Koo Quay Keong v Ooi Peng Jin: Negligence Claim for Post-Operative Care After Whipple Operation
Koo Quay Keong, as administrator of the estate of Lee Lee Chan, deceased, brought a negligence claim against Dr. Ooi Peng Jin London Lucien in the High Court of Singapore. The claim concerned the post-operative care provided by Dr. Ooi after Mdm Lee underwent a Whipple operation. The Plaintiff alleged that Dr. Ooi failed to timely diagnose and treat a post-operative complication. The court, presided over by Woo Bih Li J, dismissed the claim, finding that the Plaintiff failed to prove that Dr. Ooi's actions fell below the expected standard of care and that any alleged negligence caused Mdm Lee's death.
1. Case Overview
1.1 Court
High Court of the Republic of Singapore1.2 Outcome
Claim Dismissed
1.3 Case Type
Civil
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
Negligence claim against surgeon for post-operative care after a Whipple operation. Court dismissed the claim, finding no breach of duty.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Koo Quay Keong (Administrator of the Estate of Lee Lee Chan, Deceased) | Plaintiff | Individual | Claim Dismissed | Lost | Tan Chee Meng, Sngeeta Rai, Tang Shangwei, Chan Soh Lei Kerry |
| Ooi Peng Jin London Lucien | Defendant | Individual | Judgment for Defendant | Won | Kristy Tan, Tham Chuen Min Jasmine, Tham Hsu Hsien |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Woo Bih Li | Judge | Yes |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Tan Chee Meng | WongPartnership LLP |
| Sngeeta Rai | WongPartnership LLP |
| Tang Shangwei | WongPartnership LLP |
| Chan Soh Lei Kerry | WongPartnership LLP |
| Kristy Tan | Allen & Gledhill LLP |
| Tham Chuen Min Jasmine | Allen & Gledhill LLP |
| Tham Hsu Hsien | Allen & Gledhill LLP |
4. Facts
- Mdm Lee underwent a Whipple operation performed by the Defendant to remove a tumour on the head of her pancreas.
- Mdm Lee suffered several complications while under post-operative care.
- Mdm Lee passed away on 28 July 2011.
- The Plaintiff alleged that the Defendant failed to deliver timely and appropriate post-operative care.
- The Plaintiff submitted that Mdm Lee had suffered an anastomotic leak, which the Defendant failed to investigate, diagnose, and treat timeously.
- The Defendant submitted that Mdm Lee did not have an anastomotic leak until 2300hrs on 16 July, and was managed appropriately both before and after that time.
- The Plaintiff did not plead a loss of chance.
5. Formal Citations
- Koo Quay Keong (Administrator of the Estate of Lee Lee Chan, Deceased) v Ooi Peng Jin London Lucien, Suit No 714 of 2014, [2016] SGHC 168
6. Timeline
| Date | Event |
|---|---|
| Mdm Lee underwent a Whipple operation performed by the Defendant | |
| Mdm Lee had amylase levels of 1,361U/L and 1,942U/L respectively in her right and left operatively-inserted drains | |
| Mdm Lee experienced respiratory compromise and shortness of breath | |
| Mdm Lee's breathing difficulties worsened | |
| A chest X-ray showed bilateral basal atelectasis and a right-sided pleural effusion with free fluid around her liver | |
| The Defendant ordered the pleural effusion to be treated with percutaneous drainage of the chest | |
| A CT scan of the chest was performed to guide the insertion of a tube for percutaneous drainage procedure | |
| 2,360ml of abdominal fluid was drained from Mdm Lee | |
| 2,500ml of abdominal fluid was drained from Mdm Lee | |
| Mdm Lee had a low albumin level of 22g/L and drained “chylous” fluid | |
| Mdm Lee complained of severe pain over a wound site | |
| Mdm Lee had pain scores of 6/10 at 0930hrs and 3/10 at 1430hrs, but was alert and clinically well | |
| Mdm Lee complained of a sudden intense pain over her abdominal region at 2300hrs | |
| Dr Yeo observed that Mdm Lee had deteriorated and that her abdominal tenderness had persisted | |
| A CT scan of Mdm Lee’s chest, abdomen, and pelvis was performed | |
| Mdm Lee was moved to the High Dependency Unit for monitoring and for stabilisation | |
| The Defendant arrived at SGH, reviewed Mdm Lee, and diagnosed her with a “delayed pancreatic dehiscence” | |
| The Defendant moved her to the SICU for resuscitation | |
| Mdm Lee was sent for a brain CT scan | |
| The Defendant ordered a CT scan of Mdm Lee’s abdomen and pelvis | |
| The Defendant ordered a percutaneous drainage procedure | |
| A laparotomy was performed | |
| A second laparotomy was performed | |
| Mdm Lee passed away | |
| Judgment reserved |
7. Legal Issues
- Breach of Duty of Care
- Outcome: The court found that the plaintiff failed to prove that the defendant breached their duty of care.
