SGH neurosurgery head did not report patient’s death to coroner, says maybe his heart overruled brain

Singapore General Hospital (SGH) neurosurgery head Jai Prashanth Rao has come under scrutiny for failing to report the death of 75-year-old Tan Suan Lin to the coroner. Tan died six days after undergoing surgery to remove a brain tumor at the National Neuroscience Institute (NNI) in September 2023. An internal review had flagged the case a year after Tan's death, prompting a police report and a lack of autopsy due to the delay.

During a coroner's inquiry, Rao claimed his decision was influenced by compassion for Tan's family, stating he later changed his mind and issued a death certificate. He attributed his initial hesitation to his heart overruling his brain. Tan's family, particularly her daughter, had expressed a desire for dignity in death and against an autopsy.

Rao noted that he wanted to provide closure to the family. The cause of death was listed as malignant neoplasm - brain, unspecified, as per the death certificate signed by a junior doctor. A forensic pathologist later suggested bleeding complications during surgery as a possible cause. Rao admitted he had mistakenly believed reporting to the coroner was only mandatory for deaths within 24 hours of surgery, a misunderstanding he acknowledged after being reminded of the correct requirements.

Under the Coroners Act, anyone who becomes aware of a reportable death must inform the police as soon as reasonably practicable. Failure to do so without reasonable excuse can result in up to one month's jail or a fine of up to S$1,500. The surgery, performed on January 3, 2024, went well until the team struggled to control severe bleeding, leading to significant blood loss and brain swelling.

Tan was transferred to the intensive care unit, where her condition worsened, and she died nine days later. An independent expert witness testified that Tan's death should have been reported to the coroner, stating that such deaths are taught to doctors from the start of their specialization. However, the expert acknowledged Rao's decision-making in light of the emotional burden faced by the main surgeon. The coroner is expected to deliver his findings in due course.