Surender Singh v Li Man Kay: Medical Negligence in Kidney Donor Death
In Surender Singh s/o Jagdish Singh And Another (administrators of the estate of Narindar Kaur d/o Sarwan Singh) v Li Man Kay and Others, the High Court of Singapore heard a negligence claim brought by the administrators of the estate of Narindar Kaur against Dr. Li Man Kay, Dr. Consigliere David Terence, and National University Hospital (NUH) following Narindar Kaur's death after a kidney donation surgery. The court dismissed claims against Dr. Li and Dr. Consigliere but found NUH negligent for failing to adequately monitor the deceased post-operatively, awarding interlocutory judgment to the plaintiffs against NUH. NUH's counterclaim for medical fees was allowed and set off against the damages to be assessed.
1. Case Overview
1.1 Court
High Court1.2 Outcome
Judgment for Plaintiff against National University Hospital; claims against Dr. Li and Dr. Consigliere dismissed.
1.3 Case Type
Civil
1.4 Judgment Type
Grounds of Decision
1.5 Jurisdiction
Singapore
1.6 Description
Medical negligence claim against doctors and hospital for death of kidney donor due to slipped Hem-o-lok clips. Judgment for Plaintiff against NUH.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Surender Singh s/o Jagdish Singh | Plaintiff, Administrator | Individual | Interlocutory Judgment | Partial | Palaniappan Sundararaj, Shankar A.S. |
| Minda Kour d/o Hendar Singh | Plaintiff, Administrator | Individual | Interlocutory Judgment | Partial | Palaniappan Sundararaj, Shankar A.S. |
| Li Man Kay | Defendant | Individual | Claim Dismissed | Dismissed | Edwin Tong, Mak Wei Munn, Kristy Tan |
| Consigliere David Terence | Defendant | Individual | Claim Dismissed | Dismissed | Edwin Tong, Mak Wei Munn, Kristy Tan |
| National University Hospital (Singapore) Pte Ltd | Defendant | Corporation | Judgment for Plaintiff, Counterclaim Allowed | Lost, Won | Rebecca Chew, Kelvin Poon, Loke Pei-Shan |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Lai Siu Chiu | Judge | Yes |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Palaniappan Sundararaj | Straits Law Practice LLC |
| Shankar A.S. | Straits Law Practice LLC |
| Edwin Tong | Allen & Gledhill LLP |
| Mak Wei Munn | Allen & Gledhill LLP |
| Kristy Tan | Allen & Gledhill LLP |
| Rebecca Chew | Rajah & Tann LLP |
| Kelvin Poon | Rajah & Tann LLP |
| Loke Pei-Shan | Rajah & Tann LLP |
4. Facts
- Narindar Kaur donated a kidney to her husband, Surender Singh.
- The HALDN procedure was performed by Dr. Li and Dr. Consigliere at NUH.
- Hem-o-lok clips were used to secure the renal artery and vein.
- The autopsy revealed significant intra-abdominal hemorrhage.
- The cause of death was acute intra-abdominal hemorrhage due to failure of haemostasis.
- The Deceased was transferred to the general ward after a period in the recovery room.
- The Deceased was not adequately monitored in the general ward after 1430 hours.
- The Code Blue Team was activated after the Deceased was found unresponsive.
5. Formal Citations
- Surender Singh s/o Jagdish Singh And Another (administrators of the estate of Narindar Kaur d/o Sarwan Singh) v Li Man Kay and Others, Suit 104/2008, [2009] SGHC 168
6. Timeline
| Date | Event |
|---|---|
| Narindar Kaur undergoes HALDN procedure at NUH | |
| Narindar Kaur pronounced dead at NUH | |
| Autopsy conducted on Narindar Kaur | |
| Teleflex Medical issues contraindication for Hem-o-lok clips in laparoscopic donor nephrectomy | |
| Coroner’s Inquiry held | |
| Suit filed in 2008 | |
| Trial begins | |
| Judgment reserved |
7. Legal Issues
- Medical Negligence
- Outcome: The court found NUH negligent in post-operative monitoring, but dismissed claims against the doctors regarding the surgical procedure.
- Category: Substantive
- Sub-Issues:
- Failure to properly secure renal artery
- Inadequate post-operative monitoring
- Delay in activating Code Blue Team
- Related Cases:
- [2002] 2 SLR 414
- [1957] 2 All ER 118
- [1997] 4 ALL ER 771
- Causation
- Outcome: The court found that NUH's failure to monitor the deceased post-operatively materially increased the risk of injury, leading to her death.
- Category: Substantive
- Related Cases:
- [1973] 1 WLR 1
- Admissibility of Evidence
- Outcome: The court ruled on the admissibility of medical records prepared by a nurse who did not testify and addressed the drawing of adverse inferences.
