An elderly asthma patient was not given a certain medicine before his death in a Hong Kong hospital because it would have taken too long to obtain the drug in an emergency, an inquest heard on Tuesday.
Yau Ming-poon, 74, died in Tuen Mun Hospital on May 16, 2016, three days after he was admitted for breathing difficulties.
The inquest at West Kowloon Court heard that Yau suffered cardiac arrest twice in the hospital’s intensive care unit. The first time, his breathing tube was found unattached to the respirator. Before his death, Yau had a second cardiac arrest after his family suspected the doctor had wrongly inserted a breathing tube into his digestive tract.
Doctor Lam Ki-wai told the hearing that three hours before the patient’s death at 5.27am, he had given Yau a drug named labetalol to lower his blood pressure, but it might have had side effects on his lungs.
Lam admitted that while a drug called esmolol had fewer after-effects, it was only available in the hospital’s pharmacy. It would have taken half an hour for Lam to go through sterilisation procedures in and out of the ICU and to walk between different buildings to get the drug, a risk he did not want to take in an emergency.
The inquest heard that while Yau’s blood pressure returned to normal after he was given a small amount of labetalol continuously over 90 minutes, he had bronchospasm – constriction of muscles in the airways – forcing the doctor to apply extra medicine at around 3.30am.
Lam believed he had made the best decision after balancing the patient’s interests and the risks involved. He also dismissed links between the tightening of Yau’s airways and his death because of the considerable time that had lapsed.
“There was no perfect cure. We cannot foresee the coming of an after-effect,” Lam said.
Yau’s family suspected that Yau’s death might have been attributed to two hospital blunders when he had heart failure, but Lam said he was confident he had made no mistake in changing the breathing apparatus for the patient.
He believed he had intubated the patient correctly after observing multiple indicators, including a wheezing sound in Yau’s breath and vapour in the breathing tube. Lam admitted, however, that he had not used a detector to make sure his thoughts were correct because the machine would have taken more than a few minutes to turn on.
Yau’s family also suspected that wrongful intubation resulted in Yau’s bloated abdomen, but Lam said the swelling was because of inflation of the lungs due to inadequate gas exchange in the breathing system.
Pathologist Cheung Sai-yin said that while the patient died of respiratory failure, he found no correlation between Yau’s death and the two heart failures.
The inquest continues before coroner Stephanie Tsui May-har and a panel of five jurors on Wednesday.