Timeline of interaction between Dr Ang Peng Tiam and the patient

Dr Ang Peng Tiam of Parkway Cancer Centre has been given an eight-month suspension in lieu of a $25,000 fine.
Dr Ang Peng Tiam of Parkway Cancer Centre has been given an eight-month suspension in lieu of a $25,000 fine. PHOTO: PARKWAY CANCER CENTRE

SINGAPORE - The Singapore Medical Council disciplinary tribunal held an inquiry on Dr Ang Peng Tiam. This is what they found:

March 30, 2010: When the patient, together with her family, first consults Dr Ang, he orders that she undergo three tests: blood tests, an MRI of the brain, and a PET-CT scan. The MRI does not show any metastatic disease in the brain, but the PET-CT scan reveals a large mass in the upper lobe of the patient's right lung. Dr Ang explains that a biopsy is required to confirm whether the mass is cancerous.

April 1, 2010: They attend another consultation with Dr Ang, who confirms that the mass is cancerous and explains, in Mandarin, that there is at least a "70 per cent" chance that the disease will respond to treatment and achieve control with chemotherapy and/or targeted therapy. This is based on four factors - the patient is a Chinese female, has never smoked, and has adenocarcinoma, a type of cancer. Dr Ang notes this down in a memo and the patient's husband makes a recording of the doctor's explanation.

April to June 2010: The patient undergoes her first round of chemotherapy using the drugs gemcitabine and cisplatin together, with an alternate day dosage of Iressa, at 250mg per dose.

June 2, 2010: The patient undergoes another PET-CT scan and has a consultation with Dr Ang the next day. He informs the patient and her family that the chemotherapy does not seem to have worked well.

June to Aug 2010: Dr Ang recommends that the patient undergo a second round of chemotherapy, this time using drugs taxotere and cisplatin together, and an alternate dosage of Iressa at 250mg per dose.

 

Aug 5, 2010: The patient undergoes a third PET-CT scan, and is told that the cancer has progressed and spread to other parts of her body. Dr Ang decides that the patient should take a break to recuperate from the side effects of chemotherapy. A third round of treatment, using intravenous Zometa and Tarceva, commences after discussions.

Aug 26, 2010: The patient consults Dr Ang, complaining of giddiness. He informs her that a blood transfusion is required and makes the necessary arrangements with a hospital to do it the next day.

Sept 3, 2010: The patient visits the clinic, complaining of numbness in her right hand and leg. Dr Ang is on leave and she is attended to by a medical oncology specialist present.

Sept 5, 2010: Dr Ang and a radiation oncology specialist review the patient, separately. Both recommend that she undergo radiotherapy. This commences the next day.

Sept 22, 2010: The patient sees Dr Ang after noticing blood in her urine. He makes a provisional diagnosis of urinary tract infection and prescribes, among other things, oral ciprofloxacin 500mg.

Sept 26 to 27, 2010: The patient's condition deteriorates severely and she is taken to a hospital's accident and emergency department to be admitted. A CT scan shows that the cancer has progressed to the patient's lungs, liver and pancreas. Dr Ang informs her family that the treatment has not worked and refers them to a specialist in palliative medicine.

Oct 2, 2010: The patient dies.