Medical blunders

Antiviral drugs not given to Hong Kong patient in latest hospital blunder

Cancer and hepatitis B sufferer in serious condition two months after similar case came to light

PUBLISHED : Thursday, 13 July, 2017, 7:15am
UPDATED : Thursday, 13 July, 2017, 11:15am

An elderly cancer patient and chronic hepatitis B carrier is seriously ill after doctors forgot to prescribe antiviral drugs for her liver condition in yet another public hospital blunder.

The incident at Hong Kong’s Queen Mary Hospital was revealed on Wednesday, two months after the high-profile case of 43-year-old Tang Kwai-sze, who was the victim of a similar blunder.

She had to undergo transplant surgery twice in April after suffering from acute liver failure, as doctors failed to administer antiviral drugs to prevent side effects when treating her kidney problem with high doses of steroids. She is still in a critical condition.

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In the latest case, the 81-year-old cancer patient was found to have an elevated level of liver enzymes, indicating a risk of potential liver damage, in a blood test ahead of a hospital appointment scheduled for July 3. She was urgently admitted on June 30.

The patient was still in a serious condition on Wednesday, but was said to be conscious and had not suffered liver failure.

A preliminary review found that antiviral drugs to treat her for hepatitis B were not prescribed in three consultations between May last year, when she completed her chemotherapy, and March this year.

According to medical guideline, cancer patients who are hepatitis B carriers have to take antiviral drugs during and after chemotherapy.

Three doctors were said to have been involved in the blunder. The elderly patient has now been prescribed the drugs.

Queen Mary Hospital said it was “very concerned” and had reported the blunder to the Hospital Authority on July 8, listing it as a “serious untoward event”. The categorisation includes cases of death or permanent injury linked to medication error or patient misidentification.

An investigation panel will determine what went wrong and submit a report to the authority in eight weeks.

The hospital met the patient’s family members on Tuesday to tell them what happened.

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The authority also reminded frontline medical staff on Wednesday to follow the latest guidelines requiring prescription of antiviral drugs to patients infected with hepatitis B when treating them with immunosuppressive therapy, such as chemotherapy or high steroid doses.

The guidelines were first released on May 12 and updated on July 1.

The latest blunder came after an investigation report on Tang’s case recommended medical staff should maintain a “high level of vigilance” when treating hepatitis B carriers with therapy that could suppress their immune system.

Dr Angus Leung Kwong-chuen, a specialist in clinical oncology, said it was common practice to prescribe antiviral drugs to patients with hepatitis B after chemotherapy.

“The drug is usually prescribed for three to six months after completing chemotherapy,” Leung said.

Patients’ rights advocate Tim Pang Hung-cheong said: “Doctors [in this case] were not vigilant enough when prescribing drugs.”