A trainee doctor who mistakenly injected an intravenous drug into the spine of a leukaemia patient had never administered both intravenous and intrathecal drugs on the same occasion before the incident, an inquest heard yesterday.
Intrathecal drug delivery is a method of giving medication directly to the spinal cord.
Dr Linda Leung Kam-suet gave Lui Hau-lam an injection of vincristine at Prince of Wales Hospital on June 15, 2007. Lui, 21, died on July 7 from severe neurological damage caused by the chemotherapy drug. Leung tearfully apologised to Lui's parents, Ho Kwok-yee and Lui Kon-man, who were at the Coroner's Court. 'I understand the pain of losing someone you love the most. I also know that it had a huge impact on you both,' she said.
A nurse had told Leung that Lui Hau-lam was waiting for an intrathecal injection, she said. According to Dr Kenny Lei Ieng-kit's prescription, Leung had to administer vincristine intravenously and cytarabine intrathecally. Intravenous drugs are sent to doctors in syringes, while doctors prepare intrathecal drugs themselves. But Leung said that the difference in packaging did not ring a bell at the time.'I was concentrating on the sterility of the syringe [containing vincristine]. I had my mind set on intrathecal injections. There were two drugs on the one-page prescription,' she said.
Leung recalled thinking it was strange that the pharmacy had sent up a syringe that appeared to be unsterilised. But a nurse had told her that a doctor had the same medication for the patient the last time.
Leung transferred the vincristine into a sterile syringe and began a lumbar puncture on Lui. She injected cytarabine, followed by vincristine.