Anaesthetist who left patient during operation to take phone calls suspended 2½ years

An anaesthetist who walked out of the operating theatre several times to take calls from other patients while another in his care was undergoing surgery has been suspended for 2½ years, the Singapore Medical Council said on Tuesday.

During the operation in 2016, the patient suffered a complication when a blood clot blocked oxygen from his lungs, an event known as a pulmonary embolism. He was successfully resuscitated by a team of doctors, but died the following day.

The Singapore Medical Council’s disciplinary tribunal said the patient’s chances of surviving the embolism was very low. But that chance may have been further lowered by Dr Islam Md Towfique’s delay in recognising the changes in the patient’s vital signs and consequent delay in taking action.

Dr Islam told the tribunal it was common practice for anaesthetists to leave the operating theatre for short periods of time.

The patient, 64, had surgery performed at Gleneagles Hospital on a fracture caused by his bone marrow cancer on Sept 1, 2016. Given his age, obesity, prior heart problems and cancer, he was “considered a high anaesthetic risk patient”, said the tribunal.

During the operation, his oxygen reading fell below 90 per cent, “into the 80s and 70s”. In a normal person, the SpO2 or the amount of oxygen the blood can carry should be in the range of 96-99 per cent. Despite that, the oxygen given to the patient was not increased.

The hospital’s parent company, Parkway Pantai ltd, pointed out in a letter to Dr Islam, “Increasing the oxygen delivery is one of the first few actions that an anaesthetist should initiate when a patient’s SpO2 falls, and yet for almost 50 minutes, with the SpO2 either un-recordable or in an unacceptable range, this remedial action was not taken.”

In his defence, Dr Islam, a veteran doctor, said: “I was with the patient and did apply my expertise to keep the Haemodynamics but I forgot to increase the oxygen to 100 per cent.”

Parkway suspended him for six months in 2017, and reported the incident to the SMC.

The expert for the SMC, which was the prosecuting body, said things can go wrong very quickly “so we need to be there … there’s not at any point … that it’s safe for an anaesthetist to leave the patient.”

He added that “all you need is less than a minute for things to go wrong”.

The tribunal agreed with the prosecution that the potential harm to the patient from Dr Islam’s multiple departures from the operating theatre “would be serious injury or even death”.

According to the hospital CCTV in the corridor outside the operating theatre, Dr Islam left the operating theatre “multiple times”. The longest period he was gone was nine minutes.

Aside from those times, Dr Islam also went several times to the adjoining induction room, but these were not recorded by the CCTV.

Dr Islam had argued that there was nothing wrong with his leaving the operating theatre for short periods as this “behaviour would not be that different from that of his other anaesthetic colleagues”.

The surgeon who had carried out the operation and who gave evidence on behalf of Dr Islam at the hearing, said the anaesthetist has continued to leave the operating theatre to take phone calls.

The tribunal rejected Dr Islam’s contention that the harm caused by his behaviour was minimal, as the prospect of surviving the blockage to the lung was minimal.

It said such a defence “would lead to an illogical outcome where a doctor treating a patient whose condition makes the prospects of survival low, is able to take less care, because the chances of survival were small in any event”.

The tribunal also agreed with the SMC that such misconduct “causes significant harm to public confidence in the medical profession and the healthcare system.

“The respondent’s conduct in repeatedly leaving the operating theatre to attend to phone calls which he acknowledged were not urgent, would shock the public and harm public confidence in the medical profession.”

It also disagreed with Dr Islam’s claim that his conduct was not motivated by financial gain.

Most of the calls were from patients both overseas and local, wanting to know when they could come for treatment, so he “was simply servicing other patients who would be paying his fees after coming to Singapore for treatment”.

Dr Islam also asked for a one-third reduction of his sentence, given the long time it has taken for the case to be heard.

But given that he has continued the practice of accepting calls in the midst of surgery, the tribunal said a one-sixth reduction was more appropriate.

It reduced his 36-month suspension to 30 months. He also has to pay the costs and expenses of the proceedings, including the cost of SMC’s lawyers, and undertake to refrain from such conduct in the future.