Thursday, October 18, 2007

This following account chronicles the development from June’s falling sick to her eventual passing away.

Date & Time

Events

1 July 2005

  • June fell sick and sought treatment for flu and fever

7 July 2005

  • June consulted the general practitioner at the June & Lee Sembawang Family clinic for fever (38.2 deg C), headache and body ache. The doctor prescribed June with medications which included Ponstan, Anarex and Famotidine. She was also given medical leave and advised that to return to see the doctor if any rashes occur or when the fever remains.
  • June’s husband pointed out to the GP that June had already developed rashes on her left hand and neck?

9 July

  • June went back to the same clinic to seek treatment for fever (37.9 deg C) and sore throat. She did not have any rashes.
  • The GP prescribed June with Augmentin (Amolca) and additional amount of Ponstan after diagnosing that she had pharyngitis and fever that had lasted for 3 days. GP had also warned her June to return for consultation should any rash occur.

11 July 2005

  • June’s fever reached 40 degree C and went to see the same GP. The GP advised June to stop taking Augmentin due to the side effect of nausea which June developed.
  • The GP then gave the Voren 50mg intramascular injection as June did not want to take any more medicines for fear of vomiting.
  • In addition, the GP also prescribe June with Dimenate and Zantac tablets to cure her nausea and lessen gastric acidity.
  • Ponstan was also given to serve as standby but June was told not to consume within 8 hours of injection.
  • June did not develop any rash.

12 July 2005, about 3am

  • June’s fever did not subside and her husband brought her to Tan Tock Seng hospital at about 3am.
  • A blood test was made and no dengue fever was diagnosed. However, she had developed rashes.
  • June was examined while seated while the medical officer took a few minutes to conduct the examination.
  • The hospital gave June outpatient treatment and provided a referral letter to the Communicable Disease Centre.

12 July 2005, about 10.30am

  • June spoke to the GP and explain her condition. She also asked for advice on whether she could take Ponstan. The GP prescribed Buscopan and Anarax as substitute for Ponstan as the latter would aggravate June’s gastritis.
  • June did not personally go to collect the prescribed medicine as she was tired. June’s mother went to collect the medicines on her behalf.

12 July 2005, about 5pm

  • June was brought to Tan Tock Seng hospital the second time as her condition worsened. She was weak and unable to walk on her own, and had to be seated on a wheelchair.
  • She waited at the A&E department initially as the hospital did not have enough wards.
  • While seated on a wheelchair, June was examined by the medical officer for a few minutes.
  • She had already developed rashes on the face, neck and hands.
  • She was kept at the holding bay from about 5pm till the early morning.

13 July 2005

  • June developed maculopapular rashes due to the side effects of Augmentin and Ponstan.
  • June was diagnosed by the Infectious Disease Department and she was then started on Vancomycin, Levofloxaxin, Bactrim and Prednisolone. The department had the impression that she had developed the Stevens Johnson syndrome/Erythema Multiforme Major.
  • The dermatologist also saw June and suspected that June had developed Toxic Epidermal Necrolysis.
  • Warded at the TTSH Gastroenterology department

14 July 2005

  • June was transferred to ICU

14 July 200526 July 2005

  • June’s condition deteriorated and required intubation and inotropic support. Subsequently she also developed pneumonia, acute respiratory adult syndrome and disseminated intravascular coagulopathy.
  • She was diagnosed to have contracted Epidermal Necrolysis.
  • She developed two episodes of cardiac arrest on 25 July but responded to CPR and adrenaline infusion.

26 July 2005, 12.45pm

  • Doctor pronounced June dead

27 July 2005

  • The SGH consultant forensic pathologists conducted a post-mortem on June.
  • Her death was certified as cardio-respiratory failure, pending further investigations

30 Sept 2005

  • The final cause of death was certified to be Bronchopneumonia following Toxic Epidermal Necrolysis.

19 Oct 2005

  • The Coroner’s court ruled that it was a verdict of misadventure

14 Nov 2005

  • Filed complaint to Singapore Medical Council (SMC) against the GP who attended to June.

5 May 2006

  • SMC replied that there was no professional misconduct on the part of the GP

1 June 2006

  • Appealed to MOH against SMC’s decision

24 Jul 2006

  • Filed complaint to SMC against the emergency department of Tan Tock Seng Hospital

3 Jan 2007

  • Made statutory declaration as requirement to file the complaint to SMC

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