NUH, neurosurgeon cleared of negligence over woman left in vegetative state after brain operation

SINGAPORE: The National University Hospital (NUH) and its head neurosurgeon were not negligent in their treatment of a woman left in a vegetative state after a brain operation, a High Court judge found on Wednesday (Nov 27).

The family of 70-year-old Madam Goh Guan Sin had sued the hospital and head of neurosurgery Yeo Tseng Tai after the 2014 operation, claiming damages of about S$4.6 million.

The lawyers for Mdm Goh's family said the "truly avoidable missteps" in her care, diagnosis, treatment and advice had resulted in her persistent vegetative state.

Mdm Goh is still at NUH, following complications that developed in the post-operative period of the surgery.

Her lawyers, from Providence Law and Virginia Quek Lalita & Partners, argued that this was after a blood clot was not treated early enough after the operation. An external ventricular drain (EVD) was inserted to treat it, which they called "dangerous" by itself and in the context of a pre-existing blood clot.

Justice Tan Siong Thye on Wednesday dismissed the suit, finding that the hospital had not fallen below the required standard of care in terms of monitoring Mdm Goh's parameters.

Dr Yeo was also not negligent in coming to the view that her prognosis was poor, nor was he negligent in only inserting an EVD without treating the blood clot, said Justice Tan.

He granted NUH's counterclaim for Mdm Goh's family to pay hospital bills of S$397,500 and any further bills since Jul 26, 2019.

BACKGROUND OF CASE

Mdm Goh had gone to the hospital for an operation to remove a tumour in her brain on Jun 2, 2014.

After the surgery performed by Dr Yeo, Mdm Goh suffered post-operative bleeding in the brain.

A team of senior neurosurgeons found that the bleeding involved the brainstem, and chose not to try and clear the blood clot due to the high risk of mortality.

The lawyers for Mdm Goh's family argued that NUH had not monitored her condition diligently enough, with Dr Yeo failing to diagnose the blood clot correctly.

"If Dr Yeo had evacuated the extra-axial haematoma earlier, it is very likely that Mdm Goh would not be in a permanent vegetative state today," said the lawyers in their closing arguments for the trial.

"If the nurse had not missed out on a reading, the doctors on duty may not have been late in ordering a scan. If the doctors had not been delayed in their ordering of a CT scan, the doctor interpreting the scan may not have seen an ambiguous picture that portended such a grim prognosis to him," they said. 

"If the doctor had taken steps to obtain a firmer diagnosis, he may not have made the decision to withhold aggressive treatment of the patient on that day. 

"If not all of the above, Mdm Goh may have walked out of NUH in June 2014."

In contrast, lawyers for NUH maintained in their arguments that the surgical team's assessment of the nature of the bleeding post-surgery was "entirely reasonable", and a decision to urgently insert an EVD was "justifiable and correct".

"As he had been trained and was well qualified to do as an experienced neurosurgeon, Prof Yeo reviewed the available CT scan images and made the decision to insert an EVD to relieve the pressure that was building up in Mdm Goh’s brain," said the lawyers. 

They added that "this saved Mdm Goh’s life".

"As healthcare professionals who always want the best for their patients, NUH and its staff are saddened that Mdm Goh suffered a poor outcome following major brain surgery," said the hospital's lawyers. 

The judge said he empathises with the frustration and disappointment of Mdm Goh's family, and said Mdm Goh and her family's world was turned upside down after a successful operation.

"This is tragic and it is understandable that the plaintiff’s family finds it tremendously difficult to accept the dreadful outcome," he said. "But justice must be meted out according to the rule of law and not the feelings of the heart in order to reach a fair outcome based on the merits and facts of the case.

"I would like to convey my heartfelt sympathy to the plaintiff and her family. I hope, one day, a miracle will wake up the plaintiff from her deep slumber," he said.

FAMILY STANDS BY DECISION TO SUE

The family said in a statement after the hearing that they were disappointed by the court's ruling but stand by their decision to take the matter to court.

"We did this to create awareness because we did not want any other family to go through what we have gone through the past five years," they said through their lawyers.

"Our mother was the pillar of our family. She went to NUH in 2014 for an elective surgery to remove a brain tumour. It pains us that till today, she is in a persistent vegetative state and dependent on life support."

They said they were grateful for the support and concern that they have received from well-wishers, as well as to the team of doctors and lawyers who stepped forward to help them.

The family will wait for a written judgment before discussing with their lawyers whether to appeal.

NUH said in response to CNA's queries after the hearing that the hospital was "heartened by the court's decision, which recognises that the care provided by Prof Yeo Tseng Tsai and his team and the hospital's staff was appropriate". 

"At the same time, the hospital empathises that this has been an emotional burden on Mdm Goh's family," the statement read. 

"Throughout this time, the hospital has remained fully committed to Mdm Goh’s care. We will continue to facilitate appropriate care for Mdm Goh for as long as she remains a patient of the hospital."