At least 200 breast cancer patients at the Khoo Teck Puat Hospital (KTPH) were reportedly wrongly diagnosed with a more aggressive form of the disease that they actually had.
Some of the patients were consequently given unnecessary treatments that had likely cost each of them tens of thousands of dollars.
Following that, Senior Minister of State for Health Koh Poh Koon said in Parliament on Monday (4 January) that the amount charged for the unnecessary treatments will be refunded to the affected patients.
“The portion of the bills which arose from the unnecessary treatment will be fully refunded,” said Dr Koh, adding that the refunds will likely total millions of dollars.
On 11 December last year, the KTPH revealed that about 180 patients had been wrongly diagnosed with HER-2 positive breast cancer, a less common form of breast cancer and normally affects 15-20 percent of such patients.
It added that it was also reviewing test done since 2012.
In order to treat this particular form of cancer, there are a number of drugs used, and the first and most commonly used one is Herceptin.
During Monday’s Parliament session, several MPs asked on side effects patients may have suffered.
Dr Koh responded that among the common side effects are diarrhoea, chills and fatigue.
About 3-4 per cent of patients may suffer from heart problems.
Dr Koh added that doctors are getting in touch with affected patients so they will be able to help them and assess any side effects caused by the drug.
MP Cheryl Chan (East Coast GRC) asked why it took such a long time for the error to be detected.
As a reply, Dr Koh said that 6 per cent of patients globally are wrongly diagnosed with HER-2 positive breast cancer, adding that the test is extremely complex has no definitive answer.
He went on to explain that a trained pathologist is required to make a judgement on the test result.
However, this could be affected by multiple steps that need human intervention, like the concentration of stains and how the tissue was handled.
Dr Koh added that a fairly large number of results will be required to trigger an alert on the possibility of a disproportionate number of patients being diagnosed with this form of breast cancer.
He also said that “institutional process” was the reason how the mistakes were spotted.
The KTPH’s tumour board flagged the error after it discovered that the number of HER-2 positive cases were higher than usual, leading to the review.
He went on to note that reviews were carried out on patients diagnosed with HER-2 positive breast cancer since 2012 given that it was when the hospital first started doing such tests, and not because errors had occurred then.
Following that, Lim Wee Kiak (Sembawang GRC) and Tan Wu Meng (Jurong GRC) questioned the additional cost incurred by affected patients.
Dr Tan, who is a cancer specialist, suggested that compensation should also include the time taken from work by a patient or caregiver for the unnecessary treatment.
Dr Koh replied that it was difficult to provide a figure since the cost varies for each patient. If that’s not all, he also noted that not all the 200 patients who were wrongly diagnosed were given Herceptin.
The hospital had earlier stated that “about half of these patients may have received unnecessary treatment for HER2, usually the drug Herceptin”.
The Straits Times (ST) reported that Herceptin costs S$3,000 to S$4,000 per cycle in public hospitals, and about S$5,000 in private hospitals.
As for the duration of the treatment, patients are generally treated for a year and undergo 17 to 18 cycles. This means that it will cost a patient an average of S$50,000 to S$70,000 in the public sector.
Eight of the wrongly diagnosed patients were treated in private hospitals.
Over on social media, netizens expressed their anger towards the hospital for making such a big error.
Penning their thoughts in on ST’s Facebook page, they said that it is one thing to wrongly diagnose one or two patients, but it is “unacceptable” when the number is as high as 200.
One user noted that KTPH should be grateful as this happened in Singapore and none of the patients had filed a lawsuit against the hospital for medical negligence.
Others pointed out that a refund an inadequate form of compensation compared to the stress and trauma that the affected patients went through.
They added that the hospital appears to lack empathy, as they did not issue an apology and seems to be offering money to put the case behind the patients.
One user slammed Dr Koh’s response in Parliament and said that he should bear “all the responsibilities that a good doctor should do”.
“Your excuse is way too much for a layman to swallow, you completely show no remorse for your silly mistakes,” the user added.
Another user pointed out that the hospital should also compensate the patients and their families for “unnecessary anxiety, pain, inconvenience”.