[Top: Mr Surender Singh (in glasses) with his three children (from left) Trinisha, 12, Jesmin Pal, 5, and Balvinder, 10. The framed photo is of his late wife.]

By Ng Wan Ching

EMERGENCY resuscitation doctors who attended to Madam Narindar Kaur thought she was suffering from hypovolemia - a reduced state of blood volume in the body.

But they did not know the cause.

They also could not move her into an operating theatre for emergency surgery until they had stabilised her blood pressure and heart activity.

Madam Kaur, a living kidney donor, died on 16 Feb 2005, after donating her kidney to her husband, Mr Surender Singh.

Mr Singh is suing Madam Kaur's two surgeons, Dr Li Man Kay and Dr David Consigliere, and the National University Hospital for negligence.

Among other things, he wants to know whether his wife's resuscitation could have been carried out earlier and that it was the appropriate treatment for her condition.

He also wanted to know whether emergency surgery could have saved her life.

Dr Kannan Sunderaraj, a medical officer with the department of medicine at NUH at the time, was part of the Emergency Resuscitation Team (or Code Blue team). He was its most junior member.

In his affidavit, Dr Kannan, now a medical officer with Parkway Shenton, said that when he was activated on 16 Feb 2005 at 4.19pm, he dropped everything and rushed to ward 43.

Dr Kannan said, under cross examination, his initial impression was that Madam Kaur was suffering reduced blood volume. This was because doctors were having difficulty trying to insert tubes into her.

When and what the team did was not recorded when they were resuscitating her.

The resuscitation report was probably written in retrospect, said Dr Kannan.

'Therefore the timings may not reflect adequately, because we do not keep track of the exact timings at which they were given,' he said.

The record of all the medication given during the resuscitation period was made by Dr Lee Kang Hoe, the physician in charge of the resuscitation.

Mr Singh's lawyer, Mr S Palaniappan, said Dr Lee's resuscitation record concluded that the time of Madam Kaur's collapse was 4pm, the time the Code Blue team responded was 4.19pm, and the cause of collapse was hypovolemia.

Aggressive

The lawyer suggested to Dr Kannan that resuscitation efforts should have started much earlier than the time he arrived at the ward.

Said Dr Kannan: 'The time when we came was when we had been activated, and when we came, we did everything according to protocol, with a senior team comprising at least two consultants, two associate consultants, about four medical officers.

'So altogether there were eight doctors and support staff, and we aggressively, to our best abilities, resuscitated the patient.'

Mr Palaniappan further suggested Madam Kaur ought to have been taken to the operating theatre, where surgical options could have been considered.

But Dr Kannan replied that when they were resuscitating her, her condition was too unstable. 'There was no recordable blood pressure, there was no pumping activity of the heart, and in such a case it would be very unstable to transport the patient.'

Mr Edwin Tong, lawyer for Dr Li and Dr Consigliere, also cross-examined Dr Kannan.

He asked if some of the other causes of hypovolemia besides blood loss, would include cardiogenic shock, where there is poor cardiac function.

He asked if other characteristics of cardiogenic shock would include low blood pressure, cold skin and weak pulse.

Dr Kannan said yes to both questions.

He also agreed that signs of haemorrhage (blood loss) would include abdominal distension, and a blood drainage bottle that would be filling up very fast.

He said he would have noticed if that had been what was happening to Madam Kaur.

Hearing continues.

ABOUT THE CASE

Madam Narindar Kaur died on 16 Feb 2005, after undergoing a three-hour operation to donate her left kidney to her husband.

The surgery was uneventful and ended at 12.30pm.

She was moved to the general surgical ward at 2.30pm, reviewed by a ward doctor and found to be alert and comfortable.

About 1 1/2 hours later, around 4pm, she became breathless, pale, cold and clammy.

An emergency resuscitation team at the National University Hospital spent about an hour trying to resuscitate her.

Her time of death was recorded as 5.17pm.

Her death is believed to be the first donor fatality in almost 30 years of living-donor kidney transplants here.

A coroner's inquiry in 2007 ruled out criminal negligence on the part of the medical team.

Early last year, her husband, Mr Surender Singh, and her mother, Madam Minda Kaur, filed a medical negligence suit against National University Hospital and two surgeons, Dr Li Man Kay and Dr David Consigliere.

Hearing started on 11 Feb and is scheduled for 13 days.

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This story was first published in The New Paper.