Skandal at Singapore’s Khoo Teck Puat Hospital: Five Staff Placed in Disciplinary Hell
Who: Khoo Teck Puat Hospital (KTPH)
What Happened: A lab mishap caused misdiagnosis for breast‑cancer patients, leading to unnecessary treatments and that whole awful extra pill‑take regimen.
When: May 3, 2024
What the Hospital Said
- Staff in managerial positions got the full fury: from stern warnings to hefty fines and even forced exit.
- In addition, the hospital is conducting counselling, retraining, and re‑education for all involved.
- Ignore the “cheer up” line – the main point: errors cost lives.
Associate Professor Pek Wee Yang, KTPH Medical Board chair, addressed the fallout:
“We’ve reached out to everyone affected to offer support. We’ll figure out compensation on a case‑by‑case basis and provide psychological counselling where needed. Please bear with us – this will take some time.”
What Went Wrong (the “Human Error” part)
The error stemmed from a calibration mishap during the set‑up of HER2 staining protocols. Because the lab failed to double‑check the protocol, the slides were over‑stained. Over‑staining meant more samples were flagged as HER2‑positive than should have been, pushing over‑treatment onto patients who didn’t actually need it.
HER2‑positive breast cancers are notoriously aggressive, so mislabeling someone as a “hot” cancer can be disastrous.
Key Points from the Investigation
- The lab had already spotted higher HER2‑positive rates during routine monitoring of 2012–2020.
- The department “thinking it was just demographic” missed the plain‑old staining issue.
- Quality‑control checks were lax; the trend was ignored, delaying detection.
- When clinicians finally noticed the spike, an internal review was launched.
How the Hospital is Fixing It
- National Healthcare Group (NHG) convened a review committee of industry experts for a thorough shine‑out.
- Teams promise “strict adherence to best practices” and adherence to international benchmarks.
- Every gap discovered will be closed out quickly – no more over‑stain, no more surprise HER2 labels.
In short: We’re gonna learn, fix, and earn back your trust. The hospital is committed to ushering this glitch behind the curtain, with all the accountability and safeguards in place. The shooting at the “how to avoid this in the future” door is fully opened, and the next page is all procedures, training, and no more mis‑diagnosis on the radar.
About the incident
Hospital Test Mix‑Up: 200+ Breast Cancer Patients Misdiagnosed
What went wrong?
- KTPH’s lab started testing HER2 in 2012.
- For a few months in November 2023, tests marked many samples as HER2‑positive.
- About 200 breast cancer patients received wrong results, telling them their tumours were the aggressive, less common HER2‑positive type.
- ~50 % of those patients were sent on to unnecessary, costly treatment.
Quick response
- The hospital immediately halted all HER2 tests.
- They listed the affected patients and shipped their samples to outside labs for rapid retesting.
- Retesting uses antibody stains that reveal the HER2 protein under a microscope; the colour intensity decides the result.
Why the error happened
- HER2 testing is a fine‑tuned process that needs a skilled pathologist to read the stains.
- Multiple human steps—staining strength, tissue handling, and interpretation—can introduce mistakes.
- With such a low base‑rate disease, a huge number of false positives triggers a red flag.
Clinical consequences
- Misdiagnosed patients received Herceptin, which can cause diarrhoea, chills, and fever.
- 3‑4 % risk of heart problems is a real concern.
Official updates
- Late November: KTPH told the National Healthcare Group and Health Ministry.
- December 11: Public announcement was made.
- January: Senior Minister of State for Health Koh Poh Koon answered questions in Parliament.
- Cheryl Chan asked why it took so long to spot the slip‑up; Koh explained the intricacies of the process.
In short, a lab mishap turned a serious diagnosis into a case of “oops.” KTPH has shut down the faulty tests, corrected the records, and is monitoring every patient to make sure no one suffers from an avoidable treatment.
