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Whoaaaa..this one serious Apex court grants woman's appeal against Changi General Hospital over delay in lung cancer The Court of Appeal on Tuesday (Feb 26) granted a woman her appeal against Changi General Hospital (CGH) for delaying diagnosis of her lung cancer. A High Court judge had dismissed the claims of negligence in February last year, finding that a nodule in one of Ms Noor Azlin Abdul Rahman's lungs had been benign when first detected in 2007. However, the apex court on Tuesday found that CGH was in breach of its duty of care owed to the woman by failing to have in place a proper system for adequate follow-up of radiological results and patient management. This resulted in a delay in diagnosing Ms Azlin with lung cancer, said Chief Justice Sundaresh Menon and Judges of Appeal Andrew Phang and Judith Prakash. Ms Azlin first visited CGH in 2007, where an X-ray of her chest found opacity. She was referred to specialist respiratory physician Dr Imran Mohamed Noor, who ordered two further X-rays and assessed that the opacity "appeared to be resolving or had resolved on its own". He gave Ms Azlin an open date for a follow-up. The woman went back to CGH twice, seeing two doctors at the Accident & Emergency (A&E) department in April 2010 and July 2011. Advertisement Both times, chest X-rays were performed on Ms Azlin, and the radiologist recommended follow-up for the opacity, but none was carried out. A nodule was found in Ms Azlin's chest by a CGH respiratory physician only after she was referred there by Raffles Medical Clinic in late 2011 for coughing, breathlessness and blood in her phlegm. A biopsy in February 2012 confirmed that the nodule was malignant and she had lung cancer. The cancer progressed to Stage IV in August 2014 and Ms Azlin was found to be suffering from a rare condition known as ALK gene arrangement. By October 2016, the cancer had spread to her brain. Ms Azlin sued CGH and three doctors in January 2015, saying that their negligence delayed the diagnosis and treatment of her lung cancer, causing it to go untreated. Justice Belinda Ang in February last year ruled that the respondents had met the standard of care expected of them. She said Ms Azlin did not have lung cancer, or that the nodule was benign, between October 2007 and July 2011. Moreover, she was treated for her ALK-positive lung cancer at the earliest available time, because drugs approved for such a disease were available for clinical trials in Singapore only in 2013 and 2014 and only for patients suffering late-stage cancer. CGH NEGLIGENT BUT DOCTORS NOT NEGLIGENT, COURT OF APPEAL FINDS The Court of Appeal agreed with the High Court judge's decision that the two A&E doctors were not in breach of duty, as an A&E doctor "is not expected to conduct a general health screening". Instead, his priority is to resolve the patient's presenting complaints - in this case Ms Azlin's chest pains. The apex court also agreed with the High Court judge's ruling that the first CGH doctor Ms Azlin had seen - Dr Imran - had breached his duty of care for failing to schedule a follow-up appointment, even though he was uncertain that the opacity in Ms Azlin's chest had resolved completely. Although the judges found none of the doctors liable in negligence, they found that "CGH’s negligence caused a significant delay of at least seven months in diagnosis". According to the appeal judges, the patient management system at CGH resulted in Ms Azlin, who had a persistent nodule in her lung, being seen by only one respiratory specialist over four years. The system CGH had to review radiological reports was "inadequate" because it did not allow comprehensive management of patients, with "no appropriate mechanism for the consolidation of what was already known". That is, each time Ms Azlin went to the A&E department, and each time a radiological report on her nodule was prepared, it was seemingly "treated as an isolated incident". The A&E doctors did not have access to Dr Imran's notes, as his consultation with Ms Azlin had not been at A&E. "CGH did not have a practice of sending its patients the report and test results from the scans conducted at the hospital," said the judges. "It was plainly unreasonable for CGH to rely on the patient's account of what happened at consultations outside of the A&E department. "If the A&E doctor reviewing the radiological report had checked against Dr Imran’s notes, for example, it would have become immediately obvious to him that the only specialist who had seen her over the past four years had mistakenly concluded that the opacity was resolving or had resolved," said the judges. The A&E doctor would have concluded that "the nodule had been persistent and had not been properly assessed by a specialist", they said. The judges said an amicable settlement would allow Ms Azlin "to focus on battling her cancer and recovering as best as she can", saying it would be "appropriate for CGH to consider the possibility of a settlement in the interests of expediency and resolution". The Court of Appeal judges have reserved costs and referred the question of loss and damages back to the High Court judge. Read more at https://www.channelnewsasia.com/news/singapore/changi-general-hospital-lawsuit-lung-cancer-delay-diagnosis-11289948

From ST Forum: http://www.straitstimes.com/premium/forum-...ia-moh-20130326 Brain-death diagnosis based on stringent clinical criteria: MOH Published on Mar 26, 2013 THE Sunday Times reported on the case of Ms Suzanne Chin, who recovered from a coma ("Back from the dead: 'I have been blessed with a second chance'"; Sunday). We are happy that Ms Chin has made a recovery. However, we are not able to comment on the case as we do not have access to specific information on her medical treatment in Hong Kong and what exactly was diagnosed and communicated to her family. Brain death is diagnosed only when there is catastrophic brain injury. When brain death has occurred, blood flow and oxygen delivery to the brain ceases irreversibly and all brain functions are lost and will never return again. Brain death is determined according to strict clinical criteria. Once diagnosed, it is recognised both medically and legally in Singapore as death of the person. This definition is similar to those used in countries such as Australia, Canada, Denmark, Britain and the United States. Brain death implies the irreversible cessation of consciousness, loss of capacity to breathe and other brain stem functions, and is accepted as the termination of a human's life; correspondingly, the diagnosis of brain death is very important. The neurological criteria for diagnosing brain death in Singapore are based on current best medical evidence and knowledge, and are similar to those adopted by countries such as the US, Australia, and Britain. In Singapore, all criteria have to be fully met for the diagnosis of brain death, including absence of pupillary response to light, absence of corneal reflex and absence of respiratory drive or spontaneous breathing, to cite a few; and when one or more of these tests cannot be done, additional tests to demonstrate the absence of brain circulation need to be performed. In addition, two doctors are required to certify brain death, at least one of whom has to be independent and not involved in the care of the patient. Doctors accredited to perform brain-death certification in our hospitals are specialists who have had appropriate training to certify brain death. We would like to reassure the public of the highest standard of medical practice in our hospitals, and that correctly diagnosed brain death is not a reversible medical condition. Kwek Tong Kiat (Clinical Associate Professor) Senior Consultant, Ministry of Health, Hospital Services Division Head and Senior Consultant Dept of Anaesthesiology, Intensive Care and Pain Medicine Tan Tock Seng Hospital Lee Heow Yong (Dr) Acting Director/Hospital Services Division, Health Services Group Ministry of Health

Good for knowledge.. [thumbsup]

Recently, I installed a new car alarm system to my Honda Stream and in the process, the instasller dismentle the cables to the batteries for a while. Then the "SRS" ( air bag )warning light comes up at the dashboard. Today, I send in my car to KM to rectify this problem, and the mech told me that I have short circuit my seat belt and new a new replacement which will cost me $130 ( incl. labour ). He said so even without any test performed. Can this happen ?? I am confused and appreciate the expert's advices.

Check here: http://www.drivetrain.com/clutdiag.html