Taiwanese actress Barbie Hsu reportedly missed two critical chances to be saved, including one when she refused hospitalization because she had already booked return flight tickets, according to leaked medical records.

Taiwanese actress Barbie Hsu. Photo from Barbie’s Weibo

Sohu reported that Barbie arrived in Japan on Jan. 29 and passed away on Feb. 2 at age 49, with her family confirming that she died from influenza-related pneumonia the following day. Before her death, she exhibited severe health warning signs.

Leaked emergency department records from a local hospital—yet to be officially verified by Japanese medical authorities—reveal that Barbie showed severe health warning signs before her death.

Her blood oxygen level had dropped to 89%, and doctors detected moist rales, indicating lung damage. Despite this, she only received antipyretic medication. Instead of being admitted to the hospital, the actress insisted on returning to her hotel for observation, missing the first critical chance for treatment.

After medical staff recommended transferring her to Tokyo General Hospital on Feb. 1, Barbie and her family declined, citing their pre-booked return flight. This was considered her second missed opportunity for timely medical intervention.

On the way back to the hotel, the actress stopped breathing and was rushed to the nearest community clinic. A CT scan revealed both her lungs had turned white, signaling a severe condition. An ambulance was called, and she was finally admitted to a local clinic.

After Barbie was taken away by ambulance, her sister Dee and their mother posted a video of themselves dancing at the hotel, suggesting the family underestimated the severity of Barbie’s condition. Some speculated that her family believed she was merely suffering from a mild cold and didn’t realize her condition had escalated to pneumonia. The clinic she had been rushed to lacked specialized medical care, and Barbie ultimately passed away.

The authenticity of the leaked medical records has not been confirmed.

Barbie’s cremation ceremony took place in Japan. According to TVBS, her husband, South Korean musician DJ Koo, is expected to bring her ashes back to Taiwan on Feb. 6.

Prior to her death, Barbie had previously faced life-threatening health issues.

In 2016, while giving birth to her second child, Barbie suffered her second epileptic seizure, fell into a coma due to oxygen deprivation, and even experienced cardiac and respiratory arrest. Her then-husband, Chinese businessman Wang Xiaofei, performed CPR and saved her life. The actress remained in a coma for 10 days before regaining consciousness.

Wang later recalled the traumatic event in 2018, describing how Barbie’s face turned purple, her body trembled uncontrollably, and she became unresponsive, appearing to lose consciousness completely. Fearing she wouldn’t survive the trip to the hospital without permanent brain damage, he managed to stay calm, performing mouth-to-mouth resuscitation and CPR, which ultimately revived her.

In 2017, Hsu fainted and was hospitalized, later revealing she had chronic mitral valve prolapse. In 2018, she collapsed again due to a prolonged cold, which triggered another epileptic episode. Her mother confirmed that Barbie had also suffered two miscarriages around that time.

According to Oriental Sunday, Barbie’s perfectionism and pursuit of beauty in the entertainment industry contributed to her fragile health. Despite struggling with epilepsy and heart issues since her debut at 17, she developed extreme dieting habits, including prolonged fasting and anorexia. Standing 163 cm tall, she weighed just 39 kg and maintained 42–44 kg while filming. Her weight loss methods involved skipping meals after lunch, halving portions prescribed by a nutritionist, and rigorous exercise.

The actress reportedly brought lunch boxes containing only two bites of rice and a fingernail-sized piece of fermented tofu while on set. In one instance, she fainted during filming after not eating for three days. During a commercial shoot, she collapsed, and staff discovered she was wearing a tightly bound corset around her waist and abdomen.

Barbie’s obsession with beauty was relentless. In 2004, she published “Beauty Queen,” a best-selling book detailing skincare techniques, which remained atop sales charts for years. Within just six weeks, the book sold over 200,000 copies, setting a record for beauty publications in Taiwan. In it, she admitted to using anticoagulants to maintain fair skin despite the life-threatening risk of internal bleeding.

“I can’t accept not being fair-skinned,” she confessed on a talk show.

In “Beauty Queen 2,” released in 2007, she promoted “skin whitening injections,” which involve intravenous whitening agents, a method that has been banned in France since 2016 due to health risks.

The actress’ beauty obsession was described as a “death march” in elite beauty circles. On the show “Amazing Life,” her close friend Aya Liu recalled a camping trip to New Zealand where Barbie brought three large suitcases filled with beauty devices, oxygen injection machines, and UV sterilizers.

Barbie gained fame from her roles in TV series such as “Meteor Garden,” “Mars,” and “Summer’s Desire.” Her personal life, especially her marriages, has always been a focal point of public and media interest.

She was married to Wang, now 43, from 2011 until their divorce in 2021, and they have two children together. Just three months after her divorce, she married 55-year-old DJ Koo.