Hii Chii Kok v Ooi Peng Jin: Medical Negligence, Standard of Care, Doctor's Duty of Advice

In Hii Chii Kok v Ooi Peng Jin London Lucien and National Cancer Centre of Singapore Pte Ltd, the Singapore Court of Appeal heard an appeal regarding a patient, Hii Chii Kok, who underwent unnecessary pancreatic surgery. Hii Chii Kok sued his surgeon, Dr. Ooi Peng Jin London Lucien, and the National Cancer Centre of Singapore Pte Ltd (NCCS) for negligent diagnosis and advice. The court dismissed the appeal, finding no negligence. The court clarified the standard of care for a doctor's duty to advise patients, adopting a more patient-centric approach while retaining the Bolam test for diagnosis and treatment.

1. Case Overview

1.1 Court

Court of Appeal of the Republic of Singapore

1.2 Outcome

Appeal Dismissed in its Entirety

1.3 Case Type

Civil

1.4 Judgment Type

Judgment

1.5 Jurisdiction

Singapore

1.6 Description

Singapore Court of Appeal judgment on medical negligence, clarifying the standard of care for a doctor's duty to advise patients.

1.7 Decision Date

11 May 2017

2. Parties and Outcomes

Party Name	Role	Type	Outcome	Outcome Type	Counsels
Hii Chii Kok	Appellant	Individual	Appeal Dismissed in its Entirety	Lost	Lim Min of Straits Law Practice LLC N Sreenivasan of Straits Law Practice LLC Palaniappan Sundararaj of Straits Law Practice LLC
Ooi Peng Jin London Lucien	Respondent	Individual	Appeal Dismissed	Won	Tham Hsu Hsien of Allen & Gledhill LLP Mak Wei Munn of Allen & Gledhill LLP Christine Tee of Allen & Gledhill LLP Edwin Tong of Allen & Gledhill LLP Hoh Jian Yong of Allen & Gledhill LLP
National Cancer Centre of Singapore Pte Ltd	Respondent	Corporation	Appeal Dismissed	Won	Kuah Boon Theng of Legal Clinic LLC Felicia Chain of Legal Clinic LLC Samantha Oei of Legal Clinic LLC Karen Yong of Legal Clinic LLC Gerald Soo of Legal Clinic LLC

3. Judges

Judge Name	Title	Delivered Judgment
Sundaresh Menon	Chief Justice	Yes
Chao Hick Tin	Justice of the Court of Appeal	No
Judith Prakash	Justice of the Court of Appeal	No
Tay Yong Kwang	Justice of the Court of Appeal	No
Steven Chong	Justice of the Court of Appeal	No

4. Counsels

Counsel Name	Organization
Lim Min	Straits Law Practice LLC
N Sreenivasan	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	Allen & Gledhill LLP
Hoh Jian Yong	Allen & Gledhill LLP
Kuah Boon Theng	Legal Clinic LLC
Felicia Chain	Legal Clinic LLC
Samantha Oei	Legal Clinic LLC
Karen Yong	Legal Clinic LLC
Gerald Soo	Legal Clinic LLC

4. Facts

Patient had a nodule in his right lung, diagnosed as a low-grade malignancy neuroendocrine tumour in 2003.
Gallium PET/CT scan in 2010 incidentally noted increased tracer avidity in the pancreas, suggesting possible additional NETs.
MRI scan in Malaysia showed no masses in the pancreas.
Tumour Board recommended removal of the pancreatic body lesion, with uncertainty regarding the pancreatic head lesion.
Dr. Ooi performed Whipple procedure despite negative intra-operative ultrasound, based on palpation findings.
Post-operative histopathology revealed hyperplasia, not PNETs, in both areas of the pancreas.
Patient developed complications post-surgery, including vomiting blood and hepaticojunostomy anastomotic leak.

5. Formal Citations

Hii Chii Kok v Ooi Peng Jin London Lucien and another, Civil Appeal No 33 of 2016, [2017] SGCA 38
Hii Chii Kok v Ooi Peng Jin London Lucien and another, , [2016] SGHC 21

6. Timeline

Date	Event
2003-01-01	Patient learned he had a nodule in his right lung.
2010-07-19	Patient underwent Gallium PET/CT scan.
2010-07-20	Patient underwent MRI scan in Malaysia.
2010-07-22	Patient had multiple consultations at the NCCS.
2010-07-23	Patient emailed Dr. Ooi regarding surgery recommendation.
2010-07-29	Tumour Board meeting was held.
2010-07-29	Dr. Andrew Tan emailed the Patient the results of the Tumour Board meeting.
2010-08-09	Patient enquired about performing an endoscopic ultrasound.
2010-08-16	Patient underwent surgery.
2010-08-27	Patient was discharged from the hospital.
2010-09-03	Dr. Ooi saw the Patient for a follow-up appointment.
2010-09-15	Patient contacted Dr. Ooi, vomiting blood.
2010-09-16	Patient underwent surgery in Malaysia.
2010-10-04	Patient was transferred to a HPB disease specialist hospital in Malaysia.
2010-10-20	Exploratory laparotomy was performed.
2010-11-09	Patient was discharged.
2016-03-01	Civil Appeal No 33 of 2016 was filed.
2016-10-03	Appeal hearing.
2017-05-12	Judgment reserved.

