21st July 2017
CASE REPORTS FOR 2015
CASE NO. 1
A 56 year old man who sustained an industrial accident when heavy objects fell on him at 4pm on 1/10/2007.
CASE No. 2
A managing director, a medical doctor of a private hospital employed an unregistered doctor as a medical officer for 15 years.
The Health Department visited this hospital and made photostat copies of various documents belonging to the hospital.
The Health Department informed the Ministry of Health. The Ministry of Health informed the Malaysian Medical Council. The Managing Director was asked to attend an Inquiry by the Preliminary Investigation Committee.
The ‘medical officer’ graduated from a non-scheduled medical college. He sat and passed the medical qualifying examination. He was appointed as a house officer. He served only four months of his housemanship. Four years later he was appointed as ‘medical officer’ of the private hospital.
1) The Managing Director has contravened Malaysian Medical Council Code of Professional Conduct Clause 1.4.1 “Employment of Unqualified or Unregistered Persons.”
2) It is MDM’s view that any doctor appearing before the P.I.C. and M.M.C. he must have legal representation. The managing director sought the services of the solicitors on the panel of MDM – at his own expense. MDM does not provide funded legal service to any member who contravenes the M.M.C. Code of Professional Conduct.
3) The managing director was given reprimand by M.M.C.
4) He was very fortunate as he could have been charged under the Private Healthcare Facilities and Services Act 1998 (Act 586) and Regulations & Order, Part VI 31.1(C) and 3 ‘he shall be liable on conviction to a fine not exceeding one hundred thousand ringgit or to imprisonment for a term not exceeding two years or both.’
CASE NO. 3
A 62 year old female with a large septated left ovarian cyst of 20 weeks size, consulted a gynaecologist on 15th April.
PAST MEDICL HISTORY
13 July - admitted for operation of total abdominal hysterectomy and bilateral saphingo-oopherectomy and omentectomy.
- Warfarin was stopped 4 days pre-op. – INR was 1.25 a day before the operation
14 July – Operation performed; findings:
iii) the large left ovarian cyst was densely adherent to the small bowel and the anterior abdominal wall.
vii) TAHBSO and omentectomy were completed.
viii) peritoneal washings were done before the abdominal closure.
POST OPERATIVE PERIOD
Planned for pericardiocentesis and emergency laparotomy to drain the abscess.
The patient’s vital sign deteriorated and the surgical procedures were postponed.
Patient expired on 23 July.
Throughout the postoperative period she was on parenteral antibiotics.
CAUSE OF DEATH: Septicaemic shock.
The deceased’s sons were not happy with the delay in the diagnosis resulting in the death of their mother.
The sons lodged a complaint to the hospital
The gynaecologist received a letter of demand for RM 250,000.00
abdominal surgeon, unless the gynaecologist is trained in abdominal surgery.
to be called in to do the repair. On “opening” the abdomen and seeing the extensive adhesions the
abdominal surgeon should have been called to do the adhesiolysis.
The C.T. Scan was done too late, eight days post-operatively.
A 41 year old man sustained comminuted fractures of the distal radius with fracture of the ulnar styloid and a
disruption of the distal radio-ulnar joint on 30/10/2007.
The comminuted fractures of the distal radius were reduced and fixed with plate and screws. The disrupted distal
radio-ulnar joint was reduced and repaired on 30/10/2007 by an orthopaedic surgeon.
Post-op xrays showed good reduction with a normal radiocarpal joint space with the distal screws close to the radial
On 23/11/2007 the patient returned with pain in the left wrist and swelling. Xrays confirmed that there was early
union and the tip of the 3 distal screws were in the wrist joint. The distal radial ulnar joint was not subluxed. The
patient was offered to have the 3 distal screws re-positioned. He declined and defaulted follow up.
The patient sought treatment at another private hospital where the orthopaedic surgeon removed the 3 distal screws,
manipulated the wrist joint and did a left carpal tunnel release on 28/11/2007.
On 27/11/2008 he sought treatment at a university hospital for severe left wrist pain, numbness on the dorsum of
the left ring and little finger and stiffness of the left fingers and thumb. Clinically he had restricted movements
in the left wrist joint of 10o of palmar flexion and 30o of dorsiflexion in the left wrist joint. There was stiffness in the
joints of all the left fingers. Xray showed degenerative changes of the left wrist joint with disruption of the distal
radial ulnar joint.
At the university hospital the plate was removed, the left wrist was fused, a partial release of the collateral ligaments
of the left fingers and a decompression of the dorsal branch of the left ulnar nerve were done.
Manipulation of the wrist with a comminuted fractures of the radius which have not united is contra indicated; this would have displaced the fractures. A release of the carpal tunnel was definitely not indicated.
ulnar nerve were not indicated for symptoms of RDS (reflex sympathetic dystrophy), which he had.
70 year old man was diagnosed with stage 3 lung cancer (low grade tubopapillary carcinoma with EGFL mutation) by
a physician in November 2012. The physician, Dr. A., referred the patient to an oncologist, Dr. B, for chemotherapy.
The patient was refractory to 4 lines of systemic therapy (Gemcitabine and Cisplatin, Tarceva and Iressa,
Taxotere, and Abraxane)
The patient developed recurrent pleural effusions which required pleural taps by a chest physician, Dr. C.
Throughout the management several C.T. Scans of the lungs were done and these showed progression of the cancer.
The treatment and prognosis was regularly counselled to the relatives of the patient.
Whilst the patient was still in the ward another oncologist, Dr. D., visited the patient in the ward and perused the case
notes and asked the staff nurse to show him the chemotherapy regime prescribed by Dr. B, without the knowledge and
the consent of either Dr. A, Dr. B or Dr. C.
Dr. D. then asked the staff nurse to inform Dr. B. that he was taking over the treatment of the patient. Neither the
patient nor the relatives informed Dr. B of this.
The patient eventually succumbed to the cancer 13 months from the onset.
The daughter wrote a letter of complaint on 24.2.2014 criticising Dr. B’s management to the C.E.O. of the
The letter was very detailed in naming the drugs used, dosages and frequency of administration and duration.
Drs. A, B, and C lodged a complaint to the Chairman of MDAC of the hospital on 5.2.2014 regarding Dr. D’s actions.
This was to protect themselves from a negligence suit.
It is most likely that Dr. D instigated the daughter to write the letter after he attended the MDAC hearing.
1.2. The Practitioner and Requests for Consultation:
Clause: 1.2.2, “The attending practitioner may nominate the practitioner to be consulted, and should
advise accordingly, but he should not refuse to refer to a registered medical practitioner selected by the patient or next of kin.”
1.2.3, “The arrangements for consultation should be made or initiated by the attending
practitioner. The attending practitioner should acquaint his patient of the
approximate expenses which may be involved in specialist consultations and
1.2.4, “It is the duty of the practitioner consulted to avoid any word or action which might
disturb the confidence of the patient in the attending practitioner. Similarly, the
attending practitioner should carefully avoid any remark or suggestion which would
seem to disparage the skill or judgement of the practitioner consulted.”
1.2.5, “The practitioner consulted shall not attempt to secure for himself the care of the
patient seen in consultation. At the end of consultation. At the end of consultation or
further management where mutually agreed upon specifically between the referring
practitioner and the consultant, the patient should be returned to the referring
practitioner with a report including results of investigations and advice on further
care of the patient.”
1.2.6. “The consultant is normally obliged to consult the referring practitioner before other
Consultants are called in.”
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