Baby Yok Shan tragedy – 50th Merdeka reminder of plunge in public service standards/accountability

Newspaper headlines today like “Baby’s blackened arm removed — Procedure on Yok Shan over in 10 minutes” (The Star), “Tangan bayi tersalah suntuk tertanggal sendiri” (Mingguan Malaysia), “ORDEAL — BABY YOK SHAN LOSES HER LEFT FOREARM” (New Sunday Times) and “Tangan bayi salah suntuk dipotong” (Berita Minggu) highlight another tragic case to remind Malaysians that despite all the glitter and extravangza of the 50th Merdeka Anniversary celebrations, public service standards and accountability have fallen to a new low in 50 years.

Health Minister, Datuk Seri Chua Soi Lek should present a Ministerial statement in Parliament tomorrow on the outrageous case of five-week-old baby Lai Yok Shan who lost her left forearm from below the elbow because of medical negligence at the Tengku Ampuan Rahiman Hospital in Klang.

Lai’s parents, her father Lai Kian Khee, 24 and mother Nur Tuemthong, were told on National Day eve that Yok Shan will undergo an operation expected to last from two to four hours on Sept 1 – a day after 50th Merdeka National Day – to amputate her left arm, but in actual fact, no amputation was needed as the blackened arm came off when the orthopaedic surgeon lifted and turned it.

This showed how little the panel of medical specialists knew about Yok Shan’s condition despite all the hullabaloo about its establishment to treat the baby girl!

Chua should honour his public promise that “there will be no cover up and all will be transparent” into the negligence resulting in the Yok Shan losing her left forearm.

This is why he should present a Ministerial statement in Parliament to outline not only the shocking medical and hospital negligence resulting in the Yok Shan tragedy, but what action he has taken as Health Minister to accept full responsibility for the Yok Shan outrage and ensure that there will not be another horrible case of medical and hospital negligence akin to the Yok Shan case in future.

Yok Shan was born two months premature on July 23 and kept in an incubator and on a ventilator. When her condition deteriorated, it was decided to give her strong antibiotics which could only be administered intravenously.

A trainee doctor who received instructions over the telephone from the specialist doctor on duty administered the injection. The trainee doctor inserted the needle into muscles and tissues instead of blood vessel in the arm. This caused the baby’s arm to be infected.

It is clear that there is a chain of irresponsibility and negligence resulting in Yok Shan having to lose her arm, involving the trainee doctor, the specialist doctor, the Tengku Ampuan Rahimah Hospital, the Ministry of Health and even the panel of medical specialists announced by Chua on August 9 to save Yok Shan’s left arm.

Apart from questions of culpability of the trainee doctor and the specialist doctor who had given instructions over the phone instead of attending to the case personally, why was there a six-day delay by the authorities in taking urgent remedial action — with Chua only responding and announcing a panel of specialists to take care of Yok Shan after the DAP Pasar Besar Branch chairman Peter Tan had highlighted the incident in the media!

Furthermore, why was the panel of specialists completely unaware of the condition of Yok Shan, expecting a two-to-four hour amputation operation when it just fell off when lifted and turned?

I will raise this medical and hospital negligence issue in Parliament if Chua is not prepared to present a ministerial statement on Yok Shan’s suffering and tragedy tomorrow.

  1. #1 by sheriff singh on Sunday, 2 September 2007 - 3:01 pm

    Will Chua go on two weeks Medical Leave after making the statement which will be delivered by a small time official?

    And what of the “doctor” who injected the antibiotic into the muscle when he could not find the vein?

    And Klang…again? That place is the source of all bad news.

  2. #2 by LittleBird on Sunday, 2 September 2007 - 3:50 pm

    Really sick.. with privatisation of health services, allowing doctors to charge fees while using government facilities. Some big wigs with connections sits as panel clinics for many big companies and prescribing unnecessary procedures “just because the employer or insurance companies paying”.

    This is definetely no place for poor people and the few good ones in the government sector waitng to leave.

  3. #3 by Libra2 on Sunday, 2 September 2007 - 3:57 pm

    Even if you move a motion, the BN’s stooge of a Speaker will reject it on grounds it is not urgent. Of course, it is not urgent because the child does not belong to an UMNO bigwig.
    But then, they go overseas for treatment, even for mild flu or sinus operation.
    If one goes through your blog with a fine tooth comb, one can see that the entire county is in turmoil. Practically every institution is degenerating and disintegrating. Yes, beginning from the PM’s office, the Cabinet, the Parliament, the Universities, the Chief Justice , the IGP and all the way down to the kampong penghulu.
    The rot is complete.
    I am sure if a BN MP had brought a motion to debate Wee Meng Chee’s video clip, it would have been allowed.

