Routine procedure, then he turns blue

SINGAPORE - It was supposed to have been be a routine medical procedure, but it has left him in a coma.

Two years on, he remains "completely bedridden, totally uncommunicative and requires full assistance for all his daily activities".

This is the claim in court papers filed by the man's wife, Madam Carol Kwok Lai Yee - Mrs Carol Heo - in a lawsuit against the doctor who carried out a colonoscopy on her husband, Mr Victor Heo Hung Wu, 65.

Mr Heo is now in a nursing home here and requires round-the-clock monitoring and medical care.

This is likely to be the case for the rest of his life.

Since October last year, he has been fed directly into his stomach through anopeningin his belly.

Before the incident, Mr Heo, an American citizen who is a Singapore permanent resident (PR), was earning $250,000 a year as the managing director of an investment company.

He and his wife, a British citizen who is also a Singapore PR, have a 17-year-old son, a US citizen.

Madam Kwok, a housewife who now lives in Hong Kong with her son, claims that the colonoscopy conducted by consultant gastroenterologist Cheng Jun had resulted in Mr Heo's injuries.

But Dr Cheng denies the allegations and insists that "all proper steps were taken".

A pre-trial conference was held last Monday.

Cardiac arrest

Madam Kwok is alleging through her lawyer, Mr S Palaniappan of Straits Law Practice, that her husband suffered a cardiac arrest and serious brain injuries following the colonoscopy.

A colonoscopy is a procedure in which the inside of the colon is examined using a flexible tube fitted with a miniature camera that is passed through the anus.

In her suit, Madam Kwok said her husband went to his primary physician, Dr Gordon Ku, whose clinic is at Mount Elizabeth Medical Centre, for a regular medical examinationonNov7, 2008.

Dr Ku found that Mr Heo had bleeding in his rectum and prolapsed piles - haemorrhoids protruding through the anus -and referred him to Dr Cheng.

Mr Heo saw Dr Cheng the same day and was advised to do the colonoscopy in his clinic. Mr Heo agreed and the procedure took place there a week later.

After the procedure, the colonoscope was withdrawn from Mr Heo. This was when the oxygen level in his blood dropped to such a level that he had cyanosis, a condition in which one's skin and fingernails turn blue because of oxygen deprivation.

Dr Cheng tried to revive Mr Heo but failed. He called for help from doctors at Mount Elizabeth Hospital,who managed to revive Mr Heo.

But Mr Heo suffered brain damage and was warded in the hospital's intensive care unit (ICU). He was able to breathe on his own despite being in a coma.

Mr Heo was diagnosed to have suffered from brain damage due to insufficient oxygen or "severe post-hypoxic encephalopathy and through the months has shown very little brain function".

Madam Kwok claimed that Dr Cheng owed her husband a duty of care to give reasonably good medical care, treatment and advice, but had failed to do so.

This allegedly led to Mr Heo's brain damage and resulted in his vegetative state.

She also alleged that Dr Cheng is liable for the acts of his nursing staff who had assisted him.

In his defence, filed by his lawyers Dr Myint Soe and Mr Daniel Atticus Xu, Dr Cheng said that after the 20-minute colonoscopy, all those present heard a "throaty noise"coming from Mr Heo.

They noted that his oxygen level had dipped and tried to arouse him by administering oxygen, calling loudly to him and attempting to wake him up.

When that did not work, he was given the antidote for the sedative. That, too, was ineffective.

Dr Cheng then tried a series of measures. This included giving Mr Heo a cardiac massage and administering adrenaline. He also performed cardio-pulmonary resuscitation (CPR) on Mr Heo.

Dr Cheng said that when Mr Heo first consulted him, they talked for about 20 minutes and ended with Mr Heo giving his "informed consent".

He said that Mr Heo was "a sophisticated and intelligent businessman".

Dr Cheng said he had also made it a point to ensure that Mr Heo fully understood the risks and benefits of colonoscopy and sedation, particularly that of "haemorrhage, perforation and the possible need for further surgery, and even death".

Mr Heo, he said, was in good health at the time of his visit. His medical history of mild hypertension, chronic eczema, fatty liver, skin allergy and aspirin allergy did not affect the decision on whether he should undergo the procedure.

He was also considered to be of low risk as he had passed assessments that included the electrocardiogram( ECG) and treadmill tests.

Dr Cheng refuted Madam Kwok's allegation that he did not explain the pros and cons of doing the colonoscopy in a clinic as opposed to a hospital. Mr Heo had chosen to go through the procedure in the clinic and at a date of his convenience, Dr Cheng noted.

He added that there could not have been an overdose of midazolam (Dormicum), the sedative given to Mr Heo. This was because Mr Heo, who was conscious throughout the procedure, was breathing well and was "lively, moving his legs".

Dr Cheng added that he had used the same sedative on thousands of patients without any mishap since 1988. This was also why he did not over-emphasise the risk of using the sedative.

Dormicum is used for sedation by gastroenterologists worldwide.

Sedation

Dr Cheng has performed endoscopic procedures under sedation in his clinic since 1993, and he has used the sedative in about 10,000 endoscopy cases for patients aged between 13and 85 without any mishap.

During the procedure, he and the two nurses present had monitored Mr Heo's condition closely.

One nurse kept her finger on Mr Heo's pulse, with her eyes fixed on the pulse oximeter, a machine that measures the oxygen level in the blood.

She also kept watch on Mr Heo's face for his "grimaces and response" and observed the respiratory movements of his chest and abodomen.

Among the damages Madam Kwok is claiming in the suit are medical expenses of about $32,000 incurred at Mount Elizabeth Hospital and nursing home fees of about $87,000.

She is also claiming for Mr Heo's loss of earnings, estimated at about $275,000 from December 2008 to June this year, and the company benefits he used to enjoy, such as a driverand a car.

In his reply, Dr Cheng said he understood from Mr Heo that he was "folding up his work in Singapore, and was returning to Hong Kong".

He also noted that Madam Kwok's claim for provisional damages until Mr Heo turns 85, is "misconceived and not maintainable".

He added that at the time of the incident, Mr Heo was a managing director in an investment company and his job was a precarious one, especially during financial downturns or adverse financial conditions.


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