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SINGAPORE: A 62-year-old pastor from Faith Community Baptist Church (FCBC) died after a complex open-heart surgery that spanned 27 hours, which resulted in multi-organ failure.<\/p>\n
A coroner’s court on Friday (Apr 24) ruled that the death of Reverend Simon Yee Siak Choon was a medical misadventure, accepting the police’s conclusion that there was no foul play.<\/p>\n
The pastor’s son, who attended the hearing, declined comment when asked by CNA if he was considering taking any civil actions.<\/p>\n
Mr Yee was pronounced dead at Mount Elizabeth Hospital on Oct 12, 2022.<\/p>\n
The cause of death was multi-organ failure following cardiac surgery for valvular heart disease.<\/p>\n
In a set of findings released on Monday (Apr 27), State Coroner Adam Nakhoda found that the death was “iatrogenic in nature”, as the cause of death was related to the surgery.<\/p>\n
The term “iatrogenic” means induced unintentionally by a physician or surgeon or by a medical treatment or diagnostic procedure.<\/p>\n
Mr Yee, who lived with his wife and son, had several chronic medical conditions, including hypertension, high blood cholesterol and mild coronary artery disease.<\/p>\n
His daughter, who lived separately, gave evidence that her father had told the family he was advised to consider surgery because his heart was “slightly enlarged”.<\/p>\n
Mr Yee complained of breathlessness on Sep 27, 2022 and was taken to Mount Alvernia Hospital, where he was admitted for breathlessness due to acute pulmonary oedema \u2013 a life-threatening emergency caused by rapid fluid build-up in the lungs.<\/p>\n
Mr Yee was treated at Mount Alvernia and discharged, but he was given a referral to Mount Elizabeth Hospital for early mitral valve repair or replacement surgery.<\/p>\n
A mitral valve is a one-way valve in the heart that opens and closes with each heartbeat to ensure oxygen-rich blood flows in the right direction. Mr Yee’s valve was malfunctioning such that there was “regurgitation” or backflow of blood.<\/p>\n
Before the scheduled surgery took place, Mr Yee was admitted to Mount Elizabeth Hospital on Oct 4, 2022. He had discomfort in his ribcage and difficulty breathing.<\/p>\n
Dr James Wong Woon Wai explained to Mr Yee that the mitral regurgitation was causing his heart failure and that he would require mitral valve repair or replacement.<\/p>\n
During the discussion, Dr Wong said that he informed Mr Yee about the risks and benefits of the surgery, which included a “less than 5 per cent” risk of negative outcomes such as stroke, multi-organ failure and death.<\/p>\n
Mr Yee was also told that he could opt for a bioprosthetic valve or a mechanical valve.<\/p>\n
The surgery started at 2pm on Oct 7, 2022 with Mr Yee under general anaesthesia. Dr Wong was assisted by Dr Sivathasan Cumarasawamy.<\/p>\n
It took about 27 hours, with complications occurring during the operation.<\/p>\n
At first, the surgeons performed a mitral valve repair and an aortic valve replacement. However, the repair was not successful because there was still leakage in the repaired valve.<\/p>\n
The surgeons then performed a mitral valve replacement instead, but the aortic valve replacement they had already done obscured the procedure.<\/p>\n
On Oct 9, 2022, Mr Yee developed renal failure requiring dialysis. His liver began failing and he suffered multi-organ failure.<\/p>\n
He died on the morning of Oct 12, 2022.<\/p>\n
The case was presented to the State Coroner by the investigation officer and an autopsy was performed.<\/p>\n
Mr Yee’s heart was found to be “massively enlarged”.<\/p>\n
Mr Yee’s daughter said Dr Wong was “90 per cent confident that the surgery would go well” before an angiogram was done. An angiogram is an X-ray test that shows how blood flows through the heart’s arteries to identify blockages.<\/span><\/p>\n After the results came out, Dr Wong said he was “97 per cent confident” but prepared the family that there would be risks since it was an open-heart surgery.<\/p>\n Mr Yee’s daughter said the family did not believe that Dr Wong was negligent in the surgery.<\/p>\n However, she said they did wonder if it would have turned out differently if Dr Wong had replaced the affected valves instead of trying to repair the mitral valve first.<\/p>\n Ms Yee’s daughter said the family wanted to know why the surgery took so long.<\/p>\n Dr Wong testified that there was “a lot of generalised bleeding from medical coagulopathy”, referring to a blood disorder where clotting is impaired.<\/p>\n “It required us three to four hours to control the bleeding with blood transfusion and clotting blood products,” he said.<\/p>\n He added that the mitral valve repair he attempted was “very complex” and was not successful.<\/p>\n Dr Michael George Caleb, a senior consultant heart surgeon at the National University Heart Centre, was appointed to provide an independent expert report.<\/p>\n Dr Caleb said that in this case, every major portion of the operation sustained or encountered problems that required that step to be repeated or revised, thus prolonging the operation.<\/p>\n The operation was meant to be a routine mitral valve repair or replacement, with the possibility of an aortic valve replacement, Dr Caleb noted.<\/p>\n “It is important to be cognisant that each ‘misstep’ (for lack of a better word) could be experienced by any surgeon, but is less likely to occur in experienced hands and less likely to occur altogether in the same operation, which increases the probability of fatality,” he said.<\/p>\n Dr Caleb remarked that it was very unfortunate and unusual that every major step of the operation that could go awry did go awry in this operation.<\/p>\n Mr Nakhoda noted that the Coroners Act makes it clear that a coroner cannot frame a finding in such a way as to determine any question of criminal, civil or disciplinary liability.<\/p>\n “As such, it would not be appropriate for me to determine, in the present case, whether Dr Wong and Dr Sivathasan should have replaced Mr Yee\u2019s native mitral valve and aortic valve with bioprosthetic valves, instead of just repairing those valves,” Mr Nakhoda said.<\/p>\n In the end, even though the goals of the surgery had been achieved in that Mr Yee’s aortic and mitral valves had been replaced, he developed severe multiorgan failure that led to his death.<\/p>\n The coroner found that Mr Yee had given informed consent for the procedure and was aware of its risks.<\/p>\n He returned a finding of medical misadventure and extended condolences to Mr Yee’s family for their loss.<\/p>\n In a Facebook post on Oct 12, 2022, FCBC wrote that Mr Yee had been with the church since its inception in 1986 and had taken on a wide variety of roles.<\/p>\n This included pastoral oversight of the church’s corporate communications department and leadership in projects such as the Drops of Life blood donation drive.<\/p>\n<\/div>\nEVERY MAJOR STEP THAT COULD GO AWRY WENT AWRY<\/h2>\n