EXCERPT FROM: Transcript of the Hearing in the Matter of Medical Board of Temasek v. Ruiming Tao
CHATTERJEE: It is therefore the board's view that Dr Tao's refusal to recognize the compromised position he was in until it was explicitly pointed out to him by colleagues, as well as his insistence on proceeding as a prominent member of Miss Tao's treatment team insomuch as being the primary surgeon during the first part of the procedure, together constitute a gross breach of professional objectivity. I submit, in conjunction with the patient's adverse outcome, Dr Tao's actions were tantamount to gross negligence and any sanctions they may incur must be considered in such a light.
HER HONOUR: Thank you, Mr Chatterjee. Now, Dr Tao, I ask again. You are quite certain you will proceed with no representation?
RESPONDENT: With respect, I don't believe I'm proceeding without representation. I represent myself.
HER HONOUR: Right. Do you have an opening statement for us?
RESPONDENT: No.
HER HONOUR: (indistinct) Okay. Mr Chatterjee, who is the board's first witness?
CHATTERJEE: Ruihong Tao. He was the civilian attachment to the quest on which Miss Tao was injured. Also a staff member at Central Temasek Hospital.
[RUIHONG TAO, SWORN IN AT 10:35]
EXAMINATION BY CHATTERJEE
Q. Mr Tao, the reason we called you first is because you are the only person who was present throughout the incident, from the injury to the arrival in the hospital to the handover with surgeons, as well as throughout the operation itself until the eventual transfer to ICU. I understand this is a matter of close personal concern and it may be quite emotional for you. Please feel free to stop me at any time should you require it. As we've discussed, what we're after right now is just a timeline of events. With you, we're not interested in debating the merits of what took place at each decision point, but rather, we just want to get a sense of what happened when. So please, just focus on my questions and keep your answers purely to objective fact. Do you understand?
A. Yes.
Q. Mr Tao, what is your occupation?
A. Radiologist.
Q. Place of work?
A. Central Temasek Hospital.
Q. What is your relation to the patient Miss Ruixi Tao?
A. I am her older brother.
Q. And your relation to the respondent in this case, Dr Ruiming Tao?
A. I am his younger brother.
Q. Could you state, briefly, how you came upon the scene of Miss Tao's injury?
A. I was (indistinct), I accompanied a Silver Crane quest on which Lucy served as the Field Medic.
Q. Lucy being the colloquial name Miss Tao is known by?
A. Yes.
Q. And Silver Crane being the adventuring agency she works for?
A. Yes.
Q. And would you agree, to the best of your knowledge, that Miss Tao's injury occurred at approximately 3:15 PM on the 14th of November?
A. To the best of my knowledge, it occurred during the afternoon on the 14th of November. I can't say I was aware of the exact time when it happened.
Q. Could you describe, to the best of your knowledge, how Miss Tao sustained the injury?
A. (no verbal response)
ASIDE
HER HONOUR: Mr Tao, do you need a moment?
WITNESS: No, I'm fine.
HER HONOUR: Mr Chatterjee, please continue.
EXAMINATION BY CHATTERJEE
Q. Thank you. The question was, could you describe how Miss Tao sustained the injury?
A. I didn't see the whole thing. As far as I can attest to, the party was ambushed by a pack of Jungle-hounds. During the ambush, my glasses were knocked off, and for about a minute, I couldn't see much of what was going on around me. When I managed to replace my glasses, I saw that (indistinct), Lucy was on the ground, having already sustained the injury to her left thigh. From the circumstances, I could infer that she had been the victim of an attack by one of the Jungle-hounds, likely a swipe with the claws.
Q. Thank you. And what did you do when you saw the injury?
A. Prisha, excuse me, the Lancer of the party had already started on basic first aid, though it was clear she was not experienced with it. Knowing that the Lancer is Aqua-attuned, I instructed her in a basic form of haemostatic support to slow the bleeding. I then found a vial of Opiatum in Lucy's medical bag and administered it intramuscularly. I instructed two other members of the party to restrain Lucy while I applied partial traction to the left leg. I was able to use my Aurous manipulation to keep the bone fragments mostly aligned and intact. As I held traction, I instructed the remaining member of the party to apply splint and bandages. After that, with help from the party members, I performed a secondary survey to ensure there were no other life-threatening injuries.
Q. What did you do after first aid was given?
A. For this portion of the quest, the party had travelled on foot. First thing we needed to do was get back to our transport. We stretchered Lucy back to the Pelepas outpost where we immediately transferred her onto a transport wagon and started our way back to the city. The Lancer and I accompanied her, ahead of the rest of the group. Once we started moving, I had the opportunity to send a pigeon to the hospital.
Q. Could you describe the contents of this communication?
A. It was a note summarizing the extent of the injury and listing the vital observations taken at the time. The Lancer also added information about the location from which the note was sent and the estimated time of arrival at the city gates.
