Drug caused kidney failure

PHOTO: Drug caused kidney failure

SINGAPORE - She had complained about the pain in her right elbow and shoulder.

And he diagnosed her with osteoporosis and recommended her a $1,500 drug that would last her for a year.

Mrs Wong Chen Li Chu, 63, agreed to go ahead with the treatment. Three days after the drug injection, she was taken to a hospital emergency department and diagnosed with renal impairment.

One month later, doctors told her she had chronic renal failure. This later developed into end-stage renal disease.

In August 2009, 11 months after the drug injection, she got started on dialysis and has been on it since.

Mrs Wong is now suing consultant orthopaedic surgeon Dr Chan Heng Thye of Chan Orthopaedic Clinic at Gleneagles Medical Centre for medical negligence.

The clinic is also named as a defendant in the lawsuit filed through her lawyer, Mr Yap Gim Chuan of Soh Wong & Yap, in September.

Mrs Wong claims among other things that Dr Chan did not warn her of the possible side effects of the drug, known as Aclasta, and failed to put her through blood tests to check her kidney functions and calcium levels as recommended by the drug manufacturer, Novartis.



She also claims Dr Chan did not take her through the checklist of precautions given by Novartis to doctors administering Aclasta.

This included the recommendation that patients with severe renal impairment should not be given Aclasta.

It is not stated in Mrs Wong's statement of claim if she had a pre-existing kidney condition, although Dr Chan is alleging that she did. He claims that her kidney disease would have progressed to end-stage renal failure in due course.

Dr Chan is also denying her other claims of medical negligence in his defence papers, filed through lawyers Edwin Tong and Tham Hsu Hsien, of Allen & Gledhill, on Saturday.

Mrs Wong said she first saw Dr Chan on June 23, 2008, for a wrist fracture. He tested her mineral bone density and found that she was "very osteoporotic".

He conducted surgery on her the next day.

At a follow-up session on Oct 6, she told him she was experiencing pain in her right elbow and shoulder. He allegedly recommended a drug injection to treat her osteoporosis without telling her the name of the drug.

The next day, she returned to him for the drug injection.

But her face allegedly swelled the day after. She also had rashes all over her body and felt sharp pain throughout her limbs, chest, heart and waist.

On the second day, her head and limbs became numb and she felt electric shock sensations going through her body. Her head started to shake involuntarily and there were tingling sensations around her mouth.

When her condition worsened on the third day, she was taken to the emergency department at Mount Elizabeth Hospital, where she was diagnosed with renal impairment and hypocalcaemia, which is an abnormally low level of calcium in the blood.

Vomited blood

On Oct 15, she was admitted to Raffles Hospital when she vomited some blood. The doctor who examined her found that her renal impairment was "possibly advanced chronic kidney disease".

Her condition deteriorated and she had to go on dialysis. A medical report by her doctor at the Singapore General Hospital, dated April this year, states that she now has end-stage renal failure and is advised to go for a kidney transplant.

Mrs Wong claims Dr Chan was negligent as he did not get her informed consent, explain the risks involved in taking the drug or the precautions to be taken.

He allegedly failed to follow recommendations from Novartis to find out if the drug was suitable for her. This allegedly included checks on her kidney function and calcium level through various means such as blood tests.

In his defence, Dr Chan said Mrs Wong had twice refused to take blood tests during the time he treated her.

The first was before the operation to fix her broken wrist. She had allegedly insisted that she had always been well and did not want to take the tests.

The second was before he gave her the Aclasta injection. She again allegedly rejected his request for her to take a blood test.

He said she did not display the usual signs of renal failure such as hypertension, itchiness, and swelling of legs or eyes. Because of this, as well as other factors such as her clinical history and condition, he did not find it necessary to carry out a blood test on her.

Dr Chan said he had mentioned that the drug was called Aclasta, and he had introduced it to her when she said the existing drug she was taking for her post-menopausal osteoporosis was causing her nausea and gastric discomfort.

He claimed that he did explain how Aclasta worked, and the risks and possible complications involved.



He said he gave her the relevant advice including pointing out the precautions in the Novartis checklist - such as the warning that the drug was not suitable for patients with severe renal impairment - for her to make an informed decision.

He also claimed that she already had chronic kidney disease or renal failure before the Aclasta injection and her condition would have eventually materialised even if she had not been given the drug.

He also denied her allegation that the Singapore Medical Council (SMC) had on June 12, 2009, decided to issue him a letter of warning for his breach of duty as a doctor. This was following a complaint she lodged against him.

He claimed that the SMC did not even commence a disciplinary inquiry against him.

Mrs Wong is seeking damages for pain and suffering, medical fees, caregiver costs and loss of future earnings among other things. She had been working as a beautician before.

Her expenses including medical costs and lost earnings to date amount to about $183,000.

This article was first published in The New Paper.