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Written by our Correspondent Mr Ng Chun Kiat, son of KKH medication error victim Madam Ng L.K lambasted the two pharmacists responsible for the mistake as being "idiots" on his blog, started a few days ago to create "public awareness" for the incident! Mr Ng took issue with the fact that the two pharmacists had yet to aplogize to his mother in person: "To date, not a single one of the two idiots has personally apologize to my mum. En-route to hospital with my dad, I was told that the culprits, however, did visit Mdm Ng Poh Hung(the other victim) and apologize for the blunder. Two cases of overdosage (drug that was supposed to be administered over 3-4 days was induced within 3-4 hours), two different type of drugs (Mdm Ng's drug was much more potent, as explained)", he wrote. Mrs Ng was given an overdose of the chemotherapy drug doxorubicin over a few hours instead of days. The pharmacists had used the wrong infusion pump to deliver the toxic medicine. Upon discovery of the error by the family, the pharmacist told them that Mrs Ng's drug was "not as potent" as Madam Poh's and it was "OK" for her to go home. It was only during the inquiry conducted 5 days later that Mr Ng was told by the hospital that pharmacists have no right to send patients home. The decision has to be made by a medical doctor. Mr Ng was visibly peeved at the apparent cavalier attitude that the hospital staff had taken towards his mother: "One thing I couldn't stand is that over the past week, the words "serious" and "it's ok" have been used loosely!!! She told us it's ok and that the side effects will be similar to undergoing the treatment over 3 days. I'm like "Hello, this is a negligence by the hospital, right? No way am I going to accept that a drug that was suppose to be taken over 3 days is the same as taking it over 3 hours!" He poured scorn over reports carried by the mainstream media that KKH had spent time "counselling" the two pharmacists: "Rather than to assure or cure the victims, we were told that the hospital was looking into the matter, found out the mistake was the negligence of 2 pharmacist, and spent time counselling them when they broke down upon knowing their mistake? Counselling the pharmacists was much more important?!?! We all found it hard to swallow honestly." He was also unhappy with the inquiry conducted by KKH on 12 November 2009 which left more questions than answers for the family: "Dr Soh, my mum's chemo doctor, kept throwing medical statistics and facts at us (I HAVE THIS RECORDED), saying that the international guide for the administration of doxorubicin is acceptable even within 6 minutes, but has higher risks on the heart, which was why she prescribed it to be infused over 3 days. But she kept insisting "it is okay to have it administered over 6 minutes." WHAT DO YOU MEAN BY IT'S OKAY WHEN YOU'VE CLEARLY MENTIONED THERE'S HIGHER RISK?!?! It made me lose my cool and I argued with her by saying that if it is okay, then I suggest that you have all your patients to complete their sessions over 6 minutes rather than over days as that would rule out any chances of any blunder by anyone." According to the Washington Manual of Medical Therapeutics, cardiomyopathy (or failure of heart muscles to work as a pump) occurs in 2 per cent of patients who receive a cumulative lifetime dose of 550mg/m2. The incidence increases dramatically at higher cumulative doses. If the dose approaches 450 - 550 mg/m2, serial radionuclide ventriculography should be performed. KKH only "offered" full waiver of Madam Ng's current stay in hospital and her 4th chemotherapy treatment. Due to the cardio-toxic effects of doxorubicin, Madam Ng may require to be on long-term follow-up with a cardiologist. KKH did not mention if it will pay for her future medical expenses as such. In fact, KKH had refused to accept any responsibility should Mrs Ng suffered from complications of heart failure in the future: "The hospital claimed that in case of heart failure in future, they will perform post-mortem op to see if it was caused by the drug (which they said can be done by slicing up the heart). Cases of failure due to dietary reasons, blood clots etc will not deem the hospital responsible. WTH?!?!?!", wrote Mr Ng on his blog. The Temasek Review advises Mr Ng and his family to seek a second opinion from a cardiologist in the private sector to ascertain if Mrs Ng does require long-term cardiology follow-up. Heart failure is a chronic debilitating disease and it is almost impossible to prove that it is caused by doxorubicin unless a post-mortem is done on the heart tissue of the deceased. Medication errors like this are not uncommon in Singapore's much vaunted public healthcare system where junior doctors and nurses often work for long hours without adequate rest. The KKH drug blunder would have gone unnoticed had not Mr Ng's aunt contacted her friend in the Straits Times who in turn requested an interview with KKH authorities. Even then, the state media has gone on a PR overdrive to exonerate the hospital from blame and to play down the severity of the mistake. Minister of Health Khaw Boon Wan had refused to apologize for the blunder, blaming it instead on the manufacturer of the pump for making the two pumps too "similar" in appearance which raised the question whether the two pharmacists have received the training needed to operate the pumps. According to Mr Ng, KKH had even gone to the extent of removing the newspapers carrying the report on 12 November 2009 from its premises: "On the day the article wrote by Ms Salma Khalik was published on the Straits Times on the 12th Nov 2009, why was it that the hospital, which has the papers on their stands on a daily basis not have one on the 12th? Even 7-eleven store in KKH did not put out any for purchase." MOH and KKH should give a detailed explanation to Mr Ng's family and the public on what happened exactly without holding back any information. The two pharmacists must not be made scapegoats for the error. Surely there are flaws within the system itself which contributed to the blunder in the first place. The public deserves no less a complete disclosure by MOH. After all, Mr Khaw Boon Wan is the highest paid health minister in the world and was once praised by Senior Minister Goh Chok Tong as the "best" health minister Singapore ever has. Read Mr Ng’s blog here   Related articles: >> Interview with Mr Ng Chun Kiat >> Son of KKH victim of medication error disputes reports in state media >> KKH medication error: Khaw dismissed worker fatigue as cause >> Was medication error at KKH caused by fatigue? >> KKH CEO Prof Ivy Ng yet to apologize for drug blunder  Read More →

