No foul play: Court rules death of FCBC pastor 'medical misadventure', says he died after 27-hour surgery

A coroner has ruled the death of a pastor from Faith Community Baptist Church a "medical misadventure".

The court also accepted the police's conclusion that there was no foul play.

Reverend Simon Yee Siak Choon was 62 when he died at Mount Elizabeth Hospital on Oct. 12, 2022, several days after surgery for valvular heart disease.

In findings released on Apr. 27, State Coroner Adam Nakhoda said that the death was "iatrogenic in nature", meaning it arose unintentionally from medical treatment.

He had died after undergoing a complex 27-hour open-heart surgery that resulted in multi-organ failure, reported CNA.

The pastor's son, who attended the hearing, declined to respond to CNA's queries about whether he would pursue civil action.

Complications prolonged operation

Court findings showed Yee had several chronic medical conditions, including hypertension, high cholesterol, and mild coronary artery disease.

He first sought treatment at Mount Alvernia Hospital on Sep. 27, 2022, after experiencing breathlessness.

He was diagnosed with acute pulmonary oedema, a life-threatening condition involving rapid fluid build-up in the lungs.

Yee was later referred for surgery at Mount Elizabeth Hospital, after doctors found that his mitral valve was malfunctioning and causing blood to flow backwards.

Before surgery, heart surgeon James Wong Woon Wai told Yee that the procedure carried "less than a five per cent" risk of severe complications, including stroke, multi-organ failure and death.

The surgery

The operation began at 2pm on Oct. 7, 2022 under general anaesthesia, with Wong assisted by Sivathasan Cumarasawamy, reported CNA.

Surgeons initially performed a mitral valve repair together with an aortic valve replacement.

But the repair did not succeed. They then proceeded with a mitral valve replacement, though the previously replaced aortic valve made the procedure more difficult.

Wong later testified that there had also been significant bleeding caused by medical coagulopathy.

He added:

"It required us three to four hours to control the bleeding with blood transfusion and clotting blood products.”

By Oct. 9, 2022, Yee had developed renal failure requiring dialysis, followed by liver failure and eventual multi-organ failure.

Family asked why surgery took so long

Yee’s daughter said the family had wanted to understand why the operation lasted so long.

She told the court that Wong had initially said he was "90 per cent confident" the surgery would go well before an angiogram, and later "97 per cent confident" after the scan results.

She said the family did not believe the surgeon had been negligent, but wanted to understand whether the outcome might have differed if the valves had been replaced from the outset rather than repaired first.

An independent expert report by heart surgeon Michael George Caleb found that each major stage of the operation encountered complications that required repetition or revision.

This was very unfortunate and unusual, said the senior consultant at the National University Heart Centre, Singapore.

Every major step went awry

Caleb said that the issues ultimately increased the likelihood of a fatal outcome.

"It is important to be cognisant that each 'misstep' (for lack of a better word) could be experienced by any surgeon, but is less likely to occur in experienced hands and less likely to occur altogether in the same operation, which increases the probability of fatality."

Coroner Nakhoda said the Coroners Act does not allow him to determine criminal, civil or disciplinary liability, including whether different surgical choices should have been made.

"As such, it would not be appropriate for me to determine, in the present case, whether Wong and Sivathasan should have replaced Mr Yee’s native mitral valve and aortic valve with bioprosthetic valves, instead of just repairing those valves," he said.

He found that Yee had given informed consent and understood the risks involved before surgery.

Served church since 1986

In a Facebook post published on the day of his death, FCBC said Yee had been with the church since its inception in 1986.

He later joined its staff as a pastoral intern in 1992, was ordained in 1996, and took on a variety of leadership roles over the years.

The church also said he had led projects such as the Drops of Life blood donation drive and helped mentor churches in the Philippines and Indonesia.

Yee is survived by his wife, fellow pastor Marilyn Yee, their three children, and grandchildren.