7. Legal Issues

Standard of Care in Medical Negligence
- Outcome: The court clarified the standard of care for a doctor's duty to advise patients, adopting a more patient-centric approach while retaining the Bolam test for diagnosis and treatment.
- Category: Substantive
- Sub-Issues:
  - Application of Bolam test
  - Patient autonomy
  - Doctor's duty of advice
- Related Cases:
  - [2002] 1 SLR(R) 1024
  - [1957] 1 WLR 582
  - [1998] AC 232
  - [2015] UKSC 11
Negligent Diagnosis
- Outcome: The court found that the respondents were not negligent in arriving at the diagnosis of the Patient's condition.
- Category: Substantive
- Sub-Issues:
  - Interpretation of medical scans
  - Differential diagnosis
  - Reasonableness of clinical judgment
Negligent Advice
- Outcome: The court found that the respondents did not fall below the requisite standard of care in relation to the information and advice that was furnished to the Patient.
- Category: Substantive
- Sub-Issues:
  - Informed consent
  - Disclosure of risks
  - Alternative treatments
- Related Cases:
  - [2015] UKSC 11
Post-operative Care
- Outcome: The court found that Dr. Ooi did not fall below the requisite standard of care in relation to the care extended to the Patient during the post-operative period.
- Category: Substantive
- Sub-Issues:
  - Monitoring of patient condition
  - Detection of complications
  - Reasonableness of discharge

8. Remedies Sought

Monetary Damages

9. Cause of Actions

Negligence
Breach of Duty of Care

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	Established the Bolam test with the Bolitho addendum as the standard of care for doctors in Singapore, applicable to all aspects of the doctor-patient relationship.
Bolam v Friern Hospital Management Committee	High Court of England and Wales	Yes	[1957] 1 WLR 582	England and Wales	Set out 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 art.
Bolitho v City and Hackney Health Authority	House of Lords	Yes	[1998] AC 232	United Kingdom	Supplemented the Bolam test, requiring that the body of medical opinion relied upon must satisfy a threshold test of logic.
Montgomery v Lanarkshire Health Board	Supreme Court	Yes	[2015] UKSC 11	United Kingdom	Shifted the focus to a more patient-centric approach, requiring doctors to ensure patients are aware of material risks involved in treatment and reasonable alternatives.
Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital	House of Lords	Yes	[1985] AC 871	United Kingdom	Applied the Bolam test to the provision of advice, but was later superseded by Montgomery in the UK.
Canterbury v Spence	United States Court of Appeals, District of Columbia Circuit	Yes	(1972) 464 F 2d 772	United States	Classic statement of the doctrine of informed consent, requiring doctors to disclose all material risks to patients.
Rogers v Whitaker	High Court	Yes	(1992) 175 CLR 479	Australia	Rejected the Bolam test in relation to the provision of information, emphasizing patient autonomy.
Hucks v Cole	Unknown	Yes	[1993] 4 Med LR 393	Unknown	Case where the court found that the alleged body of opinion did exist and did have the content alleged, not only among the specific experts called at trial but in the profession at large, but that the opinion itself was illogical and should be rejected
Edward Wong Finance Co Ltd v Johnson Stokes & Master (a firm)	Privy Council	Yes	[1984] AC 296	Hong Kong	Case where the court found that the alleged body of opinion did exist and did have the content alleged, not only among the specific experts called at trial but in the profession at large, but that the opinion itself was illogical and should be rejected
JSI Shipping (S) Pte Ltd v Teofoongwonglcloong	Court of Appeal	Yes	[2007] 4 SLR(R) 460	Singapore	Applied the Bolam test and Bolitho addendum to non-medical contexts.
PlanAssure PAC v Gaelic Inns Pte Ltd	Court of Appeal	Yes	[2007] 4 SLR(R) 513	Singapore	Applied the Bolam test and Bolitho addendum to non-medical contexts.
Foo Fio Na v Dr Soo Fook Mun	Federal Court	Yes	[2007] 1 MLJ 593	Malaysia	Seen by some as standing for the proposition that the Bolam test is no longer relevant to any aspect of medical negligence there
Gold v Haringey HA	Unknown	Yes	[1988] QB 481	United Kingdom	Applied the Bolam test to professions generally
Pearce v United Bristol Healthcare NHS Trust	England and Wales Court of Appeal (Civil Division)	Yes	[1999] EWCA Civ 865	England and Wales	Introduced the terminology of the reasonable patient into English law
Reibl v Hughes	Supreme Court	Yes	(1980) 2 SCR 880	Canada	Case regarding patient-centric approaches
Dickson v Pinder	Alberta Court of Queen's Bench	Yes	[2010] ABQB 269	Canada	Case regarding the types of material information that should be disclosed
Malinowski v Schneider	Alberta Court of Queen's Bench	Yes	[2010] ABQB 734	Canada	Case regarding the types of material information that should be disclosed
Seney v Crooks	Alberta Court of Appeal	Yes	[1998] ABCA 316	Canada	Case regarding the types of material information that should be disclosed
Rosenberg v Percival	High Court	Yes	[2001] HCA 18	Australia	Case regarding the need to guard against hindsight and outcome bias
Maloney v Commissioner for Railways	Unknown	Yes	(1978) 18 ALR 147	Australia	Case regarding the need to guard against hindsight and outcome bias

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

Bolam test
Bolitho addendum
Montgomery test
Patient autonomy
Medical negligence
Standard of care
Neuroendocrine tumour
Pancreatic polypeptide hyperplasia
Whipple procedure
Anastomotic leak
Gallium PET/CT scan
Intra-operative ultrasound
Informed consent

15.2 Keywords

medical negligence
standard of care
duty of care
doctor's advice
patient autonomy
Bolam test
Singapore
Court of Appeal

17. Areas of Law

Area Name	Relevance Score
Negligence	90
Medical Malpractice	90
Breach of Duty of Care	80
Torts	60
Evidence	40
Medical Ethics	30
Contract Law	20

16. Subjects

Medical Law
Tort Law
Civil Litigation
Appeals