World Class Hospitals??? Government Should Do Reality Checks
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A week after she pulls placenta out at home, thinking that all was well, new mum says:
I FELT GUSH OF BLOOD
S'PORE MUM'S BIRTH PAINS
August 13, 2007
IT was her first baby, and the young single mother-to-be was so excited that she called KK Women's and Children's Hospital and asked for its 'top doctor'.
Posed picture
She wanted the best care for herself and her unborn baby.
But she ended up having a difficult experience, said Ms Lafone Ching, 21, a hotel reservations officer.
It included bleeding episodes at home, having to pull something out of her womb by herself and having her womb poked during a procedure.
The hospital said what happened to her is not uncommon and normal procedures were followed.
Ms Ching was first seen by Associate Professor John Tee Chee Seng, senior consultant & chairman, division of obstetrics and gynaecology at KKH. She said she had seen him 10 to 12 times, paying about $80 for each visit.
'Just before my delivery, they asked which ward I wanted to be in. I said class B2 plus,' said Ms Ching.
She was told that if she chose that ward, she could not choose the doctor who would deliver her baby.
'I was told by a nurse that chances are, I would be delivered by a midwife.'
Precious gift: Ms Lafone Ching went through a tough time to deliver her newborn Le-nel. -- picture| david tan
Ms Ching said she did not mind and stuck to her B2 choice, as she had some financial concerns.
'I am the only one working to support myself and my baby, so I did not think I could afford an A class ward,' said Ms Ching.
In KKH, as in all restructured hospitals, low-risk patients who do not opt for personalised private care get team care.
But Ms Ching's senior consultant specialist, Assoc Prof Tee, remained in charge and was responsible for her overall care, together with his team of doctors and nurses, the hospital said.
On 27 Jun, Ms Ching gave birth to a healthy baby girl. She was delivered by a midwife.
Soon after, she said she noticed the midwife looking worried.
'She told me my placenta had not come out. Then she called a doctor whom I had not seen before to help.'
The doctor said he needed to put his hand into her womb to remove her placenta. 'He did that two or three times,' MsChing said.
'I said I wanted to see the placenta to make sure he got it out.'
And she did see it.
Troubling: Ms Ching's scan, done by Dr Tanny Chan on 1 Aug, showing that her womb was still not clean. The dark area are tissues left in the uterus.
'The midwife and doctor both told me that all the placenta had been removed,' Ms Ching said.
The hospital confirmed the placenta did not come out spontaneously.
'It had to be manually removed by our medical officer on duty,' a KKH spokesman said in an e-mail reply to The New Paper's queries.
The removed placenta was checked, and as it appeared complete, Ms Ching was discharged on 29 Jun.
Almost two weeks later, on 10 Jul, she had a shock when she went to the toilet and found something hanging between her legs.
'It looked like a ball of something red had dropped out of my womb and was still attached by something which looked like a string,' she said.
She rushed out and asked her grandmother to look at it.
'My grandma used tissues and touched it but she also didn't know what to do,' said Ms Ching.
It was around 11.30pm then, and MsChing called KKH for help.
KK ASK-A-NURSE HOTLINE
She was told to call the KKAsk-A-Nurse hotline - quickly before it closed at midnight.
'The nurse on the line told me to pull it out myself,' she said.
She said she repeatedly asked the nurse if that was safe.
'After she reassured me that it was safe, I went and pulled it out. The string-like thing kept coming and coming. I had to pull quite a lot before it all came out,' said Ms Ching.
The KKH spokesman said the nurse had advised Ms Ching to go to the Women's 24-hour clinic if she was bleeding. As Ms Ching was not bleeding, the nurse then advised her to use a mirror to have a closer look at what it was and to pull it out if she felt comfortable.
Dr Tan Kok Hian, senior consultant, maternal and fetal health at KKH, said: 'Simple removal of the tissue from the vagina would be the best thing to do and does not cause any harm to the patient.'
STAINED CHAIR
On 19 Jul at around 8pm, Ms Ching felt a gush of blood flowing out when she was sitting down at home.
'I got up and noticed I had stained the chair,' she said.
When she felt another gush, she called KKH again and was told to go to the A&E immediately.
She took her baby and, along with her younger sister, rushed to the hospital.
By the time they got there, she knew she had bled some more.
'When I left the taxi, my pants were wet with blood,' she said.
Her mother, Madam Adelina Ong, 47, a customer service officer, met her at the hospital.