  4. #4 by lakshy on Sunday, 2 September 2007 - 4:07 pm

    Oh God!

  5. #5 by devilmaster on Sunday, 2 September 2007 - 4:11 pm

    The trainee doctor inserted the needle into muscles and tissues instead of blood vessel in the arm

    This is the result of mediocre instead of meritorious.

    No wonder Chan Kong Choy prefers to fly out of the country to seek treatment. Pak Helah too having his sinus problem treated in Australia.

    Only emergency heart problems will go to IJN. Because there is not enough time to take him from one airport to another.

  6. #6 by k1980 on Sunday, 2 September 2007 - 4:18 pm

    The trainee doctor inserted the needle into muscles and tissues instead of blood vessel in the arm. This caused the baby’s arm to be infected—- 6 years of medical studies and yet could not differentiate between muscles and blood vessels! And so that’s why the PM and all his ministers go to overseas hospitals for medical treatment. No confidence at all in the local specialists!

  7. #7 by Jeffrey on Sunday, 2 September 2007 - 4:21 pm

    “…//..And Klang…again? That place is the source of all bad news..//..” – Sheriff singh. Right on!

    From news reports, Tengku Ampuan Rahimah Hospital (HTAR) was negligent on at least two counts.

    One is that the doctors at the hospital did not seem to monitor Yok Shan’s blood infection of the arm in an incubator until it was very late when it turned critically gangrenous.

    Two, the specialist on call did not attend to her and instead gave orders to the houseman over the phone who mistakenly injected Vancomycin into a muscle instead of the infant’s blood vessel.

    HTAR would be vicariously liable for specialist’s and houseman’s negligence. The specialist should be hauled up by Malaysian medical Council to account whether he has acted professionally.

    But the other question is, “What is wrong with this hospital?”

    Businesswoman Zara Davies Abdul Rahman recounted her traumatic experience in trying to get accident and emergency help from HTAR to save an accident victim’s life near the Batu Tiga toll booth on Dec. 13 last year, but in vain. She complained that the personnel in attendance there could not send the ambulence. When she finally arrived on her own at the Klang Hospital with the victim, she said, “I had a hard time looking for the staff to bring a trolley to remove the victim from the car. I asked for assistance from two nurses but did not receive a response.”

    Recently swirling rumours on how an Indian drama actress K. Sujatha died of a “mysterious illness” was also linked to this hospital.

    The question was raised why Sujatha was taken to the Tengku Ampuan Rahimah Hospital in Klang when Hospital Kuala Lumpur is located much closer to her apartment. A PKR leader also claimed that mortuary attendants saw cuts on the deceased’s face and body. Did the hospital have an autopsy carried out to ascertain the true circumstances of death to confirm or dispel the rumours?

    Not that I have yet heard of.

  8. #8 by ktteokt on Sunday, 2 September 2007 - 7:13 pm

    The Minister of Health should be fully accountable for this incident.

  9. #9 by mendela on Sunday, 2 September 2007 - 7:37 pm

    Yes, Klang again! First it was the corrupt big fat Zakaria episode, then the PKFZ RM 4.6 Billions bailout, and now it is baby Yok Shan tragedy.

    What next, Klang???

    Indonesians taking over Port Klang due to the beating of their handcuffed Karate Referee by 4 Police Diraja Malaysia?

  10. #10 by Jonny on Sunday, 2 September 2007 - 9:41 pm

    Quality of life really deteriorates.

    If want good quality, pay more go to private facilities (and these are also so-so ok).

    We could have all drive Merz or BMW. Instead, we’ve got Proton Perdana.

    We’re paying much much more higher to get a decent quality.

  11. #11 by sickofmsia on Sunday, 2 September 2007 - 10:09 pm

    poor baby….. arm amputated because of some idiot;s irresponsibilities?

    will the parents & the baby get compensation? tho no amount of money can buy get her arm back …… or will the case be left unattended after some time….come on, they cant handle a murder case properly, let alone a tragedy to a small kid???

  12. #12 by raven77 on Sunday, 2 September 2007 - 10:28 pm

    The hospital is run by gangsters and dungus and managed by the Ministry’s HP6 administrators including Merican, Noorimee, Yahya Baba….. who transfer well connected new graduates to this cesspool which the local population in Klang have to put up with……currently it is a giant mortuary run by Indonesian and Russian graduates…….

    Ooiii!!!!!…Zak, Toyol, Dr. Teh Kim Poo……lu orang mau sapu semua project dan duit sapulah……tapi tada hati perut kesian sama orang Klang/Selangor ka?…….LKS must focus on at least the quality of doctors and where they graduate from…….this has gone on long enough….

