Death of Chong Yun Jing
On 10 September 1985, 22-year-old Chong Yun Jing, who underwent surgery a few months before due to a brain tumour, died as a result of meningitis, which seemingly was one of the complications of the surgery she received. During investigations however, it was suspected that Chong's medical results of a brain tumour was a misdiagnosis made by Dr Lim Djoe Phing, an Indonesian-born neurosurgeon who conducted the surgery on Chong, given that several medical experts consulted in this case stated that Chong did not actually suffer from a brain tumour all along, and she should not have received surgery in the first place. A coroner's inquiry was conducted in November 1987 to inspect the death of Chong, and after 27 days of deliberation, on 10 June 1988, the coroner's court found Dr Lim criminally responsible of causing Chong's death by negligence, and as a result, in April 1989, Dr Lim was suspended from medical practice for one year, and he was ordered to compensate Chong's surviving kin in a civil lawsuit filed against him in September 1992. The coroner's inquiry of Chong's death was known to be the longest running coroner's inquiry in Singapore's history.
Background and Chong's death
On 24 March 1985, 22-year-old Chong Yun Jing, an administrative officer and a part-time Singapore Polytechnic student who was then enrolled in a diploma course for production engineering technicians, was found unconscious in the bathroom of her home, and she was told to come back for a checkup after consulting a doctor at a hospital. A month later, when Chong's mother Pang Koi Fa referred her daughter to a general practitioner, Dr Tham Pak Onn, and told Dr Tham about the fainting spell she suffered, Dr Tham recommended Chong to consult Dr Lim Djoe Phing, a neurosurgeon at Mount Elizabeth Medical Centre. Dr Lim conducted a skull X-ray test and several other scans for Chong, and eventually, he diagnosed that Chong suffered from brain cancer, and she needed to undergo surgery to remove a tumour in her pituitary gland, or else she would become blind.After some deliberation and persuasion from her mother, Chong reluctantly agreed to do the surgery and hence, on 6 June 1985, Chong had her tumour removed by Dr Lim through an operation. However, after the surgery was completed, Chong was placed in intensive care, and she could not open her right eye, as well as having a nose pad covering the nasal dissection. A few days later, the nose pad was removed and at this point, Chong started to experience brain fluid leakage through her nose, and she also got blurred vision and a high fever. Chong began to show signs of meningitis, an infection of a membrane in her brain, and she also suffered from severe headaches, which made her turn to painkillers prescribed by the medical staff. Additionally, brain fluid continued to leak out of her nose since the end of the surgery.
Despite the family's concerns about Chong's condition, Dr Lim reassured them that she was still fine and directed that she be discharged on 24 June 1985, about less than three weeks after the surgery. However, despite the care given by her private nurses and family members at home, Chong, who was still receiving intravenous drips, continued to be in pain and her condition grew even worse over the next few days. After Dr Lim berated Chong's family for repeatedly calling him regarding her condition, Chong's family were left with no other option but to seek the help of other doctors to treat Chong, who was once again hospitalized. Dr Ong Peck Leong, one of the doctors who took over Chong's case, had to operate on Chong to close the opening in her skull, which caused the brain fluid leakage and in turn, lead to an infection due to the bacteria entering the opening and therefore caused meningitis. Despite subsequent treatments and another two surgeries, Chong eventually died as a result of meningitis and pituitary tumour. An autopsy was not done on Chong after her death due to the bereaved family not consenting to it.
At the time of her death, Chong left behind one brother Chong Yuen Ching and her parents Chong Khin Ngen and Pang Koi Fa, and other relatives including a maternal uncle, maternal aunt and three godbrothers. Her funeral was held for two days at Bedok South before being cremated at the Tse Tho Aum Temple on the Friday morning of 13 September 1985.
Police investigations
Although the death of Chong Yun Jing was ruled to be a death caused by medical reasons and therefore not referred for a coroner's inquiry, Chong's parents decided to, on the advice of their lawyer Nathan Isaac, make a police report on 16 January 1986 and asked for an investigation of their daughter's death. The case was taken over by Investigation Officer, Sergeant P. Avadiar of the Tanglin Police Division and therefore investigated as a possible criminal case of death by a rash or negligent act under Section 304A of the Singaporean Penal Code, which was punishable by the maximum of two years' imprisonment if found guilty.During the lengthy investigation process, IO Avadiar, who obtained Dr Lim's medical documents regarding Chong's condition, interviewed and consulted many medical experts, including those who had handled Chong's case. One of the first medical experts was Dr James Khoo, who was the doctor that took over Chong's case after Dr Lim Djoe Phing's operation. Dr Khoo told IO Avadiar that Chong was seriously ill with meningitis and also suffered from brain fluid leakage that arose as a complication of the surgery, as well as severe headaches and vomiting. Dr Khoo opined that Dr Lim's surgery had possibly damaged the third nerve of her right eye and also her pituitary gland, which resulted in diabetes in Chong's case. Dr Ong Peck Leong, another neurosurgeon who handled Chong's case after her re-hospitalization, told IO Avadiar that he had to conduct another surgery to stem the brain fluid leakage and also stated that when he first met Chong, he discovered that she was in a very bad shape due to meningitis for the past two weeks or so, and there was an infection that happened as a result of the meningitis. Dr Ong also said that the tear in Chong's brain membrane was most likely caused by Dr Lim's operation on Chong back in June 1985, and her condition was worsened due to improper attention paid to the meningitis, and her discharge back then should not have happened.