By the time she was wheeled to a doctor's waiting room, there was a puddle on the wheelchair and a trail of blood on the floor, Ms Ching said. 'I kept asking everyone if I would have enough blood left in me,' she said.
The doctor who saw her said they needed to do a 'wash', or evacuation of her womb.
'He told me there might be some placenta left behind,' she said.
This is not uncommon, the hospital said.
Dr Tan said retained placenta or incomplete extraction of placenta or membrane tissues occurs in two out of every 100 cases.
These women would need to go for an evacuation process in which doctors scrape the lining of the uterus to remove all the placental and membrane tissues.
The next day, this was done. MsChing had her womb 'washed'.
When she woke up, Ms Ching said she felt a terrible pain in her abdomen.
'I did not expect the pain. The doctor said everything would be done through the vagina,' she said.
She asked her sister to lift her shirt to see what it was, and her sister was shocked to see that Ms Ching had two puncture wounds, one in her belly button and one on the side of her abdomen.
'I could not see, so my sister had to use the handphone to take a picture to show me,' said Ms Ching.
Soon, the doctor who performed the procedure arrived.
'She told me that during the washing procedure, one of their instruments had poked something, so they had to check what it poked. It turned out that a part of my womb was poked,' said Ms Ching.
Perforation (cutting) of the uterus during an evacuation occurs in one out of 100 cases, the hospital said.
The KKH specialist doctor on duty immediately performed a diagnostic laparoscopy. That is, instruments allowing the doctor to see the affected area were inserted into MsChing's abdomen.
The doctor confirmed a very small cut.
Deep tissue heat treatment was then applied to the cut to ensure that no bleeding occurred and to allow the uterus to heal well, the hospital said.
This time, Ms Ching stayed in hospital for five days.
'Now I am worried about my future chances of having babies,' she said.
However, Dr Tan said: 'Small uterine perforation that heals well is unlikely to affect a woman's childbearing ability.'
WOMB STILL UNCLEAN
On 1 Aug, Ms Ching told her mother she wanted a second opinion.
'I wanted another doctor to tell me I was all right,' she said.
Her mother took her to Gleneagles Medical Centre.
'We went to see Dr Tanny Chan, the doctor who delivered all my four daughters,' said Madam Ong.
Dr Chan did a scan for Ms Ching and it showed that her womb was still not clean.
The scan cost more than $350.
'Dr Chan called Assoc Prof Tee for us. He asked us to see him straightaway that day,' said MadamOng.
Dr Chan confirmed this.
Back at KKH, Assoc Prof Tee saw Ms Ching, five weeks after her delivery, and the next day, performed another evacuation, the second in two weeks, to clean out her womb again. She got another scan on 6Aug.
KKH said one in 20 of the women who have the evacuation procedure done would need to go for a second one.
'This is because the risk of an incomplete evacuation is quite high,' said Dr Tan.
As the placenta was noted to be complete before Ms Ching was discharged the first time, no ultrasound scan of the uterus had been done then.
However, sometimes, even if the placenta appears complete to the trained eye, small pieces of membrane or placental tissue may remain in the uterus, KKH said.
After Ms Ching returned on 19 Jul with heavy vaginal bleeding and a history of having passed out a piece of placental tissue, Assoc Prof Tee personally gave the medical team on duty the approval to proceed with the evacuation of the uterus followed by the deep heat treatment of the uterine cut.
He has apologised to Ms Ching that due to unforeseen circumstances, he was unable to personally speak to her in the ward. He has also given her a detailed explanation.
Said Assoc Prof Tee: 'I fully empathise with her distress. We should have provided her with a more detailed understanding of the events that occurred and the steps that we needed to take.'
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Hospital says:
Incomplete removal of placenta happens in 2% of cases
If there is no bleeding, it's safe for patient to pull it out herself
Some will need womb to be cleaned more than once, and may have small cuts when it is done -
The left behind placenta was not the fault of the hospital so i won't blame them.
The poked uterus during the cleaning procedure does occur just as abortions do often cut the wombs of women. A 1% rate is not considered high given the nature of the procedure.
The real question we need to ask is, why do we allow abortions in singapore when the scaring rate for such procedures is much higher? How can any world class hospital allow abortions? -
A lot of incompetent people around these days, the top rung people are incompetent leading to a trickling down domino effect, therefore the lower rungs also incompetent.
The SMA should suspend those who are found to be incompetent. Else we will have lots of useless mushrooms running around killing innocent patients thru their incompetence.
