SINGAPORE — Changi General Hospital (CGH) has addressed a recent viral Facebook post, in which a deceased woman’s granddaughter expressed unhappiness at poor palliative care given by the hospital.
While it insisted that “appropriate medical care” was given during the 81-year-old’s stay, it acknowledged in a media statement on Wednesday (15 May) that there were “communication gaps which could have been prevented”.
It added that it could have done better in engaging the family members and helping them understand the medical interventions by their care team.
The hospital has also apologised for the anxiety caused to the family.
The Facebook post on Monday (13 May) by marketing executive Isabella Alexandria Lim detailed her family’s “disappointing experience” at CGH when her grandmother was warded on two occasions: from 19 February to 4 April, and from 7 April to 3 May.
As of Thursday (16 May), the post has been shared more than 4,400 times, with more than 300 comments.
Lim, 24, wrote in her post that her grandmother, who suffered from dementia, was initially admitted to CGH after suffering a compression fracture after a fall, but developed urinary tract infection which required hospitalisation.
She was eventually transferred to a dementia ward where she could receive better care for her condition. However, Lim said in her post that her grandmother was then diagnosed to have ischemic bowel (blocked or narrowed arteries to the bowel). Due to her grandmother’s old age and existing kidney condition, surgery was ruled out and palliative care was opted.
Encounters with ‘insensitive’ staff
Lim listed a series of discomforts her grandmother suffered during her stay at the dementia ward – “severe” bedsores at the ward, denial of a thermal blanket for a period by staff, and not having her diapers changed until a request was made.
Lim also wrote that her family was perturbed by the shoddy treatment of her grandmother, as well as “insensitive” and “rude” remarks by the ward’s staff.
For example, she claimed that a thermal blanket used to help alleviate her grandmother’s low body temperature was removed. When her aunt asked a nurse to put it back on, the nurse purportedly said, “Put every day, got cost, you know?”
Lim also said that when she approached an on-call doctor to discuss her grandmother’s alternative treatment options when the primary care doctor was away, that doctor responded, “I just want to say that I don’t know anything about your grandmother.”
“She could have at least read my grandma’s case file first, or asked me how her condition was, instead of making me feel like I was forcing her to answer something against her will. Unprofessional and rude!” Lim wrote in her post.
Later that night, the same doctor allegedly sighed loudly when called to help, as Lim’s grandmother’s heart rate went from 40 beats per minute (bpm) to 110 bpm. Eventually, her colleague attended to her grandmother, and told the family it “depends on God” when asked for an update.
Better care when transferred to NUH
Lim’s family eventually decided on 3 May to transfer her grandmother to National University Hospital (NUH). Even then, Lim wrote that they encountered unhelpful CGH doctors and staff.
She wrote, “Whenever we brought (the transfer) up to the doctors, they would deny our request stating that ‘doctors in the other hospital would say the same thing’ or ‘she would probably die on the way in the ambulance’ so there was no point...
“We were asked to sign a release form stating that CGH will not be liable should anything happen and they kept emphasising on the fact that my grandma would most likely pass in the ambulance. When we called NUH and told them we wanted to transfer my grandma over, they said it was possible but they needed to speak with the CGH doctors or else we would have to be admitted directly into A&E.
“Guess what? Our primary care doctor refused to speak to NUH at all. The nurses also refused to book an ambulance for us to get to NUH and told us to get an ambulance on our own. We eventually managed to get a private ambulance and are so thankful we went ahead with the transfer.”
Lim’s grandmother was admitted to NUH on 3 May, and Lim said the NUH staff attended to her grandmother’s bedsores by applying creams, protecting her wound with medicated gauze and giving her heel sponges. They also conducted one to three-hourly checks on her to change her diapers or position, and helped ease her severe water retention by giving her compression stockings.
The grandmother passed away on 5 May.
Lim commented on her post, “CGH, I urge you to re-evaluate your training towards your staff for end-of-life protocols! Learn how to deal with families who are going through a difficult time. Don’t make insensitive remarks like ‘it depends on God’.
“Most importantly, treat your dying patients with the same respect and care you would give to a regular patient in the hospital. It was heartbreaking to see my grandma in the state that she was during the last days of her life. In fact, I wish we had admitted her to NUH from the start. Now, we have to pay a five-figure medical bill to CGH for what? Disappointing service.”
Communications gaps which could have been prevented
In CGH’s media response to queries on Lim’s Facebook post, Associate Professor Lim Si Ching, a senior consultant in the department of geriatric medicine, said, “We are saddened by the news of the patient’s passing and empathise with the family’s anguish.
“Appropriate medical care was given during her stay at CGH. However, there were communication gaps which could have been prevented. While the care team provided regular updates to the family member designated as main caregiver, we could have done better in engaging the different family members and helping them understand the diagnostic and therapeutic interventions by the care team.”
On the elderly woman’s bedsores, Assoc Prof Lim said CGH had promptly taken preventive measures, such as by closely monitoring the woman’s skin condition and placing her on a pressure-relieving air mattress.
Staff had also “turned the patient at regular intervals” while respecting family members’ request to minimise the disruption to her rest, she added.
Continuity of care was ensured when the family requested a transfer, as CGH’s care team had facilitated the move with a doctor’s letter to NUH’s Emergency Department, she said.
Assoc Prof Lim added: “Owing to patient confidentiality, it would be more appropriate for us to meet with the family to address their concerns, and provide full details of the case. We will do our best to learn from this incident and improve our care delivery processes.”
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