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A man in Singapore, Chia Soo Kiang, is suing Tan Tock Seng Hospital (TTSH) and three of its doctors for medical negligence over the death of his mother.
According to The Straits Times, the first day of the civil trial commenced on Monday (Aug. 15) at the High Court.
Chia was represented by lawyers from Fervent Chambers, while TTSH and its three doctors were represented by lawyers from Dentons Rodyk & Davidson.
As reported by Today, the doctors involved in this case are:
- Doraj Raj Appadora, an internal medical specialist
- Lee Wei Sheng, a house officer
- Ranjana Acharya, consultant-in-charge of reviewing new admissions to the general medicine department
Chia is seeking S$800,000 in damages from them and TTSH.
His mother, Tan Yaw Lan, had a history of medical issues including diabetes, hypertension, heart failure, ischaemic heart disease, chronic kidney disease and anaemia, according to CNA.
She died in TTSH in May 2018, a few weeks after suffering a serious cardiac arrest. She was 74 years old.
Withheld patient's pre-existing medications
Tan was first admitted to TTSH on Apr. 20, 2018 after developing a fever, cough and lethargy.
She was diagnosed with sepsis complicated by type two myocardial infarction and clotting impairment, anaemia and kidney issues, CNA reported.
Withheld pre-existing heart medications
As part of the treatment plan, Tan was instructed to stop taking aspirin, furosemide and losartan, the medications she was already relying on for her heart issues.
Chia accused Dorai of failing to treat Tan's heart condition appropriately by approving the withdrawal of her pre-existing medications without advising her or getting her informed consent.
Chia's lawyers claimed, as reported by CNA, that Doraj also did not inform Tan's family about the treatment plan.
The defendants' lawyers, however, argued that Doraj did not owe Tan a legal duty of care as he did not personally review her and was not consulted on her case.
The defence also argued that Tan's heart medications were withheld as aspirin could increase the risk of bleeding, and losartan and furosemide could worsen her kidney injury.
Replaced mixtard insulin with a sliding scale insulin
On Apr. 21, 2018, the day after Tan was admitted, house officer Lee reviewed her during his ward rounds.
According to ST and Today, he ordered the withdrawal of Tan's usual mixtard insulin and replaced it with a sliding scale insulin which varies the dose based on the patient's blood glucose level.
Chia claimed that by withdrawing his mother's usual premixed insulin, Lee had failed to appropriately treat her diabetes, and had thus put her at risk of complications.
However, the defence argued that Lee had withheld the mixtard insulin as he felt that there was a risk of low blood glucose. This was a decision that Ranjana had agreed with too, Today reported.
The defence added, as reported by ST, that it is also usual for hospitalised patients to be placed on a sliding scale insulin.
Did not refer patient to cardiology department
While he was reviewing her during his ward rounds on Apr. 21, 2018, Lee had referred Tan to the cardiology department.
However, the referral was later cancelled by Ranjana as she felt it was "not clinically indicated", CNA reported.
Chia alleged that Ranjana had breached her duty of care to Tan by failing to refer her to the cardiology department.
He also claimed, according to CNA, that Tan was wrongly diagnosed with type two myocardial infarction, and that the cancellation of the referral to a cardiologist "deprived [Tan] of detection and life-saving treatment for her heart condition".
Allowed a nursing intern to handle patient alone
On the morning of Apr. 23, 2018, a nursing intern took Tan to shower without the supervision of other nurses.
According to Today, the intern was an 18-year-old student who was undergoing a two-week attachment at TTSH.
While in the toilet, Tan collapsed. She became unresponsive to verbal commands and was gasping for air, CNA reported.
Today reported that the nursing intern, who was medically untrained, left Tan's side to look for help.
After about six to nine minutes, trained nurses arrived. Tan was wheeled and transferred to her bed, where she was given cardiopulmonary resuscitation (CPR).
However, Tan's condition worsened and she died about three weeks later.
Chia claimed that the defendants were negligent by allowing a nursing intern who was medically untrained to handle Tan without any supervision in a closed-door environment.
Ignored instructions from patient's family
Chia also alleged that TTSH had ignored instructions from his sister, who had previously told the nurses that Tan should not be showered as she was prone to fainting.
Chia further alleged that there was a prolonged delay after Tan had collapsed in the toilet and before CPR was given.
However, according to CNA, the defence argued that there was no delay in resuscitation efforts.
The defence added that it was appropriate to transfer Tan to her bed instead of giving CPR in the wet toilet.
The trial will continue on Tuesday (Aug. 16).
Top image via TTSH/FB.