Hii Chii Kok v Ooi Peng Jin London Lucien: Medical Negligence, Pancreatic Neuroendocrine Tumors, Bolam-Bolitho Test

In Hii Chii Kok v Ooi Peng Jin London Lucien and National Cancer Centre of Singapore Pte Ltd, the High Court of Singapore addressed a medical negligence claim. Dato’ Seri Hii Chii Kok sued Professor Ooi Peng Jin London Lucien and the National Cancer Centre of Singapore Pte Ltd for negligence related to the diagnosis and treatment of pancreatic lesions. The court, applying the Bolam-Bolitho test, found that the defendants were not negligent in their diagnoses, advice, or post-operative management. The plaintiff's claims were dismissed.

1. Case Overview

1.1 Court

High Court of the Republic of Singapore

1.2 Outcome

Plaintiff's claims dismissed in total.

1.3 Case Type

Civil

1.4 Judgment Type

Judgment

1.5 Jurisdiction

Singapore

1.6 Description

Medical negligence case involving Hii Chii Kok, Prof Ooi, and NCCS. The court applied the Bolam-Bolitho test, finding no negligence in diagnoses or advice.

1.7 Decision Date

21 February 2016

2. Parties and Outcomes

Party Name	Role	Type	Outcome	Outcome Type	Counsels
Hii Chii Kok	Plaintiff	Individual	Claim Dismissed	Lost	Lim Min of Straits Law Practice LLC Palaniappan Sundararaj of Straits Law Practice LLC
Ooi Peng Jin London Lucien	Defendant	Individual	Judgment for Defendant	Won	Tham Hsu Hsien of Allen & Gledhill LLP Mak Wei Munn of Allen & Gledhill LLP Christine Tee of Allen & Gledhill LLP Edwin Tong SC of Allen & Gledhill LLP Hoh Jian Yong of Allen & Gledhill LLP
National Cancer Centre of Singapore Pte Ltd	Defendant	Corporation	Judgment for Defendant	Won	Kuah Boon Theng of Legal Clinic LLC Felicia Chain of Legal Clinic LLC Karen Yong of Legal Clinic LLC Gerald Soo of Legal Clinic LLC

3. Judges

Judge Name	Title	Delivered Judgment
Chan Seng Onn	Judge	Yes

4. Counsels

Counsel Name	Organization
Lim Min	Straits Law Practice LLC
Palaniappan Sundararaj	Straits Law Practice LLC
Tham Hsu Hsien	Allen & Gledhill LLP
Mak Wei Munn	Allen & Gledhill LLP
Christine Tee	Allen & Gledhill LLP
Edwin Tong SC	Allen & Gledhill LLP
Hoh Jian Yong	Allen & Gledhill LLP
Kuah Boon Theng	Legal Clinic LLC
Felicia Chain	Legal Clinic LLC
Karen Yong	Legal Clinic LLC
Gerald Soo	Legal Clinic LLC

4. Facts

Plaintiff diagnosed with possible neuroendocrine tumors (NETs) in pancreas.
Tumour Board considered differential diagnosis of pancreatic polypeptide hyperplasia.
Plaintiff informed of clinical and differential diagnoses, and treatment options.
Plaintiff chose aggressive treatment and proceeded with Whipple Surgery.
Post-operative histopathology revealed hyperplasia, not NETs.
Plaintiff sued for negligence in diagnoses, advice, and post-operative management.
Plaintiff had a history of lung NET.

5. Formal Citations

Hii Chii Kok v Ooi Peng Jin London Lucien and another, Suit No 806 of 2012, [2016] SGHC 21

6. Timeline

Date	Event
2000-01-01	Plaintiff underwent surgery for hyperthyroidism.
2003-01-01	Nodules discovered in plaintiff's lungs.
2006-11-23	Plaintiff experienced pain in left shoulder and underwent chest x-ray.
2010-06-17	Lung nodule grew to 18mm.
2010-07-08	Histopathological analysis identified lung nodule as NET of low grade malignancy.
2010-07-13	Plaintiff consulted Dr. Foo Yoke Ching regarding treatment of lung NET.
2010-07-19	Gallium PET/CT scan performed on plaintiff.
2010-07-20	MRI scan performed on plaintiff.
2010-07-21	Plaintiff saw Dr. Foo YC to update her on scans.
2010-07-22	Plaintiff informed case to be discussed by Tumour Board on 29 July 2010.
2010-07-22	Plaintiff consulted Dr. Darren Lim and Dr. Koo.
2010-07-22	Plaintiff met Prof Ooi.
2010-07-23	Dr. Tan recommended plaintiff wait for Tumour Board opinion.
2010-07-23	Plaintiff emailed Prof Ooi, agreeing in principle to surgery.
2010-07-24	Plaintiff replied to Dr. Tan, expressing concern about scan discrepancies.
2010-07-29	Tumour Board met to discuss plaintiff's case.
2010-08-08	Plaintiff emailed Dr. Tan for further clarification.
2010-08-09	Plaintiff emailed Dr. Tan about Endoscopic Ultrasound.
2010-08-10	Plaintiff emailed Prof Ooi about EUS guided Fine Needle Aspiration biopsy.
2010-08-12	Plaintiff emailed Dr. Tan again about EUS-FNA.
2010-08-13	Plaintiff consulted with Prof Ooi again.
2010-08-16	Plaintiff admitted to SGH and consented to Whipple Surgery.
2010-08-16	Whipple Surgery commenced.
2010-08-26	Histopathology results reported suggestive of islet cell hyperplasia.
2010-08-16	Resected specimens sent for histopathological examination.
2010-08-16	Plaintiff managed as inpatient.
2010-08-27	Plaintiff discharged.
2010-09-02	Plaintiff consulted Dr. Agasthian Thirugnanam.
2010-09-03	Outpatient review noted normal serum amylase level and total white cell count.
2010-09-05	Plaintiff emailed Dr. Tan about surgical options for lung NET.
2010-09-09	Plaintiff emailed Prof Ooi about bitter taste.
2010-09-13	Draining on site of Whipple Surgery.
2010-09-15	Plaintiff contacted Prof Ooi, vomiting blood.
2010-09-15	Plaintiff went to SDMC.
2010-09-16	Plaintiff underwent surgery to remove necrotic tissue.
2010-10-04	Plaintiff transferred to Hospital Selayang.
2010-10-20	Exploratory laparotomy performed.
2010-11-09	Plaintiff discharged from Hospital Selayang.
2012-02-13	Plaintiff remained well when last seen by Dr. Krishnan Raman.