Background: On 6 November 2009, two cancer patients receiving chemotherapy at Singapore's Kandang Kerbau Hospital (KKH) was given an overdose of the drugs. One of them is Madam Ng L. K who received doxorubicin over a few hours instead of days. Madam Ng's son, Mr Ng Chun Kiat, had started a blog to raise public awareness of what really happened which is quite different from what was reported in the mainstream media. We manage to catch up with Mr Ng to find out more about the case via email:   Temasek Review: After the mistake was discovered by your mother, she was told to go home by the pharmacists and not by the doctors as is the usual practice? Did any doctors explain to your mother what happen? Who is the consultant in charge of your mother? Chun Kiat: Yes, it was the pharmacist who told us that it was OK for my mum to go home. The only explanation offered by the pharmacist was that the drug my mum was taking for her chemotherapy was not as potent as Mdm Ng's, and that some people who have had the same chemo drug as my mum had it infused in 15 minutes. The only doctor who attended to us that very night was the junior doctor on duty who could only assure us that the necessary tests have been arranged and various doctors have been notified of the situation. He commented that he was in no position to offer us further information or explanation as that was not his specialty. During her previous stay, her principal doctor was Dr. Chia Yin Ning and her chemotherapy doctor is Dr. Soh Lay Tin.   Temasek Review: It was only after your request for your mother to stay overnight in hospital for observation that the pharmacist relented, is that correct? She initially wanted to send your mother home? Chun Kiat: It wasn't exactly a request on my part. I voiced out that it shouldn't be a case of the victims wanting to stay in hospital but rather the professionals advising us to do so immediately since effects etc were not know yet. Again, the pharmacist told us it was okay if my mum went home.   Temasek Review: KKH arranged only for your mum to stay in B2 and you had to pay a down payment first? It was reported in the papers that the hospitalization bill was waived by the hospital? Chun Kiat: There were no initial arrangements made by the hospital. We were only instructed to do the necessary paperwork for admission, which included the down payment. My mum was then asked to choose the ward class and bed to stay in. She selected the B2 ward as there was no assurance of any compensation or cover of the hospitalisation fees and it was also the same ward she had previously stayed. After explaining the incident to the assistant (clerk?) arranging the admission arrangements, she replied that we'd actually have to make the payment first while the hospital does the investigations before we can get the claim. As the payment required my father's signature and IC for the medisave payment to be processed, we held on to the form for the next few days as we felt it was really unnecessary that we had to take responsibility to pay for the admission which was a blatant negligence on the hospital's part. Not a single staff came to offer the waiver of the hospitalisation charges until my aunt made the request only a few days later.   Temasek Review: How long did you wait in the ward before a doctor attend to your mother? Is he/she a house officer, medical officer or registrar on call? Chun Kiat: We reached the hospital at early 10pm and if I'm not wrong, the doctor came around 12 plus or past 1am. He's the junior doctor on duty. However, note that from the time we got in the ward, there had been several doctors gathered at the nurses' station, which is very conveniently located right outside the ward. If this had been seriously regarded by the hospital, why wasn't there any urgency in the doctors to assess my mum or to examine her right there and then? Instead, we were told they had to retrieve my mother's case file before any action could be done.   Temasek Review: KKH only gave you an official explanation after 5 days? You mean no senior figures spoke to you during this period of time? Chun Kiat: KKH arranged for an inquiry to answer our concerns and uncertainties after 5 days. I suspect that they only did so as they received an email from the media asking for coverage on the 4th day. It was at the inquiry when we finally got to speak to senior figures. Run-on-the mill doctors and nurses came and went, often just telling my mum her blood test was fine etc. Some did mention it was due to overdose, others said it was fine with regards to the dosage when we questioned them about my mum's status and condition.   Temasek Review: Did KKH offer your mother an official apology? Chun Kiat: I would suppose the official verbal apology was made during the inquiry on the 11th of November 2009. Official in terms of black and white, none.   Temasek Review: Did KKH offer to compensate your mother for the pain and distress she has been through? Chun Kiat: Pain and distress, no. They only mentioned during the inquiry that they will waive off all the charges incurred during this period of stay and waive off my mum's fourth session of chemotherapy (total of 6 sessions). Also, they claimed that they will only take responsibility, should my mum's heart fail in future due to the effects of the drug, doxorubicin, and this could be tested with post-mortem.   Temasek Review: Are you considering taking legal action against KKH? Chun Kiat: We are definitely considering. We thank Mr Ng Chun Kiat for agreeing to this email interview and we wish his mother a speedy recovery. Read Mr Ng’s blog here   Related articles: >> Son of KKH victim of medication error disputes reports in state media >> KKH medication error: Khaw dismissed worker fatigue as cause >> Was medication error at KKH caused by fatigue? >> KKH CEO Prof Ivy Ng yet to apologize for drug blunder      Read More →