Sequence of Events and Clinical Development   

 

My association with the doctor began on 23th June 2008 after I fractured my wrist. He was recommended to me by a friend. Despite the high cost of his medical services, I sought him out as my primary doctor to assist in my healing. This was because my insurance company MSIG provided compensation for my medical expense up to one month after the injury. 

 

On Monday, 6th October 2008, I visited the doctor's clinic to follow up on the condition of my fractured arm which he had operated upon on 24th June 2008. The doctor told me that I have osteoporosis and suggested that I should take an injection of a medical product. According to the doctor, the medication would last me for a year and cost me S$1,500. Apart from that, the doctor did not elaborate on the medication, obliterating as well any information on the name or warnings of side effects which may be caused by the medication. Furthermore, he did not convey that any blood tests should be undertaken. I was not asked to read through or sign any document that would inform me more about the medication. Trusting the doctor's medical judgment and professionalism, I was led to believe that the doctor would have my interest as a patient at heart and provide me with the necessary medical treatment. As a result, I decided to heed his advice despite the hefty cost of the injection. On this day 6th Oct., the medication I received from the doctor’s clinic is

ULTRACET 375MG/Cap.    (see Appendix 1A)

 

On the next day, Tuesday 7th October 2008, I visited the clinic again for the injection. the doctor advised me to drink 2 cups of water and take 2 Panadol pills. After the injection administered by the doctor, I was directed to the clinic receptionist, Margaret. It was only through her that I learned that I should take two Panadol pills every eight hours after the injection. Since the doctor had not told me that there would be any side effects I should be concerned about for which the Panadol pills were prescribed, I asked for an explanation on why it was necessary to take the pills. However, I was told to just do as I was told. The only medication I received after the injection was a box of Panadol. Later, after going home, it was from the receipt that my husband realized that I had just been injected with ACLASTA 5MG/100ML.   (see Appendix 1B) 

 

Next day morning, Wednesday, 8th of October, I experienced sharp pain throughout my limbs, chest, heart and waist. My face also became swollen. Rashes also appeared throughout my body and I felt extremely itchy.  I called up the clinic to ask for the doctor’s advice but was told by Margaret that he had gone overseas and would be back by the 20th of October. Margaret did not direct me to any other medical personnel, she just instructed me to take Panadols again to ease the pain. 

  

On Thursday, 9th of October, my head and limbs started to feel numb and sensations similar to those of slight electric shocks started to go through my body. On Friday morning, 10th of October, my condition had worsened. Those feelings of numbness had got stronger, my head started to shake involuntary and there were tingling sensations around my mouth. I called up the clinic again and related my condition to a receptionist by the name of   Doris. Despite the urgency of my call, she failed to direct me to any medical personnel who could explain the symptoms and offer me any medical advice. Doris said she would get representatives from the drug company to talk to me. After some time, Margaret called me back and said nobody else showed such symptoms except for me. She said she was willing to refer me to a neurologist 3 days later, on the coming Monday (13th   October). Later when I called them back, I was told by Doris  that I would not be able to talk to the representatives of the drug company.  

      

By the evening of Friday Oct 10th, around 9pm, my condition had severely worsened. My whole body started to feel numb, my heart began to tense up, breathing became difficult and I went into a spasm. My husband immediately sent me to the A&E department of Mount Elizabeth hospital. The doctor on duty thought my condition was due to hypertension. After he saw rashes over my body, he diagnosed that I was having an allergy and immediately gave me an injection to stabilize my condition.    However, my condition persisted even after some time. 

 

At that time, my husband told the doctor on duty about the ACLASTA injection I had recently taken. The doctor looked it up over the internet. He did a blood test on me at 22:42 hrs, the result of my blood test showed that: 

 

Bicarbonate                 14             (21 - 32 mmol/l ) 

Urea                             20             (2.8 - 7.7 mmol/L) 

Creatinine                 503              (35 - 97 umol/L) 

Calcium                     1.47            (2.10 - 2.6 mmol/L)               (see Appendix 2A) 

 

The doctor explained to my husband that the test indicated hypocalcemia and critical renal condition. He advised me be warded for the night as he feared my condition will worsen when I get home. A nurse told my husband that they were running full house on the normal wards and the only room available was a private ward at $900/per night. Though we found the room rate too costly, we had no choice but to accept given my severe health condition. 

