SINGAPORE - The Singapore General Hospital said Ms Sarina Kaur's complications following a procedure at the hospital in 2012 "could possibly be the result of her multiple underlying conditions".
Ms Kaur, 51, is suing Singapore General Hospital (SGH) and two of its doctors for negligence that resulted in her losing her legs at the knees, her right arm and left hand.
She claims that the doctor went ahead with a procedure, even when tests showed she had an infection, which subsequently led to blood poisoning and the loss of her limbs.
She had been diagnosed with multiple sclerosis about 25 years ago and has been on long-term treatment at SGH.
Around 2008, she was diagnosed with vesico-ureteric reflux, a condition where her urine would flow back from the bladder to her kidney. She also had recurrent urinary tract infection.
In 2012, she was referred to Dr Ng Lay Guat, who was head of urology at SGH, for treatment.
Dr Ng recommended a deflux procedure. The statement of claim filed with the High Court on Wednesday said Dr Ng had told Ms Kaur that the procedure "was simple, straightforward and low-risk".
The procedure was scheduled for November 20, 2012.
Pre-admission test results, available on Nov 17, showed Ms Kaur's urine had multi-resistant Escherichia Coli bacteria. Ms Kaur is arguing that Dr Ng should have treated the infection before doing the procedure, which could have been postponed.
Instead, Dr Ng gave Ms Kaur an injection of a broad-spectrum antibiotic before the treatment, with instructions for a daily dose starting the day after the procedure.
But on the night of the procedure, Ms Kaur developed high fever of 38.7 degree Celsius.
Dr Du Jingzeng, the medical officer on duty, diagnosed "likely sepsis" or blood poisoning, but did not call in a more senior doctor.
The next morning, during ward rounds, Dr Ng and her team did an ultrasound scan and found Ms Kaur's right kidney was swollen.
The court papers said they did not, "in accordance with standard management" relieve the swelling and/or obstruction in the kidney, drain the infected urine, or effectively treat the infection.
Later that day, Ms Kaur's fever rose to 39.3 degrees Celsius. That evening she was in "severe septic shock" and she was moved to intensive care.
Over the next several days, Ms Kaur "developed multiple and critical complications" including respiratory distress, multiorgan failure and gangrene in all four limbs.
As a result, all her limbs had to be amputated.
On Dec 1, both legs were cut off at the knee.
On Jan 7, 2013, both hands were amputated.
On Jan 31, the lower right forearm had to be cut off.
On Oct 11 and Dec 3, further treatment was needed to remove dead tissue on her left forearm stump.
A report from orthopaedic surgeon Lee Soon Tai at the end of last month stated: "The absence of wrist/hands and legs/feet deterred Sarina from carrying out her daily self-care and physical activities. She relied on her domestic helper to do the simplest things".
Yesterday, Professor London Lucien Ooi, who chairs the Division of Surgery at SGH, said: "Whilst a positive urine culture result indicates the presence of bacteria in the urine, in the absence of other symptoms, it is not conclusive of an infection."
He added that Ms Kaur had been given an antibiotic that the bacteria was sensitive to, "to cover any possible infection".
"She developed a serious complication of septic shock following a routine procedure. This could possibly be the result of her multiple underlying conditions," the statement said.
Prof Ooi said Ms Kaur's doctor had her best interests in mind when the decision was made to proceed with the procedure under suitable antibiotic cover, given the urine culture result but with no symptoms of infection.
"Whilst a positive urine culture result indicates the presence of bacteria in the urine, in the absence of other symptoms, it is not conclusive of an infection. It does not preclude the decision to continue with the procedure provided that proper consideration has been taken based on the underlying conditions of the patient, and with appropriate steps taken to minimise the risk.
In Ms Kaur's case, the urine culture had identified the particular bacterium, and a treating dose of antibiotic which the bacterium was sensitive to was prescribed to cover any possible infection."
He added: "We have given Ms Kaur our full support throughout her treatment as we understand that the complication has been devastating for her and her family.
Her well-being remains our priority, and we are committed to providing her with continued appropriate care."
In a statement, Prof Ooi apologised, saying the hospital is "sorry" for what Ms Kaur went through.
The pre-trial hearing is scheduled for December 17