Q. Could a reasonably competent medical professional start planning the in-hospital treatment based on this note?
A. Well, that is the intention. My formatting and conventions probably deviated from what are typically done by Field Medics, but I believe the information itself was salient.
Q. And what time, to the best of your knowledge, did this note go out?
A. I can give a fairly accurate answer to this. I checked with the Lancer when I wrote the note. It would have gone out at around 5:45 PM.
ASIDE
CHATTERJEE: Your Honour, I would like to make note for the panel's benefit. Allowing variance in flight times, the witness's field missive would have arrived at Central Temasek Hospital by no later than 6:30 PM.
HER HONOUR: Noted, Mr Chatterjee. Please continue.
EXAMINATION BY CHATTERJEE
Q. I know I'm the one that told you to stick to objective facts, Mr Tao, so I apologize in advance for the speculative nature of my next series of questions. To the best of your knowledge, based on your training and experience working in the hospital, what is the typical process that follows when a field missive is received by Triage?
A. I believe the Triage supervisor on shift would contact relevant duty specialists as he or she deems fit and ask that they either attend or be ready to receive further information upon the patient's arrival.
Q. Again, based on your training and experience, would you suppose that this particular missive you sent on this occasion would have warranted the notification of the duty Angiologist?
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A. I believe so, yes. I believe my note conveyed the significant nature of vascular damage at the site of injury and the compromised state of the distal circulation.
Q. Who was the duty Angiologist at the time when the missive would have arrived?
A. I believe it would have been Michael.
Q. Michael being the respondent in this case?
A. Yes.
Q. Thank you. Going back to your transport, now. Do you remember what time you and the patient arrived in Triage?
A. 9:25 PM.
Q. Please name the doctors who were present to receive the patient, and their roles. To the best of your recollection.
A. Dr Marta Fernandez, Triage supervisor. Dr Shani Colonne, Triage registrar. Dr Ken Wong, duty Haemologist. Dr Deepak Mohan, duty Trauma Surgeon. Dr Michael Tao, duty Angiologist.
Q. Thank you, and what is Dr Michael Tao's level of training in Angiology?
A. He's in his sixth year. Nearly finished.
Q. So is it correct to say he is not an Angiology consultant?
A. Correct. Technically, he's still a registrar, but he's just as capable as—
Q. Thank you. In your experience, is it commonplace for registrars on after-hours duty to contact senior members of their department, possibly even ask them to come into hospital to assist with potentially difficult cases?
A. Well, I can't speak to how common it is, but it happens, yes.
Q. And throughout the episode of care for Miss Tao, up until she was transferred to ICU from the operating theatres, did you see an Angiology consultant come in and be involved in her management?
A. Not to my knowledge, no.
Q. Thank you. Going back to the initial treatment at Triage, how would you describe what you were doing at the time?
A. I watched.
Q. Right. And would you say you kept a distance because of the ethical implications of treating your own family member?
A. No. I wasn't thinking about anything like that. Wasn't thinking about much at all, to be honest.
Q. Did you observe what Dr Michael Tao did in Triage?
A. Yes.
Q. And how would you describe that?
A. He assisted in starting a new intravenous line.
Q. Could you be more specific than that? My understanding is his actions were a bit more involved than that.
A. (no verbal response)
ASIDE
HER HONOUR: Please answer the question, Mr Tao. The panel believes this is relevant.
EXAMINATION BY CHATTERJEE
Q. What exactly did your brother do to start an IV line?
A. He pushed aside a Triage nurse who had been assigned to it and had missed on her first attempt. After he put the line in, he started wheeling the bed before Dr Fernandez had given the OK. And without waiting for the porter to get in position.
Q. Thank you. Now, please describe your whereabouts and actions after the patient was wheeled out of Triage.
A. I followed the bed to the entrance to theatres, but at that point, I was unsure what to do next. I was off-duty at the time, and I suppose even if I were working, I would not be part of Lucy's management team. However, Dr Malhotra, the Radiology consultant who had been called in, was heading into theatres at the time and invited me in, just as an observer.
Q. When you got changed and walked into the operating room, which doctors were present then? And their roles as well, if you please.
A. I have to say I'm a bit unsure about this, as everyone was gowned and masked. Ones that I'm certain of were Dr Ishan Malhotra, Radiology consultant, Dr Deepak Mohan, duty Trauma Surgeon, Dr Ken Wong, duty Haemologist, Dr Safina binti Ismail, Anaesthetist, and Dr Michael Tao, duty Angiologist.
Q. Thank you, I believe those were indeed all the medical personnel who were present. Now, I believe soon after the patient arrived in the operating room, diagnostic procedures and assessments were conducted to fully characterize her injuries. Could you describe the ensuing discussion about the surgical approach to be taken? Let's start with naming the doctors who were most prominently involved in the discussion.
