. PHOTO ILLUSTRATION: ST FILE
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Salma Khalik
Senior Health Correspondent


JUN 14, 2022

SINGAPORE - A doctor who certified a domestic worker from Myanmar as fit, when she actually was suffering from multidrug-resistant tuberculosis (TB), has been suspended for 15 months.
Dr Teo Sze Yang, a general practitioner at Providence Clinic, also did not refer her for treatment, as required by law, after her X-ray showed possible infection in her lungs.
She was later diagnosed with TB by another doctor.
The Singapore Medical Council (SMC) disciplinary tribunal said in a release on Monday (June 13) that it was possible the more than a month's delay in the domestic worker's treatment caused the brother of the woman's employer, who was living in the same household, to contract TB.
TB is an air-borne disease transmitted through close and prolonged exposure to someone who is infected but untreated.
The patient had seen Dr Teo at his clinic in Redhill on March 17, 2018, for the regular six-monthly medical examination as required by the Ministry of Manpower (MOM).
Her X-ray results showed possible infection in both lungs, and it came with the recommendation for further management and follow-up.

Dr Teo saw her again on March 29 and she had a fever, cough and sore throat.
He prescribed antibiotics and a cough mixture, and said he planned to refer her to the TB Control Unit (TBCU) within a week if needed.
But he did not follow up on this.

On May 5, she was diagnosed to have TB by another doctor, who referred her to the TBCU.
In November 2018, the then director of the TBCU lodged a complaint against Dr Teo with the SMC, the professional watchdog.
The SMC filed two charges against Dr Teo: Failure to provide appropriate care to his patient, and certifying in a form that she did not have TB "when there was in fact no basis for him to do so".
A disciplinary tribunal found him guilty of both charges and suspended him for 15 months.
The SMC told the tribunal that the symptoms "would have greatly increased the suspicion that the patient had TB and the need to refer her to TBCU promptly".

That Dr Teo did not do so was either "an intentional, deliberate departure from standards of the medical profession or such serious negligence that it objectively portrayed an abuse of the privileges accorded to a medical practitioner".
In his defence, Dr Teo said the Ministry of Health (MOH) guidelines did not stipulate that a patient must be referred to the TBCU immediately if his X-ray screening was abnormal.
But Dr Teo admitted that he did not have the expertise to say she did not have TB.
On the second charge, Dr Teo said he had pre-signed the certification form, which he claimed was submitted by his clinic assistant without his instructions due to an "administrative error".
In finding the doctor guilty, the tribunal said it was apparent that he "was simply indifferent to the patient's welfare or to his own professional duties".
His notes on the case were very brief and did not support his claim that he had mentioned the possibility of TB.
An aggravating factor, it said, was Dr Teo repeatedly providing false and/or misleading information on why he did not refer the patient to TBCU, and how the wrong certification was submitted to MOM.
There were no mitigating factors.

The tribunal said doctors are required to refer suspected TB patients to the TBCU "to reduce the risk of transmission and to ensure that suspected TB cases can be expeditiously managed", as it could be fatal if not treated properly.
Last year, more than 1,300 people were diagnosed with TB here.
The tribunal agreed with the SMC that a deterrent sentence was merited as medical certification forms are often "the first (and only) line of defence against a public health threat", and doctors should take their responsibility seriously.
 

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Dentist suspended, fined for placing dental implants in patient not suited for procedure​

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The Singapore Dental Council said Dr Oliver Hennedige did not take proper precautions to ensure the implants were safe. PHOTO: OLIVERDENTALSURGERY.COM
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Wong Shiying

