SINGAPORE: An elderly woman was recovering in hospital after surgery for a broken leg when she fell and fractured the other.
Madam Pappa Veeramuthu, 80, then sued the National University Health Services Group (NUHSG), which manages Jurong Community Hospital, for damages.
She said the hospital and its employees were negligent and breached their duty of care, by not helping her to move from a chair to a bed.
A district court earlier dismissed Mdm Pappa’s claim, but the High Court on Wednesday (Mar 29) allowed her appeal against the dismissal.
Justice Hri Kumar Nair found that there was a breach of duty of care owed to Mdm Pappa, by leaving her in the chair and failing to move her to the bed despite knowing she was suffering back pain.
This breach set the stage for Mdm Pappa to fall and suffer loss.
However, the issue of whether Mdm Pappa herself was responsible to a certain degree – as she chose to walk on her own – will be determined in a later hearing.
THE CASE
Mdm Pappa was admitted to Ng Teng Fong General Hospital in March 2017 after fracturing her right thigh in a fall at home.
She underwent surgery and was assessed as a patient at risk of falling.
She was then transferred to Jurong Community Hospital and placed in a single-bed isolation ward after developing an infection.
Mdm Pappa’s only means of communicating with nursing staff was via an emergency call bell.
On the morning of Apr 10, 2017, Mdm Pappa was served breakfast by a patient care assistant before staff nurse Hou Wenfeng gave her medication. She was left alone in the room after that.
Mdm Pappa said Ms Hou had left the room without checking if the bell was within the patient’s reach.
Mdm Pappa said she then felt “immense and unbearable” pain in her back but could not reach the bell. She tried shouting for help but no one responded.
A few minutes after, as she did not know when a nurse would return, she decided to try and get out of a chair she was sitting in, and move to the bed on her own. She fell.
Mdm Pappa then crawled to the bed where she pressed the bell. She was eventually carried to the bed.
But her left femur was fractured and she had to undergo surgery again.
Mdm Pappa was then transferred to another hospital for rehabilitation.
She said Jurong Community Hospital and its employees had failed to ensure proper and effective supervision and regular monitoring, to make sure she was comfortable and not in pain.
She also said the hospital and its employees failed to know that she would not have been able to sit in the chair for a prolonged period of time, without feeling pain.
She attributed her fall to their failures.
NUHSG’S CASE
NUHSG said Mdm Pappa’s breakfast had been served while she was seated on the bed.
Lawyers for NUHSG said she must have made her own way from the bed to the chair.
Ms Hou had seen Mdm Pappa seated in the chair when she entered the room, and left her there as she appeared comfortable.
NUHSG argued that the bell was within Mdm Pappa’s reach, but she had tried to move to the bed on her own instead of asking for help.
The lawyers said Mdm Pappa was contributorily negligent in her actions.
JUDGE’S FINDINGS
Justice Nair found that the district judge who dismissed Mdm Pappa’s claim had erred, in concluding that the elderly woman was able to walk at the time.
Mdm Pappa had testified during her trial that she was unable to walk on her own, and this was not challenged. It was also not put to her that she had made her own way from the bed to the chair.
The district judge had relied on the patient care assistant’s evidence that Mdm Pappa was on “minimum assistance” at the time, meaning she could “transfer but not stable”.
But Justice Nair said this evidence should have been given very little weight. In fact, the day of the incident was the assistant’s first day at the ward, and her first time looking after Mdm Pappa.
The chair that Mdm Pappa was sitting on was also meant for visitors. This should not have been allowed, and NUHSG owed a standard of care to Mdm Pappa by ensuring she was seated on a geriatric chair instead, said Justice Nair.
As she was recovering from surgery and sitting on an unsuitable chair – for the first time – there was a reasonably foreseeable risk that she would suffer discomfort or pain, or not be adequately supported.
The judge noted that the hospital’s “pain score” records were “highly unsatisfactory and unreliable”.
Ms Hou, the staff nurse, had recorded Mdm Pappa’s pain score as “0” just a few minutes after she fell and broke her femur and was crying in pain.
Justice Nair said it was unclear how the assessment was even done, as Mdm Pappa spoke only Tamil while the nurses did not.
He found that Ms Hou had allowed Mdm Pappa to continue sitting on the visitor’s chair despite being informed of Mdm Pappa’s pain.
The bell was also not within reach as NUHSG claimed, and it had thus breached its duty of care owed to Mdm Pappa.
“The evidence suggests that but for the respondent allowing Mdm Pappa to remain seated in the visitor’s chair and failing to ensure that the bell was within her reach, Mdm Pappa would not have suffered the fall,” said Justice Nair.
“However, the issue of whether Mdm Pappa is to some, if any, degree responsible by choosing to attempt self-ambulation, goes to the issue of contributory negligence.”
He said he would hear parties separately on this issue, as well as on costs.
The matter of damages will be dealt with at a later date.