MINDEF's Investigation into the Deaths of NSmen

Ms Irene Ng Phek Hoong asked the Minister for Defence (a) what is the outcome of his Ministry's investigations into the deaths of full-time National Serviceman Private (PTE) Lee Rui Feng Dominique Sarron, and Private (PTE) Amirul Syahmi Bin Kamal; (b) what are the measures in place to ensure the safety of our servicemen, especially those with medical conditions, as they undergo training; (c) whether the investigations revealed any deficiencies in systems and procedures or human lapses; and (d) whether remedial measures would be taken to prevent similar incidents in the future.

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The Minister for Defence (Dr Ng Eng Hen): Mr Speaker, Sir, I want to again offer my deepest condolences to the families of Amirul Syahmi Bin Kamal and Lee Rui Feng Dominique Sarron. MINDEF is committed to assist these families during these difficult times.

Sir, in every case involving the death of a National Serviceman, a number of investigations have been activated and are proceeding concurrently to specifically address the same queries which the Member has posed. First, in MINDEF, the Armed Forces Council has convened an independent Committee of Inquiry or COI to thoroughly examine the circumstances surrounding each of the two incidents. The COI is to ascertain fully the facts leading to the death and determine the contributory cause or causes of death. The COI is also tasked to determine if measures taken to treat, resuscitate and evacuate the affected NS men were adequate and prompt, and recommend measures to rectify shortcomings, if any. It shall also determine whether there were any breaches of relevant instructions, directives, orders and safety regulations. The COI shall ascertain whether the incident could have been prevented or avoided, and recommend appropriate measures to prevent future occurrence. This four-man COI is chaired by a senior civil servant from outside of MINDEF, with a senior doctor from the public sector as one of its members. The Committee is empowered to call any witness and hear his or her testimony, as well as receive any evidence regardless of its admissibility in civil or criminal proceedings in court.

Second, the Police will submit their independent report to the State Coroner who shall ascertain the cause of and circumstances connected with the death. The Coroner's inquiry is held in an open court. As part of this process, the Police will report to the Public Prosecutor if their investigations conclude that a person or persons may be arrested and charged in connection with the death.

Third, the State Coroner will review findings from post-mortem examinations to establish the manner and cause of death. The period to complete full post-mortem examinations by the Health Sciences Authority varies depending on the need for supplementary laboratory tests. For some complex cases, it can take as long as three months. As a matter of routine, MINDEF does receive the findings of these post-mortem examinations, to aid us in our investigations.

As these investigations are on-going and MINDEF has not received the finalised reports of post-mortem examinations of these two cases, I can only reveal some facts at hand in response to the Member's question.

First, on PTE Amirul. On 15 March this year, PTE Amirul did not turn up for a routine roll-call. A search was initiated and PTE Amirul was found unconscious in a locked toilet cubicle, with a rope tied around his neck and hanging from the shower beam.

Resuscitative procedures were immediately activated on site and continued en-route and at Changi General Hospital. Unfortunately, the resuscitation failed and PTE Amirul was pronounced dead at Changi General Hospital.

Second, on PTE Lee Rui Feng Dominique Sarron. PTE Lee was noted to have breathing difficulties while participating in a platoon exercise involving the use of smoke grenades at a training facility at Lim Chu Kang on 17 April 2012. The unit Chief Safety Officer immediately accompanied him to exit the building. Outside the building, PTE Lee lost consciousness and received Cardio Pulmonary Resuscitation on the spot. He was given supplemental oxygen and evacuated in the safety vehicle to the Medical Centre. Resuscitation efforts by a SAF medical officer continued at the medical centre as well as en-route to the National University Hospital in an SAF ambulance. Unfortunately, the efforts were not successful, and PTE Lee was pronounced dead at NUH.

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PTE Lee was noted to have a history of asthma during pre-enlistment screening on 4 January 2011 with his last reported asthma attack more than three years prior to enlistment. Based on the SAF medical classification system which is devised in consultation with leading senior medical specialists from the public and private healthcare sectors, NS men with well-controlled asthma are given a PES grading of A or B and certified fit for military training. Based on SAF's medical records, PTE Lee did not report sick for any asthmatic attacks in the five-month period after enlistment until this incident.