MAY 27, 2022

SINGAPORE - A dentist has been suspended for 15 months and fined $15,000 after he placed mini dental implants in a patient despite clear signs that it would cause her problems later.
Dr Oliver Hennedige was also found guilty by the Singapore Dental Council's (SDC) disciplinary committee of failing to exercise due care in doing a permanent bridge for the patient - a procedure that involves replacing missing teeth with fake ones.
He had filed an appeal to the High Court to overturn the SDC's decision, but this was dismissed on April 28.
Dr Hennedige had been practising at two clinics with the same name - Oliver Dental Surgery - at 242 Tanjong Katong Road and at Camden Medical Centre in Orchard Boulevard.
According to the clinics' website, Dr Hennedige has been a dentist for more than 30 years and is the secretary-general of the Asia Pacific Dental Federation.
In a statement on Friday (May 27), the dental council said it started the inquiry into Dr Hennedige when a patient made a complaint against him on March 12, 2016.
The council then pressed two charges against the dentist, which he contested at first, but later pleaded guilty to.

The first charge involved Dr Hennedige using mini dental implants on a patient even though they were not appropriate for her given her limited bone width.
Sufficient bone is required around an implant to support it.
The disciplinary committee said there were "clear red flags" about performing the procedure as it could lead to inflammation and bone loss in the patient.

The committee added that Dr Hennedige did not take proper precautions, such as doing a three-dimensional X-ray, to ensure that the implants were safe for the patient.
As for the second charge, the dentist was found to have poorly designed and executed the dental bridge meant to help the patient replace missing teeth.
The committee said the bridge's design was "doomed to fail from the start for various reasons".

First, its rough surface acted as a food trap - where food gets stuck after a meal and cannot be removed without flossing.
This trap may lead to tooth decay if left uncleaned or untreated by a dentist.
Second, the bridge was poorly fitted with excess cement, the committee said.
"This would cause inflammation of the gingiva (or gums) and bone loss around the implants.
"The limited space between the implants made it difficult for the patient to maintain an adequate level of hygiene, exacerbating any inflammation and irritation," it added.
As part of his punishment, Dr Hennedige has to take a basic course in dental implantology before his suspension ends.
In 2004, the SDC had found him guilty of professional misconduct for failing to obtain the consent of a patient before carrying out a mini implant procedure on her.
Dr Hennedige had appealed against this decision in the High Court, and it was found that the prosecution could not prove its case against him beyond reasonable doubt. As such, he was cleared of those charges in 2006.
 

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5 Khoo Teck Puat Hospital staff disciplined for lapses that led to wrong treatment for some breast cancer patients​

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The hospital also apologised to the affected patients and said it will compensate them. PHOTO: ST FILE
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Rei Kurohi
Tech Correspondent


MAY 3, 2021

SINGAPORE - Khoo Teck Puat Hospital (KTPH) has taken disciplinary action against five of its staff members for their roles in an incident at its laboratory that resulted in some breast cancer patients receiving unnecessary treatment due to inaccurate test results.
The hospital on Monday (May 3) also apologised to the affected patients and said it will compensate them.
"We have reached out to all affected patients to offer our support, and we give the assurance that we will look into the appropriate compensation for each individual patient," said Associate Professor Pek Wee Yang, who is chairman of the KTPH Medical Board.
"We would also like to seek their understanding and patience as this process will take some time to complete. In addition, we will provide psychological counselling to these patients, where needed, during this period."
The staff members punished included those in management roles. The disciplinary action meted out ranged from stern warnings to financial penalties and cessation of employment.
Counselling, retraining and re-education are also being conducted for the staff.
In its statement, KTPH said the incident was caused by human error during the establishment of the staining procedure for human epidermal growth factor receptor 2 (HER2) tests.

The calibration error was not discovered due to a failure to conduct rigorous checks when the protocol was established, KTPH said.
This resulted in the over-staining of lab slides, which affected the interpretation of the results and led to a higher positive rate of HER2 than usual.
HER2-positive breast cancers are typically more aggressive than HER2-negative cancers. Some of the patients who were wrongly diagnosed with HER2-positive breast cancer received over-treatment as a result.

