Gunapathy Muniandy v James Khoo: Medical Negligence, Radiosurgery, and Informed Consent

In 2001, the High Court of Singapore heard the case of Gunapathy Muniandy v James Khoo, Neurological Surgery Pte Ltd, and Khor Tong Hong, concerning medical negligence. Gunapathy claimed that the defendants were negligent in advising and performing radiosurgery, leading to severe neurological complications. The court found in favor of Gunapathy, holding that the defendants breached their duty of care by recommending and performing radiosurgery without adequate justification and informed consent, resulting in significant damages.

1. Case Overview

1.1 Court

High Court

1.2 Outcome

Judgment for Plaintiff

1.3 Case Type

Civil

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Medical negligence case involving radiosurgery. Plaintiff suffered neurological complications. Court examined standard of care, informed consent, and expert evidence.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Gunapathy MuniandyPlaintiffIndividualJudgment for PlaintiffWonMichael Khoo, Andy Chiok Beng Piow
James KhooDefendantIndividualJudgment against DefendantLostMichael Hwang, Christopher Daniels, Renuka Chettiar
Neurological Surgery Pte LtdDefendantCorporationJudgment against DefendantLostMichael Hwang, Christopher Daniels, Renuka Chettiar
Khor Tong HongDefendantIndividualJudgment against DefendantLostMichael Hwang, Christopher Daniels, Renuka Chettiar

3. Judges

Judge NameTitleDelivered Judgment
G P SelvamJudgeYes

4. Counsels

Counsel NameOrganization
Michael KhooMichael Khoo & Partners
Andy Chiok Beng PiowMichael Khoo & Partners
Michael HwangKaruppan Chettiar & Partners
Christopher DanielsKaruppan Chettiar & Partners
Renuka ChettiarKaruppan Chettiar & Partners
Tan Beng SweeNetto Tan & S Margin

4. Facts

  1. Gunapathy underwent surgical removal of a brain tumour in 1995.
  2. She received radiotherapy after the surgery.
  3. A small nodule was detected in her brain after radiotherapy.
  4. Doctors recommended radiosurgery to remove the nodule.
  5. Gunapathy developed severe neurological complications after radiosurgery.
  6. The nodule was later determined to be scar tissue, not a tumour.
  7. The doctors did not adequately warn Gunapathy of the risks of radiosurgery.

5. Formal Citations

  1. Gunapathy Muniandy v James Khoo and Others, Suit 1768/1999, [2001] SGHC 165

6. Timeline

DateEvent
Gunapathy married.
Gunapathy experienced headaches and weakness in her right arm.
MRI of Gunapathy's head was done.
Dr James Khoo surgically removed a tumour from Gunapathy's brain.
Dr Khor began radiotherapy on Gunapathy.
Dr Khor completed radiotherapy on Gunapathy.
MRI showed a small nodule in the roof of the left ventricle of Gunapathy’s brain.
Dr Khor attended a course on the use of the XKnife in Sydney.
Another MRI was done on Gunapathy.
Gunapathy was referred to Dr Ho Kee Hang.
Dr Devathasan wrote to Dr James Khoo stating that Gunapathy prefers to have Radio Surgery to the residual lesion.
Gunapathy visited Dr James Khoo to discuss radiosurgery.
Dr Khor performed radiosurgery on Gunapathy.
Gunapathy developed tingling and numbness of the right arm.
MRI showed marked swelling of the left side of Gunapathy's brain.
Gunapathy sought advice of Dr Prem Pillay.
Michael Khoo & Partners wrote to Dr James Khoo and Dr Khor.
Decision Date

7. Legal Issues

  1. Medical Negligence
    • Outcome: The court found that the defendants breached their duty of care by recommending and performing radiosurgery without adequate justification and informed consent.
    • Category: Substantive
    • Sub-Issues:
      • Breach of duty of care
      • Inadequate advice
      • Lack of informed consent
      • Incompetent medical practice
  2. Informed Consent
    • Outcome: The court held that the plaintiff did not give informed consent to the radiosurgery due to inadequate information about the risks involved.
    • Category: Substantive
    • Sub-Issues:
      • Failure to disclose risks
      • Inadequate explanation of treatment options
  3. Standard of Care
    • Outcome: The court determined that the defendants failed to meet the required standard of care in recommending and performing radiosurgery.
    • Category: Substantive
    • Sub-Issues:
      • Deviation from accepted medical practice
      • Reasonable skill and knowledge

