After Tan Yaw Lan, a 74-year-old woman, died while being hospitalised in Tan Tock Seng Hospital (TTSH) in 2018, her son has decided to sue the hospital and three doctors who were responsible for the care of his mother in one way or another.
In particular, the man, Mr Chia Soo Kiang, said that the relevant staff misdiagnosed and neglected his mother during her stay at the hospital, eventually causing her to pass.
Just today (15 August), Mr Chia explained in court that his mother sustained a fall and subsequent cardiac arrest during her stay at the hospital, and succumbed to injuries caused by the fall around three weeks afterwards on 13 May.
He also added that his mother’s death would not have occurred if the staff did not neglect her.
Seeking $800,000 in Damages
Mr Chia, 48, is also seeking damages for his mother’s pain and suffering, reduced life expectancy, loss of amenity and eventual death.
In total, the damages he is seeking from the medical professionals amount to $800,000.
Mr Chia, who works as a public servant at the National Library Board (NLB), is represented by a team of lawyers from Fervent Chambers led by Mr Clarence Lun.
Mr Lun has previously represented others in Singapore such as Iris Koh, founder of Healing the Divide.
He was also the only plaintiff witness to take the stand in court today (15 August).
Here’s what happened.
Admitted to Hospital With Fever
Before her passing, Tan was first admitted to TTSH on 20 April 2018.
At that time, she was running a fever, and had a cough and lethargy as well.
Her pre-existing health conditions included sepsis, poorly controlled diabetes, anaemia, hypertension, heart failure, ischaemic heart disease and chronic kidney disease.
She suffered the fall which eventually cost her life in the morning two days after being admitted.
Doctors Involved in Case
Apart from TTSH, the three doctors who have been sued by Mr Chia are Dr Doraj Raj Appadora, Dr Lee Wei Sheng and Dr Ranjana Acharya.
Dr Doraj, an internal medical specialist, was the consultant for the department of general medicine at TTSH who was on overnight call when Tan was first admitted to hospital.
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Dr Lee Wei Sheng, who was going through residency training at that time, was the house officer on call when Tan was warded in the hospital. As part of his training, he was rotated between multiple healthcare institutions.
On the other hand, Dr Ranjana Acharya was the consultant in charge of reviewing new admissions received by TTSH’s general medicine department.
The three doctors are all represented by solicitors from law firm Dentons Rodyk & Davidson.
Tan’s Death Was “Entirely Preventable”
The lawyers from Fervent Chambers mentioned in their opening statement that Tan’s “untimely demise” was “entirely preventable”.
They also said that the defendants “acted in a callous manner to a high-risk and vulnerable person”, and that Tan’s passing was due to the doctors’ “negligent misdiagnosis and medical treatment”.
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Mr Chia’s lawyers then listed the aspects of the case that they would be talking more about, including whether or not Tan was misdiagnosed and given “inappropriate treatment methods”.
Other issues include if Tan had consented to change her medication before the defendants did so, and if they had “acted reasonably” when they tended to her and administered cardiopulmonary resuscitation (CPR) on Tan after her fall.
Doctors Allegedly Did Not Obtain Consent Before Approving Treatment Plan
Regarding Tan’s treatment plan, Mr Chia’s lawyers pointed out that Dr Doraj was responsible for approving a treatment plan during her time in the hospital without consulting Tan or her family about the plan.
They added that he did not obtain informed consent from either Tan or her family members as well, and that the least he could do was to tell her family members about the change in her treatment plan.
The plan included withholding the three main medications that Tan took for her heart.
The medications that were temporarily removed from her plan were aspirin, a painkiller which lowers fevers, furosemide, which helps reduce excess fluid in the body, as well as losartan, a medication to lower blood pressure.
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After Dr Rodaj made the adjustments, Dr Lee conducted a review on Tan when he was doing his ward rounds. He then added a referral to TTSH’s cardiology department and ordered for Mixtard insulin, which was part of her pre-existing medications, to be removed.
Dr Ranjana reviewed the plan again two hours after Dr Lee’s amendments and cancelled the referral.
Family Member informed Nurses Not to Shower Mother
Apart from the changes made to Tan’s plans, Mr Chia’s lawyers also noted that the medical staff caring for Tan had been instructed to not shower her, but still did anyway as a result of miscommunication.
In particular, Tan’s daughter brought this issue up to the nurses when she visited her mother in the evening of the following day.
She had asked the nurses to not shower her mother as she was prone to fainting.
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However, Mr Chia’s lawyers revealed that the instructions given by Tan’s daughter were not relayed to the staff who were responsible for Tan’s care the following morning.
18-Year-Old Untrained Nursing Intern Showered Tan
The next day, a nursing intern who was unaware of the instructions took the elderly lady to have a shower.
The intern was an 18-year-old student who was at the hospital as part of a two-week attachment of TTSH’s nursing internship programme.
At that point in time, the nursing intern was not supervised by other nurses in the hospital.
After bringing Tan to the shower, Tan collapsed in the shower due to a cardiac arrest, prompting the nurse to leave Tan’s side in search of help even though there was an emergency distress call button located in the shower room.
Nurse Had to Leave For Help Due to Being Untrained
The nurse was also not trained in basic cardiac life support and the operation of the automated external defibrillator (AED), which prompted her to leave in order to find other nurses to help.
Trained nurses only arrived at Tan’s side around six to nine minutes after her fall, and transferred her to her ward bed before they started administering CPR on her.
Although Tan eventually gained consciousness, she sustained new injuries as well as a form of permanent paralysis.
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She was then admitted to the intensive care unit (ICU), but eventually passed away due to complications from the fall on 13 May 2018.
Doctor’s Lawyers Said that Tan Was Treated “Appropriately
In the opening statement, the defendants’ lawyers stated that Tan was treated and managed in an appropriate manner, and that all that the doctors did “met the required standard of care”.
For Dr Doraj’s case, the lawyers argued that he was not legally bound to care for Tan since she was not a patient personally reviewed by him.
He was also not the doctor who was consulted on issues pertaining to her health.
Regarding the change in medications, the lawyers pointed out that the treatment plan was initially changed by another doctor, and that he had good reason to withhold Tan’s heart medications.
In particular, aspirin might have increased the risk of bleeding, and both losartan and furosemide could cause the condition of her kidneys to deteriorate further.
On the other hand, Dr Lee’s order to withhold Mixtard insulin was due to his concerns that Tan might end up with low blood glucose.
His decision was also supported by Dr Ranjana.
In addition to that, the lawyers also noted that Tan did not exhibit any signs of discomfort even around one hour before her shower.
She was “alert, comfortable and cheerful”, and had stable parameters as well.
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Trial to Continue
With the first day of the civil trial coming to an end today (15 August), the trial will resume tomorrow (16 August) in court.
In total, 30 witnesses, as well as multiple medical experts, are expected to testify over the course of the entire trial.
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