The investigation also revealed that the deviation in the HER2-positive rates compared with international benchmarks was noted early on during the laboratory's regular monitoring.
The section in charge of the tests conducted checks on the processes involved in interpreting the stained slides but attributed the deviation to differences in patient population. It did not recheck the accuracy of the staining protocol itself.
KTPH said staff from the section had failed to perform quality control checks properly, including monitoring and properly analysing the HER2-positive trend closely over time, which affected the interpretation of the over-stained slides and a delay in detection of the error.
The hospital added that these gaps contributed to the failure to detect the over-staining issue early, as well as in the subsequent years - from 2012 to 2020 - when the tests were conducted.

An internal review was conducted last year when the clinicians reviewing breast cancer cases noticed the higher-than-usual positive rate.
KTPH comes under the National Healthcare Group (NHG). An NHG review committee comprising experts in various disciplines from the healthcare industry conducted the investigation and made several recommendations to prevent similar incidents from occurring in future.
"We are determined to set things right to regain the trust and confidence of our patients. We will expeditiously rectify all gaps in our processes in the laboratory," said Prof Pek.
"Moving forward, we will ensure strict adherence to industry's best practices and international benchmarks."


About the incident​

In November last year, Khoo Teck Puat Hospital (KTPH) was informed by its laboratory that its tests for human epidermal growth factor receptor 2 (HER2) were producing higher-than-expected rates of HER2-positive results for breast cancer patients.
At least 200 breast cancer patients received the wrong test results - they were told their cancer was HER2-positive, a less common and more aggressive form of the disease. Of this group, about half received unnecessary treatment as a result.
Once the testing flaw was discovered, the hospital stopped all such tests and identified the affected patients.
The samples - dating back to 2012, when KTPH started doing the tests - were then sent to various external laboratories to expedite retesting.
The test checks for HER2 proteins, which normally regulate the healthy growth of breast tissue.
It works by introducing antibodies tagged with a coloured dye to a sample of breast tissue. These attach themselves to HER2 proteins, which show up as a stain when a doctor observes the sample under a microscope.
The intensity of the stain determines whether the result is HER2-positive or negative.
After discovering the error, KTPH informed the National Healthcare Group (NHG) and the Health Ministry in late November last year. It publicly announced the incident on Dec 11.
Those who were over-treated as a result of their mistaken HER2-positive diagnosis were prescribed the drug Herceptin, which can cause side effects like diarrhoea, chills and fever. In about 3 per cent to 4 per cent of cases, patients may also experience heart problems.
In January, Senior Minister of State for Health Koh Poh Koon addressed questions on the incident in Parliament. Ms Cheryl Chan (East Coast GRC) asked why it took so long for the error to be discovered.
Dr Koh noted that the test is complex and does not give a definitive answer. He said it takes a trained pathologist to make a judgment on the test result, but this could be affected by the multiple steps that require human intervention, such as the concentration of stains and how the tissue was handled.
It also requires a fairly large number of results to trigger an alert on the possibility of a disproportionate number of patients being diagnosed with the condition, Dr Koh had said.
 

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Man's death after stretcher trolley collapsed during hospital transfer ruled medical misadventure​

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The Coroner's report said CCTV footage showed "the stretcher appeared to be pulled out steadily and the stretcher's collapse was sudden". ST PHOTO: LIM YAOHUI
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Salma Khalik
Senior Health Correspondent

APR 16, 2021

SINGAPORE - A coroner's inquiry into Mr Razib Bahrom's death in 2018 has thrown up a series of potentially dangerous issues.
There were mishaps in his care after a heart attack, one of which likely precipitated his death.
Mr Razib was 55 years old when he felt chest pains on June 17, 2018, and it worsened during the day. At about 9pm, he went to Khoo Teck Puat Hospital, where he was diagnosed and treated immediately.
The doctors inserted two stents that night. They also gave him medication, but in spite of that, his heart function remained poor.
The team called the National Heart Centre Singapore (NHCS) for an extra-corporeal membrane oxygenation (Ecmo) machine - which pumps blood into an artificial lung that removes carbon dioxide and adds oxygen to the blood before returning it to the body.
A team from the Heart Centre arrived with the Ecmo machine at 11.50pm and Mr Razib was successfully put on its support.
All was fine up to that point. It was during the transfer of the patient from KTPH to the Singapore General Hospital (SGH) that things went wrong.


