Tan Sri Dr Noor Hisham, on World Health Day 7/4/21, you said: ‘Govt to ensure optimal, equitable healthcare for all’. So please show your sincerity by justifying a Bias Investigation conducted by Malaysia Medical Council from 2010 to 2012.

Under Preliminary Investigation Committee II; besides, the Chairman there were 4 retired Doctors; 4 temporary Secretariats and 1 lawyer whom only attended once in every 1 of the 3 short meetings. PIC II and Dr T’s Lawyer cross-examined the Complainant in 2 meetings. In last meeting, although the Case Notes and Medical Report submitted by Dr T were seriously deviated from the Hospital’s Medical Records, resulted in a lot of discrepancies among them; but no query put forward to him.

Doctors only gave Medical advice; and it was impossible for those temporary staffs to understand Medical Case. So, the dismissal of this inhumane Malacca Private Hospital Case was solely the Chairman’s decision.

It happened on 22/7/2010, a physically well old lady with chronic constipation went wrongly to a Surgeon (Dr T), shortly before lunch, due to sudden stomachache. Dr T allowed her Partial Bowel Obstruction, that had 90% chances of recovery with proper Conservative Management, to distend and dilate until Ischemic and Peritonitis with DIVC and multiple Organs failure, and her Bowel was already dead for many hours; only then operated on her on 27/7/2010.    

SUMMARY OF CASE EVENTS

1. Dr T did not even take Patient’s Vital Signs, which were taken in the Ward. He only used his finger tips to touch her abdomen, and told her there was traffic jam. So, after jam cleared by vomiting, she took some high fiber biscuits for lunch. Instead of making her vomit out the foods she just took; he admitted her under IV drips with Buscopan to slow down bowel movement, when it was congested with food materials.

2. At night, Dr T took Patient’s hyper-peristalsis pain on and off as gastric pain and wait for her to vomit. NG suction only inserted after her 2nd vomiting, and was pulled out for 3rd vomiting. Next morning, he refused to listen to her daughter about the 3 times vomiting, indicating Bowel Obstruction; so he did not reinsert NG suction. Dr V said NG suction prevent Bowel distention and dilatation by sucking out fluid and gas from the stomach, amount of fluid collected indicate Bowel Obstruction.

3. To pass the blame of foods taken due to fail to advise ‘nil by mouth’ to the Patient; Dr T stated in Medical Report that she admitted in the Ward, that she took some food before admission after his advice; but there was no such records in the Nursing Care Plan and Case Note.

4. On 3rd day morning, Dr T failed to know Patient’s Bowel obstruction dilatation had deteriorated to cause dehydration even though BUSE taken shown catalysts at lowest and below normal level. So, he still did not insert NG suction; and he said based on the number of Diapers Patient’s urine very good; but Dr V said it was impossible to measure Urine with Diapers.

5. Dr T said her condition normal in the Evening by adding another BUSE in Case Note; but  Nursing Care Plan and Laboratory Report shown BUSE only taken in the morning.

6. On 4th morning (Sunday), Dr T asked Patient to ask her daughter to discharge her when no Relative was around, just because X-ray not done yet; and left the Hospital without examine her. He said in Case Note that he asked her to ‘AOR’ discharge because her Daughter want CT scan and he was concerned about high radiation and cost. Ironically, after he viewed the X-ray, he allowed her to take CT scan.

7. In the Afternoon, due to no examination, even with Radiologist remarks of dilated loops of Bowel, and Bowel Obstruction either at end of Ileum or beginning of Colon; Dr T still unaware of Patient’s Bowel Obstruction’s Emergency condition; so he advised Relative to wait for her 5 days off Aspirin and declined the daughter’s request for Laparoscopic Surgery.

8. ‘Fleet Enemas and motion large amount’ noted in Case Note to mislead her Bowel not obstructed could not be found in, In-house Prescription form and Nursing Care Plan. He later confirmed Bowel Obstruction at Mid Ileum, in Court.

9. The contradicting phrase ‘Reluctant due to risk of bleed’, Dr T scribbled in Case Note that stated ‘KIV operation waiting for Patient 5 days off Aspirin’ to pass the blame of delay in operation to the Relatives, could not be found in Nursing Care Plan, proved that it was added retrospectively.

10. To justify his postponing of emergency operation, when it was impossible to see Bowel’s diameter and number of loops, in X-rays, Dr T said it shown they were not serious. In his Witness Statement, Dr V stated that Aspirin taken 4 days ago, could not be taken as the cause of not to operate, when Patient’s raised temperature could mean impending Peritonitis.

11. At nigh, Dr T did not go to Hospital, when the Patient was having rapid  heart beat of 100 bpm, struggling on Bed in serious pain and confusion with Bulging Abdomen. Both Dr T and Dr V testified that was deadly Peritonitis with Septic Shock that need immediate operation.