The concurrent investigations will examine all the facts to determine the cause of death, and if the asthma or smoke grenades were contributory factors. Smoke grenades have been commonly used for many years during military training and the SAF has not had any similar incident in the past. Sir, we will have to await the conclusive findings of these investigations to determine the cause and measures to be taken arising for these two specific cases.

But allow me to share general aspects on the existing system, which have incorporated lessons learnt from previous incidents. The on-going investigations are conducted so that we can continue to improve our system to ensure the highest standards of training safety for our NS men. This is our top priority and the SAF will do its utmost to implement all recommendations. This includes appropriate disciplinary action against any SAF personnel whose negligent actions have contributed to the death.

For NS men, the SAF stands guided by leading medical specialists drawn from the public and private sectors to formulate both medical screening protocols as well as a classification system based on known medical conditions to ensure the safe training and appropriate deployment of our servicemen. For this purpose, all NS men are subjected to a compulsory and detailed pre-enlistment medical screening to detect anomalies and diseases. Additional screening is also conducted prior to onerous training activities such as overseas exercises. We have and we will continue to review our medical screening procedures on a regular basis, to make sure they stay in line with international and national standards of clinical practice. After medical screening, NS men are deployed to suitable vocations to undergo military training. This Physical Employment Status or PES system has been in use since 1971, and NS men with a history of well-controlled asthma have been graded PES A or B and suitable for military training for more than 20 years.

In addition, ground commanders know that they have a responsibility for the safety of their servicemen during training. They have to keep a keen eye on the safety and condition of their servicemen before, during and after the training is completed. They have the prerogative to stop training for any serviceman at anytime if they sense something is amiss.

The SAF also reminds individual servicemen to ensure their own safety and that of their NS buddies. Servicemen who are unwell at any time during training are required to highlight their condition to their commanders. They are asked proactively before exercises and given the opportunity to excuse themselves. If in the course of their national service, they develop a new medical condition or injury, they have ready access to SAF medical officers or the public health care system. If need be, they would then be excused from certain types of training or redeployed to a role more suited to their medical condition.

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Sir, safety is top priority for MINDEF and the SAF. We know that we have the responsibility to keep sons of Singapore safe while training. Every incident resulting in injury or death is painful to us and gets top management priority to make it right. We will spare no effort to investigate every incident thoroughly. We will also incorporate findings and recommendations from independent investigations by the Police and Coroner. Where there are mistakes, we will own up to them, learn, rectify and continuously improve. That way, we can put in place a robust safety system that will prevent all avoidable injuries and deaths. Once again, MINDEF and the SAF extend our deepest condolences to the families of the late PTE Amirul and PTE Lee.

Ms Irene Ng Phek Hoong (Tampines): I would like to thank the Minister for his useful replies. I would like to focus my supplementary questions on PTE Dominique Lee who was my resident. He suffered from asthma. Sir, asthma attacks can kill quite quickly if the sufferer does not receive emergency treatment. Yet, despite the seriousness of the condition, PTE Lee was exposed to asthma triggers such as the smoke grenades during the training exercise.

Can I ask the Minister, given the fact that NSF medics are not trained or equipped to give emergency treatment for asthma, why does MINDEF not exempt soldiers with asthma from such training which puts their life at undue risk? Can I also ask the Minister, given the fact that acute asthma attacks can lead to death and can be triggered by exposure to dusty and smoky environments, would the Minister agree that there is a need to confront the problem of asthmatic recruits given that the militaries in the US and UK have also reviewed their processes, and in fact discharged soldiers with asthma? Can the Minister review the SAF's medical classification system and screening tests and improve the safety culture to ensure that our military system identifies and disqualifies recruits with chronic diseases such as asthma that could be exacerbated by combat training?