As Mr Razib was on the Ecmo, he was accompanied in the ambulance by medical staff from both NHCS and KTPH.
With so many people in the ambulance, the porter, who would normally help the driver to move the patient, had to be left behind.
On the way, the Ecmo started beeping, indicating that it was low on battery. The machine had been checked and the battery was full before it left the NHCS.

The ambulance has a power supply, so the team tried to plug the machine in. They asked the driver to turn on the power supply, but he didn't know where the switch was. He tried two switches but neither worked.
The coroner heard that the standalone power pack in the ambulance requires two switches - a master switch behind the driver's seat and a manual switch near the steering wheel.
KTPH has since modified its ambulances so that the battery power supply is turned on along with the ambulance engine.
The Ecmo machine ran out of battery power just as Mr Razib arrived at SGH and he was without the machine's support for five minutes.
Staff there were standing by with an extension cord.
In spite of five minutes without the machine, Mr Razib's condition remained stable.
The machine had been properly maintained, so the coroner said its failure "can be regarded as an unexpected electrical failure and should not be regarded as a lapse in care".
But she suggested that a full spare battery pack be carried in future.

On arrival at the hospital, the driver pulled the stretcher out a quarter of the way. He then needed to lift the stretcher up by 23cm before pulling it out further so that the legs would be deployed.
This is usually done with the help of the porter, who had been left behind. The driver found this difficult as Mr Razib weighed 85kg. He called for help and staff from SGH assisted.
But the legs of the trolley did not deploy and the end of the trolley, where Mr Razib's head was, dropped to the floor.
The driver said the ambulance bay was "chaotic" and he was unable to hear the sound of the legs clicking into place. He thought the trolley had been pulled out too fast, not giving the legs time to lock into place.
He was still holding one end when the other side dropped.
The coroner's report said CCTV footage showed that "the stretcher appeared to be pulled out steadily and the stretcher's collapse was sudden". Mr Razib had been properly strapped in, so his head did not hit the floor.
An independent medical expert, Dr John Thomas, a senior consultant neurosurgeon from Immanuel Centre for Neurosurgery, said that an 85kg man falling in a 45-degree arc from a height of about 1m would experience a fairly significant force even if he did not fall off the trolley.
Mr Razib was also on anti-platelet therapy for this heart problem which increases the risk of bleeding. Dr Thomas said the fall contributed significantly - as much as 95 per cent - to bleeding in the brain.
He added that a blood clot in the brain "tipped everything over", made the condition caused by the heart attack worse and was the cause of his death on June 21, 2018.
State Coroner Kamala Ponnampalam ruled that Mr Razib's death was an unfortunate medical misadventure.
 

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Oxygen tank not turned on, patient dies: Coroner calls for stricter safeguards​

Ian Poh

JUL 30, 2014

SINGAPORE - The state coroner has called for stricter procedural safeguards when patients dependent on ventilation equipment are moved from one place to another, following a "medical misadventure" that led to the death of an elderly patient a year ago.
These include closely monitoring the patient and devices tracking his vital signs when he is placed on the equipment, instead of other "subsidiary" tasks, and retesting the machine on-site beforehand.
Neither had been done before Madam Ramasamy Krishnama, 83, went unresponsive while being transferred to Mount Elizabeth Novena hospital on the evening of July 8 last year.
Shortly after being moved from her Tan Tock Seng Hospital bed to an adjacent trolley and put on a portable ventilator, her level of oxygen saturation became "unrecordable" because a transfer team had failed to turn on an oxygen tank that was supplying the ventilator.
But the team first checked for other problems, as they assumed the tank had been switched on after hearing a gushing sound when the two pieces of equipment were connected.
Three to four minutes had passed before they realised this and flipped the switch.
Madam Ramasamy's condition did not improve even after the ventilator was turned to the maximum setting. She was moved back to her bed, where cardiopulmonary resuscitation was unsuccessfully attempted on her.