Dr John A. Tambyah, an endocrinologist who examined Chong's diabetes condition and medical reports forwarded to him by Dr Ong, later told police that he found Chong's blood hormone levels to be normal, even though Dr Lim had earlier certified that Chong's blood tests showed abnormal hormonal readings, and Dr Tambyah said that the surgery was not needed at all in the first place, and he also stated that the brain leakage would have been averted if immediate steps, such as the prescription of antibiotics, had been taken and the infection would, in turn, be avoided. Dr Low Chen Hoong, a radiologist who had conducted scans on Chong under Dr Lim's request, also told the police that although his scans confirmed the possibility of a brain tumour in Chong's case, he stated that a scan alone was not accurate to determine whether Chong had brain cancer or not, as there should be an additional hormone level test and at least four radiological tests to ascertain and confirm this possibility, but he did not do it as Dr Lim did not ask for further tests, which Dr Low felt should have been done.
After weeks of investigation, the police had a breakthrough. Even though Chong's body was cremated after her death and no autopsy was conducted, it was discovered that she had a tissue sample taken from her pituitary gland by Dr Lim during the operation. The tissue sample was later found to be in the possession of Dr Seah Han Cheow, a veteran forensic pathologist who received it from Dr Lim after the surgery. During police questioning, Dr Seah confirmed that based on his examination of the tissue sample, he found it to be consistent with a pituitary tumour and bone fragment. A second medical opinion was later sought by police to verify the accuracy of Dr Seah's reports, and after examination from Dr Gilbert Chiang, a senior consultant pathologist, he found that the tissue was neither cancerous nor a tumour, but normal gland tissue, giving rise to the possibility that Chong did not have brain cancer in the first place. This led to the police sending the case for a coroner's inquiry, and Dr Lim Djoe Phing was suspected to have committed medical malpractice in his treatment of Chong.
Background information revealed that prior to Chong's death, Dr Lim, who came from Medan, Indonesia, had formerly studied in West Germany when he was 20, and he first came to Singapore in 1984. Dr Lim was also married with a son and daughter at the time when the coroner's inquest was conducted. Dr Lim was convicted of speeding and therefore fined S$180 in July 1986, and he was also involved in another coroner's case, where 62-year-old Jammaan Abdullah suffered a head injury and died. In that case, Dr Lim was reprimanded for issuing a death certificate when the "unnatural death" of Jaaman should have been referred for a coroner's inquiry and an autopsy should have been conducted. An open verdict was issued for the death of Jaaman, given that the exact cause of death was not ascertained.
Coroner's inquiry (1987 – 1988)
Hearing and testimony
On 9 November 1987, two years after the death of Chong Yun Jing, a coroner's inquest into her death was conducted by the coroner's court, with State Coroner Lim Keng Seong presiding over the inquiry. Dr Lim Djoe Phing, who was in charge of Chong's operation, was summoned by the coroner's court as a potential defendant in this case. Dr Lim engaged Richard Tan during the proceedings while Chong's family was represented by Nathan Isaac. Inspector M. Neethianathan also attended the inquiry to render assistance during the hearing.During the coroner's inquiry hearing, it was debated on whether Chong had indeed suffered from a tumour at the time of the surgery based on the tissue sample extracted from Chong. Although Dr Seah Han Cheow maintained that the tissue sample he received was a tumour based on his repeated examinations, his findings were countered by Dr Gilbert Chiang, who stated that the tissue sample showed that it was normal cellular tissue of the pituitary gland, and a tumour would have had one uniform cell type without any discernable pattern, which was not proven by his examination of the tissue sample. Dr Chiang also told the court that he had sent two samples of the tissue to England for further medical opinions from the world-renowned pathologists based there, and they agreed with Dr Chiang that this was not a tumour. Several other medical experts - including Dr Ong Peck Leong, Dr James Khoo, Dr Low Chen Hoong and Dr John Tambyah - were also called to testify on the exact medical condition of Chong.
When Dr Lim was called to enter his defence, he chose to remain silent, and instead, he called on Dr John Lester Firth, a British neurosurgeon, as his witness. Dr Firth supported Dr Lim's diagnosis that Chong indeed had pituitary tumour and there was no need for Dr Lim in his position to conduct further check-ups, and he even disagreed that the official cause of Chong's death was meningitis, and also stated that the fainting spell sustained by Chong back in March 1985 was not a simple fainting attack but rather caused by bleeding in the pituitary or an epileptic fit. When cross-examined by Isaac, Firth rejected the lawyer's suggestion that the cause of death was due to Dr Lim's negligence, and he also stated it was unnecessary for further tests to avoid confusion and delaying surgery. Isaac, in his rebuttal to Firth's testimony, stated that the only reason why Dr Lim did not bother to make further tests was because he wanted to operate on Chong "at all costs".
As the final witness of the coroner's inquest, Professor Chao Tzee Cheng, a senior forensic pathologist, was summoned as the coroner's medical adviser. Professor Chao testified that the cause of Chong's death was indeed meningitis, which was a complication from Dr Lim's operation on Chong, and he told the coroner that it was effectively proven that a causal link existed between the operation and Chong's death. Professor Chao also pointed out that Chong was discharged by Dr Lim even though she was still experiencing symptoms and signs of CSF leak and meningitis and was still on intravenous injections, and he affirmed with cautious approach, that it was essential to assess a case fully before a surgery was considered, which should also be applicable to the case of Chong Yun Jing.