Can woman who lost unborn baby after 2-hour wait at NUH take legal action? Lawyers weigh in

SINGAPORE — The media statement by National University Hospital (NUH) apologising to a patient who lost her unborn baby and conceding that it should have done more does not mean that the hospital is taking liability for the case.

And if the patient were to pursue legal action against the hospital, the courts would need to look deeper into the facts of the case and what had caused the woman to lose her child, lawyers told TODAY. 

Ms Jessica Cheung, senior associate of Edmond Pereira Law Corporation, said that the hospital's statement was not an admission of liability.

"As lawyers, we scrutinise every word. The apology brought up that the hospital should have done more, but only addressed issues like the two-hour wait," she said.

Mr Mark Teng, executive director of law firm That.Legal LLC, noted that legal action "should be the last resort as it can be costly for all parties involved".

"It is best to first consider alternative dispute resolution mechanisms like negotiation or mediation," he added. 

The woman's husband had taken to social media to share their account of the incident: On March 15, the woman, who was 36 weeks' pregnant and bleeding at her birth canal, was waiting in the hospital's emergency ward for about two hours before she was moved to a maternity ward, where scans later showed that the unborn baby had no heartbeat.

NUH said in its statement and apology that this “should not have been the case” and it should have done more to provide her with closer monitoring and care. The hospital also said that it has met the family and will "do our best to support them and ensure the patient’s well-being".

Health Minister Ong Ye Kung has said that the Ministry of Health will work with NUH on a "thorough investigation” of the case.

The couple has not said whether they plan to take legal action. TODAY has reached out to them.

In a media statement last Wednesday, Professor Aymeric Lim, chief executive officer of NUH, said that the emergency department was seeing a high patient load at the time the woman was there, and the hospital was managing three other expectant patients with Covid-19 in the emergency department and labour ward.

He also said that NUH would review the process of managing expectant patients who are admitted into the emergency department when the labour ward is full, so that such incidents do not happen again.

MORE FACTS NEEDED TO DETERMINE NEGLIGENCE

When asked if the couple could sue the hospital, Ms Cheung said that more details would be needed to understand the case.

Noting that there were differences in details between the husband's Facebook posts and NUH's statement — such as whether the expectant mother was bleeding while at the emergency unit — facts would need to be established to determine if there is a case for legal recourse.

Mr Teng said: "Ultimately, a successful claimant would have to prove, among other things, that an objectively ascertained standard of care owed by the hospital to the patient was breached and that the same breach was the cause of the harm."

This means that they would need to determine if the hospital had provided an expected standard of care, and if it did not, then whether that caused the patient to lose the unborn child.

Ms Lydia Lee, senior associate of IRB Law LLP, said that if the couple does sue, the court would need to examine if the hospital's conduct was "reasonable in the circumstances".

"The standard of care against which the hospital would be assessed is specific to the facts of each case," she said, adding that the standard of care may differ from case to case as it takes into account the circumstance of the case.

This would include comparing against what hospitals may have done, closely examining NUH's manpower allocation and understanding if other hospitals would support the said action taken, Ms Lee added.

Experts from other hospital's emergency wards may also be called in as witnesses in such cases.

Ms Cheung said: "Doctors will also have to testify on what is the standard of care and the guidelines the hospital has when handling a case in the accident and emergency department, especially if it involves a pregnant woman with heavy bleeding."

Hospitals have been under great strain as they try to attend to non-Covid-19 patients who have chronic illnesses and debilitating diseases. This “business-as-usual" debt is only just starting to be repaid, Health Minister Ong Ye Kung has said recently, noting that hospitals are seeing a high influx of people in their emergency wards.

Prof Lim of NUH also touched on this when he said that the hospital struggled to meet its “high standards of care” given the high number of patients being admitted during the Covid-19 pandemic.

Ms Lee said that although the case highlights how hospitals may struggle to meet their standard of care, it may not be enough to avoid liability from such cases.

"The court will look beyond that to understand why there was a lack of manpower to begin with, in assessing whether there was negligence."

Once the facts have been established, the court would then have to determine if the hospital's actions had resulted in the loss of the unborn child. 

Liability would then depend on who was involved and what they did, Ms Cheung said.

Noting that the doctor can be liable if found to be negligent as the one who leads the team, Ms Cheung added that hospitals may be found liable, too.

"Hospitals set the guidelines and determine acceptable practices by their employees. As the doctor is an employee, if he goes beyond what is acceptable, the hospital holds some responsibility," she said.

She also said that hospitals are responsible for ensuring that their medical workers are competent and provide quality services.