She died from lack of oxygen to the brain later that evening.
On Wednesday, State Coroner Marvin Bay found that the grandmother's death had been caused by a failure to ensure she received sufficient ventilation.
No foul play is suspected.
Coroner Bay said that patients in Madam Ramasamy's situation would be too frail to say or gesture if they were in distress.
"They are therefore utterly dependent on the vigilance of the doctors and nurses of the transfer teams to spot if anything is amiss," he said.
 

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Kidney disease patient died after artery, vein accidentally punctured during catheter insertion procedure for dialysis​

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It is believed to be the first case of death of its kind here, according to an independent doctor nominated to look into the matter. ST PHOTO: KUA CHEE SIONG
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Shaffiq Alkhatib
Court Correspondent


AUG 26, 2020

SINGAPORE - A kidney patient at Tan Tock Seng Hospital (TTSH) died in 2016 from acute haemorrhage after an artery and a vein were accidentally punctured during the catheter insertion procedure for his peritoneal dialysis.
This is believed to be the first case of death of its kind here, according to an independent doctor who was nominated by the Academy of Medicine, Singapore (AMS) to look into the matter.
According to the National Kidney Foundation's website, peritoneal dialysis is a treatment for kidney failure in which a sterile fluid is introduced into the body through a permanent tube placed in the peritoneal cavity - a space within the abdomen that contains the intestines, stomach and liver.
The fluid then circulates through the abdomen to draw impurities from the surrounding blood vessels in the abdominal cavity and is drained from the body.
On Wednesday (Aug 26) following an inquiry, Coroner Marvin Bay found Mr Lee Kuen Ngian's death to be a "truly unfortunate medical misadventure".
The coroner said: "This court would recommend that the circumstances leading to Mr Lee's death... be closely investigated with a view to the establishment of a commonly acceptable protocol of best practices for such procedures.
"This would be all the better to prevent such tragic recurrences to patients hoping to avail themselves to the therapeutic benefits of peritoneal dialysis."

He said that Dr See Yong Pey, a consultant at TTSH's renal medicine department, reviewed Mr Lee on Nov 2, 2016.
The 74-year-old Singaporean was then admitted to day surgery eight days later and Dr See started the catheter insertion procedure.
An incision was made in Mr Lee's abdomen and normal saline was flushed into a cannula, which is a thin tube inserted into a vein or body cavity to administer medication, drain off fluid, or insert a surgical instrument. Clear liquid, without blood, was flushed out.

Mr Lee was then placed in a Trendelenburg position, where his head was placed facing upwards at a lower level than his feet to facilitate access to the abdominal organs.
The peritoneal space was then insufflated or filled with air.
Coroner Bay said: "The surgery thus far seemed uneventful, with no indication of any presenting complications, and the insufflation of air with the syringe did not show any return of blood suggestive of a bleed.
"Nevertheless, shortly after 800ml of air was introduced into his peritoneal cavity, Mr Lee... collapsed at 1.10pm. The procedure was abandoned and the cannula was removed immediately."
The AMS later nominated two experts to look into the case: Dr Cheng Shin Chuen, a surgeon in private practice from Mount Elizabeth Novena Specialist Centre, and Dr Tan Chieh Suai from the Singapore General Hospital's department of renal medicine.
Dr Cheng expressed his view that "Dr See most likely punctured the (vessels) unknowingly with a faulty technique. He basically passed the sharp point of the trocar (a sharp-pointed surgical instrument used with a cannula to puncture a body cavity) all the way in, injuring the artery and vein at the same time".
Dr Cheng also said that the "technique falls short of what is an acceptable level of competency", causing a "wholly preventable puncture" of the vessels.
Separately, Dr Tan expressed his concern that Dr See had undertaken the procedure only slightly after two months of being granted the "clinical privilege".
Coroner Bay said that to the best of Dr Tan's knowledge, this was the first case of death of its kind in Singapore.
Dr See, however, questioned the independent AMS medical experts' opinion that the pattern of Mr Lee's injury was a direct consequence of the trocar being pushed too deep into the abdominal cavity.
Coroner Bay said: "Dr See maintained his alternative theory that the injury to the vessels had been inadvertently inflicted by the metal cannula, which had been within the peritoneal cavity after the trocar was removed for the sterile air insufflation process.
"While one of his hands was used to stabilise the cannula, he posited that minor movement of (Mr Lee's) part... may have occurred when Mr Lee was placed in the Trendelenburg position despite his being strapped down to the operating table."
Dr See believed that this movement by Mr Lee led to the injuries seen in his vessels, said the coroner.
On Wednesday, Coroner Bay said that there is no basis to suspect foul play in this case.
 