Third, can I urge the Minister to expedite the work of the Committee of Inquiry so that things can be put right quickly to prevent such unnecessary deaths and to assure parents that indeed MINDEF does take the safety of our NS men seriously and that preventable deaths will have the utmost seriousness of MINDEF and will be eliminated?

Dr Ng Eng Hen: Sir, before I reply to Member Irene Ng's question – and I share her concerns – I just want to state a caveat that we do not know the cause of death and we should await the investigations of the COI. As I said, the terms of the COI will determine if the cause of death was contributed by the asthma and smoke grenade, but until then, we should not make that conclusion. It is better for the panel of medical experts and the COI to determine it. So, the questions that I am answering in her specific questions related to asthma does not mean that SAF/MINDEF had prejudged that it was indeed related. We have to await the findings of the COI.

With that caveat, the Member's concerns are similar to ours. And we are careful to ensure that the medical classification system that we have developed is safe enough for our NS men to train. As I have said, the SAF stands guided by our medical experts who are drawn from the public and private sectors. They tell us which diseases, or in a particular case of asthma, whether mild, moderate or severe asthma, where they can be deployed. And as I have said in my reply, mild asthmas have been PES A or B for the last 20-over years and this is the first such incident that we have had in the presence of the smoke grenade. I do not know whether it has been the cause, and the COI will determine if it may have been the presence of the smoke grenade.

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Just in terms of frequency, asthmatics are quite prevalent among our servicemen and they follow the general population. The prevalence of asthma – around 20% of our servicemen are found to have some form of asthma, the majority are mild and many of them have been put through military training without adverse effects.

The Member asked if our medics are trained to deal with asthma attacks and the answer is "yes". They are trained to administer substances like Ventolin through metered dose inhaler if patients are already prescribed with one. In this particular case, supplemental oxygen was administered.

I take the Member's suggestion that we should review our medical classification system if the COI does recommend it. And we will try to expedite it but we will have to wait for a number of investigations to be completed, including the forensic reports and lab tests. But I share her concern and we should try to do this as quickly as possible without compromising full fact-finding.

Dr Lim Wee Kiak (Nee Soon): Mr Speaker, Sir, I would like to thank the Minister for his reassurance that the SAF takes safety as paramount, especially in training. And certainly it has been the concern of many, many mothers after hearing the mishap that happened recently, especially over the last weekend, Mother's Day. I received much feedback on that.

I would like to ask the Minister: what is the estimated duration of the COI. Is there a time limit given for the COI? It cannot drag on forever. When does SAF declare a time-out for this, like for example in the earlier case, why was a time-out not declared; in the recent incident, why was a five-day time-out exercise declared? What is the purpose of the time-out? Would the safety review of the time-out be made public after it is done? And last of all, it is that there was one further question asking whether the SAF will review the medical response to severe injury, whether the evacuation to the medical centre should be the most appropriate or should they be evacuated directly to the hospital if there is a nearby hospital because a hospital's capability is definitely higher compared to a medical centre's.

Dr Ng Eng Hen: Sir, the first question on whether there is a timeline for the COI to be completed. Obviously, the SAF/MINDEF is also keen to have the COI conclude so that we can improve our system if there are any recommendations. As I have said, sometimes it depends on the laboratory tests which can take up to three months. So, it varies. Experience shows that it usually takes around a few months, not forever, but a few months. And we will expedite it as much as we can.

On when SAF takes a time-out: that is a command decision that our commanders on the ground have to assess. In this particular instance, they felt that it was necessary and I backed them. What was done during the time-out, basically, there was a stop to all field training. The Chief of Army called all commanders, all warrant officers who were in command positions, to emphasise to them, to give them the facts. And independently, the safety inspectorate would also review our SOPs, our processes to make sure that the safety guidelines were adhered to.

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Another question related to our evacuation and resuscitative norms: apart from the COI examining this, we are not going to wait for that. Obviously, our HQ Medical Corps within the SAF is also reviewing the norms to see whether the steps taken and whether the facilities and expertise are up to par.

I want to assure Members that every incident does cause us to re-examine the system. As I have said, we want to do this deliberately. We are giving top-management priority and learn the right lessons to make our system stronger.