SGH head of neurosurgery under probe for failing to report patient’s death to coroner

There was massive surgical blood loss of about 3,000ml, the brain began to swell and would have come out of the skull cavity if the swelling had continued.

Dr Rao thus stopped the operation and closed the skin before telling Mdm Tan’s husband and daughter outside the operating theatre about the complications and her poor prognosis.

The patient was transferred to the intensive care unit, but her condition later deteriorated, and she died on Jan 9, 2024.

In the interim, Dr Rao told the family that Mdm Tan’s likelihood of survival was not high.

He also told them there was a possibility that an autopsy would have to be done, although he was not the one to make that decision.

Dr Rao, who testified as the second witness, said that Mdm Tan’s husband was not keen on this at first, but he tried to accept the rationale with further explanation.

However, Mdm Tan’s daughter said many times that she did not want her mother to go through the process, Dr Rao recounted.

He said that she wanted her mother to retain “dignity in death”.

MISTAKEN IMPRESSION

Dr Rao said he had been under the mistaken impression that only deaths occurring within 24 hours of a surgery required mandatory reporting to the coroner.

He thus assumed that he had discretion over whether to report the death.

He said he told the family that he would prefer to report the death to the coroner, but was motivated by the desire to “demonstrate compassion” and provide closure, as well as prevent further distress.

State Coroner Adam Nakhoda questioned whether Dr Rao had received any training on determining when a report should be made to the coroner.

Dr Rao said that such training occurs “when we are very junior”. He added that he has since refreshed his memory and knows now that he ought to have reported the case.

“I work in a specialty that, unfortunately, when complications happen, they are severe,” he said. “This is the only death I’ve had in 12 to 13 years.”

He also said he was not sure where he got the mistaken impression that he only had to report deaths that occurred within 24 hours of surgery.

Dr Rao added that there were no unexpected events during the surgery that deviated from standard operating procedures, except for the brain swelling at the end.

“I couldn’t explain the cause,” he said. “But from my medical expertise, it seemed like a seizure to me.”

He said Mdm Tan had been given the usual medication to reduce the electrical activity that causes seizures before the surgery, but such medication is not 100 per cent effective.

When questioned about the exact wording of the cause of death on Mdm Tan’s death certificate, Dr Rao explained that a junior doctor had signed it.

This is because death can happen at any time, and junior doctors are usually on site.

Dr Rao said he had given instructions to indicate the cause of death as a brain tumour, but the junior doctor then went into the electronic system and selected the relevant category.

He was not required to review the cause of death after the junior doctor selected it, Dr Rao added.

An independent expert witness, who was called by the state, told the court it was obvious to him that the case should have been reported to the coroner, but said he empathised with Dr Rao.

“Yes, the death should have been reported because that is in our training and experience from the time we started this speciality, that has been one of the things that is highlighted,” the expert said.

“However, the academic knowledge of it sometimes can be marred by emotions.”

He added that as a surgeon himself he understood that the main surgeon is the one who bears “the most emotional burden”, and it is “entirely reasonable” that this burden can sometimes cloud one’s judgment.

The coroner’s findings will be delivered at a later date.

Under the Coroners Act, any person who becomes aware of a death that is, or appears to be, a reportable death, must make a report to the police as soon as reasonably practicable.

Failure to do so without reasonable excuse is an offence, punishable by up to one month’s jail or a fine of up to S$1,500, or both.

The Coroners Act lists examples of reportable deaths, including an unnatural or violent death, a death that resulted directly or indirectly from medical treatment or care, and any death in Singapore where the cause or manner is unknown.

CNA has contacted NNI for more information.