News

Woman Dies From Multiple Organ Failure After Knee Replacement Surgery; Mt Elizabeth Doctors & Nurses Questioned

2019-09-18 , 10:00 pm

As a huge fan of medical dramas, I would be lying if I said I haven’t fantasised being a doctor myself.

I guess the weight of the responsibility of a doctor is too heavy for me to carry and like Izzie Stevens from Grey’s Anatomy, I would have been too attached to my patients.

Deaths from complications in surgery are a norm in medical dramas and over time I feel that you kinda get immune to the deaths as a viewer.

However, it’s a whole different story when it happens in real life.

Woman Dies Following Knee Replacement Surgery

Mrs Yuen Ingeborg, a Singapore permanent resident from Germany, died on 7 November 2016 after going under the knife for total knee replacement surgery.

She went for the surgery conducted by Dr Sean Ng Yung Chuan at Mount Elizabeth Hospital on 1 November 2016.

Ingeborg went into a cardiac arrest and developed multi-organ failure before she died.

Here’s the series of event that happened after her surgery which led to her eventual death.

Her Doctor Left For A Medical Conference

Ingeborg’s doctor, Dr Ng, left for a medical conference in Tokyo less than two days after her operation.

One would have expected him to leave her under the care of another specialist, but he did not.

He did continue observing her for recovery and ordering post-surgery care before leaving for his medical conference on the night of 2 Nov 2016.

She Was In Pain And Her Left Foot Was Cold

The evening that Dr Ng left, she was in a lot of pain and a nurse found her left foot to be cold.

The nurses informed Dr Ng of her cold limb and he called in the consultant anaesthetist who was present during her surgery.

He told Dr Ng to continue with his trip.

Later on, the nurse and a resident medical officer Dr Jeffrey Mah were unable to find a pulse. Since Dr Ng could not be reached, Dr Mah got in touch with Dr Chin Pak Lin, an orthopaedic surgeon who had helped him during the surgery.

The scan on her leg revealed that severed blood vessels had caused an ischaemic limb, which meant that there was a lack of blood flow to a limb.

Emergency Surgery

She went into an emergency operation to save her life. The surgery was successful.

However, she continued to deteriorate and Igenborg’s leg was amputated above the knee to save her life.

However, she went into cardiac arrest on 4 November 2016.

Dr Ng had cut his trip short and returned the next day but she died two days later.

Children Questioned The Care Given To Their Mother

Ingeborg’s daughter told coroner Ms Ponnampalam that she had pointed out to the nurses on two separate occasions that her mother’s operated limb “felt icy cold”.

However, the issue was brushed off as “normal” and nothing further was done.

HOLD UP.

NORMAL?

I am no doctor or nurse but I think I have watched enough Grey’s Anatomy to know that that’s not normal.

A nurse was given a “verbal warning” for having documented circulation as normal in Ingeborg’s chart when she did not personally assess her.

Her children were also unhappy over how Dr Ng chose to leave the country soon after the surgery and was not present when the complications arose.

Acted With Best Of Intentions

Dr Ng had said that he had proposed for the surgery to be done after he came back from abroad but Igenborg had insisted on it being done before he leaves.

He also said that he did not hand over Ingeborg to another specialist because there were no post-surgical complications before his departure.

Her progress was “acceptable”.

The coroner also noted that she had already started on physiotherapy and she “did not complain of anything” to her doctor.

Dr Ng made retrospective clinical notes after returning from his trip when her condition worsened. This was a breach of the Singapore Medical Council’s guidelines.

However, he claimed that he made the entries because he wanted the documentation to be complete.

Final Words From The Coroner

State Coroner Kamala found that there was no suggestion of a surgical complication during the surgery.

However, one of the independent experts who testified during the questioning said that Dr Ng had cut an artery and vein in Ingeborg’s leg during the initial knee surgery. This was what led to the blood supply being cut off from her foot.

The coroner noted that the nurses had made brief and inaccurate notes and Dr Ng did not conduct any neurovascular examination before leaving the country.

Changes To Protocols

Nurses are now required to conduct and document limb circulation assessments after Mount Elizabeth Hospital reviewed its nursing protocols.

State Coroner Kamala hopes this will improve patient monitoring.

According to Cleveland Clinic, approximately 85 to 95 per cent of all total knee replacement surgeries are successful for about 10 to 15 years.

However, Dr Tang Jun Yip from Singapore General Hospital said that arterial complications from total knee replacement surgeries are rare but are known.

I guess this incident not only shows that mistakes can go a long way but life is precious too.