SINGAPORE — A 51-year-old woman recovering from a brain tumour died after consuming traditional Chinese medicine (TCM) which likely caused her acute liver failure, the State Coroner found.
Shirley Seah's cause of death was certified as massive hepatic necrosis, with a forensic pathologist stating the conclusion by clinicians was that Seah had sustained drug-induced liver injury, likely due to use of TCM.
While it was unclear how the TCM herbs had caused Seah's liver failure, State Coroner Kamala Ponnampalam classified her death on 2 August 2019 as an unfortunate medical misadventure, in findings made available on Monday (31 May).
SC Ponnampalam said that conflicting accounts between witnesses raised the possibility that Seah had consumed the wrong dosage of TCM medication.
Seah had undergone an emergency operation on 15 June 2018 to remove a tumour in her brain, which was later found to be cancerous. The next month, Seah sought cancer treatment from a registered TCM physician. She consumed both Western and TCM medication from July 2018. She continued her TCM prescription until 25 June 2019.
She also started a course of combined chemotherapy and radiation therapy, followed by six cycles of chemotherapy at National Cancer Centre Singapore (NCCS) from August 2018 to March 2019.
The medical report prepared by a senior consultant from NCCS stated that Seah had not informed him about consuming TCM during her consultation with him. Her liver function, which was monitored regularly during the time of her consultations at NCCS, was normal. NCCS prescribed Seah medication during the period.
In May 2019, a magnetic resonance imaging of her brain done showed no recurrence of the tumour.
In July 2019, Seah developed jaundice and was admitted to Khoo Teck Puat Hospital. She was later referred to National University Hospital for a liver transplant surgery but was assessed not suitable for the surgery. Her liver function continued to deteriorate until she died on 2 August 2019.
The TCM physician stated that he had prescribed mild herbs to Seah, and instructed her on how to prepare and when to consume them. He told her to take the herbs and the western medicine four hours apart. Seah appeared to have complied with the instructions.
However, Seah's aunt, who was her caretaker, gave a conflicting account. The aunt said that Seah had been advised by the physician to stop her prescription a week before her radiotherapy and chemotherapy sessions and Seah had complied.
"These conflicting accounts raises the question of which regime Madam Seah had followed. If there was some confusion about the dosage during the cancer treatment, it raises the possibility that the confusion persisted even after her therapy at (NCCS), resulting in possible wrong administration of the herbs or inadvertent overdosing," said SC Ponnampalam.
An expert from the Academy of Chinese Medicine had stated that the herbs prescribed to Seah were routinely used in clinical TCM practice in Singapore.
"The prescription dosage was appropriate and therefore unlikely to affect the liver function if the gap between the intake of western medicine and TCM medication was several hours apart," according to SC Ponnampalam.
The SC said, "It is always important to clearly explain to patients the dosage and use of drugs and medications dispensed. This applies to those in TCM practice as well."
Patients recently recovering from an illness had to be monitored more closely with proper consultation to confirm compliance with prescriptions, and that patients should disclose other medications in order to avoid complications, she added.
Hospitals should consider implementing a protocol compelling disclosure of alternative medical treatments so that the patient can be properly advised to avoid unfortunate outcomes, according to SC Ponnampalam.
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