The National University Hospital (NUH) and its head neurosurgeon, Dr Yeo Tseng Tsai, are being sued by a woman whose mother has been left in a permanent vegetative state for nearly five years, after surgery to remove a cystic brain tumour in June 2014.
64-year-old Goh Guan Sin, who had been complaining of headaches, nausea, fatigue and dizziness, was diagnosed with a large tumour on the back of her head in May 2014. On 15 May, NUH neurosurgeon Dr Ho Kee Hong recommended surgery to remove the tumour.
Mdm Goh accepted and her procedure was scheduled to take place on 2 June, with Dr Ho scheduled as the operating surgeon. On the day of the surgery, however, Mdm Goh’s family were informed that the surgery would be conducted by Dr Yeo.
Dr Yeo, who had been overseas the weekend before the surgery and was due to travel on 3 June for a family holiday, conducted the procedure. Mdm Goh, who seemed to be recovering well, was later discovered to have post-operative bleeding in her brain.
A second surgery was subsequently conducted. Mdm Goh, however, did not recover and was left in a permanent vegetative state.
Mdm Goh’s daughter Chiam Yu Zhu is now suing NUH and Dr Yeo for alleged medical negligence. Today (17 Apr), Ms Chiam’s lawyer cited the alleged mismanagement of Mdm Goh’s case before and after the surgery and the failure to identify and interpret her critical symptoms as the reasons for her current state.
Ms Chiam’s lawyer, Abraham Vergis, said that it was “shocking” that the patient had only met Dr Yeo for the first time while she was lying on the operating bed just before being anaesthetised, even though the surgery was scheduled weeks earlier with another doctor she was comfortable with.
Mr Vergis asserted that Dr Yeo’s willingness to be “a fly-in and fly-out surgeon” was contrary to clinical and surgical conventions where doctors examine and treat patients before and after procedures, in case complications arise.
He also said that the operating team “completely and repeatedly” missed critical signs. He argued: “The post-op management of Goh was sorely deficient: the level and regularity of monitoring was well below standard. And what is worse, very telling clinical signs of distress and neurological deterioration were missed — completely and repeatedly.”
Arguing that Mdm Goh was supposed to be monitored on an hourly basis, Mr Vergis said that Mdm Goh was only checked on once, some four hours after the first operation. He said: “Had the hourly monitoring been done, the deterioration in the motor power could have been picked up earlier…before it grows into something much worse.”
The lawyer also noted that Mdm Goh’s condition could have been flagged earlier when she displayed weakness in the right side of her body but a doctor who checked in on Mdm Goh felt this symptom was normal, despite Dr Ho’s notes that said that the patient experienced pre-operative pain on the left side of her body.
Mr Vergis also told the full courtroom that a CT scan was wrongly interpreted.
He said that Dr Yeo and two other surgeons who reviewed the CT scan after discovering the bleeding decided that the patient’s “prognosis was poor” since she suffered “substantial haemorrhage” in her brain stem. All three surgeons agreed that the surgical evacuation of the blood clot was “futile”.
They instead removed the accumulated fluid in her brain to reduce further damage, by inserting an external ventricular drain into the patient’s head.
Calling the surgeons’ assumption that it would be “futile” to remove the blood clot “unsupportable and premature”, especially since Mdm Goh’s fluid-filled cystic brain tumour was known to bleed post-surgery, Mr Vergis said the doctors missed the opportunity to surgically evacuate the growing blood clot.
He argued: “This single decision was monumental in scope and calamitous in its consequence. Essentially, the doctors at NUH had written the patient off and had given up trying to save her because they had wrongly interpreted the CT scan to conclude that she had a massive brainstem bleed.”
Dr Yeo’s lawyer, Lek Siang Pheng, however asked for the case to be dismissed in documents submitted to the court as he argued that Dr Yeo had properly discharged his duty of care to Mdm Goh.
Mr Lek said that Dr Ho had informed Mdm Goh and her family that he would discuss her case with other neurosurgeons since he would not be performing the procedure himself. The lawyer said that Dr Yeo agreed to conduct the surgery when Dr Ho requested him to do so during a discussion about the case with other doctors on 22 May.
Senior Counsel Kuah Boon Theng and Vanessa Yong, who are representing NUH, added that Mdm Goh had been scheduled to meet Dr Yeo on 27 May but she did not turn up for the appointment.
They said that Mdm Goh was seen by another doctor two days later, where she was informed that her surgery would be performed by Dr Yeo.
The lawyers also argued that surgical evacuation of the blood clot would not reverse brain damage and that the surgeons decided against the removal of the clot due to the high risk of mortality.
They added that there is evidence that Dr Ho gave proper advice on the risks of the proposed surgery and that the patient and her family were specifically advised on the risk of bleeding and death repeatedly before the surgery.
The trial will continue until 16 May 2019.