02 Oct 2011
By: FIONA LOW
If nerves happen to be accidentally severed during hand surgery, the surgeon’s immediate concern is to repair the damage in the same operation, doctors say.
This is to ensure that the repair is done as quickly as possible, even if the patient is sedated and prior specific consent had not been given.
Dr Andrew Chin, head of the Department of Hand Surgery at Singapore General Hospital (SGH) said: “If the recovery process starts immediately before the condition deteriorates, there is the best chance for recovery. If the procedure is delayed, the eventual outcome could be worse.”
Doctors say the key is to prepare patients for such complications by providing sufficient counselling and telling them, beforehand, about the risks of the procedure.
“In the consent form, there should also be clauses to let the patient know what steps will be taken if various complications arise during surgery,” added Dr Chin.
It was reported last month that hand surgeon Looi Kok Poh had performed an additional procedure on a patient without consent, and later had the consent form altered.
Dr Looi, who heads a private practice at Gleneagles Medical Centre, had severed the patient’s nerves during surgery in 2006. He then performed, in the same operation, a procedure to reattach the nerves.
He later had a nurse edit the patient’s consent form to include the latter procedure without telling the patient.
It was reported yesterday that Parkway Holdings revoked Dr Looi’s accreditation. This means he can no longer perform surgery at three of Parkway’s facilities: Gleneagles, Parkway East and Mount Elizabeth hospitals.
Dr Looi and Gleneagles Hospital have admitted liability and the damages both will have to pay will be assessed by the court at a later date.
Doctors who spoke to The Sunday Times said that consent forms should not be doctored and stressed that it is necessary to tell patients about complications that may arise during surgery and any additional procedures done afterwards.
However, surgeons also explained that it may not be uncommon to accidentally sever a patient’s nerves during surgery especially if there is already existing damage to the hand, making surgery that more complicated.
The patient in the case had consulted Dr Looi after experiencing a tight feeling in the movement of his fingers. The operation was on his tendons, to alleviate his condition.
Dr Jonathan Lee, a hand surgeon at Mount Elizabeth Medical Centre, said: “If there is already damage or scarring to the tendons, this could result in a dense, entangled mass of indistinguishable tissue. In such difficult surgery, a higher risk of nerves accidentally being cut is possible.”
To prevent the doctoring of consent forms, some hospitals have measures in place.
At Tan Tock Seng Hospital (TTSH), electronic consent forms are used where no cancellations or alterations are possible after the forms have been submitted.
A new consent form must be rewritten electronically if there are changes, said adjunct assistant professor Winston Chew who heads TTSH’s Hand and Microsurgery section.
Dr Chin said that such a system is also under consideration at SGH and could be implemented in the future.
Email: fionalow@sph.com.sg
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