After a patient who had an asthma attack at his clinic went into cardiac arrest, a Singapore doctor performed cardiopulmonary resuscitation (CPR) on the unconscious man who was still seated.

The patient, who was subsequently brought to hospital, died a week later.

The doctor, Ho Tze Woon, was given a three-month suspension on Aug. 7 by the Court of Three Judges, for failing to reposition the patient to a lying position before performing CPR, according to CNA.

The incident

The incident took place at the Central 24-Hr Clinic in Yishun on Jan. 14, 2017, where Ho practised as a locum — a stand-in doctor.

When he was on duty, the patient arrived and said he was experiencing breathlessness.

Ho ascertained that the patient was having an asthma attack, so he instructed a clinic assistant to administer a nebuliser treatment while the patient was seated in a chair.

This was done with a device that converts medication into a mist which the patient inhaled.

However, while the patient was being treated, he went into cardiac arrest and fainted.

Ho proceeded to perform CPR on the patient while he was still seated.

The man was then conveyed to hospital, but he died a week later.

Charged for failing to meet professional standards

Subsequently, Ho was charged under the Medical Registration Act for failing to provide professional services of the quality expected of him, in neglecting to reposition his seated patient to a supine position before trying to resuscitate him.

Ho was found guilty by a disciplinary tribunal under the Singapore Medical Council (SMC) and given a nine-month suspension.

However, he appealed against the decision.

Ho's actions 'reasonable' in the 'chaotic' situation: Defence

In the hearing, Ho's defence lawyer asked for a fine instead of the nine-month suspension, deeming it an excessive punishment.

The lawyer asserted that Ho's course of action was "reasonable" because the clinic's treatment room was small, it was a "chaotic" situation and he was not trained in patient transfer.

He added that the 33-year-old Ho was a locum, and a doctor of seven years at the time of the incident.

Shin Min Daily News also reported that he said the patient was known to have health problems, so even with effective CPR, his survival rate would not have been very high.

Not his 'first rodeo': Prosecution

SMC's prosecutor, however, argued that it was not Ho's "first rodeo", as he was trained in CPR and had attended to numerous cases of cardiac arrest during his work in A&E.

He cited statements from medical experts, who believed Ho performed an ineffective form of CPR which lowered the patient's survival rate, according to Shin Min.

The prosecutor also pointed out that there were clinic assistants present during the incident, who could have helped Ho transfer the patient to a supine position before performing CPR.

Sentence cut to 3 months

Judges presiding over Ho's appeal noted that patients who suffer from cardiac arrest outside the hospital have a high mortality rate, according to Shin Min.

However, they pointed out that as a doctor, Ho should have known better that CPR would be less effective in a seated position.

Justice Steven Chong, who presided over the appeal along with Justices Judith Prakash and Tay Yong Kwang, said that while it was a tense situation, "as a doctor, you would know that for CPR to be effective, you have to have maximum compression".

However, Ho had not even attempted to put the patient in a supine position, he said.

Nevertheless, the judges reduced Ho's suspension from nine months to three months, and will provide their reasons at a later date.

Previous disciplinary action

This is not the first time Ho has faced disciplinary action in the course of his practice.

In 2021, he was fined S$2,000 and given a five-month suspension for downloading pornographic materials into polyclinic computers, and attempting to sell erectile dysfunction medication to a man who was not his patient.

Top image from Unsplash.