CGH found guilty of negligence in cancer diagnosis

Changi General Hospital (CGH) has been found negligent in a case where its lack of a proper system led to the delayed diagnosis of cancer in a patient. Instead of the lung cancer being detected at an early stage, it was diagnosed only after it spread to a lymph node.

Ms Noor Azlin Abdul Rahman, 39, is now fighting Stage IV cancer that has progressed to her brain. Had the condition been diagnosed earlier, "we find it unlikely that the lung cancer would have progressed to Stage IIA", the Court of Appeal said.

Ms Noor Azlin had appealed after losing her case in February last year against the hospital and three of its doctors for negligence.

Yesterday, the Court of Appeal found the hospital negligent in their care of the patient.

The court also said that respiratory specialist Imran Mohamed Noor, who saw her in 2007, should not have discharged her when he was not certain that her suspected infection had cleared. He should have scheduled a follow-up consultation instead.

Ms Noor Azlin had gone to the hospital's emergency department on various occasions in 2007, 2010 and 2011.

She had been referred to Dr Imran by the emergency department in 2007 for an "opacity" in her lungs. He diagnosed her condition as an infection and told her to return if she had further problems.

Ms Noor Azlin Abdul Rahman had sought damages from CGH and three doctors for their alleged failure to diagnose and treat a nodule in her right lung earlier. The judge said her negligence claims failed because a causation was "simply not made out".

Justice Andrew Phang, who delivered the court's judgment, said that Dr Imran was "the last in line" examining the patient. He said: "There would have been no one else who would have been in a better position to conduct the necessary follow-up action."

The court also said it could not be proven that Ms Noor Azlin had cancer at that time. But it said that Dr Imran should have been more cautious and scheduled a repeat consultation, even if the patient was asymptomatic.

The court was far more scathing about the hospital's "serious inadequacies" in ensuring proper follow-up procedures for patients.

Ms Noor Azlin had X-rays taken in 2010 and 2011 and, both times, the radiologist recommended follow-up consultation.

The court said it had "grave concerns" over how the radiological reports were treated. It found "no record whatsoever of the senior doctor who had supposedly reviewed the radiological reports and who made the clinical decision" not to recall the patient.

The hospital's procedures allow two senior doctors to decide against the radiologist's recommendation of a follow-up. But the hospital did not require a record of who these doctors were and the reasons for their decisions.

As a result, not only did the patient not know about the decision, the court said, but "more worryingly... any doctor further down the line would have no reference against which to check why such a decision was made".

It said such a lack of accountability was unacceptable.

The court also criticised the hospital for treating the patient's problem as an isolated incident each time she turned up. Otherwise, the doctors seeing her later would know that the "opacity" in her lung had not been resolved as expected.

The court told CGH "to consider the possibility of settlement in the interests of expediency and resolution" as Ms Noor Azlin "will continue to face physical and emotional challenges as a result of her medical condition, and we think that an amicable settlement will assist the appellant in achieving some sense of closure and allow her to focus on battling her cancer and recovering as best as she can".

Her lawyer, Mr Vijay Kumar Rai of Engelin Teh Practice, said she broke down when she heard the court judgment in her favour. She had had difficulty breathing and had been admitted to CGH on Monday, but has since been discharged.

Ms Noor Azlin told The Straits Times: "I am relieved for now, but the settlement has not been decided on."

She said the medication she needs is very expensive, and not all of the cost is covered by Medifund. She is still working part-time at a corporate secretarial firm, which has been very supportive, in order to pay for it.

She accepts that there is no cure for Stage IV cancer, but she intends to fight it for as long as she can, saying: "I love my life too much, and the people around me. I don't want my mum to worry."

She lives with her parents. Her mother is 73 and her father 81.

When she agreed to have her photograph taken, she wanted time to put on her make-up. "No matter how sick I am, I don't want to look like a cancer patient," she said.

Correction note: The headline for an earlier version of the story, “CGH and doc found guilty of negligence in cancer diagnosis”, was wrong. While the patient succeeded in her claim against Changi General Hospital, she failed in her claim against Dr Imran Mohamed Noor. Although the Court of Appeal said that Dr Imran had breached his duty of care for failing to schedule a follow-up appointment for the patient, it ultimately did not find him liable for negligence as the patient did not have lung cancer when she saw Dr Imran in 2007. We are sorry for the error.  

This article was first published in The Straits Times. Permission required for reproduction.