Singapore

Hep C not main cause of designer's death

Coroner's inquest into hepatitis C-related death

A 64-year-old man who had undergone a kidney transplant and was a cancer survivor died a few days after a procedure to drain fluid accumulated in his abdominal cavity, a coroner's inquest heard.

Freelance designer Alan Kong Ban Huat was later found to have sepsis. He suffered from a clotting disorder (coagulapathy) and had contracted hepatitis C while warded at Singapore General Hospital (SGH).

He is one of seven people identified by a Ministry of Health-convened independent review committee in which hepatitis C, likely acquired at SGH, was identified as a likely "contributary" factor in their deaths.

In Mr Kong's case, senior consultant forensic pathologist, Dr Paul Chui, found he had died primarily because of a surgical injury caused by a physician or during therapy - rather than from contracting hepatitis C.

Mr Kong suffered from several medical conditions, including hypertension, post-transplant diabetes mellitus and osteoporosis.

He was first admitted to SGH on May 16, 2015, with fungal infection in the lower limb tissue. When he was admitted a second time in June 2015, he was found to have ascites, an accumulation of fluid in the abdomen. He also had bleeding in the liver, kidney cysts and hepatitis C, and was suspected to have had an infection, resulting in sepsis.

On June 25, the day after a procedure to drain the abdominal fluid, he collapsed and had to be resuscitated due to low blood pressure and haemaglobin levels. Despite intervention, Mr Kong remained critically ill and died on June 29.

In his findings, State Coroner Marvin Bay said there was no basis to suspect foul play. While hepatitis C was among Mr Kong's maladies, he said it was not the main cause of death. Fungal sepsis resulted in Mr Kong's multiple organ failure and he had suffered massive internal bleeding consistent with vascular damage that was further complicated by his clotting disorder.

Mr Kong's death was caused by "traumatic damage" that occurred during the procedure to drain abdominal fluid. The coroner found the death to be the result of an "unfortunate medical misadventure".

SGH has since put in place a series of measures to minimise the risk of hepatitis C transmissions. They include a mandatory annual online competency assessment for all clinical staff; daily audits on safe injection practices, compliance with hand and environmental hygiene; and the use of multi-dose vials for injection has been discontinued since June 29, 2015.

The hospital has also improved its system of pathogen surveillance and created a nerve centre to strengthen its response to possible outbreaks.

Kidney FailureCoroner's InquiryTRANSPLANT