8. Remedies Sought

  1. Monetary Damages
  2. General damages for pain and suffering
  3. Special damages for loss of earning capacity

9. Cause of Actions

  • Medical Negligence

10. Practice Areas

  • Medical Malpractice
  • Neurology
  • Oncology
  • Personal Injury

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Bolam v Friern Hospital Management CommitteeN/AYes[1957] 1 WLR 582N/ACited for the principle that a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.
Roe v Minister of HealthN/AYes[1954] 2 QB 66N/ACited for the principle that the court must insist on due care for the patient but must not condemn as negligence that which is only a misadventure.
Mahon v OsborneEnglish Court of AppealYes[1939] 2 KB 14England and WalesCited as a medical negligence case where the doctrine of res ipsa loquitur was applied.
Cassidy v Ministry of HealthEnglish Court of AppealYes[1951] 2 KB 343England and WalesCited as a case where the onus lay on the hospital authority to prove that there had been no negligence.
Bull v Devon Area Health AuthorityCourt of AppealYes[1993] 4 Med LR 117England and WalesCited as a case where the doctrine of res ipsa loquitur applied due to delays in summoning medical assistance.
Bolton v StoneHouse of LordsYes[1951] AC 850England and WalesCited to show that the doctrine of res ipsa loquitur has no application where all the facts are known.
Saunders v Leeds Western Health AuthorityN/AYes[1993] 4 Med LR 355N/ACited as a case where res ipsa loquitur was successfully invoked in relation to cardiac arrest.
Coyne v Wigan Health AuthorityN/AYes[1991] 2 Med LR 301N/ACited as a case where res ipsa loquitur applied in relation to brain damage caused by a failure to intubate the patient.
Rex v BatemanCourt of Criminal AppealYes(1925) 19 Cr. App Rep 8England and WalesCited for the definition of the civil and criminal standards of negligence.
Hunter v HanleyCourt of SessionYes[1955] S C 213ScotlandCited for the test for establishing negligence in diagnosis or treatment on the part of a doctor.
Chin Keow v Government of Malaya and AnotherPrivy CouncilYes[1967] 1 WLR 813MalaysiaCited for the principle that the test of negligence is the standard of the ordinary competent practitioner exercising ordinary professional skill.
Greaves & Co v Baynham Meikle & PartnersN/AYes[1974] 1 WLR 1261N/ACited for the principle that special circumstances of a particular case may require the reasonably competent and careful expert to take special steps.
Edward Wong Finance Co Ltd v Johnson Stokes & MasterPrivy CouncilYes[1984] 1 AC 296Hong KongCited for the principle that a professional can be found negligent even if following a practice in accordance with a body of professional opinion.
Bolitho v City and Hackney Health AuthorityHouse of LordsYes[1998] AC 232England and WalesCited for the principle that expert medical evidence must be subject to the scrutiny of the court and be discarded if found to be unsupported by sound reason or logic.
Whitehouse v JordanN/AYes[1981] 1 WLR 246N/ACited for the principle that expert evidence should be the independent product of the expert.
National Justice Compania Naviera SA v Prudential Assurance Co Ltd (The Ikarian Reefer)N/AYes[1993] 2 Lloyds Rep 68N/ACited for the principle that an expert witness should provide independent assistance to the Court by way of unbiased opinion.
Davie v Magistrates of EdinburghN/AYes[1953] SC 34N/ACited for the principle that expert witnesses cannot usurp the functions of the jury or Judge.
Folkes v ChaddN/AYes(1782) 99 ER 589N/ACited for the principle that in matters of science, the reasonings of men of science can only be answered by men of science.
Reg v TurnerN/AYes[1955] 1 QB 834N/ACited for the principle that the opinion of scientific men upon proven facts may be given by men of science within their own science.
In Re Robinson’s Settlement, Gant v HobbsN/AYes[1912] 1 Ch 717N/ACited for the principle that reasons of practice and justice and convenience require the party to tell his opponent what he is coming to prove.
Davie v New Merton Board Mills LtdN/AYes[1956] 1 WLR 233N/ACited for the principle that a denial does not entitle the defendant to cast about and come up with justifications at the trials.
Regina Fur Company Ltd v BossomN/AYes[1958] 2 Lloyds Law Rep 425N/ACited for the principle that a defendant is not permitted to put forward some affirmative case which they have not pleaded or alleged.
Chin Keow v Government of Malaya & AnorPrivy CouncilYes[1967] 1 WLR 813MalaysiaCited for the principle that the test of negligence is the standard of the ordinary competent practitioner exercising ordinary professional skill.
