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SINGAPORE: A doctor who performed a failed liposuction procedure in 2013 was found liable for negligence in the death of his patient and ordered to pay about S $ 5.6 million in damages, a Superior Court judge ruled on Thursday (November 26). ).
The “negligent acts” of Dr. Edward Foo Chee Boon were enough to cause the death of his patient, Ms. Mandy Yeong Soek Mun, 44, who died after undergoing a liposuction and fat transfer procedure at TCS at Central Clinic in June 2013.
Judge Choo Han Teck ruled that Dr. Foo was negligent in both performing the procedure and managing Ms. Yeong’s postoperative condition, as he delayed calling an ambulance even after her blood oxygen dropped. at emergency levels.
He died at Singapore General Hospital (SGH) from pulmonary fat embolism, a condition in which globules of fat become trapped in a patient’s blood vessels and obstruct his pulmonary circulation.
He suffered from the fulminant form of fat embolism syndrome, which is rare and “almost always fatal,” according to the ruling.
Blood vessel perforated while injecting fat
In May 2013, Ms. Yeong met with Dr. Foo for a consultation, as she was dissatisfied with the uneven appearance of her thighs after two previous liposuction procedures, including one performed by Dr. Foo, according to sentence.
Dr. Foo recommended additional liposuction and a fat transfer procedure to correct the irregularities. This would involve transferring fat from your abdomen to your thighs.
The surgery was performed from noon to 2 p.m. at The Central mall clinic on June 28, 2013.
At 2:05 p.m., Ms. Yeong’s blood oxygen level dropped to 72 percent, according to the clinic’s anesthesia registry. Dr. Foo attempted to raise her oxygen level above 95 percent without success, and by 2:45 p.m., Ms. Yeong had suffered a cardiovascular collapse.
An ambulance was called at 2.53pm and arrived at the clinic in seven and a half minutes.
Ms Yeong was then taken to the SGH Accident and Emergency (A&E) room, where she died at 5.46pm after further attempts to resuscitate her failed.
The plaintiffs in the case, including Ms. Yeong’s husband, argued that Dr. Foo negligently caused her death in three respects: failure to obtain her informed consent, performing the procedure, and monitoring her postoperative condition.
Dr. Foo denied all three accusations.
In his view, Judge Choo found that the fat embolism occurred as a result of surgery in which Dr. Foo inserted a blunt-tipped cannula into Ms. Yeong’s thigh and injected fat molecules directly into her bloodstream. .
“That is not an accepted risk if the surgery is performed correctly, and therefore the inference must be that the surgeon was negligent in the course of the procedure itself,” the judge said.
He considered the scar tissue on Ms. Yeong’s thighs that made it more difficult to inject fat into those areas, the “extremely rapid” onset of her symptoms, meaning that a large volume of fat had suddenly entered her bloodstream as well. like bruises on her abdominal walls and upper thighs.
“All things considered, it is most likely that Dr. Foo inadvertently punctured a blood vessel while injecting fat into (Ms. Yeong’s) thigh,” Judge Choo said.
“Consequently, I am of the opinion that Dr. Foo’s negligent performance of the procedure (of Ms. Yeong) caused her eventual disappearance.”
“TOTAL MAYHEM AND CONFUSION”
Regarding the management of Ms. Yeong’s postoperative condition, Judge Choo said that from the point where her blood oxygen level dropped, “the evidence from those present is neither clear nor consistent, but the picture that emerges is that of total chaos and confusion. “
“Nobody seemed to know what to do,” added the judge.
According to Dr. Foo and Dr. Chow Yuen Ho, another doctor called into the operating room to help a little after 2 pm, they both tried various procedures to raise Ms. Yeong’s oxygen saturation level.
Dr. Foo was simultaneously attempting to diagnose the cause of the drop in oxygen saturation before the ambulance was called, according to the ruling.
