I can imagine what the doctors involved would have said;
"Oh, we didn't know her heart was swollen.."
Are doctors supposed to check? Take precautionary measures? Or is
this another 'how much you can pay is what you get' kind of
standard?
I say that there's no CRIMINAL negligence, but there's PROFESSIONAL
negligence!!!
================================
She dies when doctors pierce her heart
Coroner rules the mistake was not the result of criminal
negligence
July 22, 2006
SHE was warded for sudden wheezing, but died of a bleeding heart in
hospital.
Doctors accidentally punctured Madam Lee Ah Hoe's heart with a
trocar, a sharply pointed shaft.
It happened while they were trying to drain fluid from around her
left lung on 5 Sep 2005.
Complications arose during the procedure because the patient had an
enlarged heart.
Yesterday, State Coroner Tan Boon Heng recorded a verdict of
misadventure in the 66-year-old's death.
While the coroner had 'no doubt' that Madam Lee's death was
'physician- induced', he ruled that the two doctors attending to
her had not been criminally negligent.
NO CHARGES
The two potential defendants in the case, Dr Akash Verma, 33, and
Dr Wijeweera Olivia, 25, will thus not have any charges brought
against them.
It all started when Madam Lee was sent to Tan Tock Seng Hospital
for sudden wheezing and stomach pains on 29 Aug 2005.
Dr Soon Puay Cheow, senior consultant and head of endocrinology,
examined her on 3 Sep 2005 and found she had a large amount of
fluid around her left lung.
He then instructed Dr Wijeweera, a medical officer in the
department of general medicine, to drain the fluid and conduct a
biopsy.
Dr Soon also told her to look for an experienced senior doctor who
could supervise her during the procedure.
She approached Dr Verma, a senior medical officer in the department
of respiratory medicine, and he agreed.
The procedure was scheduled for 1pm on 5 Sep 2005.
That day, Madam Lee was propped up in bed at 60 degrees while two
student nurses helped hold her left arm above her head.
Under local anaesthesia, a 22-gauge hypodermic needle and syringe
was inserted near her fourth rib under her left armpit.
When no fluid was drawn out, a larger 18-gauge needle was used
instead. (Gauge is a term used to describe the thickness of needle.
The smaller the gauge number, the bigger the needle.)
Blood-stained fluid was then drawn out. Next, a 2cm cut was made
and a biopsy needle was inserted. After an adjustment to the
needle, the fluid drained freely.
A chest tube was inserted and about 200ml of bloody fluid was
drained.
But at this point, Dr Wijeweera noticed that Madam Lee was pale and
had slumped down in the bed.
HEART BEATING TOO FAST
The patient's blood pressure could not be detected and her heart
was beating too fast, at 120 beats per minute.
The chest tube was removed and the blood flow from the 2cm cut was
manually blocked.
They immediately started to resuscitate Madam Lee. But her pulse
became weaker and her heart pumped even faster.
The amount of oxygen in her heart started to fall while her blood
pressure remained undetectable the whole time.
Ward Registrar Dr Chia Pow Li was called in to help while hospital
staff tried to contact Madam Lee's family.
But after more than an hour of continuous resuscitation, Madam Lee
died at 4.50pm.
The autopsy report stated the cause of death as heavy bleeding from
the puncture of the heart's left ventricle following the insertion
of the chest tube.
After a discussion with the ward consultant, Dr Soon decided to
call for a coroner's inquiry.
Further investigations revealed that Dr Wijeweera had seen Madam
Lee's enlarged heart from the same CT scan which showed the fluid
around her left lung. However, she did not inform Dr Verma, who had
not seen the CT scan, about this condition before the chest tube
insertion started.
INDEPENDENT EXPERT
Dr Lim Chong Hee, senior consultant at the National Heart Centre's
department of cardiothoracic surgery, was called as an independent
medical expert to give his opinion on whether there was any medical
negligence.
His report noted that there was no requirement to view the CT scan
of the chest before the chest tube insertion.
But it would have been wise for Dr Verma to have done so in this
case because he was unfamiliar with the patient's case and the CT
scan was already available.
Dr Lim also noted that the inexperienced Dr Wijeweera should have
prepared for the case thoroughly.
She should also have informed the supervising doctor of any
abnormality, such as an enlarged heart.
However, the coroner, citing Dr Lim, noted that there was 'no lack
of care given to the deceased' and the incident was 'entirely
accidental'.
One of Dr Lim's suggestions: In future, difficult and complicated
cases should be referred to thoracic surgeons for consultation and
tubes should be placed with X-ray guidance.