- Category: Procedural
8. Remedies Sought
- Monetary Damages
9. Cause of Actions
- Negligence
- Breach of Contract
10. Practice Areas
- Medical Malpractice
- Civil Litigation
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| The Popi M | N/A | Yes | [1985] 2 All ER 712 | N/A | Cited for the principle that the test is not whether the plaintiffs’ case is more probable than the defendants’ but whether it is more true than not on a balance of probabilities. |
| Dr Khoo James & Anor v Gunapathy d/o Muniandy | Court of Appeal | Yes | [2002] 2 SLR 414 | Singapore | Cited as the legal framework for liability in medical negligence cases in Singapore. |
| Bolam v Friern Hospital Management Committee | N/A | No | [1957] 2 All ER 118 | N/A | Cited in relation to the Bolam test for medical negligence. |
| Bolitho v City and Hackney Health Authority | N/A | Yes | [1997] 4 ALL ER 771 | N/A | Cited in relation to the Bolam test for medical negligence. |
| Rogers v Whitaker | High Court of Australia | No | (1992) 109 ALR 625 | Australia | Cited as an example of a jurisdiction that rejected the Bolam test. |
| Reibl v Hughes | Supreme Court of Canada | Yes | (1980) 114 DLR (3d) 1 | Canada | Cited as an example of a jurisdiction that rejected the Bolam test. |
| Foo Fio Na v Dr Soo Fook Mun | Federal Court | No | [2007] 1 MLJ 593 | Malaysia | Cited as an example of a jurisdiction that rejected the Bolam test. |
| Cheong Ghim Fah v Murugian s/o Rangasamy | N/A | Yes | [2004] 1 SLR 628 | Singapore | Cited for the application of Section 116(g) of the Evidence Act regarding adverse inferences. |
| Mohamed Ghouse v The King | N/A | Yes | [1909] SSLR 2 | N/A | Cited for the strict construction of Section 32 of the Evidence Act. |
| Sim & Associates v Tan Alfred | N/A | Yes | [1994] 3 SLR 169 | Singapore | Cited for the conditions in Section 32 of the Evidence Act. |
| Central Bank of India v Hemant Govindprasad Bansal | N/A | Yes | [2002] 3 SLR 190 | Singapore | Cited for the conditions in Section 32 of the Evidence Act. |
| RDC Concrete Pte Ltd v Sato Kogyo (S) Pte Ltd and another appeal | N/A | Yes | [2007] 4 SLR 413 | Singapore | Cited for the principle that courts should not make a decision on an issue that was not raised. |
| Tan Kia Poh v Hong Leong Finance Ltd | N/A | Yes | [1994] 1 SLR 270 | Singapore | Cited for the principle that allowing submissions to be made on matters not previously pleaded might result in material prejudice to the other party. |
| R v Turner | N/A | Yes | (1816) 5 M. & S. 206 | N/A | Cited for the origins of Section 108 of the Evidence Act. |
| McGhee v National Coal Board | N/A | Yes | [1973] 1 WLR 1 | N/A | Cited for the principle that it is sufficient to show that the defendant’s breach of duty made the risk of injury more probable even though it was uncertain whether it was the actual cause. |
| Yeo Peng Hock Henry v Pai Lily | N/A | Yes | [2001] 4 SLR 571 | Singapore | Cited for the principle that the plaintiffs must prove on a balance of probabilities, that negligence and/or breach of duty caused or materially contributed to the Deceased’s death. |
| Sunny Metal & Engineering Pte Ltd v Ng Khim Ming Eric | N/A | Yes | [2007] 3 SLR 782 | Singapore | Cited for the principle that the damage must have been caused by the defendant’s act or omission which amounted to a breach of his duty. |
| Yeo Yoke Mui v Ng Liang Poh | N/A | Yes | [1999] 3 SLR 529 | Singapore | Cited for the question of causation. |
| F v Chan Tanny | N/A | Yes | [2003] 4 SLR 231 | Singapore | Cited for the question of causation. |
| Ikumene Singapore Pte Ltd v Leong Chee Leng | N/A | Yes | [1992] 2 SLR 890 | Singapore | Cited for the common sense notion of causation. |
| Alexander v Cambridge Credit Corp Ltd | N/A | Yes | (1987) 9 NSWLR 310 | N/A | Cited for the common sense notion of causation. |
| Mohd bin Sapri v Soil-Build (Pte) Ltd and another appeal | N/A | Yes | [1996] 2 SLR 505 | Singapore | Cited for the Sanderson order for costs. |
| Sanderson v Blyth Theatre Co | N/A | Yes | [1903] 2 KB 533 | N/A | Cited for the Sanderson order for costs. |
13. Applicable Rules
| Rule Name |
|---|
| Order 59 Rule 2(2) of the Rules of Court (Cap 322, R 5, 2006 Rev Ed |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Civil Law Act (Cap 43, 1999 Ed) ss 20 and 21 | Singapore |
| Evidence Act (Cap 97, 1997 Rev Ed) s 32 | Singapore |
| Evidence Act (Cap 97, 1997 Rev Ed) s 116(g) | Singapore |
| Evidence Act s 108 | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- HALDN
- Hem-o-lok clips
- Renal artery
- Renal vein
- Nephrectomy
- Intra-abdominal hemorrhage
- Post-operative monitoring
- Code Blue Team
- Warm ischemic time
- Hypovolemic shock
15.2 Keywords
- Medical negligence
- Kidney donation
- Laparoscopic surgery
- Hem-o-lok clips
- Post-operative care
- Standard of care
- Causation
- Singapore
- Hospital negligence
16. Subjects
- Medical Law
- Negligence
- Civil Litigation
- Transplant Surgery
17. Areas of Law
- Tort
- Negligence
- Medical Negligence
- Civil Procedure
- Evidence