Man loses lawsuit against Tan Tock Seng Hospital and 3 doctors over his mother's death

SINGAPORE: A man who sued Tan Tock Seng Hospital (TTSH) and three doctors over the death of his mother had his case dismissed by the High Court on Thursday (Oct 13). 

Justice Choo Han Teck found that the hospital and the doctors had not been negligent in their treatment of 74-year-old Tan Yaw Lan, who died in May 2018. 

Madam Tan's son Chia Soo Kiang had argued that doctors Dorai Raj D Appadorai, Lee Wei Sheng and Ranjana Acharya had been negligent in diagnosing his mother at TTSH's emergency department and on admission to a ward.

Mr Chia said the doctors had failed to realise that Mdm Tan was having an acute heart attack when she arrived at the hospital. 

Mr Chia also said the doctors and nurses were negligent in taking his mother for a shower against the family's wishes, not resuscitating her promptly after she collapsed and not obtaining consent from Mdm Tan when they stopped her medication for her heart, high blood pressure and hypertension.

Mr Chia sued the three doctors and TTSH for S$800,000. 

Mdm Tan had a history of chronic heart disease, type 2 diabetes, stage four chronic kidney disease, hypertension, high cholesterol and heart failure among other ailments. 

On Apr 20, 2018,  she was taken in an ambulance to the emergency department of TTSH due to a persistent fever. She was diagnosed to have an infection of an unknown source. 

Mdm Tan began to show improvement by Apr 22.

On Apr 23, an intern nurse helped her with showering and was in the midst of dressing her when Mdm Tan went limp and lost consciousness.

Other staff alerted to the incident helped with resuscitation but she did not regain consciousness. She died three weeks later on May 13, 2018. 

Mdm's Tan family had declined to have an autopsy performed; and a coroner’s report produced later stated that Mdm Tan died of ischaemic heart disease with pneumonia - which was likely the source of her infection. 

Her son's lawyer Clarence Lun argued that Mdm Tan had died from an acute heart attack, but Justice Choo said this was unclear.

Mr Lun had relied on the evidence of two experts - a cardiologist and a heart surgeon - to argue that Mdm Tan had type 1 myocardial infarction when she was admitted to hospital.

Type 1 myocardial infarction is an acute heart attack and an emergency with shortness of breath and chest pain as key signs. It requires immediate intervention.

On the other hand, a type 2 myocardial infarction causes a different degree of damage and would be managed by treating the underlying condition.

At the general ward, Mdm Tan was seen by Dr Lee, then a first-year house officer, and Dr Ranjana, a senior consultant. 

Dr Ranjana agreed with Dr Lee and another doctor that Mdm Tan had an infection complicated by other conditions, including type 2 myocardial infarction.

But Dr Ranjana did not feel the need to refer Mdm Tan to a cardiologist then, as the underlying cause of the type 2 myocardial infarction was the infection, which was being treated. 

In his judgement issued on Thursday, Justice Choo said: "I am of the view that Mr Lun had misunderstood the medical evidence of both sides in so far as he claims that the doctors at the Emergency Department had been negligent in not recognising that Mdm Tan had a type 1 myocardial infarction.

"The evidence does not support a finding that Mdm Tan was having an acute heart attack on Apr 20, 2018. What is clear to me is that if Mdm Tan did have  a heart attack on Apr 20, it was more likely to be a type 2 myocardial infarction."

The judge accepted the defendant expert's evidence that Mdm Tan had suffered a cardiac arrest when having her shower, and that was not necessarily due to an acute heart attack. 

The judge also found that Mdm Tan's signs of improvement showed that the approach to treat her underlying infection was working and there had been no signs of an impending cardiac arrest. 

On the claim that the doctors were negligent in changing Mdm Tan's medication, Justice Choo said that Mr Lun had not presented any evidence that continuing the medications would have prevented Mdm Tan's collapse. 

Dr Dorai was the consultant on-call when Mdm Tan was warded, and it would have been his duty to advise and obtain consent on withholding any medication.

But he was not contacted by the on-call team and hence, did not review Mdm Tan.

Justice Choo added: "The plaintiff’s claim that TTSH was negligent in taking Mdm Tan for her shower is similarly without basis.

"First, Mr Lun submits that the hospital ought to have obeyed the family’s instruction not to have Mdm Tan take her shower. The only evidence he has is the hearsay evidence of the plaintiff that Mdm Tan was old-fashioned and did not believe in having a bath or shower when ill."

The intern nurse also testified that Mdm Tan had readily agreed to a shower on Apr 23, 2018. 

The claim that TTSH was slow in its efforts to resuscitate Mdm Tan was similarly without merit, said the judge. 

"When a patient who has the kind of chronic ailments that beset Mdm Tan for so long dies suddenly, one might be forgiven for focusing, with hindsight, to see a connection between those ailments and the death," said Justice Choo.

"But what Mr Lun and his experts are doing is quite the opposite. They are saying that given  Mdm Tan’s conditions, the defendants ought to have been soothsayers and foresee her cardiac arrest."

In closing the judgement, Justice Choo also observed that Mdm Tan's estate would have received S$15,000 for bereavement and S$10,000 for funeral expenses under the Civil Law Act. 

"Given the figures, this claim should have been brought in the Magistrates’ Court — not even the District Court," he said.

"As it turned out, that does not matter as it would have failed in any court."