Daughter of woman left in vegetative state after brain operation sues NUH, head neurosurgeon

SINGAPORE — The daughter of a woman left in a permanent vegetative state after a surgery has taken the National University Hospital (NUH) and its head neurosurgeon to court.

Goh Guan Sin, 64, has remained in the condition at NUH following a June 2014 surgery to remove a cystic brain tumour.

Chiam Yu Zhu, Goh’s daughter, is now representing her mother in a suit against NUH and Dr Yeo Tseng Tsai, the hospital’s senior consultant and head of neurosurgery, for alleged medical negligence. Dr Yeo had led a team that included two other specialist neurosurgeons while conducting Goh’s operation.

On Wednesday (17 April) – the first day of the hearing – Goh’s lawyer Abraham Vergis said it was the failure to identify and interpret Goh’s critical symptoms, along with the mismanagement of her case both before and after the surgery, that had led to her current state.

Diagnosed with tumour in 2014

In May 2014, Goh was diagnosed with a large tumour at the back of her head. The tumour was causing an accumulation of fluids in her brain and had caused her headaches along with feelings of nausea, tiredness and dizziness.

On 15 May, Goh consulted a Dr Ho Kee Hang from NUH’s neurosurgery division, and was advised to undergo surgery to remove the tumour. Goh’s procedure was scheduled for 2 June that year with Dr Ho listed as the operating surgeon.

However, on the day before the surgery, Goh and her family were informed that the procedure would instead be conducted by Dr Yeo.

While Goh was showed to be recovering well immediately after the surgery, she was later found to have post-operative bleeding in her brain. This led to a second surgery being conducted on the same night, which Goh did not recover from.

Missed signs

Opening the plaintiff’s case on Wednesday, Vergis said, “The post-op management of Goh was sorely deficient: the level and regularity of monitoring was well below standard.

“And what is worse, very telling clinical signs of distress and neurological deterioration were missed — completely and repeatedly.”

Vergis noted that Goh had only been checked on once between the first operation and the time when her change in condition was flagged some four hours later. This was despite the fact that she was meant to be monitored on an hourly basis.

Goh’s condition could have been flagged earlier when she showed weakness in the right side of her body, said Vergis. “Had the hourly monitoring been done, the deterioration in the motor power could have been picked up earlier… before it grows into something much worse,” said the lawyer.

However, another doctor who checked in on Goh had been under the impression that her right-side weakness was normal, despite Dr Ho’s notes indicating that Goh’s pre-operative weakness had been on her left side.

‘Wrongly interpreted CT scan’

Following the detection of Goh’s post-operative bleeding, a team of three surgeons – including Dr Yeo – reviewed her CT scan and decided that she had a “substantial haemorrhage” in her brainstem for which “prognosis was poor”.

As a result, all three thought that surgical evacuation of the blood clot was “futile” and carried too high a risk for the patient, Vergis told a full courtroom. The team instead inserted an external ventricular drain into Goh’s head to remove the accumulated fluid and reduce any further damage to her brain.

“This single decision was monumental in scope and calamitous in its consequence. Essentially, the doctors at NUH had written the patient off and had given up trying to save her because they had wrongly interpreted the CT scan to conclude that she had a massive brainstem bleed,” said Vergis.

He added that the surgeons had missed the opportunity to remove the growing blood clot compressing the left side of Goh’s brain due to their “unsupportable and premature” assumption. This was even though Goh was diagnosed with a cystic brain tumour – a type of fluid-filled tumour that was well-known to bleed in the post-operation stage.

‘Fly-in, fly-out’ surgeon

Vergis noted it was “shocking” that Goh had only met Dr Yeo while she was lying on the operating bed just before being anaesthetised.

This was despite the surgery having been scheduled weeks earlier with Dr Ho, whom Goh was comfortable with.

Vergis also noted that Dr Yeo had agreed to conduct the brain surgery with the full knowledge that he would be in Bangkok the weekend just before the surgery, and would again be travelling for a family holiday the day after it was done.

Dr Yeo’s willingness to be “a fly-in and fly-out surgeon” defied clinical and surgical conventions that a surgeon ought to examine and treat his patient before and after the surgery, in case complications should arise, said Vergis.

Lawyers defend doctor’s, hospitals actions

In Dr Yeo’s defence, lawyer Lek Siang Pheng said in documents that his client had properly discharged his duty of care to Goh and that the case against him should be dismissed.

Dr Ho had informed Goh and her family that he would not be performing the surgery himself and he would discuss her case with other neurosurgeons, said Lek in documents submitted to the court.

During a discussion about Goh’s case with other doctors on 22 May, Dr Ho requested that Dr Yeo perform the surgery for Goh and the latter agreed.

NUH’s lawyers – Senior Counsel Kuah Boon Theng and Vanessa Yong – also noted that an appointment had been made for Goh to meet Dr Yeo on 27 May but Goh did not turn up for it. Instead, Goh was seen by another doctor on 29 May 2014, which was when she was informed that Dr Yeo would be her lead surgeon, the lawyers argued.

With regard to the surgeons’ decision not to remove Goh’s blood clot after the first surgery, Kuah and Yong said this was made on the basis that doing so carried a high risk of mortality. Such a move would also not have benefited Goh since surgical evacuation of the clot would not reverse the brain damage that had already set in, said the lawyers.

They added that evidence would also show that Dr Ho had provided comprehensive and proper advice on the proposed surgery and its risk. Goh and her family were specifically advised on the risk of bleeding and even death on multiple occasions before her surgery, said the lawyers.

The trial is scheduled to run until 16 May.

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