SINGAPORE — Changi General Hospital (CGH) has insisted that it gave “appropriate care” to an 81-year-old woman in what turned out to be her final days, in response to her granddaughter’s allegations of shoddy palliative care given by the hospital.

In an emotional Facebook post, the deceased woman’s granddaughter, marketing executive Isabella Alexandria Lim, accused CGH of not treating dying patients with the same respect and care that it gave to other patients.

The 24-year-old said her grandmother, who was admitted in February after a fall, developed “severe” bedsores, was denied a thermal blanket for a period by hospital workers, and did not have her diapers changed until a request was made — among other discomforts.

Ms Lim said her grandmother’s condition deteriorated rapidly at CGH. The family eventually moved the dying woman — who was not named in the Facebook post — to National University Hospital (NUH) where she received much better treatment, she said.

The post went viral; it had been shared more than 4,000 times as of 9pm on Wednesday.

'COMMUNICATION GAPS'

When CGH was approached for comment, Dr Lim Si Ching, senior consultant in its Department of Geriatric Medicine, responded on its behalf. She said that the CGH Medical Board had conducted a thorough review of the case following the family’s feedback.

She said that CGH was saddened by the news of the patient’s passing and empathised with the family’s anguish, but insisted that “appropriate medical care was given during her stay at CGH”.

However, she acknowledged that there had been “communication gaps” that could have been prevented.

“While the care team provided regular updates to the family member designated as main caregiver, we could have done better in engaging the different family members and helping them understand the diagnostic and therapeutic interventions by the care team,” said Dr Lim.

NUH PRAISED FOR ITS TREATMENT OF PATIENT

The woman’s granddaughter said that at NUH, before her death on May 5, doctors attended to her grandmother’s bedsores by applying creams, protecting her wound with medicated gauze and giving her heel sponges.

Staff members there also conducted one- to three-hourly checks on her to change her diapers or position, and helped ease her severe water retention by giving her compression stockings.

These were all services that CGH did not render to her grandmother, Ms Lim alleged, despite having to foot a “five-figure medical bill” for two hospital stays that totalled about two-and-a-half months.

The grandmother was discharged briefly between April 4 and 7 after doctors said a urinary tract infection had cleared. But back at home, she still had trouble urinating and had blood in her urine, so the family took her back to CGH.

Ms Lim said that at CGH, her family had to contend with its staff members’ "insensitive" and "rude" remarks as well. A doctor had allegedly told a family member that her grandmother “would probably die on the way in the ambulance” if they transferred her to another hospital.

When the decision was finally made to transfer her, her grandmother’s primary care doctor reiterated that the patient was on end-of-life care, and they had given her “the best they could”, she said.

“Were they? Were they trying to maximise the quality of life of my grandma during her last days, or were they just waiting for her to die?” asked Ms Lim.

The doctor later refused to speak to NUH “at all” to provide information on the patient’s condition, and nurses at CGH refused to book an ambulance to facilitate the transfer, she added.

Ms Lim also claimed that a thermal blanket used to help alleviate her grandmother’s “really low” body temperature was removed. When queried, a nurse purportedly said: “Put every day, got cost, you know?”

Ms Lim also said that when she approached an on-call doctor to discuss her grandmother’s alternative treatment options when the primary care doctor was away, that doctor’s response was: “I just want to say that I don’t know anything about your grandmother”, raising both her hands in the air.

Said Ms Lim of the reaction: “As if I asked her to surrender?… She could have at least read my grandma’s case file first, or asked me how her condition was, instead of making me feel like I was forcing her to answer something against her will. Unprofessional and rude!”

That night, that same doctor sighed loudly when called to help since her grandmother’s heart rate went from 40 beats per minute (bpm) to 110 bpm, she said. Eventually, her colleague attended to them, but this staff member told the family it “depends on God” when asked for an update, she added.

On that, she remarked: “CGH, I urge you to re-evaluate your training towards your staff for end-of-life protocols! Learn how to deal with families who are going through a difficult time. Don’t make insensitive remarks like ‘it depends on God’.”

Ms Lim told TODAY that CGH had on Tuesday called her father to say that the hospital needed time to investigate the matter before it gets back with a response.

BEDSORES TREATED 'PROMPTLY'

On the woman’s bedsores, Dr Lim said CGH had promptly taken preventive measures, such as by closely monitoring the woman’s skin condition and placing her on a pressure-relieving air mattress.

Staff members had also turned the patient at regular intervals while respecting family members’ request to “minimise” the disruption to her rest, she added.

Continuity of care was ensured when the family requested a transfer, as CGH’s care team had facilitated the move with a doctor’s letter to NUH’s Emergency Department, she said.

Dr Lim said: “We are sorry for the anxiety caused to the family… We will do our best to learn from this incident and improve our care delivery processes.

“Owing to patient confidentiality, it would be more appropriate for (CGH) to meet with the family to address their concerns, and provide full details of the case.”