7. Legal Issues

Medical Negligence
- Outcome: The court found that the defendants did not breach their duty of care and were not negligent.
- Category: Substantive
- Sub-Issues:
  - Breach of duty
  - Causation
  - Standard of care
Non-Delegable Duty of Care
- Outcome: The court found that the NCCS did not owe a non-delegable duty of care to the plaintiff in relation to the Whipple Surgery and post-operative care.
- Category: Substantive
Informed Consent
- Outcome: The court found that the plaintiff gave informed consent to the Whipple Surgery.
- Category: Substantive

8. Remedies Sought

Monetary Damages

9. Cause of Actions

Negligence
Breach of Duty

10. Practice Areas

Medical Malpractice
Oncology
Surgery

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	Sets out the law on medical negligence in Singapore, adopting the Bolam-Bolitho test.
Bolam v Friern Hospital Management Committee	English Court	Yes	[1957] 1 WLR 582	England	Establishes the Bolam test for medical negligence.
Bolitho v City and Hackney Health Authority	House of Lords	Yes	[1998] AC 232	England	Supplements the Bolam test, requiring expert testimony to have a logical basis.
Surender Singh s/o Jagdish Singh and another (administrators of the estate of Narindar Kaur d/o Sarwan Singh, deceased) v Li Man Kay and others	High Court	No	[2010] 1 SLR 428	Singapore	Discusses the application of the Bolam-Bolitho test versus informed consent in medical advice cases.
D’Conceicao Jeanie Doris (administratrix of the estate of Milakov Steven, deceased) v Tong Ming Chuan	High Court	No	[2011] SGHC 193	Singapore	Discusses the application of the Bolam-Bolitho test versus informed consent in medical advice cases.
Tong Seok May Joanne v Yau Hok Man Gordon	High Court	No	[2013] 2 SLR 18	Singapore	Discusses the application of the Bolam-Bolitho test versus informed consent in medical advice cases.
Montgomery v Lanarkshire Health Board (General Medical Council intervening)	UK Supreme Court	No	[2015] AC 1430	England	Sets out the doctrine of informed consent in English law, moving away from the Bolam-Bolitho test.
Woodland v Swimming Teachers Association	UK Supreme Court	Yes	[2014] AC 537	England	Discusses non-delegable duties of care.
BNM (administratrix of the estate of B, deceased) on her own behalf and on behalf of others v National University of Singapore and another	High Court	Yes	[2014] 2 SLR 258	Singapore	Endorses the principles in Woodland regarding non-delegable duties.
Farraj v King’s Healthcare NHS Trust	English Court of Appeal	Yes	[2010] 1 WLR 2139	England	Deals with non-delegable duties in a hospital context.
Canterbury v Spence	US Court of Appeals, District of Columbia Circuit	No	(1972) 464 F 2d 772	United States	Sets out the doctrine of informed consent.
Reibl v Hughes	Supreme Court of Canada	No	(1980) 114 DLR (3d) 1	Canada	Sets out the doctrine of informed consent.
Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and others	House of Lords	No	[1985] 1 AC 871	England	Discusses the Bolam test in relation to a failure to advise a patient of risks involved in a treatment.
Rogers v Whitaker	High Court of Australia	Yes	(1992) 175 CLR 479	Australia	Discusses the duty to inform a patient of material risks.
Foo Fio Na v Dr Soo Fook Mun & Anor	Federal Court (Putrajaya)	Yes	[2007] 1 MLJ 593	Malaysia	Discusses the duty to inform a patient of material risks.
DOMINIC Puthucheary & Ors (personal representatives of the estate of Thayalan a/l Kanapathipillai) v Dr Goon Siew Fong & Anor	Malaysian Court of Appeal (Putrajaya)	Yes	[2007] 5 MLJ 552	Malaysia	Discusses the duty to inform a patient of material risks.

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 Surgery
Pancreatic Neuroendocrine Tumors
Pancreatic Polypeptide Hyperplasia
Bolam-Bolitho Test
Gallium Scan
Tumour Board
Informed Consent
Non-Delegable Duty

15.2 Keywords

Medical Negligence
Pancreatic Cancer
Neuroendocrine Tumors
Whipple Procedure
Bolam Test
Singapore Law
Informed Consent

17. Areas of Law

Area Name	Relevance Score
Negligence	90
Medical Negligence	90
Breach of Duty	70
Causation	70
Personal Injury	40
Evidence Law	30
Evidence	30
Contract Law	20
Trust Law	10

16. Subjects

Medical Law
Oncology
Surgery
Civil Procedure