In December last year, Khoo Teck Puat Hospital (KTPH) disclosed that approximately 180 of its patients had been mistakenly diagnosed as HER-2 positive, a less common type of breast cancer as opposed to HER-2 negative, which is more common. The negative or positive result affects the treatment that is doled out with those that are HER-2 positive likely to receive the drug Herceptin.
Needless to say, this is a revelation that has resulted in deep concerns for, among other things, the processes that have permitted this error to occur as well as the potential side effects that those who have been misdiagnosed may suffer.
Unsurprisingly, therefore, a number of members of parliament (MPs) including, Tan Wu Meng, Joan Pereira (Pereira), Cheryl Chan, and Non-Constituency Member of Parliament (NCMP) Hazel Poa (Poa) have asked Senior Minister of State for Health Koh Poh Koon (Koh) a series of questions with regards to this lapse.
While it is reassuring to hear that reviews are underway to investigate how the failures occurred and to see how the current processes can be improved upon and strengthened, some of Koh’s answers will no doubt raise some eyebrows.
The first answer that may cause disquiet relates to the issue of patient redress. When quizzed about whether affected patients will be compensated for psychological effects caused by the unnecessary treatment by Pereira, Koh made it clear that this was not being considered.
Koh said that “the portion of the bills which arose from the unnecessary treatment will be refunded” and that KTPH was “ready to provide clinical and financial support for the affected patients including ongoing and follow on treatments”.
When Poa asked if a lifetime of free healthcare was being considered as a form of compensation, Koh flatly rejected the idea stating that “to then say that this translates to a lifetime of compensation… will be a little bit too far to stretch…Most complications, if any, are transient”.
At this point, however, we do not have any public data on exactly how many patients suffered transient effects or how many have more long term effects. Nor do we know how many have suffered or continue to suffer mental health concerns as a result of the anxiety that is being caused by the misdiagnosis.
For example, will they need ongoing counselling as a result of the trauma caused by the misdiagnosis? Or, what if a patient suffers physical effects that require ongoing medical attention? And if so, shouldn’t the costs of these be borne by KTPH?
It is therefore concerning that Koh is so quick to reject the idea of compensation for effects such as anxiety, added stress and physical ailments when these symptoms whether physical, mental or emotional would never have presented but for the misdiagnosis and unnecessary treatment in the first place?
By Koh’s own admission, the mistaken diagnosis could have caused “a lot more anxiety and maybe a few more extra visits to monitor side effects”. Koh also said that “3 to 4 per cent” of those given Herceptin “may experience heart problems”.
With this in mind, how can a simple refund for the portion of the bill that was the hospital’s fault in the first place be considered sufficient by any yardstick?
Shouldn’t there be an element of basic compensation built in to reflect and acknowledge the harm that has been inflicted on the affected patients whether short term or long term (with the patients with long term effects getting more)?
In other words, shouldn’t misdiagnosed patients be paid damages in lieu of the anxiety, stress and physical side effects of the unnecessary treatment. Simply refunding them the cost of the treatment they did not need in the first place does not alleviate any of the stress or physical side effects that were needlessly inflicted on a patient.
To add insult to injury, Koh said that “it is not necessarily a bad thing” to be diagnosed as HER-2 positive when you are HER-2 negative because overtreatment is “a preferred state” to “under-treatment” especially when one has cancer.
This, however, totally misses the point. The point here is that people have had to endure unnecessary anxiety and needless physical symptoms such as chills, diarrhoea and/or heart problems directly as a result of hospital error. It isn’t a philosophical exercise into what Koh arbitrarily considers “preferred”.
This is a serious lapse on the part of KTPH which requires proper compensation to the victims of the misdiagnosis. A refund of the part of the bill that wasn’t necessary in the first place does not quite cut it.