84-year-old man dies 2 weeks after fall

A fall at home last month landed 84-year-old Chiu Cho Tak at the emergency department of the Changi General Hospital.

Although his X-ray did not show any breaks, Mr Chiu was hospitalised.

Things went downhill after that.

After two weeks of being shuttled in and out of the intensive care unit (ICU) and the geriatric ward, Mr Chiu died from what was diagnosed to be a lung infection.

The episode left the family shaken.

"What I want to know is how this could happen and whether there was an over-treatment of my father's condition," said Mr Chiu's daughter, Mung Hing, 47, a businesswoman.

She had written in to The New Paper to share her story.

Relating the harrowing two weeks, Ms Chiu said her father slipped and fell at home when he was going to the toilet in the middle of the night.

He was rushed to CGH by Ms Chiu the next day after he complained of pain in his left leg.

On arrival, Mr Chiu was assessed by a doctor and sent to the X-ray department.

"Although the X-ray did not show any fractures, the doctors wanted to keep him for observation, in case he had a stroke," Ms Chiu said.

The family had wanted to take him home so they could get a second opinion, but was advised against it, she claimed.

Mr Chiu was warded.

During her father's first few days in the geriatric ward, a subsequent scan showed a small hip fracture.

Once again, the family expressed its wishes that the hospital discharge him so he could recover at home, but "the ward doctor insisted he should stay longer," Ms Chiu claimed.

The hospital, however, said that as Mr Chiu had suffered a fracture, his family's maid required caregiver training.

It added that doctors had made plans for Mr Chiu's discharge "together with his family". (See report on facing page.)

A week into his stay at CGH, Mr Chiu suffered a heart attack and was sent to the ICU.

Puzzled

"I was puzzled as to why the doctors at ICU insisted on putting a respiratory tube through my father when he could breathe normally on his own," Ms Chiu asked.

Four days later, Mr Chiu was transferred back to the geriatric ward, but started running a high fever.

He died on May 31 from lung infection.

"During his stay there, I saw at least seven doctors and every one of them gave me different information about my father's condition," said Ms Chiu.

She said she was asked at least six times if the family wanted to resuscitate her father should he collapse.

Ms Chiu said her father, despite his age, was still very alert, even though he "walked rather slowly".

Explaining her initial decision to take her father to the hospital, she said: "I wanted to make sure he was okay and there was no internal injury."

Ms Chiu said she later received a bill of $16,000 for her father's stay and treatment at CGH.

The hospital management and the doctors met with Mr Chiu's family for two hours on Thursday to explain his treatment.

Speaking to The New Paper after, Ms Chiu said CGH was sympathetic to her grief and during the discussion, "realised that there could have been a gap in communication".

Although she does not want to pursue the matter further, Ms Chiu hoped her father's experience would create awareness among the public and medical professionals alike.

What the hospital says

IN A written reply to The New Paper, Changi General Hospital said that Mr Chiu Cho Tak, 84, was admitted on May 17 through its Accident & Emergency department after his fall at home.

Its spokesman said that during Mr Chiu's stay at the geriatric ward, he was found to suffer from giddiness due to low blood pressure from lying down, and the hospital suspected it might have caused the fall.

He also had pain at the left side of his hip due to a fracture sustained from his fall. This was confirmed by a CT scan.

Doctors adjusted his medications to reduce giddiness and treated his pain, the spokesman said.

Mr Chiu was advised not to stand on the affected leg and to use a wheelchair instead.

As Mr Chiu had a fracture, he needed full assistance of a caregiver to move around.

Said the spokesman: "As such, the family's maid required caregiver training to enable her to look after Mr Chiu at home while the doctors made plans for his discharge together with the family.

"His daughter had requested for an early discharge on May 21 and it was planned for within a week of his admission but (as) his caregiver needed time to be trained, his daughter agreed with our plan to discharge him on May 25 instead," she added.

Throughout that period, Mr Chiu's vital signs were stable and he did not have any symptoms of chest pain, shortness of breath or palpitations.

But on May 24, he became acutely unwell and had a heart attack.

He was treated and referred immediately for further investigation and supportive treatment.

Procedures explained

The spokesman said Mr Chiu's daughter was present and the procedures were explained to her in the ward.

In light of his instability and decreased consciousness, Mr Chiu was intubated and sent to the Medical Intensive Care Unit (MICU).

The doctor spoke to the family about the option of not subjecting Mr Chiu to CPR (cardiopulmonary resuscitation) or advanced cardiac life support should his heart stop.

"This topic was broached respectfully and sensitively when the doctors assessed that further interventions are unlikely to produce any significant benefit for the patient. Mr Chiu's family was given time to discuss and consider, and his daughter signed the Do Not Resuscitate (DNR) form four days later," the spokesman said.

"Although the form was signed, our doctors will still check with the family on their wishes thereafter as we understand the sensitivity of a DNR," she added.

Mr Chiu was transferred to the general ward after four days at the MICU, when his condition improved and he was able to breathe without ventilatory support.

"Our doctors remained guarded in their prognosis and this was conveyed to his daughter.

"Mr Chiu was also receiving treatment for an ongoing infection after having fever, and subsequent X-rays revealed a pneumonia which progressed rapidly despite maximal medical therapy," she said.

Unfortunately, Mr Chiu's condition deteriorated o nMay29 and he died two days later.

"Throughout his stay, our doctors had constantly kept his family, especially his daughter, informed of his condition. Our doctors work in a team and although different membersof the team have spoken to the family throughout the admission, the medical team was always clear about the medical management plan," the CGH spokesman said.

She added that the Geriatric Medicine Consultant in-charge, who is the primary doctor, managed MrChiu with his colleagues and updated his daughter.

Other specialists included the bone specialists and cardiologists.

On the meeting with the family on Thursday, the spokesman said the hospital "has given her (Ms Chiu) a clearer understanding of the treatment provided for her father and addressed all her concerns in detail".

"We assured her of the commitment of our medical team and the specialists who took care of her father," she said.

This article was first published in The New Paper.

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