After being warded, I was subsequently referred to Dr. Anthony Hiong, a specialist doctor at Mount Elizabeth Hospital. My husband related to me that upon seeing my condition, Dr. Hiong had specifically asked if the doctor administering ACLASTA performed a blood test prior to the injection. When I said no, Dr. Hiong appeared surprised and kept silent in discretion. 

 

After warning my husband that I was in critical condition, Dr. Hiong immediately instructed the nurses to infuse calcium into my blood until the next day. My condition gradually stabilized over the night. 

 

 

Critical condition persists amid increasing financial concerns 

  

On the next morning, Saturday, 11th October, at 9:08 am, my blood test result showed: 

      

Bicarbonate        14              (21-32 mmol/l) 

Urea                    19.2           (2.8-7.7 mmol/L) 

Creatinine           493             (35-97 umol/L) 

Calcium              1.66           (2.10-2.6 mmol/l)                 (see Appendix 2B) 

 

Nonetheless, Dr Hiong told me that my condition was still very serious and suggested that I remain hospitalized. However, my husband and I decided that the fees were too expensive at the Mt. Elizabeth Hospital, as the total charge for the night was S$2,200. I decide to check out and seek help from our family doctor, Dr Alfred Loh of Singapore Raffles Hospital. 

 

On Wednesday, 15th   October, my husband and I met with Dr Loh. He put me through a series of medical tests. After a while, a nurse came and said that the doctor had decided that I should be hospitalized after viewing the results of my blood tests. 

    

My blood test results stated the following: 

  

Bicarbonate          17            mmol/l        (21 – 32 mmol/l) 

Urea                       144          mg/dl         (10 – 50 mg/dl) 

Creatinine              5.46       mg/dl          (0.50 – 1.6 mg/dl) 

Calcium                  6.0         mg/dl          (8.8 – 10.2 mg/dl)        (see Appendix 3A) 

 

After being warded, Dr. Ekachai Danpanich, a nephrologist, was referred to me. He said that my kidneys were in a critical condition and I was also suffering from hypocalcemia. My calcium deficiency still persisted and I was again infused with ‘calcium’ in addition to oral calcium supplements. On 20th October at 9:31 am my blood test results revealed:

  

Bicarbonate              18              (21-32 mmol/l) 

Urea                       101               (10-50 mg/dl)   

Creatinine              5.41              (0.50-1.60 mg/dl) 

Calcium                 8.1                (8.8-10.2 mg/dl)                  (see Appendix 3B) 

 

 

I was told by Dr. Ekachai Danpanich MD that the possibility of permanent dialysis was very high and I might have to plan for a renal replacement therapy should my renal function continue its deterioration. At this point, my hospital fees had accumulated to around $14,000. Despite Dr. Danpanich’s concern, my husband and I decided that I should be discharged due to financial considerations. 

 

On Tuesday, 4th November, I returned to the hospital for a review of my condition. The blood test showed: 

 

Bicarbonate        20            (21 – 32 mmol/l) 
Urea                    155          (10 – 50 mg/dl) 
Creatinine          5.96            (0.50 – 1.60 mg/dl) 
Calcium              8.2            (8.8 – 10.2 mg/dl)                 (see Appendix 3C) 

Due to financial considerations, Dr. Ekachai Danpanich advised that I should visit a nephrologist at a restructured hospital for further review and treatment of renal replacement or dialysis. (see Appendix 3D1, Appendix 3D2) 

On 14th to 17th November, I was hospitalized at Singapore General Hospital (SGH). The clinical diagnosis was ACUTE RENAL FAILURE. (see Appendix 4A)

 

 

The ultrasound on my kidneys showed that it measures 8.2cm on the right and 8.4cm on the left. (see Appendix 4B) 

 

 

On the day I was discharged 17th Nov., the Creatinine Clearance Test showed: 

 

Creatinine serum                         520           (40-85 UMOL/L)  

Creatinine clearance                  10             (70-150 ML/MIN)     (see Appendix 4C) 

  

 

List of Appendices

 

 

(Appendix 1A): Official receipt for consultation and medication by the doctor on 6th October 2008

 

 

(Appendix 1B) Official receipt for administration of Aclasta 5MG/100ML by the doctor on 7 October 2008 

 

(Appendix 2): Blood test result in Singapore Mt Elizabeth Hospital ( 10 – 11 October 2008 ) 

 

(Appendix 3): Blood test result and medical report from Raffles Hospital (15 October – 04 November 2008) 

 

(Appendix 4): Blood test result and medical report from Singapore General Hospital (SGH) (14 - 17  November 2008) 

 

 

 

 

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