A. I'd say those would have been Dr Mohan and Dr Tao.
Q. To the best of your recollection, how long would you say this discussion lasted before they started operating on her?
A. Not sure exactly. I would guess somewhere between five to ten minutes.
Q. And if you could summarize the discussion for us?
A. There were considerations for either surgical revascularization and salvage of the limb or above-knee amputation. The decision was made to proceed with limb salvage.
Q. Would you say opinion was split?
A. How do you mean?
Q. You said Dr Mohan and Dr Tao were primarily involved in the discussion. Would you say opinion on how to proceed was split between them?
A. They agreed on the plan before proceeding.
Q. Let me rephrase that. Please tell me if my characterization is accurate. Prior to coming to an agreement, Dr Mohan advised amputation as the direct option, but Dr Tao pushed for limb salvage to be attempted. You say the discussion took five to ten minutes. Most of that time was taken up with Dr Tao arguing for limb salvage before Dr Mohan relented and agreed to the plan. Would you agree that's an accurate description of events?
A. In a sense.
Q. Yes or no, if you please, Mr Tao.
A. Yes.
Q. Thank you. Now, how would you describe the tone and words used by Dr Tao to argue for limb salvage?
A. I don't understand the question.
Q. Did he raise his voice?
A. Some people might construe it as such.
Q. Yes or no, Mr Tao.
A. Yes.
Q. He raised his voice. And what did he say exactly, do you remember? Right before Dr Mohan agreed to go with his plan?
A. (no verbal response)
ASIDE
HER HONOUR: Mr Tao, may I remind you that you are under oath. If you can remember, please answer honestly.
EXAMINATION BY CHATTERJEE
A. He said something like, "She's my sister. I'm going to save her leg whether you help me or not. Are you going to stand in my way?"
Q. Thank you. Now, I understand you may have toned it down for the court's benefit, but would you say that the language Dr Tao used was more colourful than what you relayed to us?
A. Sure.
Q. And his voice was raised. Having observed the discussion, would you say Dr Tao was agitated prior to operating on the patient?
A. I don't know.
Q. You don't know or you don't want to say?
ASIDE
HER HONOUR: Mr Chatterjee, perhaps if you could rephrase your question.
EXAMINATION BY CHATTERJEE
Q. If it please the panel. In your professional opinion, Mr Tao, would you say, at the time of the discussion in the operating room and of starting the surgery, Dr Michael Tao was of sound mind and emotional state to perform his duties to his fullest abilities?
A. No.
Q. Thank you. Okay, nearly done, Mr Tao. One last event I wanted you to confirm. In the middle of the procedure, multiple attempts at revascularization have failed, and it is becoming clear that the patient is becoming more unstable and showing signs of Maladous infection. At this point, I believe Dr Mohan announces to the team that he is going to covert the procedure to an above-knee amputation. How did Dr Tao react to this?
A. He agreed with the decision and helped complete the amputation to good effect.
Q. Before that. Between Dr Mohan's announcement and the commencement of the amputation procedure.
A. (indistinct) He knocked over a surgical tray and threw a needle driver across the room.
Q. Okay, and just to confirm, he knocked over the surgical tray deliberately?
A. Yes. Presumably in anger.
Q. Sure. And how did Dr Mohan react to this?
A. He asked my brother to leave the room. Michael said something like, "You're not going to kick me off my own sister's operation." He wouldn't budge, so they proceeded with Michael assisting Deepak, and completed the amputation to good effect.
Q. Thank you. That will be all.
END OF EXAMINATION
HER HONOUR: Thank you, Mr Chatterjee. Now, Dr Tao, will you be cross-examining the witness?
RESPONDENT: Yes.
HER HONOUR: Okay, perhaps it might be best if we adjourn for a short—
RESPONDENT: I will be short, your Honour.
HER HONOUR: I must warn you, Dr Tao. Strictly speaking, this is still a court of law. It's within your rights to represent yourself, but I expect you to behave according to the proper decorum and etiquette.
RESPONDENT: Of course.
HER HONOUR: You may proceed.
CROSS-EXAMINATION BY RESPONDENT
Q. Why are you here, Rui?
A. (no verbal response)
ASIDE
HER HONOUR: Dr Tao, I think, clearly—
RESPONDENT: If it please the panel, I will rephrase the question.
CROSS-EXAMINATION BY RESPONDENT
Q. What were you doing on that quest?
A. I—
Q. Damn it, Rui, what the hell were you thinking? Thought you'd play adventurer?
A. Michael, I—
Q. Because of you, Rui. Because of you, she—
ASIDE
HER HONOUR: Okay, that's it. I'm calling a recess. Now. And Dr Tao, if you cannot control yourself, I will have no choice but to hold you in contempt.
END OF CROSS-EXAMINATION
SHORT ADJOURNMENT