12. High blood medication still given to the Patient with Systolic Blood Pressure below 90 mmHg at 8.00 a.m. the next morning,, caused her blood pressure to drop drastically to 75/38 mmHg from 10:30 a.m. onward; proven in Hospital Meeting Transcription.

13. High Blood Medications noted in ‘In-house Prescription Form’ was being canceled; Dr T had confirmed that Patients take Medications base on condition and would only be noted when it were served, could not be noted before hand and then cancel.

14. At 9.00 a.m., Relatives informed Dr T about Patient’s low blood pressure and requested for Nutritional therapy; he asked them to go to his next door colleague Gastroenterologist for 2nd opinion, then left the Ward without examine her; proven by his Case Note: KIV gut resection, unless Peritonitis set in.

15. Unaware of her seriously low blood pressure at Noon, he still postponed Operation upon confirmation by Patient’s Daughter in his Clinic; proven by his ordering of CT scan and BUSE coming morning. In Hospital Meeting Transcription, it was postponed to Wed, 28/7/2010.

16. The contradicting phrase of ‘Advise bite the bullet not agree’, scribbled into the Case Note that stated ‘order CT scan and BUSE cm (coming morning)’, not found in Nursing Care Plan, again proved that it was added retrospectively to pass the blame of delay to the Daughter. His not asking her to ‘AOR’ discharge the Patient in Urgent condition proved that she went to confirm operation.

17. At 7.00 pm, Dr T asked for consent of infusion of  blood through phone; used a ‘?’ in Case Note to deny that he knew Patient was Sepsis with DIVC before operation; but both him and Dr V had testified that Blood test shown she was  in severe Sepsis of Disseminated Intravascular Coagulation (DIVC) with multiple organs failure and her Bowel was dead.

18. Dr T waited until around 1:30 a.m. of the next day to ask for consent of immediate operation in ICU. He did not give time for the Relatives to see Patient, and also did not tell them her Bowel was dead; and then taken her thumb print involuntarily when she was in semi conscious condition; and conducted the operation when her blood system was bleeding.    

19.  In order to change Patient’s Bowel Ischemic and Peritonitis due to Bowel Obstruction, to Mesenteric Ischemic Bowel; Dr T change her undergone Angiography 10 years ago to Angioplasty; Backache 4 months, due to fracture in lower Spinal Cord to Abdominal pain 3 to 4 months; Constipation with Fleet Enemas to loose yellowish stools; and ECG normal to Ischemic Heart, in his Case Notes.

20. He then written an untrue Operation Note of Patient’s cause of death as Mesenteric Ischemic Bowel which was caused by blockage in blood vessel that cause Paralytic Ileus, without Bowel Obstruction; but he had testified that her Bowel obstruction was at Mid Ileum, and she did not have Paralytic Ileus.    

CONCLUSION

There was totally no treatment only IV drips with Buscopan, without NG suction even after the Patient’s Bowel was obstructed and seriously dilated; throughout the whole 6 days of her stay. He did not examine and was unawareness of her Bowel Obstruction dilatation deterioration; so, he postponed emergency operation; and did not go to Hospital at night, when she was in critical condition of Peritonitis with Septic Shock, denied her of her last chance of survival.   

The next morning, he did not stop high blood medication; but postponed operation again. He asked for infusion of blood in the Evening when she was in Severe Sepsis of DIVC and her Bowel dead. He took her thumb print involuntarily; and asked for consent of immediate operation when she was not operable.    

BIAS INVESTIGATION CAUSED THE COMPLAINANT TO LOSE THE CASE IN COURT (2016-2018)

Plaintiff’s witness Doctor was being put out from Trial together with the Complainant’s Witness Statements based on his Medical Advice. Dr T’s Witness Statements based on those untrue Medical documents sent to MMC, were allowed to be verified during re-examination, without objection.

Without any Documented Proof of Relatives refusal of Operation; Dr T was allowed to use his own scribbling words added into the Case Notes as Relatives refused operation, to pass the blame of delay in operation to them. The Case was killed beyond Appeal with another false statement of family members refused operation, in the Submission.  

The Case Notes and Medical Report consisted of a lot of unfounded matters and incidences were proven in Court. The Complainant had compiled meticulously all evidences found in Medical Records, Hospital Meeting Transcriptions with the Court Proceeding Records, sent again to MMC in 2019 and then later Ministry of Health; but MMC still insisted not to justify the Case.      

Tan Sri Dr Noor, it is imperative that actions should be taken to curb unscrupulous Doctors from taking Patient’s life for granted and cause suffering and death cruelly, in the Hospitals. The Complainant still waiting for you to justify the Case, so that the deceased can rest in peace. 

Thank You Very Much

Wecare