Hospital wants to chase my mother out

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An honorable member of the Coffee Shop Has Just Posted the Following:

Hospital wants to chase my mother out? (Part II)


July 13th, 2013 | Author: Contributions



[The first letter was published here - 'Hospital wants to chase my mother out?']


SGH



Andy:
July 11, 2013 at 8:10 pm (Quote)

Was your mother known to be allergy to allopurinol before the doctor
prescribed it?

If yes, then the doctor is definitely at fault and the hospital should/must
offer free and reasonable treatment plus some form of compensation and the
doctor punished.

If, however, your mother was not known to be allergy to allopurinol, then
there is no way the doctor or anyone else will know and it’s no fault of anyone.
Having said that, reasonable and immediate treatment must be apply when the
allergy or side effect occur.

Question is, was there negligence from the hospital or from the doctor?

Did the hospital wanted to chase your mother out because she is recovering
and does not need hospitalised treatment or something else?

We need to have more background information in this case.

Regards
Here are my clarifications and the chain events went like this:

1. My mother was given allopurinol on 11 Nov 2009. This was the first time
she was taking this medication.

2. Any side effect, whether serious or not, was not disclosed by the doctor
before prescription.

3. Rashes surfaced on my mother body on 23 Dec 2009. I informed the doctor.
The doctor did not pull out the allopurinol but instead prescribed another
medication called Hydroxzyine to suppress the itchiness and rashes.

4. Rashes did not subside. I admitted my mother to hospital on 26 Dec 2009
(it was a Saturday). The doctor who prescribed allopurinol was not in, probably
she doesn’t work on Saturday and Sunday. Hospital on-call doctor also did not
stop the allopurinol medication.

5. The doctor who first prescribed allopurinol to my mother finally stopped
the drug on 28 Dec 2009 and started to disclose serious side effect about the
drug, which we know was already too late. All in all, my mother continues for
another 5 daily dosage before the drug was finally withdrawn.

6. A whole chain of reactions started off on my mother for the next 2 to 3
months. I called it the “torture chamber process” – Her skin got ripped off 90%
from her body, blood spilled out, hair fell off, wrapped up bandages like an
Egypt’s mummy, lips got burnt, tongue got burnt, finger nails came off. Wait a
second, did I just say “finger nails came off?” Yes, I just did, and it’s true.
The scariest moment was when my mother screamed so loud in pain when the nurse
needed to change the old bandages which stick hard to my mother raw skins.

7. Around March 2010, I began to do my own research and investigation on what
went wrong. I don’t have a clue at that time, except a nurse ever told me “it’s
allopurinol again”. That gave me a hint on something – history repeats itself.
So I went for background internet check. I dig deep. Indeed I did. I found
something, an article from Health Sciences Authority (HSA): http://www.hsa.gov.sg/publish/etc/me..._Vol11_No2.pdf.
By the way, HSA is a statutory board of MOH.

8. On the front page of the article, the heading reads “Serious skin
reactions associated with allopurinol”. The 1st paragraph on the front page
reads “HSA would like to alert healthcare professionals (that is, including the
doctors) on a series of local suspected adverse drug reaction (ADR) reports of
death associated with the use of allopurinol locally.” Also on the front page,
the 2nd paragraph reads “Four fatal cases linked to allopurinol use were
reported to HSA over the first five months of 2009.” If you remember the
previous link (the horror pictures) which I provided in my previous thread put
up by TR Emeritus, these were actually the same four cases.

9. On the second page of the article under the HSA’s Advisory heading, in the
second paragraph, it reads “An early signs of rash and skin reactions may be
indicative of a more serious reaction such as SJS or AHS, healthcare
professionals are advised to educate their patients on early recognition of
allergic reactions, on the importance of prompt withdrawal of the drug at the
first sign of rash and to seek medical advice.” Key phase – withdrawal
of the drug at the first sign of rash.

10. Now, this HSA article was published in August 2009, meaning to say this
article came before the doctor first prescribed the allopurinol to my mother on
11 Nov 2009 (see item 1 above). This was about 3-months gap, so logically the
doctor should have seen the article and read about the HSA’s advisory. However,
when rashes occurred on my mother body, the doctor did not heed the HSA’s
advisory to stop the allopurinol. Well, maybe we think the doctor is always so
busy; 3-months time is still not sufficient time for the doctor to read the
HSA’s advisory. Well, continue read on…

11. I found another link from HSA: http://www.hsa.gov.sg/publish/hsapor...HCPL/2001.html.
It said, on 22 Oct 2001, “Physicians are….to inform patients to discontinue
allopurinol therapy at the first sign of rash and to seek medical advice.
So the same key phase “withdraw allopurinol at first sign of rash” is
not new, it has been existed for more than 10 years.

