Sons' fury over mum's fractured arm

SINGAPORE - She was hospitalised for bed sores, but ended up with a shorter arm.

Madam Kuah Kwan, 81, suffered a fracture in her arm a day before she was to be discharged.

There was a risk of infection in the fractured area and she had to undergo an operation to shorten the arm.

Madam Kuah's elder son, Mr Toh Eng Chong, 56, said that his mother was admitted to Changi General Hospital (CGH) on Oct 30.

He said his mother, who has been bedridden for about five years, had a fever and bad bed sores as she could not turn over by herself.

He and his younger brother, who wanted to be known only as Mr Toh, 54, took turns to visit their mother in hospital.

They would regularly check their mother's left arm, which had become stiff after a fall more than five years ago.

She is very frail, with her both knees bent until they almost touch her chin, and is tube-fed. She is conscious, but has difficulty speaking.

The older Mr Toh, who stopped his relief taxi driving to care for his mum early this month, told The New Paper: "Every day when I visited her (in hospital), I would touch her left arm and squeeze her left hand. She would usually squeeze my hand back."

He said his mother could not straighten her arm and both he and his brother had alerted the hospital staff about this because they were afraid that someone would pull her arm and hurt her.

He said: "I'm very scared to come to the hospital because every time I skip visiting for a day, something would happen to my mum.

"I have to tell the nurses what to do. I told the nurses not to force her arm."

On Nov 6, the younger Mr Toh, who is unemployed and has a 14-year-old son, visited her around 3am to "spot check" on her condition.

Like his brother, he also checked her left arm. He didn't find anything amiss, so he left at about 4am.

But when the older Mr Toh visited her at 7.30pm on the same day, he found that his mother's left arm was bruised.

It was then discovered that she had suffered a fracture.

No evidence

CGH said it investigated how this happened and found no evidence of its staff being at fault.

The older Mr Toh told The New Paper: "When I visited, I saw that her hand was covered with a blanket. I didn't check her arm then.

"I thought everything was okay, so I went out to watch television. After about 20 minutes, I returned and pulled away the blanket.

"I was shocked to see that my mother's arm was kind of straightened, swollen and had bruises. I held her arm and it was soft, no longer stiff like previously.

"When I squeezed her hand, there was no response. I knew immediately that something was wrong." He quickly called his brother.

The younger Mr Toh said: "I rushed down. I was very angry. I saw that her arm was twisted and her bone looked as though it was coming out. I was scared just looking at it."

He claimed they alerted a doctor about this, but was told that the doctor needed to tend to another patient with a more serious condition.

He also claimed the hospital called in security because he was shouting.

He added that the hospital did an X-ray close to midnight, confirmed that she had a fracture and put a cast on her arm.

The younger Mr Toh said: "She was supposed to be discharged on Nov 7 and now she has to stay in the hospital for a longer time because of this."

Then there was another complication. The fractured bone jutted out, the younger Mr Toh claimed the doctor told him.

On Thursday, she went for an operation to "shorten" her arm to prevent infection, he said. He elaborated: "The doctor told me that if they don't carry out the operation, an infection could spread to the heart and she could die."

He also claimed that that there was pus coming from the fractured area where the bone was jutting out.

He added that the doctor told him that if an infection on his mother's arm spread, the doctor may need to amputate the whole arm.

He said the hospital had offered to waive her mother's medical bills, but he didn't want to accept because "medical bills cannot save my mum".

He also claimed that the hospital is trying to restrict the hours he can visit his mum.

He said: "The person (who broke her arm) must have been using force to pull her hand, probably to change her clothes. If there's no force, the arm won't break.

"We have been looking after her for five years and there was no fracture."

The older Mr Toh said: "At home, I don't put a shirt on her because of her arm. I just cover her with a blanket.

"In the hospital, I would put the hospital clothes on her with the buttons behind her back." The older Mr Toh added: "Even when she's in pain, she can't scream very loud. It pains me to see my mum suffer."

Fragile bones

In an e-mail reply to The New Paper, the chief executive officer of CGH, Dr Lee Chien Earn, said Madam Kuah's bones were very fragile.

After Mr Toh alerted the hospital that her arm "appeared to be broken", she was confirmed to have suffered a fracture of the left upper arm and it was immobilised in a sling for it to heal. Unfortunately, her abnormal muscle tone caused the fractured bone to puncture the skin, creating a risk of infection.

This made an operation necessary. The family was kept informed and offered assistance, Dr Lee said. He added that the investigations could not reveal how the fracture happened between the time the nurses did their last review and when the son discovered it.

The staff had not touched the patient during this time.

When told of the hospital's reply, the younger MrToh said: "My family and I beg the Ministry of Health and the police to investigate."

Staff were extra careful with patient: CGH

In an e-mail reply to The New Paper, the chief executive officer of Changi General Hospital, Dr Lee Chien Earn, said Madam Kuah Kwan, 81, was sent to its emergency department on Oct 30.

She had been referred by the Home Nursing Foundation for fever, chest infection and and multiple infected bed sores.

Madam Kuah, who suffers from dementia and hypertension, had been bed-bound at home, and is being tube-fed.

Dr Lee said she was "severely osteoporotic", which meant her bones were very fragile.

"She also had prior fractures of her right patella (knee cap), left hip and multiple compression fractures of the spine," he wrote.

"All four limbs of the patient were badly contracted, that is, 'frozen' in a folded position, with her knees bent and reaching up to her chin."

He told TNP that Madam Kuah was due to be discharged on Nov 7, but the day before, her elder son observed that his mother's arm "appeared to be broken and alerted our staff".


She had suffered a fracture of the left upper arm and it was immobilised in a sling for it to heal.

Dr Lee said: "The care team had made the decision not to insert a metal plate and screws to 'set' the fracture because of her severe osteoporosis, her general unfitness for surgery and the fact that her left arm had been contracted and non-functional."

The decision that the hospital would be investigating the incident was told to the family the next day.

Dr Lee said the patient's younger son had, during this period, been "calling CGH constantly" and had "on several occasions disrupted activities and other patients in the ward by shouting loudly, causing a commotion".

Later, Madam Kuah's shortened and contracted muscle tone caused the fractured bone to puncture the skin, creating a risk of infection.

Surgery was quickly scheduled and her family's consent sought.

Dr Lee said: "The surgeon had explained to the family that it is necessary to shorten the arm bone because of the severe contractures to prevent a recurrence of another open fracture.

"We have been keeping the family updated at all junctures of her care and treatment plan."

He added that investigations could not ascertain how the fracture happened between 7.30pm on Nov6, when the nurses did their last review, and when the son discovered the fracture at around 8pm.

Dr Lee explained: "Our staff did not touch the patient from 7.30pm to the time the fracture was discovered. The patient, during her stay, needed to be cleaned, turned regularly and cared for.

"The staff were especially careful in handling this patient due to her fragile condition.

"Despite the incident occurring at CGH, we offered to waive the charges for this admission, as a gesture of goodwill, even though we had no reason to believe that it was caused by our staff."

Madam Kuah is still warded at CGH for the fracture.

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