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http://newpaper.asia1.com.sg/news/story/0,4136,193204,00.html?
DEATH OF KIDNEY DONOR
'Alert' to 'unresponsive' in 2 hours
Lawyer raises questions over monitoring
By Ng Wan Ching
February 18, 2009
GRIEF: Mr Surender Singh with a picture of his wife Narindar Kaur. TNP FILE PHOTO
WAS Madam Narindar Kaur properly monitored after her surgery?
That is one of the key questions being asked in a medical negligence suit involving her death, after she underwent surgery to donate her kidney to her husband.
According to her surgeons, she was supposed to be on hourly monitoring after her surgery.
But hospital records do not reflect this.
That is one of the issues in the hearing at the High Court.
Madam Kaur went from being 'alert and comfortable' at 2.30pm to 'collapsed and unresponsive' between 4pm and 4.15pm. Her time of death was recorded as 5.17pm on 16 Feb 2005.
Her husband Surender Singh has brought a medical negligence suit against the two surgeons who operated on his wife, Dr David Consigliere and Dr Li Man Kay, and the National University Hospital.
Yesterday, the ward doctor who was on duty the day Madam Kaur died could not tell the court what Madam Kaur's condition was between 2.30pm and 4pm to 4.15pm that day.
Dr Ng Kah Wee was then a house officer with the Urology Department at National University Hospital.
She is now working at the Institute of Mental Health and training to be a psychiatrist.
Dr Ng said in her affidavit that Madam Kaur was well the day before her operation and had understood when the complications of her surgery were explained to her.
After her operation on 16 Feb 2005, Dr Ng reviewed her at 2.30pm at ward 43.
She found Madam Kaur to be alert and comfortable. She took Madam Kaur's blood pressure, measured her pulse rate and documented in her case notes that all Madam Kaur's vital signs were stable.
But sometime between 4pm and 4.15pm that day, when Dr Ng was at the nurses' station at ward 43, she was informed by a nurse that Madam Kaur was unresponsive.
She told the nurse to inform the medical officer of Madam Kaur's collapse and then went immediately to assess Madam Kaur's condition.
She said that when she went to Madam Kaur's bed, there were visitors. She asked them to leave.
Another nurse was with Madam Kaur trying to measure her blood pressure.
Unresponsive
Dr Ng noted that Madam Kaur was unresponsive to pain stimulus assessed by way of a sternal rub (using one's knuckles and grinding them hard into the central bony portion of the chest).
At that point, Madam Kaur's blood pressure and pulse reading could not be obtained by the nurse. Dr Ng noted on quick examination that Madam Kaur was 'cold and clammy'.
Code Blue (a call for resuscitation) was activated.
Under cross examination, Dr Ng was asked by Mr Singh's lawyer, Mr S Palaniappan, whether at 3.30pm, following monitoring done at 2.30pm, there were any records to show Madam Kaur's blood pressure, pulse rate or temperature.
Dr Ng said the next parameters that were taken 'were not reflected as 3.30pm'.
'However, having worked in hospitals and wards, knowing that ward 43 is a busy general surgical ward, I would not be surprised that the next parameters is (sic) not taken on the dot,' she said.
Mr Palaniappan asked if Dr Ng would agree with him that the only matter that is actually reflected in the documents is a measurement that appears to have been taken at 4pm.
Dr Ng said 'it would reflect this way'.
She also confirmed that she had not seen that measurement - Madam Kaur's blood pressure - being taken.
She said in her affidavit that during Madam Kaur's resuscitation, she and Dr Consigliere noticed an entry of a blood pressure reading about 80/60 mmHg after the first entry of about 108/70 mmHg made at 2.30pm on the observation chart.
There was no time given for the second blood pressure reading and she was not aware of it before Madam Kaur's collapse.
After checking with the nurses, one of them, Nurse Lourdes Leilani, told her that she had taken that reading at 4pm.
Nurse Lourdes then wrote 4pm on the observation chart to indicate the approximate time that the blood pressure was taken.
Dr Ng said she saw Nurse Lourdes doing this.
Mr Palaniappan asked whether the records showed any other parameters also being taken, such as urine output, pain score, the drainage amount. Dr Ng said she was unable to answer the part about pain score.
With regard to the intake and output chart, she said she was unable to say that any records were taken.
Mr Palaniappan then referred Dr Ng to a page on her affidavit, which is the pain monitoring chart. It showed the last monitoring at 2.30 pm, where the oxygen saturation was 99 per cent, the pain score at rest was at 5 and on movement was at 6.
No other records
After this record, no other measurements on pain score were recorded. Dr Ng agreed it was not reflected on the record.
When Mr Palaniappan put his case to Dr Ng and asked whether the monitoring of Madam Kaur's vital parameters while she was in the ward after the surgery was totally inadequate, Dr Ng disagreed.
Mr Palaniappan said the measurement of Madam Kaur's vital parameters, if it had been done adequately, or at the very least on an hourly basis, would have provided essential information which would have assisted in expeditiously attending to her.
Dr Ng said she was unable to 'postulate this'.
Mr Palaniappan asked if the standard at NUH at that point in time was hourly monitoring, would it have to be strictly followed.
Dr Ng said 'it should be strictly monitored'.