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Not the fault of the hospital?Originally posted by Mat Toro:The left behind placenta was not the fault of the hospital so i won't blame them.
The poked uterus during the cleaning procedure does occur just as abortions do often cut the wombs of women. A 1% rate is not considered high given the nature of the procedure.
The real question we need to ask is, why do we allow abortions in singapore when the scaring rate for such procedures is much higher? How can any world class hospital allow abortions?
Man! You are totally whacked!
The doctor who delivered the baby gave the thumbs up that there was no leftover placenta.
More like our system has produced alot of incompetent people. -
Originally posted by Mat Toro:The left behind placenta was not the fault of the hospital so i won't blame them.
>> How is it NOT hospital's fault?
The poked uterus during the cleaning procedure does occur just as abortions do often cut the wombs of women. A 1% rate is not considered high given the nature of the procedure.
>> Does such 'exceptions' gell well with the World Class label?
The real question we need to ask is, why do we allow abortions in singapore when the scaring rate for such procedures is much higher? How can any world class hospital allow abortions?
>> I think this 'allowance' is more commercial decision than a an ethical one... -
Originally posted by HyperFocal:
left behind placenta is common thing. there is no way the hospital could have known if most of it came out which was the case. how can it be the hospital's fault.
>> How is it NOT hospital's fault?
it is a world class hospital, thats why its an exception given the nature of the procedure.
>> Does such 'exceptions' gell well with the World Class label?
the chances of harming the womb is high for abortions if you know how its done. it is therefore an ethical problem.
>> I think this 'allowance' is more commercial decision than a an ethical one... -
Originally posted by Mat Toro:
Hey, you're tone is so much better now..!
left behind placenta is common thing. there is no way the hospital could have known if most of it came out which was the case. how can it be the hospital's fault.
it is a world class hospital, thats why its an exception given the nature of the procedure.
the chances of harming the womb is high for abortions if you know how its done. it is therefore an ethical problem
Well, for a country that pursues perfection and Global Standards in everything, it sure is unbecoming to dismiss a "left behind placenta" as a common thing. And how can there be 'no way' for a World Class fully equiped hospital to detect remnants of a placenta? There is ultrasound, there is x-ray, and there is such a thing as thorough check. How is it the hospital's fault? Well, one pays substantially for medical services and products rendered by such reputable medical establishments, one should expect up to par quality, of performance and service standards.
I don't quite understand, how such an exception can be related to World Class..?
I believe if abortions are properly done, harm to any part of a female anatomy should be zero.. as for the matter of ethics, it is left debatable... -
quite an unfortunate delivery for the lady
really feel for her
but den on further thoughts
the article & this topic actually doesn't seem to be related at all
this article more of reflects of that things can still go wrong
EVEN with the best care & intentions
hmn... maybe you shld find out more thingsOriginally posted by maurizio13:Not the fault of the hospital?
Man! You are totally whacked!
The doctor who delivered the baby gave the thumbs up that there was no leftover placenta.
More like our system has produced alot of incompetent people.
b4 you may a comment like this
whether in a normal delivery, when the placenta comes out by itself
or in this case where there is manual extraction of the placenta,
the placenta is checked by the midwife to see if it is complete
however, there are cases when the placenta seems complete
even to the best of trained eyes
but a small chunck is left behind
hence, the advice will be the mother to come back
if she has any fever, excessive vaginal bleeding
so there was NO issue of competency (or incompetency) involved here
but more of an unfortunate happening
for her, it was more of an unfortunate series of events afterwards
but from another point of view, this is actually not uncommon
the retained placenta now comes out
hence she notice it & was adviced to pull it out herself
for most ppl, that would have been the end of story
everything has come out (no need hospitalization)
but for her it was not
uterine perforation is a common & very known risk of evacuation
because evacuation is a completely BLIND procedure
it's completely by feel
you juz imagine people chopping vegetables can cut their fingers
what more, you blindfold ur eyes
hence, uterine perforation is an accepted risk
one thing that everyone shld noe is that
going for a surgical procedure is like crossing the road
you can check left & right, play it safe, cross at the green man
but then there is ALWAYS a risk that you may be knocked down
get a few grazes, or even die
& this is the risk that you are undertaking
whenever you go for other operation -
oxford?Originally posted by maurizio13:A lot of incompetent people around these days, the top rung people are incompetent leading to a trickling down domino effect, therefore the lower rungs also incompetent.