Greaves & Co v Baynham Meikle & PartnersCourt of AppealYes[1975] 1 WLR 1095England and WalesCited for the principle that special circumstances of a particular case may require the reasonably competent and careful expert to take special steps.
Readhead v Midland Railway Co.Court of Exchequer ChamberYes(1869) LR 4 QB 379England and WalesCited for the principle that due care means a high degree of care, and casts on carriers the duty of exercising all vigilance.
Edward Wong Finance Co Ltd v Johnson Stokes & MasterPrivy CouncilYes[1984] 1 AC 296Hong KongCited for the principle that a professional can be found negligent even if following a practice in accordance with a body of professional opinion.
Yeo Yoke Mui v Ng Liang PohSingapore Court of AppealYes[1999] 3 SLR 529SingaporeCited for the principle that the mere fact that the respondent lawyer had complied with the standard conveyancing practice in Singapore did not preclude a finding that he had not done enough to advise the appellant.
Bolitho v City and Hackney Health AuthorityHouse of LordsYes[1998] AC 232England and WalesCited for the principle that expert medical evidence must be subject to the scrutiny of the court and be discarded if found to be unsupported by sound reason or logic.
Penney v East Kent Health AuthorityEnglish Court of AppealYes[2000] PNLR 323England and WalesCited for the principle that the Bolam test has no application where what the Judge is required to do is to make findings of fact.
Chatterton v GersonN/AYes[1981] QB 432N/ACited for the principle that the cause of action to base a claim for failure to inform of risks and implications is negligence, not trespass.
Hills v PotterN/AYes[1984] 1 WLR 641N/ACited for the principle that the cause of action to base a claim for failure to inform of risks and implications is negligence, not trespass.
Doughty v North Staffordshire Health AuthorityN/AYes[1992] 3 Med LR 81N/ACited for the principle that a given prophylactic, therapy or procedure should be prescribed only when the possible risks and complications potentially faced by the patient are outweighed by the potential benefit.
Loveday v RentonN/AYes[1990] 1 Med LR 117N/ACited for the principle that the Bolam test has no application to questions relating to causation.
Cavangh v Bristol & Weston Health AuthorityN/AYes[1992] 3 Med LR 49N/ACited for the principle that the Bolam test has no application to questions relating to causation.
Joyce v WandsworthN/AYes[1996] 7 Med LR 1N/ACited for the principle that the Bolam test has no application to questions relating to causation.
Harrison v RowanN/AYes(1820) 11 F. Cas. 658N/ACited for the principle that the mere opinions of the witnesses are entitled to little or no regard, unless they are supported by good reasons, founded on facts.
Langley v FisherN/AYes(1843) 49 ER 650N/ACited for the principle that a witness has no business to concern himself with the merits of the case.
Polivitte Ltd v Commercial Union Assurance Company PlCN/AYes[1987] 1 Lloyds Rep 379N/ACited for the principle that an expert witness should provide independent assistance to the Court by way of unbiased opinion.
Thorn v Worthing Skating Rink CompanyN/AYes(1876) 6 Ch D 415N/ACited to show that a party had commissioned 68 expert’s reports until a favourable one was obtained.
Kua Kok Kim & Ors v Ernst & YoungN/AYes[2000] 1 SLR 707SingaporeCited for the principle that a person providing professional services is in general under an obligation to possess reasonable care and skill.
Tan Joon Heng v Thiam Boon Kiap & AnorN/AYes[1989] BLD Yearbook 681N/ACited for the principle that previous awards are not treated as statutory tariffs.
Peh Diana & Another v Tan Miang LeeN/AYes[1991] 3 MLJ 375SingaporeCited for the principle that previous awards are not treated as statutory tariffs.
Hucks v ColeN/AYes[1993] 4 MLR 393N/ACited for the principle that when the evidence shows that a lacuna in professional practice exists by which risks of grave danger are knowingly taken, then, however small the risks, the courts must anxiously examine that lacuna.

13. Applicable Rules

Rule Name
Rules of Court

14. Applicable Statutes

Statute NameJurisdiction
Evidence Act (Cap 97)Singapore
Supply of Goods and Services Act 1982England

15. Key Terms and Keywords

15.1 Key Terms

  • Radiosurgery
  • Radionecrosis
  • Neurocytoma
  • Informed Consent
  • Medical Negligence
  • Standard of Care
  • Tumour
  • MRI
  • Radiotherapy
  • XKnife
  • Gamma Knife
  • Collimator
  • Brain Edema
  • Hemiparesis

15.2 Keywords

  • medical negligence
  • radiosurgery
  • informed consent
  • brain tumour
  • Singapore
  • neurology
  • oncology

16. Subjects

  • Medical Law
  • Negligence
  • Radiology
  • Neurosurgery
  • Oncology

17. Areas of Law

  • Medical Negligence
  • Tort Law
  • Radiosurgery
  • Civil Procedure