    LKS in parliament must ask for the list of all doctors in Klang and where they graduated from and where they got their specialist degrees……..the answer to GHKlang’s killing fields will lie in there………….someone sold out healthcare and medical education…….LKS surely knows who they are……there is sordid politics behind the GHKlang mess which every doctor there knows………the answers all lie with ………Datuk Dr………

  13. #13 by Billy on Sunday, 2 September 2007 - 10:42 pm

    The moment the British Medical Council withdrew their recognition of our medical degree, I knew then we would be in deep shit (pardon my language). The results are now so plain for all to see. We are putting our lives in the hands of under-qualified doctors and that really scares me. A few months ago, it was reported in the press that an Indian girl told her mum she was going to the doctor for a check up. At the time she left, she was one healthy human being. She returned in the evening dead. Whether these cases are considered murder or negligence, lives are lost and families distraughted. Chua must resign if he has any more moral fibres left in him. He cannot look the other way and scapegoat those below him.

  14. #14 by smeagroo on Sunday, 2 September 2007 - 11:01 pm

    How bad is our public health svc? ASk AAb cos he went overseas to treat his sinus problem. ASk Rafidah cos she went overseas to treat her knee. Ask Chan Kong Choy cos he too went overseas cos too much heat in Msia now.

  15. #15 by badak on Monday, 3 September 2007 - 12:33 am

    Black hole of… Malaysia… KLANG..Next scandle please

  16. #16 by dawsheng on Monday, 3 September 2007 - 12:37 am

    If you want to committ suicide, check in to Malaysia’s hospital, for better result, choose the Klang one.

  17. #17 by Plaintruth on Monday, 3 September 2007 - 4:17 am

    This tragedy is just a sign of a big problem that brewing over the last 30 years.

    The Tidak Apa attitude is one.

    The UMNO policy / NEP influencing and controlling the standard of the graduating student.

    The UMNO way of doing things transient throughout Malaysian life.

    Can you do something about it? Yes you can. Go and participate in active politicing. Tell the truth, let more people aware of what is going on.

    We need to vote UMNO and the Barisan down.

    Time had long due for a change.

  18. #18 by UFOne on Monday, 3 September 2007 - 8:04 am

    Setting a drip on babies or premature babies or adults takes skills. The most prominent veins for a baby will be on the scalp, the upper part of the hand not arm and the upper part of the feet, not leg. Umbilical vein catheterization can be performed and a cut down if the prominent veins cannot be seen. The doctor who heads the unit should review the cases everyday including resetting the drip himself or herself if he or she knows that the others have tried and failed. Many times these doctors themselves fail also because this procedure is not considered a major procedure for him or her to perform and therefore he or she will lack the skill to do it. The nurses should be sharp enough to report to the doctors.

    I do not think these medical personnel in Tengku Ampuan Rahimah Hospital Klang lack the skills and the knowledge. The single biggest problem is the attitude. After failing to reset the drip so many times, they could only hope that somehow the needle would enter a vein. Since the tissue in the premature baby is soft, they were desperate to think that they have entered the blood vessel.

    What is Islam’s punishment for all these ?

    There are many other negligences that happened in the country. Some are not reported at all. Since the medical personnel know about medicolegal in theory, it is time for them to face it in reality.
    Singing the song ” cemerlang, gemilang, terbilang ” is one thing but applying it is not as joyful as singing it. May be we should think twice before singing any of the cemerlang songs because we should mean it if we sing it. But if the quality of the medical services is getting worse and the necessary equipments are not around without the knowledge of the Ministry of Health, then all this Merdeka celebration remained just a big grand party. How long do Malaysians wish to tolerate lies ?

  19. #19 by Jon J on Monday, 3 September 2007 - 8:29 am

    This is one of the saddest tragedies I’ve ever read regarding the healthcare services in Malaysia. As a Plastic Surgeon who has experience dealing with extravasation injuries (inadvertant injection into surrounding tissue rather than the vein) in newborns, here are a few thoughts.

    Finding veins for cannulation in newborn babies is hard enough, it’s even harder in premature babies. Hence, extravasation injuries do happen in paediatric intensive care units. I think the first failure here is that the supervising specialist failed to give his/her junior doctor the support required. Giving instructions over the phone in a situation like this is simply not good enough. Secondly, why did the nursing/medical staff fail to adequately monitor the drip site after the cannula was inserted? This should be standard practice in any reputable intensive care unit; particularly as babies’ veins can be very difficult to cannulate. Extravasation injuries can/will happen in babies – but if it is picked up early enough, then effective treatment can be instituted to prevent a subsequent disaster like this!

