A jury has ruled the death of a woman with kidney disease who developed serious liver problems after hospital treatment seven years ago was “misadventure” and a coroner told her daughter to channel the love she felt for her mother into “filling the void she has left”.
Coroner Monica Chow Wai-choo was speaking on Tuesday after a five-strong jury voted four to one for a death by misadventure verdict in the case of Tang Kwai-sze, 44, who, also carried hepatitis B, and who died on August 26, 2017 at Queen Mary Hospital after two liver transplants.
“On January 20, 2017 and February 17, 2017, Tang had taken a large dose of steroids, but without the prescription of antiviral drugs at the same time, causing a hepatitis B attack,” Chow said.
Chow singled out Tang’s daughter Michelle Wu and praised her courage for her offer at the time to donate part of her own liver to her mother, as well as for her participation in the inquest.
“You said time will not diminish anything, as your love for your mother will not reduce with time, but I hope that you will use this time to use your love for your mother, or your mother’s love for you, to fill this void she has left,” Chow told Wu.
“Your mother wouldn’t want you to feel this pain because of her absence.”
Chow added that Wu’s strength could help her fill the emotional void left by the tragedy.
“All mothers in the world can tell you, having such a brave, selfless and loving daughter like you … she would’ve been proud of you,” Chow said.
Lam earlier told the Coroner’s Court that he did not prescribe an antiviral drug needed by Tang because of her hepatitis B status when he gave her immunosuppressive steroid drugs because he was “distracted”.
Hong Kong doctor says he did not add to prescription in liver failure death
Hong Kong doctor says he did not add to prescription in liver failure death
Chan said in evidence that he had not prescribed antivirals either, because he had assumed Tang and Lam had “reached a conclusion” about not taking the drug in spite of her steroids treatment.
Both doctors had told the court that they were aware that failure to prescribe an antiviral drug to a hepatitis B patient on large doses of steroids could cause liver failure.
The authority was recommended to categorise patients on large doses of steroids for less than seven days as high risk and to make sure they were also given antiviral drugs.
Hepatitis B carriers, even those without symptoms, should be considered for subsidised regular check-ups at private clinics, the court heard.
Hospitals should also teach patients to be on the alert for symptoms of hepatitis B.
The jury also appealed to doctors to keep clear, legible records that could be easily understood by other doctors and asked that hospital laboratories should have to explain the reasons for cancellations of tests.
Hong Kong doctor in liver patient death case blames being ‘distracted’
Hong Kong doctor in liver patient death case blames being ‘distracted’
Chow directed the jury before they retired to consider their verdict to examine whether the Hospital Authority had sufficient guidelines in place to prevent similar tragedies from happening again.
She highlighted evidence from expert witness Professor Grace Wong Lai-hung of the Chinese University of Hong Kong’s medicine and therapeutics department, who testified that the dosage of steroids used for patients mattered more than the time the drug was taken for in the case of risk of triggering hepatitis B attacks.
The jury was also invited to consider whether chronic hepatitis B patients should receive regular check-ups to monitor their liver function.
Chow also directed the jury to discuss the suggestion that doctors should record their explanation to patients on the major side effects of drugs they were prescribed.
She added the jurors should also consider the need for better education on the symptoms of hepatitis B flare-ups and whether doctors should tell families about medical errors.
“In Tang’s case, it had been reported through the Advanced Incident Reporting System, but Wu thought that no one from the hospital had told them why the liver had failed, until the family had asked why she had entered the hospital for a kidney problem, but ended up having liver failure and needing a transplant,” Chow said.