Hearing continues on Thursday.
DEATH OF KIDNEY DONOR
'Alert' to 'unresponsive' in 2 hours
Lawyer raises questions over monitoring
By Ng Wan Ching
February 18, 2009
GRIEF: Mr Surender Singh with a picture of his wife Narindar Kaur. TNP FILE PHOTO
WAS Madam Narindar Kaur properly monitored after her surgery?
That is one of the key questions being asked in a medical negligence suit involving her death, after she underwent surgery to donate her kidney to her husband.
According to her surgeons, she was supposed to be on hourly monitoring after her surgery.
But hospital records do not reflect this.
That is one of the issues in the hearing at the High Court.
Madam Kaur went from being 'alert and comfortable' at 2.30pm to 'collapsed and unresponsive' between 4pm and 4.15pm. Her time of death was recorded as 5.17pm on 16 Feb 2005.
Her husband Surender Singh has brought a medical negligence suit against the two surgeons who operated on his wife, Dr David Consigliere and Dr Li Man Kay, and the National University Hospital.
Yesterday, the ward doctor who was on duty the day Madam Kaur died could not tell the court what Madam Kaur's condition was between 2.30pm and 4pm to 4.15pm that day.
Dr Ng Kah Wee was then a house officer with the Urology Department at National University Hospital.
She is now working at the Institute of Mental Health and training to be a psychiatrist.
Dr Ng said in her affidavit that Madam Kaur was well the day before her operation and had understood when the complications of her surgery were explained to her.
After her operation on 16 Feb 2005, Dr Ng reviewed her at 2.30pm at ward 43.
She found Madam Kaur to be alert and comfortable. She took Madam Kaur's blood pressure, measured her pulse rate and documented in her case notes that all Madam Kaur's vital signs were stable.
But sometime between 4pm and 4.15pm that day, when Dr Ng was at the nurses' station at ward 43, she was informed by a nurse that Madam Kaur was unresponsive.
She told the nurse to inform the medical officer of Madam Kaur's collapse and then went immediately to assess Madam Kaur's condition.
She said that when she went to Madam Kaur's bed, there were visitors. She asked them to leave.
Another nurse was with Madam Kaur trying to measure her blood pressure.
Unresponsive
Dr Ng noted that Madam Kaur was unresponsive to pain stimulus assessed by way of a sternal rub (using one's knuckles and grinding them hard into the central bony portion of the chest).
At that point, Madam Kaur's blood pressure and pulse reading could not be obtained by the nurse. Dr Ng noted on quick examination that Madam Kaur was 'cold and clammy'.
Code Blue (a call for resuscitation) was activated.
Under cross examination, Dr Ng was asked by Mr Singh's lawyer, Mr S Palaniappan, whether at 3.30pm, following monitoring done at 2.30pm, there were any records to show Madam Kaur's blood pressure, pulse rate or temperature.
Dr Ng said the next parameters that were taken 'were not reflected as 3.30pm'.
'However, having worked in hospitals and wards, knowing that ward 43 is a busy general surgical ward, I would not be surprised that the next parameters is (sic) not taken on the dot,' she said.
Mr Palaniappan asked if Dr Ng would agree with him that the only matter that is actually reflected in the documents is a measurement that appears to have been taken at 4pm.
Dr Ng said 'it would reflect this way'.
She also confirmed that she had not seen that measurement - Madam Kaur's blood pressure - being taken.
She said in her affidavit that during Madam Kaur's resuscitation, she and Dr Consigliere noticed an entry of a blood pressure reading about 80/60 mmHg after the first entry of about 108/70 mmHg made at 2.30pm on the observation chart.
There was no time given for the second blood pressure reading and she was not aware of it before Madam Kaur's collapse.
After checking with the nurses, one of them, Nurse Lourdes Leilani, told her that she had taken that reading at 4pm.
Nurse Lourdes then wrote 4pm on the observation chart to indicate the approximate time that the blood pressure was taken.
Dr Ng said she saw Nurse Lourdes doing this.
Mr Palaniappan asked whether the records showed any other parameters also being taken, such as urine output, pain score, the drainage amount. Dr Ng said she was unable to answer the part about pain score.
With regard to the intake and output chart, she said she was unable to say that any records were taken.
Mr Palaniappan then referred Dr Ng to a page on her affidavit, which is the pain monitoring chart. It showed the last monitoring at 2.30 pm, where the oxygen saturation was 99 per cent, the pain score at rest was at 5 and on movement was at 6.
No other records
After this record, no other measurements on pain score were recorded. Dr Ng agreed it was not reflected on the record.
When Mr Palaniappan put his case to Dr Ng and asked whether the monitoring of Madam Kaur's vital parameters while she was in the ward after the surgery was totally inadequate, Dr Ng disagreed.
Mr Palaniappan said the measurement of Madam Kaur's vital parameters, if it had been done adequately, or at the very least on an hourly basis, would have provided essential information which would have assisted in expeditiously attending to her.
Dr Ng said she was unable to 'postulate this'.
Mr Palaniappan asked if the standard at NUH at that point in time was hourly monitoring, would it have to be strictly followed.
Dr Ng said 'it should be strictly monitored'.
Hearing continues on Thursday.
