Doctor gets reduced suspension for performing CPR on seated asthma patient who later died in hospital

Singapore

Counsel for the Singapore Medical Council said that even if Dr Ho Tze Woon was not trained in patient transfer, it was a matter of "common sense" to put the patient on the floor before performing CPR.

File photo of a doctor. (Photo: AFP/Joe Raedle)

SINGAPORE: A doctor was handed a reduced suspension of three months by the Court of Three Judges on Monday (Aug 7) over his failure to make a seated patient lie down before performing cardiopulmonary resuscitation (CPR) on him in 2017.

The asthmatic patient, who had gone to his clinic for breathlessness and went into cardiac arrest, later died in hospital.

Dr Ho Tze Woon was practising as a locum or a stand-in doctor at the Central 24-Hr Clinic (Yishun) on Jan 14, 2017.

A disciplinary tribunal had earlier found Dr Ho guilty of the charge and ordered him to be suspended for nine months. Dr Ho appealed against the decision, and on Monday the court reduced the period to three months. The Court of Three Judges said they would give their full reasons at a later date.

While Dr Ho was on duty, the 45-year-old patient came in complaining of breathlessness. He assessed that the patient was having an asthma attack and asked a clinic assistant to administer a nebuliser treatment.

This is a type of treatment administered with a device that turns liquid medicine into a mist which is inhaled.

While the treatment was being administered, the patient who was seated on a chair suffered cardiac arrest and fainted.

Dr Ho began performing CPR on the patient while he was still seated.

Paramedics later arrived and took the patient to hospital, but the man died a week later.

Dr Ho was later charged under the Medical Registration Act for failing to provide professional services of the quality expected of him, in failing to reposition the patient from a seated position to a supine position before performing CPR.

The Singapore Medical Council (SMC) argued that his failure to do so was a failure to meet the minimum standards of acceptable care by medical practitioners.

His lawyer, Mr Amos Cai from Yuen Law, said there was room for a fine instead of a suspension. He said the nine months' suspension imposed by the disciplinary tribunal was "manifestly excessive".

In Monday's hearing before the Court of Three Judges, Mr Cai described the situation as "a perfect storm".

He said the patient suffered cardiac arrest in a general practitioner's clinic, in a small and narrow treatment room instead of a typical accident & emergency room.

He cited an expert called by SMC who said he had seen 10 cardiac collapses in about 20 years, only two of which were in seated positions.

His client was a locum, and was 33 years old and a doctor of seven years at the time of the incident, said Mr Cai.

He said it was "reasonable" for Dr Ho to do what he did because the space was small, it was "chaotic" and he was not trained in patient transfer.

Justice Steven Chong, who heard the appeal along with Justices Judith Prakash and Tay Yong Kwang, said he accepted that it was a tense situation, but "as a doctor, he would know that for CPR to be effective, you have to have maximum compression".

For this to be achieved, a person should not be in a seated position, said Justice Chong. Dr Ho did not even attempt to put the patient in a supine position, he said.

According to Mr Cai, Dr Ho had stated in September 2017 that he was "deeply saddened by the demise of the patient" and wanted to apologise unreservedly to the patient's family.

SMC's counsel, Mr Chia Voon Jiet, said the case was not a perfect storm as Mr Cai described.

A perfect storm would be if the patient was "up in the mountains" with Dr Ho, with Dr Ho having no experience with cardiac arrest.

"That's not the case," said Mr Chia. "In fact, the patient was fairly fortunate to have suffered a cardiac arrest in a clinic with a doctor."

He said Dr Ho was trained in CPR and had witnessed and attended to numerous collapsed cases, worked in A&E and had clinic assistants present.

Mr Chia said this was "not his first rodeo".

"What we say Dr Ho failed to do in this case was to do the very basic step in CPR, that requires him to lay the patient in a supine position," said Mr Chia.

He said there were four people present in the clinic at the time, and academic literature that three people would be "optimal to effect the transfer".

"We know Dr Ho is saying that neither he nor his assistants were trained (to do patient transfer). It's really a manner of common sense," said Mr Chia. "It's a controlled descent."

This is not the first sanction Dr Ho has been given. In 2021, he was fined and suspended for downloading pornography at a polyclinic and trying to sell an erectile dysfunction prescription drug to a man who was not his patient.