    I also cannot understand this nonsense reasoning that the soft tissues of the forearm died from infection. If the forearm soft tissues were so severely infected as to die-off, it would have spread to the rest of Yok Shan and she would have died from fulminant sepsis. (Google “necrotising fasciitis” to see what I mean)

    I believe the greater likelihood was that the infusion of antibiotics was given into the muscle; and that the tissues died from “compartment syndrome”. Muscles are surrounded by a sheath with limited capacity for stretch. Significant trauma to the muscle (eg: injection in this case) results in swelling. As the surrounding sheath cannot stetch, the muscle swelling causes pressure within the sheath to rise, and cuts-off the blood flow to the muscle. Thus leading to death of the muscle within about 6 hours. Sadly, there is a cure for this if caught in time. A simple surgical release of the surrounding sheath (called a “fasciotomy”) will allow the internal pressure to be released and restore circulation to the muscles. The key is in having a high index of suspicion for this condition to allow early diagnosis when treatment can still be instituted.

    Reading some of the other reports, it would appear that Yok Shan’s father even noticed that his daughter’s hand had gone white after the attempted antibiotic injection! Why did the medical/nursing staff fail to notice this when even a non-medically qualified person did?

    So here’s my overall take:
    1) Was the junior doctor negligent for putting the drip in the wrong place? No – this can easily happen.
    2) Was the senior specialist negligent for failing to provide his/her junior adequate support? Yes – the specialist is being paid to do a job – and he/she did not fulfill his/her duty of care.
    3) Were the medical/nursing staff negligent in failing to monitor the drip site? Yes – it should be routine, particularly in paediatric intensive care where even 10mls can be a large volume in a tiny baby.
    4) If it had been a case of “compartment syndrome”, could early diagnosis and surgical fasciotomy saved Yok Shan’s forearm? Yes, very likely – but I guess we’ll never know now.
    5) Was this caused by infection rather than compartment syndrome? Possibly, but it’s very much less likely.

    My thoughts are with Yok Shan’s parents at this difficult time. May she grow up a happy and fulfilled child even with such a terrible tragedy in her early age.

  20. #20 by Libra2 on Monday, 3 September 2007 - 9:13 am

    “How long do Malaysians wish to tolerate lies ?”

    Answer: As long as BN is in power.

  21. #21 by raverus on Monday, 3 September 2007 - 9:38 am

    I was in an accident and waited for half a day until my blood went dry, then i call my friend and send me to a private hospital. G hospital is full of shit.

  22. #22 by sotong on Monday, 3 September 2007 - 12:09 pm

    With narrow and damaging politics together with bad leadership at almost all levels, this is expected…..and it’s only the tip of the iceberg.

    Ordinary people life is cheap and dispensable.

  23. #23 by k1980 on Monday, 3 September 2007 - 1:28 pm

    If anything, I hope this tragedy of Shakespearen proportions will serve to wake up those umnonites, including our daft PM, who still harbour the idiotic view that all non-bumis are rich and hence do not deserve the NEP. For if the girl’s parents were indeed rich, they would had gone to a private hospital for her birth.

  24. #24 by Toyol on Monday, 3 September 2007 - 4:30 pm

    Is CKC back from leave? Too hot for him to handle? When is the Health Minister going on leave. Ministers seem to go on leave whenever there is a problem in their backyard. Perhaps there is some truth in what is written on the blogs, then.

    This is the result of having mediocre leaders leading us…I can only imagine the hell we will be facing in 50 years time!

  25. #25 by megaman on Tuesday, 4 September 2007 - 2:23 pm

    Hi k1980,

    Definitely agree and double triple multiple strongly agree with you on this point … Not all non-bumis are rich enough to afford private sector’s medical care …

    It is not only unfair but inhumane to deny any poor rakyat regardless of bumi or non-bumi of proper medical care and it is criminal when discrimination is performed in the medical profession.

  26. #26 by Zeebra on Tuesday, 4 September 2007 - 7:38 pm

    Chua Soi Lek ask those medical doctor to resign if they cannot do their job. I wonder if he will praqctice this on himself?????? ALL SHIT.

  27. #27 by ktteokt on Friday, 7 September 2007 - 9:31 am

    Get a great chef to turn the amputated hand into a delicacy and serve it to the Minister of Health to remind him of his negligence. He cannot escape from vicarious liability!!!

  28. #28 by shame4you on Saturday, 8 December 2007 - 2:51 pm

    RM60,000.00 to lost a hand ?? How this to be calculated ?? by the WEIGHT of the pity little hand ??? or by Lenght of the pity little hand ?? Sad ….. sad …. and Nonsense !!!

    How dare you (doctor) to call yourself as a ” Angel like Doctor ” , shame of you .

    A little hand from “Pablo Picasso ” is an human hand from Baby too , is the same Weight and Lenght like Baby Yok Shan !! and not the RM60,000.00

    God Bless !!

You must be logged in to post a comment.