12. The doctor who prescribed the allopurinol to my mother was a senior
doctor, holding a Senior Consultant designation. If history repeats itself, how
could it be possible for the doctor not to withdraw the allopurinol after I
first informed her about the rashes on my mother? Well, that’s probably
Singapore Medical Council is trying to find out now.

So far I have only referred on my mother case. What about the rest – those
repeated cases? Read on…

13. About a year later, an article released http://www.hsa.gov.sg/publish/etc/me..._Vol13_No1.pdf
indicated that there were 6 cases on skin disorders due to allopurinol. I sent
an email to HSA to ask if my mother belongs to one of the 6 cases. HSA came back
to me and confirmed that it was.

Now, the interesting part, what happen to the rest of the 5 cases? DOA? (I
mean Dead Or Alive?) It appears that there was a breach on these doctors who did
not follow the HSA’s advisory. In fact, I sent another email to ask if they are
taking any disciplinary action against these doctors who did not follow their
HSA’s advisory. HSA came back and said the professional conduct of doctors is
not under the purview of HSA but governed by Singapore Medical Council (SMC). In
other words, HSA will not take any action and it’s only up to those who are
educated enough, dig very hard to source evidences and then file in complains to
SMC. So, the elderly are not protected because they (most of them) are not
educated enough to know the real truth.

14. If you just do your sums, from the time 22 Oct 2001 which HSA first
disclosed the news until now, there must be quite significant cases – 20, 30 or
40 cases? The scary part is still not the patients who died or suffered a lot of
allopurinol deadly side effect. The scariest part – the doctors continue to walk
free and think nothing is wrong by not withdrawing the drug at first sign of
rashes.

MOH should have stepped in to investigate the cases for possible breaches,
and should not wait for elderly to response. Or, better still, the government
should initiate a Committee of Inquiry, because it seems that there is a lapse
of medical protocol – doctors did not follow health’s advisory, patients die or
suffer a lot, and the doctors still walk free.

As to whether the hospital or doctor is negligence, this is what I have to
say:

I have a discussion with my lawyer before whether to take on (meaning sue)
both hospital and doctor, or only on doctor. It was my decision to take on both
hospital and doctor. My rationale of suing the hospital is to ask them (assume
mediation takes place in future) to waive off all the past medical expenses and
provide future medical treatment to my mother, whereas suing the doctor is to
ask her to pay for my mother pain and suffering. If I only sue the doctor, the
hospital can come after me (since I didn’t sue them, it can mean they did
nothing wrong) to ask for the medical expenses paid up, and it doesn’t make
sense for me to get the compensation from the doctor side to pay for the
hospital side. So I ask my lawyer to take on both parties. Moreover, it’s
employer-employee relationship, so technically the hospital should hold
accountable (it’s called vicarious liability in legal terms) for their doctors
mistake.

The Writ of Summon is only served to both parties last week (3 July
2013 – Wednesday). All along I hold off to serve the writ because I
don’t want to put both the hospital and us in an awkward position, for example,
like hospital provide treatment to my mother and I still sue them. I have no
choice but to serve the writ because the high court has given us the final
ultimatum. Either we serve the writ to the hospital and doctor by 4 July 2013,
if not, it will be considered void.

After the writ is served, I anticipate “reciprocal effect” or “tit-for-tat”
action from the hospital side, since the suing has begun on our side. Trust me,
they will make things difficult for us such as applying court judgment to chase
my mother out. When I heard from my lawyer that the hospital lawyer is going to
do that, I quickly email to MOH directly to try to hold off the hospital from
chasing my mother out. I will consult my lawyer on the next course of action,
while we wait for our next PTC (pre-trial conference) in high court next Tuesday
(16 July 2013).

Thanks and regards,



Anthony Lim Boon Han



Editor’s note: Separately, TRE has also emailed MOH to
get their comments on the matter. And by the way, we haven’t forgotten about the
PRC doc who sold Viagra illegally in the US and who later was allowed to work in
NUH. SGX has cleared him but we haven’t heard from SMC. SMC is notoriously slow
in making decisions when come to deciding on the conduct of doctors.


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