NUH, neurosurgeon cleared of negligence over woman in vegetative state
SINGAPORE — The High Court has dismissed a suit against the National University Hospital of Singapore (NUH) and its top neurosurgeon over the condition of a woman who was left in a vegetative state after her brain surgery.
Goh Guan Sin, now 70, has remained comatose following a June 2014 surgery to remove a cystic brain tumour.
The court on Wednesday (27 November) found that Goh’s family was liable to pay $397,478.78 in bills that were accumulated from the hospital’s care for Goh up to 26 July this year. The family will also have to pay any hospital fees incurred from that point and the cost of the legal proceedings.
Goh was diagnosed with a large tumour at the back of her head in May 2014.
After discussions with a visiting consultant neurosurgeon at NUH, Goh was scheduled for surgery on 2 June that year. At 2.15pm, she appeared to be recovering well immediately after the procedure, but her condition subsequently worsened and a second surgery was conducted five hours later.
The second surgery involved inserting an external ventricular drain (EVD) to drain the fluid that had accumulated in Goh’s brain.
In a hearing that began on 17 April this year, Goh’s daughter, Chiam Yu Zhu, sued the hospital and Dr Yeo Tseng Tsai for what she said was a series of serious missteps taken in the care, diagnosis, treatment and advice of her mother both before and after the surgery.
Dr Yeo and NUH contended that there was no breach in the duty of care, with the hospital counterclaiming for Goh’s outstanding hospital bills to be paid.
A change in arguments
Towards the end of the hearing, the plaintiff dropped the case for negligence towards Goh in the pre-operative stage, a move that Justice Tan Siong Thye described in his verdict as “unsurprising” given the evidence.
The plaintiff had also wanted to sue NUH and Dr Yeo for negligence evinced during the surgery, but dropped the claims at the start of the hearing.
Instead, the plaintiff focused on post-operative claims of negligence, arguing that Dr Yeo, as NUH’s senior consultant and head of neurosurgery, had breached his duty of care by misinterpreting Goh’s CT scan, which was carried out after her first surgery.
After Dr Yeo arrived to review Goh’s condition following her first surgery, he concluded that there was significant bleeding within her brain stem, which carried a grim prognosis.
The neurosurgeon concluded that no further action would be of any help to Goh. He had consigned her to her current vegetative state by failing to address the most direct cause of her neurological deterioration, the plaintiff had argued.
The hospital also did not have a proper system in place to ensure that Goh’s condition was recorded in a chart. It also failed to carry out a CT scan when it was needed urgently, the plaintiff had stated.
‘Dreadful outcome’
In delivering his verdict on Wednesday, Justice Tan said that Dr Yeo and NUH had not been negligent in their care and treatment of Goh after her first surgery.
In choosing to insert an EVD into Goh’s brain, Dr Yeo could not have been faulted for his choice, given that the alternative - to evacuate the hematoma in Goh’s brain - could have resulted in her death and had limited benefit.
The judge noted that miracles do happen with comatose patients, citing a recent case of a mother who had awakened from a 27-year coma in the United Arab Emirates.
The judge also found that the hospital’s hourly monitoring of Goh’s condition following her surgery was adequate, notwithstanding one missing entry at 4.10pm. When Goh’s condition deteriorated, she was rushed to a CT scan. The doctor had also obtained consent from Chiam after apprising her of the purpose of the second surgery and its risk.
The plaintiff had also failed to show that the failure to record Goh’s condition at 4.10pm, and the failure to order a CT scan earlier, actually resulted in damage to Goh. It was also not proven that the family would have opted to have the hematoma evacuated as opposed to inserting an EVD.
Addressing the fracture that Goh suffered in her right knee while in a vegetative state, the judge noted that while the injury could have been caused by NUH staff, the plaintiff had failed to prove that it was not caused by Goh’s own family moving her.
“The plaintiff has not eliminated the option that the family could have caused injury, such that the injury could only have resulted from negligence,” said Justice Tan.
The judge expressed sympathy for Goh’s family, noting that their world had been “turned upside down” by Goh’s condition.
“This is tragic and it is understood that the plaintiff’s family find it tremendously difficult to accept this dreadful outcome,” said the judge, adding however that justice had to be meted out according to the rule of law and based on the merits of each case.
“I hope one day a miracle will wake up (Mdm Goh) from a deep slumber like the case of the mother in the UAE that I had cited,” he added.
In a statement to Yahoo News Singapore, Dr Yeo said that he was “happy to be vindicated by the High Court”.
”Truly I am sorry for the eventual poor outcome for Mdm Goh, but I know my team and I at the National University Hospital have done our very best for her. It is regrettable that her family could not accept my honest explanation for the reason for Mdm Goh’s poor outcome and instead decided to sue me.”
NUH also issued a statement, saying it is “heartened” by the court's decision, which recognises that the care provided by Dr Yeo and his team was appropriate. “At the same time, the hospital empathises that this has been an emotional burden on Mdm Goh's family. Throughout this time, the hospital has remained fully committed to Mdm Goh’s care. We will continue to facilitate appropriate care for Mdm Goh for as long as she remains a patient of the hospital," it added.
Separately, Goh’s family told Yahoo News Singapore that they were “disappointed” by the outcome, but stood by its decision to take the matter to court. The Gohs will be discussing the prospects of an appeal with their lawyers.
“We did this to create awareness because we did not want any other family to go through what we have gone through the past 5 years.
“Our mother was the pillar of our family...It pains us that till today, she is in a persistent vegetative state and dependent on life support.”
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