“Contrary to Dr. Foo’s claim that the patient’s condition was improving, evidence showed that Ms. Yeong’s oxygen saturation level was rising and falling due to her efforts, but it did not exceed 92 percent, said the judge.
“That’s an emergency,” he said, adding that there was evidence in the form of photographs from the vital sign monitor.
“One was next to the camera of a phone that belonged to one of the nurses. The other was with Dr. Chow’s small digital camera that was not produced at trial, although it appears that photographs could have been taken with that camera, ”said the judge.
“HE IS NOT PROPERLY TRAINED”
Noting that there was some dispute over when Ms Yeong collapsed, Judge Choo said the time between a patient’s collapse and an ambulance call is “especially significant in fat embolism cases where the time is essential”.
He also pointed to Dr. Foo’s testimony that it was “a medical procedure to phase out one condition after another until the correct diagnosis was made,” but said there was no reason why he couldn’t have called an ambulance while diagnosing the disease. problem.
“Also, there is no evidence that Dr. Foo ultimately diagnosed fat embolism. And the fact that it took 45 to 50 minutes for him to realize that he couldn’t understand what was happening forces me to infer that Dr. Foo was not adequately trained for such surgeries, ”Judge Choo said.
“Liposuction and related procedures are generally considered the specialty of plastic and reconstructive surgeons, and Dr. Foo is a general surgeon who only attended several liposuction courses and internships abroad before practicing liposuction.
“This is not to say, however, that general surgeons should never be able to perform liposuction surgeries,” the judge said, adding that ultimately it was up to the health authorities and the medical profession to resolve these limits.
“The plaintiffs’ expert testimony on this point was simple and straightforward: when a doctor is unable to handle the situation, he should ask for help,” Judge Choo said.
“In this case, asking for help is an understatement: Dr. Foo should have sounded the alarm; and I should have done it much earlier. “
Of all the doctors who testified on behalf of the plaintiffs and SGH, Ms. Yeong had arrived at the emergency department “too late to be saved,” the judge said.
The “general consensus” among doctors was that if the ambulance had been summoned when Ms. Yeong’s blood oxygen dropped for no apparent reason, she “would have had a chance” to survive the fat embolism.
Fat embolism patients have a “reasonably good” chance of survival when given rapid expert resuscitation in a hospital with such facilities, the judge added.
“SGH has the necessary resuscitation equipment, but not Dr. Foo’s clinic … Therefore, the speedy transfer to SGH was vital, and I am of the opinion that Dr. Foo’s delay in sending the ambulance it was an act of negligence. “
On the plaintiffs’ allegation that Dr. Foo did not obtain Ms. Yeong’s informed consent for the surgery, the judge found that the surgeon did not adequately draw his patient’s attention to the risk of fat embolism prior to the procedure, but he did not come to consider it negligent.
“Given the unusual nature of the risk of pulmonary embolism, (Ms. Yeong’s) personal experience with liposuction, as well as her desire to correct the irregularity of her thighs, it seems that she is more likely to accept the risk and proceed, Judge Choo said.
ABOUT S $ 5.6 MILLION IN AWARDED DAMAGES
Ms. Yeong is survived by two elderly parents, her husband, and two sons aged 17 and 13 at the time of her death.
In deciding the plaintiffs’ claims for damages, Judge Choo noted that Ms Yeong was the head of regional marketing development for Roche Diagnostics Asia Pacific at the time of her death and had worked there for nearly 20 years.
He awarded about S $ 3.8 million in damages for the projected loss of inheritance suffered by his dependents, as well as about S $ 1.7 million for a dependency claim.
Another sum of approximately S $ 31,390 was awarded for funeral, legal and administrative expenses, as claimed by his estate.
Dr. Foo had argued that it should be liable for only one-third of the claimable damages, a position the judge described as “non-initiating.”
“As the analysis of this sentence makes clear, Dr. Foo’s negligent acts alone were enough to cause Mandy Yeong’s death. Therefore, it should be fully responsible for the losses suffered by the plaintiffs. “
