Elderly patient dies after heart surgery at St Paul’s Hospital, negligence allegations arise as abdominal bleeding goes unnoticed

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St Paul's Hospital.

23rd May 2024 – (Hong Kong) A 71-year-old heart patient passed away within 48 hours after undergoing a heart valve replacement surgery at a private hospital. The patient’s family has raised concerns regarding the alleged negligence by the hospital and medical staff during and after the procedure. They claim that the patient complained of severe abdominal pain on three consecutive occasions following the surgery, but their pleas for help were dismissed as normal occurrences. It was only later in the evening when the patient’s blood pressure dropped and they slipped into a semi-comatose state that medical examinations revealed internal bleeding in the right abdomen. Despite efforts to save the patient’s life, they succumbed to the complications in the early hours of the third-day post-surgery. The family questions the doctor’s claim of a 95% success rate prior to the operation and the lack of disclosure regarding the potential risks associated with the right abdominal incision. They assert that the patient’s complaints of excruciating pain were disregarded three times, leading them to suspect medical malpractice. The family has lodged a complaint with the Medical Council and the Department of Health, urging the hospital to conduct a fair investigation and provide a prompt and reasonable response within 14 days.

According to the deceased patient’s son, Mr. Chan, the 71-year-old underwent minimally invasive heart valve replacement surgery at St. Paul’s Hospital on 17th April due to valve deterioration. Recounting the conversation with the primary attending physician after the surgery, Chan recalled the occurrence of unexpected complications, including the need to change the planned approach of using the right leg artery to the left leg artery. During this alteration, two blood vessels in the left leg artery continued to bleed profusely, necessitating an emergency procedure to ligate and stop the bleeding. As a result, the patient’s left leg, which originally had three blood vessels, was left with only one.

The day after the surgery (18th April) the patient was transferred from the Intensive Care Unit to a regular ward. Chan recollected that his father sought help three times at 1.30pm, 3.30pm and 4.30pm due to severe pain in the lower right abdomen. However, on all three occasions, the doctors dismissed the pain as normal. As the patient’s condition failed to improve throughout the evening, their blood pressure dropped, and they even fell into a semi-comatose state, with their left leg losing colouration. According to Chan, despite obtaining consent from the family to perform a computer scan on the site of pain, the hospital delayed the examination for approximately 45 minutes. Furthermore, it took an additional hour for a vascular specialist to arrive and use an instrument to locate the exact bleeding site. In total, there was a delay of nearly two hours.

Chan further revealed that in the early hours of 19th April, the doctor informed the family that during resuscitation, the patient’s heart had stopped beating for 3 to 4 minutes. A subsequent computer scan revealed internal bleeding in the right abdomen, and for the first time, the doctor disclosed the presence of a small incision at the site of the intense pain. This incision was made during the surgery to facilitate the delivery of related equipment through blood vessels. The internal bleeding occurred due to the dislodgement of a “hemostatic plug” in that area. Despite attempts to stop the bleeding through surgery, the use of seven cardiac needles, and external cardiac massage, the patient’s condition deteriorated, leading to their demise on the third day following the operation.

Chan cited the doctor’s preoperative claim of a 95% success rate for the surgery without mentioning any significant risks. He questioned why his father was transferred to a regular ward after just one-day post-surgery without specific nursing instructions and without disclosing the subsequent right abdominal incision that led to internal bleeding. The patient’s wife, Mrs. Chan, criticised the doctor for not taking the initiative to inquire about her husband’s condition after the surgery and for dismissing his complaints of excruciating pain on three occasions. She expressed her frustration, stating, “I feel that my husband’s death remains unexplained.”

Furthermore, after the patient’s demise, the doctor revealed to the family that the actual duration of the heart stoppage during resuscitation was 8 minutes, contradicting the previous statements. Chan mentioned that his father required a significant amount of blood transfusions during resuscitation, saying, “The doctor said the human body has about 13 units of blood, and my father received all 13 units. At the end, he was swollen all over.” If they had known about the 8-minute cardiac arrest earlier, they could have considered refraining from the bleeding control surgery and resuscitation, thus alleviating the patient’s suffering and allowing them to have a final interaction.

The family recently met with the hospital on Tuesday (14th) but was disappointed by the response. The hospital stated that they would conduct an internal investigation and provide a response within 14 days. However, the family found the hospital’s response unsatisfactory, as they were seeking a fair and independent investigation into the alleged medical negligence. They have lodged a complaint with the Medical Council and the Department of Health, hoping for a prompt and thorough investigation into the matter.

The Medical Council and the Department of Health are responsible for overseeing medical practices and ensuring patient safety. They will review the complaint and conduct an investigation to determine if there was any negligence or misconduct involved in the patient’s treatment. If the allegations are substantiated, appropriate actions will be taken, which may include disciplinary measures against the medical professionals involved.