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Widow wins appeal in medical lab negligence case, top court rules for reassessing $1.2 million award​

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The Appeal Court urged all parties to explore the possibility of arriving at a settlement on the damages issue in the interests of "effecting closure as well as the saving of costs". ST PHOTO: KUA CHEE SIONG
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K.C. Vijayan
Senior Law Correspondent


NOV 26, 2019

SINGAPORE - The Court of Appeal has ordered the High Court to redetermine an award of more than $1.2 million to a widow who sued a medical lab and its medical director for failing to detect cancer in her husband's skin sample.
The five-judge court allowed the appeal of Carol Ann Armstrong, 53, that the medical negligence caused her husband, Peter Traynor, to lose his full life expectancy instead of the four years held in the judgment of the High Court last year.
The Court of Appeal affirmed the High Court's finding that Quest Laboratories and its director, Dr Tan Hong Wui, had failed to spot the skin cancer in a skin sample from Mr Traynor in 2009. Mr Traynor, a Singapore-based information technology specialist, died in 2013 at the age of 49. The Canadian couple have two daughters aged 10 and 12.
Judge of Appeal Andrew Phang in decision grounds on Tuesday (Nov 26) said: "It is difficult to understate the significance of the Respondents' breach... lives depend upon accurate diagnoses by pathologists, and diagnoses had therefore to be undertaken with due diligence."
"In the present case, Dr Tan not only failed to state that he could not rule out melanoma, he also delivered a report indicating the exact opposite - that there was no malignancy. Put simply, Dr Tan intended to convey, and did convey, that the lesion was benign," wrote Justice Phang on the court's behalf.
Both parties' appeals on the calculation of damages were partially allowed and the case is to be remitted to the High Court to revise the sum payable based on the parameters provided by the Court of Appeal.
The High Court last year found that the defendants' breach was "straightforward and obvious" and rejected their claim that Mr Traynor's fate was biologically determined and he would have died from his cancer anyway. But the High Court judge had then also rejected Ms Armstrong's claim that her husband could have been cured, finding instead that he would have lived only for four more years.


The judge, in assessing the sums payable last year, awarded the widow $1,241,334 in damages, comprising $346,677 on the grounds of dependency and $894,657 for the loss of inheritance.
Ms Armstrong appealed to the apex court and the defendants also cross-appealed.
Her lawyers led by Edmund Kronenburg and Christopher Goh argued that the damages should have been awarded based on Mr Traynor's full life expectancy of up to the age of 82.