The SMA should suspend those who are found to be incompetent. Else we will have lots of useless mushrooms running around killing innocent patients thru their incompetence. -
Originally posted by HyperFocal:
placenta don't show up on x ray, neither will ultra sound because it has no specific shape, especially when its small.
[b]
Hey, you're tone is so much better now..!
Well, for a country that pursues perfection and Global Standards in everything, it sure is unbecoming to dismiss a "left behind placenta" as a common thing. And how can there be 'no way' for a World Class fully equiped hospital to detect remnants of a placenta? There is ultrasound, there is x-ray, and there is such a thing as thorough check. How is it the hospital's fault? Well, one pays substantially for medical services and products rendered by such reputable medical establishments, one should expect up to par quality, of performance and service standards.
I don't quite understand, how such an exception can be related to World Class..?
I believe if abortions are properly done, harm to any part of a female anatomy should be zero.. as for the matter of ethics, it is left debatable...
There will be exceptions cos every body is different, humans are not robots.
teh only way to be sure is to cut open, not even an option.
As for abortion, the way the crushing and suction works, risks are high, there is no running away from it. again, all bodies are different and different bodies do reaction differently. very difficult to control. -
too much negative news already lah -
Actually we all this for a fact for the longest time....its just that as we plod along in Sillypore....we have grown accustomed to the propaganda feaces that has become the hallmark of the powers that be....ie their hospitals are world class....we all know that world class facilities are for those with moneyOriginally posted by maurizio13:A lot of incompetent people around these days, the top rung people are incompetent leading to a trickling down domino effect, therefore the lower rungs also incompetent.
The SMA should suspend those who are found to be incompetent. Else we will have lots of useless mushrooms running around killing innocent patients thru their incompetence.
In fact the motto in Sillypore is...got money can live a little longer....no money, go and die faster -
As since we are to make exceptions of these shortcomings, the World Class label shoud be more sparingly proclaimed of such public facilities...Originally posted by Mat Toro:placenta don't show up on x ray, neither will ultra sound because it has no specific shape, especially when its small.
There will be exceptions cos every body is different, humans are not robots.
teh only way to be sure is to cut open, not even an option.
As for abortion, the way the crushing and suction works, risks are high, there is no running away from it. again, all bodies are different and different bodies do reaction differently. very difficult to control.
because they are run by humans and are far from perfection...
This way, people would be more tolerant and understanding of such 'common' mishaps... -
Please world class hospitals, the public hospitals in Singapore, don't bullshit! I was working on project in SGH for a couple of years and I witnessed how they treat the patients there. A senior doctor once told me some doctors when on duty in the wards do not practise safety. Still in contact with some of the people there and they told me the no of complaints from patients and families have increased. The attitude of staff are still as bad as ever.
World class hospital does not bluff their way to get patients to donate blood without indicating that purpose is for research. The doctor in SGH attempted to con my neighbour's husband to donate blood for the cause of research. He does not know English, when he asked doctor, he told him it was nothing just sign the form. Thank goodness my neighbour sense something wrong took the form and read it. That was a consent form for patient to sign to permit the doctor to take blood for research. My neighbour was so infuriated so she scolded the doctor for his unprofessionalism. The doctor did not apologised instead he put the blame on the nurse.
The above is just one of the many complaints from patients. So I don't understand why are these hospitals considered first class. With those unethical doctors around to treat patients, hospitals like that can never be world class. -
As in the case of the NS CPL who died of a rare bacterial infection, none of the doctors, housemen, and senior medical staff could identify the cause before it was too late.
The unfortunate death led to a medical inquiry, a lawsuit and possibly the option of civil suits taken against the doctors/NUH staff concerned for gross negligence.
Even the judge was disdainful in the manner the NUH staff conducted their defence, before noting several obvious gaps in their procedures, and ultimately throwing out the case.
In this incident, it is hard to determine whether negligence was the cause as the details have yet to be published. However, i fear the day a doctor is held accountable in a court of law and convicted of a 'crime'. If doctors are to be treated as such, then the way medical practices are being conducted will change dramatically, with legal representation and indemnity forms drafted against the patient, absolving the doctor of responsibilities in surgeries and consultations, and this ripple effect will degrade into a 'line-drawing' senario of whose responsibility is it to care for a patient's well-being.
If it is proven that the doctor's deliberate actions caused the incident, then the situation may differ. At this point, i caution against pinning the blame on the doctor.