Doctor at Yishun clinic who performed CPR on seated patient gets three-month suspension

SINGAPORE - A doctor at a clinic in Yishun who performed cardiopulmonary resuscitation (CPR) on a patient while the 45-year-old man was in a seated position has been suspended from practising medicine for three months.

The patient, who had a long history of severe asthma, was later taken from the clinic to the hospital, where he died seven days later.

Dr Ho Tze Woon, 38, was originally handed a nine-month suspension by a three-member disciplinary tribunal for failing to provide professional services of the quality that was reasonably expected of him.

On Monday, after an appeal by Dr Ho, the Court of Three Judges reduced the suspension period to three months. The court will give its full reasons at a later date.

The Singapore Medical Council (SMC) had brought the disciplinary charge against Dr Ho, saying that a reasonable and competent doctor would have repositioned the patient to a supine position before performing CPR.

Mr Chia Voon Jiet, representing the SMC, argued that CPR should be performed with patients lying on their back on a firm flat surface. He argued that there were no exceptional circumstances that justified Dr Ho’s failure to reposition the patient.

Dr Ho’s lawyer, Mr Amos Cai, said there was no evidence that CPR on a seated patient was entirely ineffective. He argued that in an emergency situation, it was reasonable for Dr Ho to assess that there was not enough space to move the patient into a supine position.

On the night of Jan 14, 2017, the patient visited Central 24-Hr Clinic with a friend, complaining of breathlessness. 

Dr Ho was the locum doctor on duty. At the time, he held a valid basic cardiac life support (BCLS) certification and was qualified to administer CPR. He also had experience with collapse cases in his prior postings at hospitals.

He assessed the patient to be having an asthma attack and instructed a clinic assistant to treat the patient with a nebuliser in an adjacent room. A nebuliser is a small machine that turns liquid medicine into a mist that can be easily inhaled.

While the treatment was being carried out, the patient’s face turned purple. The clinic assistant shouted for Dr Ho, who assessed that the patient, who did not have a pulse and was unconscious, was in cardiac arrest.

Dr Ho began performing CPR on the patient who remained in a sitting position, and told another clinic assistant to call for an ambulance. When the paramedics arrived, they found the patient seated on the chair with a nebuliser mask on and Dr Ho still performing chest compressions.

The patient remained unconscious after he was taken to Khoo Teck Puat Hospital. On the morning of Jan 21, 2017, he was declared brain-dead while still on life support. His cause of death was severe asthma.

On March 10, 2017, the patient’s sister filed a complaint with the SMC alleging that Dr Ho had failed to correctly administer CPR on her brother.

In its grounds of decision issued on Feb 21, 2023, the disciplinary tribunal said members of the public are entitled to expect that a BCLS-trained doctor working in a family clinic would perform the minimum standards expected of him in resuscitation efforts.