Man loses S$800,000 lawsuit against Tan Tock Seng Hospital and 3 doctors over mother’s death

SINGAPORE — A High Court judge on Thursday (Oct 13) dismissed a man’s claims for S$800,000 in damages for alleged medical negligence by Tan Tock Seng Hospital (TTSH) and three of its doctors.

Justice Choo Han Teck ruled that Mr Chia Soo Kiang’s allegations were “woefully short of evidence” and were refuted by not just the doctors and nurses who had treated his elderly mother, but also by the defendants’ expert witnesses.

Mr Chia sued the hospital and doctors after his mother’s death, claiming they had misdiagnosed and neglected his mother while she was warded there four years ago.

Tan Yaw Lan, then aged 74, collapsed from a cardiac arrest while an untrained intern nurse was helping her to take a shower.

She sustained injuries due to the fall and died about three weeks later on May 13, 2018.

The civil trial began in the High Court about two months ago. Mr Chia alleged that Tan’s death would have been prevented if the doctors were not negligent in caring for her.

The damages that he sought included for Tan’s pain and suffering, reduction in life expectancy, loss in amenity and her subsequent death.

The doctors listed in the case are:

• Dr Doraj Raj Appadora, an internal medical specialist who was working as the department of general medicine’s consultant on overnight call when Tan was admitted
   
• Dr Lee Wei Sheng, the house officer on call when Tan was admitted. He was undergoing residency training during which he was rotated to various healthcare institutions
   
• Dr Ranjana Acharya, who was the consultant-in-charge of reviewing new admissions to the general medicine department

TAN WAS 'FULLY AND CAREFULLY OBSERVED'

In his 21-page judgement, Justice Choo noted that Tan had a history of multiple ailments including chronic heart disease, type 2 diabetes, hypertension, chronic kidney disease and high cholesterol.

She was warded at TTSH on April 20, 2018 as she was suffering from a persistent fever. She was diagnosed with sepsis, which was complicated by her other ailments, doctors said.

Mr Chia claimed that the doctors were negligent in not diagnosing Tan correctly in the emergency department and when she was warded.

He also alleged that they were negligent in taking her for a shower against the family’s wishes and for not resuscitating her promptly.

Mr Chia’s lawyers argued that one of the doctors approved a treatment plan to withhold her primary heart medications — aspirin, a painkiller that reduces fever; furosemide which is used to reduce extra fluid in the body; and losartan which lowers blood pressure.

The lawyers, led by Mr Clarence Lun from Fervent Chambers LLC, also alleged that the doctor did not advise Tan or get her informed consent and should have at least informed her next-of-kin of the intended treatment plan.

In his judgement, Justice Choo ruled that the defendants did not have a reason to send Tan to the intensive care unit or a high-dependency unit and had correctly diagnosed her with sepsis from an unknown source.

This was complicated by ailments that included a type 2 myocardial infarction. She did not have any symptoms of a type 1 myocardial infarction, Justice Choo said.

The judge ruled that one of the doctors could not be faulted in diagnosing or treating Tan for sepsis and for not referring her to a cardiologist or admitting her to the ICU or HDU.

As for the change in Tan’s medication, Justice Choo noted that it had no bearing on her diagnosis or her eventual collapse in the shower. Tan was also alert and conscious when her medication was changed.

As for getting Tan’s consent, the judge said that doctors do not have a duty to ask if a patient consents to specific drugs, though they may have to check on allergies.

"The idea of liability for not seeking a patient’s consent to stop medication or treatment under the guise of informed consent is a solution without a problem. On the contrary, it will be the seed of big problems,” Justice Choo said.

In any case, Tan’s doctors had stopped her medications to “avert acute complications” and changed her antibiotics to those with wider coverage, the judge said.

“The evidence from all sources show that Mdm Tan was being fully and carefully observed so that the medical team may move swiftly and with flexibility when needed.”

BASELESS CLAIM THAT HOSPITAL WAS NEGLIGENT FOR SHOWERING TAN

Justice Choo then ruled that another of Mr Chia’s claims — that the hospital was negligent in taking his mother for a shower — was similarly baseless.

The intern nurse, who is now studying medicine at the National University of Singapore, testified during the trial that Tan readily agreed to have a shower.

Assisting a patient with a shower does not require specialised skills and it was something Tan’s family members could have done as well, Justice Choo said.

As for the claim that TTSH was too slow in its efforts to resuscitate Tan after she collapsed, Justice Choo said it was “also without merit”.

Tan was still breathing in the shower and her airway was still intact, the judge noted. Moving her to the bed, which was connected to crucial resuscitation equipment, was the right thing to do as the shower area was not a safe location to perform resuscitation.

Separately, Justice Choo pointed out that one of the plantiff’s experts — Dr Eric Chong, a cardiologist in private practice at the ESC Heart Clinic — submitted an affidavit that was lifted almost verbatim from the affidavit of an expert for the defence.

Dr Chong then filed another affidavit where he changed his mind about Tan having a type 2 myocardial infarction. He merely explained that he had since seen fresh evidence.

Justice Choo said: “It seems to me that Dr Chong had not at all applied his mind to the issues when preparing his first expert report, but instead adopted the views and words of (the other expert).

"This puts Dr Chong’s neutrality and independence as an expert in considerable doubt.”

The judge ordered for the issue of costs to be heard at a later date.

CORRECTION: An earlier version of this article stated that Dr Eric Chong was an expert for the defendants. This is incorrect. He was an expert for the plaintiff. We are sorry for the error.