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Patient’s death referred to Hong Kong coroner, botched eye procedures under investigation

South China Morning Post logo South China Morning Post 17/10/2020 Christy Leung and Elizabeth Cheung
The Hospital Authority has apologised for two blunders made during eye procedures. Photo: Felix Wong © SCMP The Hospital Authority has apologised for two blunders made during eye procedures. Photo: Felix Wong

The death of a hospital patient with abnormally high potassium levels has been referred to the coroner after the care he received was found to be inadequate, as two more medical blunders involving eye laser procedures were revealed on Saturday.

Investigation panels will be set up by Pamela Youde Nethersole Eastern Hospital in Chai Wan, the location of the death and one of the bungled eye procedures, and Alice Ho Miu Ling Nethersole Hospital in Tai Po, where the other medical mistake was made.

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The deceased patient, an 83-year-old man with lymphoma, was admitted to Eastern Hospital on September 30 due to shortness of breath.

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Five days later, he was sent to the public hospital's intensive care unit after suffering acute respiratory failure. During his time at the unit, he was given medication for hyperkalemia, a condition where the levels of potassium in the body are unusually high.

The man was transferred to the medical ward after his condition stabilised on Wednesday, but he required monitoring and treatment for his potassium condition. During his stay, blood tests were performed, which detected repeatedly high levels of potassium.

He was found unconscious without a pulse early on Thursday evening by an ICU nurse during a follow-up ward round. Resuscitation was performed but the man later died.

"An initial review has suggested room for improvements in the monitoring and treatment of hyperkalemia for the patient," a statement from the hospital read.

The case has been reported to the coroner for further investigation, while a panel formed by the hospital is expected to submit a report in eight weeks.

According to the American Heart Association, hyperkalemia can lead to fatal cardiac arrhythmia, which relates to the abnormal beating of the heart.

a large city landscape: Two of the incidents under review took place Pamela Youde Nethersole Eastern Hospital in Chai Wan. Photo: Martin Chan © Provided by South China Morning Post Two of the incidents under review took place Pamela Youde Nethersole Eastern Hospital in Chai Wan. Photo: Martin Chan

The Hospital Authority on Saturday also apologised for two blunders involving laser ophthalmology procedures.

One of the patients suffered slightly impaired vision after receiving higher levels of laser energy than planned, while a doctor operated on the wrong eye of another.

The authority said in a statement that investigation reports on the two cases would be ready within eight weeks.

The first case involved a patient who went to the hospital in Tai Po for macular laser treatment on Monday. During the procedure, the doctor noticed the degree of laser energy output was higher than intended and discovered a deviation in the setting of the micropulse laser instrument, a device used for the procedure.

The doctor readjusted the laser instrument setting to the appropriate energy level immediately and the procedure resumed.

"The patient was seen again on Wednesday and examination revealed that the patient's macular edema had increased and vision was slightly impaired," the statement continued, referring to the increase in build-up of fluid in the macula, an area in the centre of the retina.

Treatment was provided accordingly while another follow-up examination would be arranged.

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Another incident involved a patient attending a macular grid laser therapy in Eastern Hospital on Monday. Two nurses made a marking next to the outer corner of the patient's left eye and instilled two doses of prescribed medication.

However, the procedure was performed on the patient's right eye by the doctor. No issues of discomfort were raised by the patient, the authority said, but the doctor later realised the error and immediately stopped the procedure.

The equipment was readjusted and the procedure was carried out uneventfully to the patient's left eye.

The authority said the hospital had arranged a follow-up appointment, adding that the clinical teams would continue to stay in close communication with the two patients and provide support as necessary.

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