- Category: Substantive
- Sub-Issues:
- Failure to diagnose
- Failure to provide timely treatment
- Failure to order appropriate diagnostic tests
- Causation
- Outcome: The court found that the plaintiff failed to prove that the defendant's alleged negligence caused the deceased's death.
- Category: Substantive
- Sub-Issues:
- Proximate cause
- Intervening events
8. Remedies Sought
- Monetary Damages
9. Cause of Actions
- Negligence
10. Practice Areas
- Medical Malpractice
- Civil Litigation
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Khoo James and another v Gunapathy d/o Muniandy and another appeal | Court of Appeal | Yes | [2002] 1 SLR(R) 1024 | Singapore | Cited as the leading authority on medical negligence in Singapore, referencing the Bolam test and its supplementation by Bolitho. |
| Bolam v Friern Hospital Management Committee | Not specified | Yes | [1957] 1 WLR 582 | England and Wales | Cited for the Bolam test, which states that a doctor is not negligent if they acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular act. |
| Bolitho v City and Hackney Health Authority | House of Lords | Yes | [1998] AC 232 | England and Wales | Cited for supplementing the Bolam test, requiring that an expert view must satisfy the threshold test of logic to be considered a proper practice. |
| D’Conceicao Jeanie Doris (administratrix of the estate of Milakov Steven, deceased) v Tong Ming Chuan | High Court | Yes | [2011] SGHC 193 | Singapore | Cited to support the principle that a doctor's acknowledgement of one practice while preferring another does not make their opinion inconsistent. |
| Chua Thong Jiang Andrew v Yue Wai Mun and another | High Court | Yes | [2015] SGHC 119 | Singapore | Cited for the principle that an allegation of negligence in failing to order a post-operative diagnostic test must be positively proved. |
| Deans Property Pte Ltd v Land Estates Apartments Pte Ltd and another | Not specified | Yes | [1994] 3 SLR(R) 804 | Singapore | Cited for the principle that every case must be decided on the issues raised by the pleadings, which bind the parties. |
| Holland Leedon Pte Ltd (in liquidation) v C & P Transport Pte Ltd | High Court | Yes | [2013] SGHC 281 | Singapore | Cited for the principle that evidence at trial can overcome omissions in a party’s pleadings where the opponent is not taken by surprise. |
| John G Stein & Co Ltd v O’Hanlon | Not specified | Yes | [1965] AC 890 | United Kingdom | Cited for the principle that evidence may not establish facts radically different from those pleaded that more than simply vary, modify, or develop what has been alleged. |
| Brodie McCoy (A Minor by her Mother and Litigation Friend Joanne Jones) v East Midlands Strategic Health Authority | High Court | Yes | [2011] EWHC 38 (QB) | England and Wales | Cited for the approach to causation where the loss stemming from a negligent omission could have been avoided if all of several hypothetical intermediate events had occurred. |
| Bright (Billy-Joe Marie) (by her father and litigation friend Peter Bright) v Barnsley District General Hospital NHS Trust | High Court | Yes | [2005] Lloyd’s Rep Med 449 (QB) | England and Wales | Cited for the principle that each probabilistic event is a separate hypothetical fact to be decided on the balance of probabilities. |
| Yeo Peng Hock Henry v Pai Lily | Not specified | Yes | [2001] 3 SLR(R) 555 | Singapore | Cited for the principle that even if there was a negligent omission, no liability lies unless the negligence caused or materially contributed to the injuries suffered. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| No applicable statutes | |
15. Key Terms and Keywords
15.1 Key Terms
- Whipple operation
- Anastomotic leak
- Post-operative care
- Negligence
- Standard of care
- Causation
- Pancreatic fistula
- Abdominal CT scan
- Percutaneous drainage
- Laparotomy
15.2 Keywords
- medical negligence
- whipple operation
- post-operative care
- anastomotic leak
- surgical error
16. Subjects
- Medical Law
- Tort Law
- Civil Litigation
17. Areas of Law
- Tort
- Negligence
- Medical Negligence
- Civil Procedure