Medical protection society of SIngapore case studies at SEMS ASM 2014

1. SEMS ASM 2014
CRITICAL CARE IN THE ED
13 April 2014
MPS: A Presentation of
Case Studies
Eric Tin Keng Seng
Head, Litigation & Dispute Resolution Practice
Head, Medico-Legal Practice Group

2. Red Herring on X-ray
•71yo lady presented to A&E with pain on swallowing
after eating fish
•Referred to ENT and neck X-ray and CXR were
reported as clear
•The following day radiologist reported “spiculated
opacity 2.5 x 2.7cm in RLZ” and patient had surgery to
remove fishbone that day
•2 yrs later patient presented with haemoptysis; lung
cancer removed followed by chemotherapy

3. Claim for Missed Tendon Injury
Good Records and Causation Defence
•Girl injured foot on broken glass door
•Seen at A&E cleaned and explored wound referred to
orthopaedic surgeon
•Surgical toilet and suture. Advised exploration but
patient declined – recorded in notes
•3 weeks later tibialis anterior tendon laceration
confirmed on USS
•Direct tendon repair performed a week later by
another surgeon – prognosis unchanged

4. Losing Cool on Social Media
•Mother and baby tried to register at GP clinic near
closing time
•Misunderstanding of the receptionist’s refusal led to
a heated exchange involving the doctor
•Another patient in waiting room filmed the incident
using her mobile phone
•The clip was put on STOMP and story picked up by
local press

5. Confidentiality in A&E
•24 M presents to A & E with h/o fight with friend that
got out of hand
•O/E laceration to dorsal aspect of forearm and
fractured 2nd metacarpal bone - discharged home,
OPD 3 days
•Police contact A&E next day wanting info re man
fitting patient’s description in connection with break-in
at a local newsagent
Should you inform the police?

6. Confidentiality in A&E (continued)
•Police advise that elderly shopkeeper assaulted
during raid. Serious head injury. Now in ITU at
regional neuro unit
•Witness reports raider armed
Should you inform the police?

7. Consent
• Girl age 16 brought in semi-conscious in A&E by
police who requests examination to confirm sexual
assault
•Older brother who is drunk refuses to allow doctors
to examine her

8. More discussion later
Eric Tin Keng Seng
Advocate & Solicitor (Singapore)
Solicitor-Advocate (England & Wales)
Email: erictin@donburk.com.sg
Office: 6595 9525
Mobile: 8100 8570