The respondents' team of lawyers led by Senior Counsel Kuah Boon Theng and lawyer Eric Tin submitted that the High Court erred in finding their clients liable for breach of duty. Among other things, they urged the court to reduce the damages payable in relation to Mr Traynor's estimated income.
The Appeal Court comprising Chief Justice Sundaresh Menon, Judges of Appeal Andrew Phang, Judith Prakash and Tay Yong Kwang as well as Justice Belinda Ang, heard the case in January and reserved judgment and affirmed the respondents' misdiagnosis was a straightforward breach.
The court found that the sole cause of Mr Traynor's death was the melanoma that had spread through his bloodstream from his infected lymph nodes after 2009, and the breach by Quest Lab and Dr Tan led to a delay in diagnosis which allowed the cancer to grow in his lymph nodes.
The Appeal Court revised the High Court's finding of Mr Traynor's annual income from $450,000 to $308,386 but affirmed the majority of the judge's assessments on the pre-trial dependency and the loss of inheritance claims.
It also allowed Ms Armstrong's appeal in relation to the post-trial loss of inheritance claim.
This would now depend on the judge's determination and the multiplier-multiplicand to be applied. The judge would also have to assess, among other things, Mr Traynor's retirement age, the educational expenses for his daughters beyond four years and savings in deriving the appropriate sum.
"Accordingly, we remit these issues to the judge for him to reach the appropriate sum for the post-trial loss of inheritance," said the Appeal Court.
The Appeal Court said that in the context of a dependency claim, the multiplier is the number of years for which a dependent can claim for his or her loss, with a discount for accelerated receipt of funds and the vicissitudes of life. The multiplicand is the annual value of the dependency.
However, in the context of a loss of inheritance claim, the multiplier must also be adjusted to reflect the post-retirement expenses of the deceased. The multiplicand is the savings of the deceased per annum.
The widow in her initial statement of claim in January last year sought more than $10 million.
The Appeal Court urged all parties to explore the possibility of arriving at a settlement on the damages issue in the interests of "effecting closure as well as the saving of costs".
Quest Lab and Dr Tan were ordered to pay $75,000 to Ms Armstrong for the cost of appeal.
 

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Doctor suspended for 10 months for overprescribing sleeping pills​

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The drugs in question included Alprazolam, Lorazepam, Diazepam, Librax, Zolpidem and Zopiclone. PHOTO: ST FILE
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Salma Khalik
Senior Health Correspondent


OCT 14, 2021


SINGAPORE - A doctor has been suspended for 10 months for the overprescription of sleeping pills such as Dormicum.
He had originally been suspended for 20 months by a Singapore Medical Council's (SMC) disciplinary tribunal. But the sentence was halved because of the six years it took for the case to be resolved.
Dr Eugene Ung's overprescription of these addictive drugs was discovered during an audit by the Ministry of Health (MOH) in March 2015.
The ministry informed the SMC of its concern in June that year. The SMC started proceedings against the doctor the following month.
The doctor faced 22 charges of professional misconduct for "the inappropriate prescription of benzodiazepines and other hypnotics (sleeping pills) to 13 patients between January 2012 and March 2015, and inadequate medical record-keeping for nine of these patients".
Dr Ung pleaded guilty to all the charges.
The publication of the grounds of decision by the SMC did not name the clinic where Dr Ung was practising when he inappropriately prescribed such drugs.

Among other things, these drugs are used to treat insomnia, schizophrenia, depression and anxiety. Long-term use is not recommended for insomnia or anxiety problems.
The patients involved were given the drugs over long periods - in some cases, three years or more. In many of the cases, their medical records do not contain the indications or justifications for such prescriptions.
Because these are controlled drugs, such justification is needed for every prescription. This is because improper or long-term use can lead to addiction.
According to the MOH, withdrawal symptoms such as anxiety, perceptual disturbances and tremors may develop upon cessation of benzodiazepine use.
The tribunal found that several patients had likely become addicted to the drugs. In spite of that, Dr Ung continued prescribing them. The prescriptions given were sufficient for daily use.
The drugs in question included Alprazolam, Lorazepam, Diazepam, Librax, Zolpidem and Zopiclone, which were prescribed either alone or in various combinations.
Aside from the suspension, Dr Ung was censured and required to give a written undertaking not to reoffend. He also has to pay the cost of the proceedings.
 
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