Singapore— Isabella Alexandria Lim took to Facebook on May 13 to narrate how her grandmother, who recently passed away, had received very poor care at Changi General Hospital (CGH), and in contrast, she and her family felt that when they transferred her to National University Hospital (NUH), her grandmother was given the care she deserved before she passed away.
Ms Lim’s grandmother had been staying at CGH from mid-February to early April, first with a compression fracture, and then a Urinary Tract Infection (UTI). She also suffered from dementia.
Due to continued poor health, her grandmother was brought back to CGH on April 7 and was eventually transferred to a dementia ward, where her health deteriorated. The CGH doctors told the family that there were no more treatment options available for the grandmother and that she would only be given palliative care.
The grandmother’s conditioned worsened, and by April 26, the family was told to stay in the hospital as she had little time left. However, Ms Lim’s grandmother rallied.
During this time, Ms Lim found much to be dissatisfied with regarding how her grandmother and even her family were treated by the nurses and doctors at CGH.
First, she was unhappy that she and her family were not always given complete information about her grandmother’s condition and treatment. The family wondered why the grandmother had become extremely unresponsive one day, only to find out that she had been administered morphine.
She wrote, “Please bear in mind that my grandma has dementia, cannot speak/understand much English and would not have been able to understand what morphine was or how it could have helped her, therefore would not have been able to consent to morphine. Moreover, once my grandma was on morphine, she never fully regained consciousness until she passed away. I really wish we were at least informed about the morphine administration instead of keeping quiet UNTIL we asked why she was unresponsive.”
Secondly, she expressed dissatisfaction with CGH’s “unsympathetic, insensitive and unprofessional staff.” Due to her grandmother’s low body temperature, the elderly lady had been given a heated blanket, which was taken away without a word to the family. When Ms Lim’s aunt asked for it to be returned, the nurse told her “Put everyday got cost you know?”
Another instance was when Ms Lim wanted to ask an on-call doctor about her grandmother’s condition. “The first thing she said when she saw me was “I just want to say that I don’t know ANYTHING about your grandmother” while raising both her hands in the air as if I asked her to surrender?? Errr,” Ms Lim wrote.
She gave other examples, such as when the doctors allegedly refused to give Ms Lim’s grandmother a blood test, or when the family had to do everything for the grandmother, as the nurses showed no initiative, or when they always had to wait for the nurses to come and change the older woman’s diapers, or her position so she could avoid bedsores.
One time, she asked a nurse about her grandmother’s low heart rate and was told, it “depends on God”.
The family had discussed transferring the grandmother to NUH but had been discouraged from doing so, and were told, “doctors in the other hospital would say the same thing” or “she would probably die on the way in the ambulance.”
But by May 3, against the doctors’ advice, they transferred Ms Lim’s grandmother to NUH anyway, even though their primary care doctor allegedly refused to speak to NUH, and they had to get an ambulance on their own.
When she was transferred, the family was told that there was nothing that could be done for her, but that they would give her the best care possible.
The nurses at NUH discovered that the grandmother had severe bedsores, something the family had never been told. Her wounds were given creams and medicated gauze, and she was moved every hour or two to prevent the bedsores from worsening, which had not been done at CGH.
Ms Lim wrote, “The service at NUH from the moment we reached the hospital was a complete change from CGH. My grandma was immediately placed under end-of-life care and we were given booklets and guides on how to cope with end of life. My grandma was given heel sponges to prevent further bedsores and compression stockings for her severe water retention – none of which were done by CGH. They conducted frequent checks (diaper change, position change) on my grandma every 1-3 hours. Also, before they did anything to my grandma, they would say ‘Ah ma, sorry ah, I’m going to change your diapers’ compared to some of the CGH nurses who could still joke and laugh with each other while they were changing her diapers.
The doctors and nurses at NUH are better equipped to deal with families going through a difficult time. They were kind, sensitive and respectful to my grandma (and us) and it felt like they were giving her 100% care even though she was going to pass. They also moved us to a private room. The last 3 days of my grandma’s life at NUH was made so much better….
To be honest, it really felt like the staff at CGH had given up completely on my grandma when they decided to put her under palliative care. Just because she was on palliative care, does it mean that a hospital doesn’t treat her bedsores? Does it mean that they can give her as little care as possible? No. You treat a dying person with the same dignity and respect as you would treat a regular patient.”
Toward the end of her post, she appealed to CGH to change their end-of-life policies for their staff.
“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’. …
It was heartbreaking to see my grandma in the state that she was during the last days of her life. In fact, I wish we had admitted her to NUH from the start.
Now, we have to pay a 5 figure medical bill to CGH for what? Disappointing service.”
Ms Lim also thanked the staff at NUH for how they treated her grandmother. “My grandma passed away peacefully on 5th May 2019 in NUH surrounded by all her children and grandchildren. My family would like to thank the doctors and nurses at NUH Ward 6A for making the last 3 days of her life a much more comfortable one. Thank you all.”
CGH responds, says grandmother was given “appropriate care”
CGH, who had been asked for a comment on Ms Lim’s Facebook post, responded through senior consultant Dr Lim Si Ching from the hospital’s Department of Geriatric Medicine.
Dr Lim told TODAY Online that, while the hospital staff sympathised with Ms Lim’s family over her grandmother’s death, “appropriate medical care was given during her stay at CGH”.
However, Dr Lim did admit to certain avoidable “communication gaps”: “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.”
She also contradicted Ms Lim’s account and instead relayed that CGH staff had responded ” promptly” to her grandmother’s bedsores and had assisted with her grandmother’s transfer to NUH via a letter to NUH’s Emergency Department.
Dr Lim added: “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.”/ TISG