Rathanamalah v Chia Kok Hoong: Negligence Claim for Nerve Injuries Post Varicose Vein Surgery

In Rathanamalah d/o Shunmugam v Chia Kok Hoong, the High Court of Singapore heard a negligence claim by the Plaintiff, Rathanamalah d/o Shunmugam, against the Defendant, Chia Kok Hoong, a vascular surgeon. The Plaintiff alleged that the Defendant's negligence during varicose vein surgery (EVLT, Foam Sclerotherapy, and Phlebectomy) caused her permanent nerve injuries. The court, presided over by Aedit Abdullah JC, found that the Plaintiff failed to prove that the Defendant breached his duty of care. The court also noted that even if a breach had been established, the Plaintiff had exaggerated her claimed damages. The court ruled in favor of the Defendant.

1. Case Overview

1.1 Court

High Court of Singapore

1.2 Outcome

Judgment for Defendant

1.3 Case Type

Civil

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Plaintiff sued Defendant for negligence after suffering nerve injuries post varicose vein surgery. The court found no breach of duty of care by the Defendant.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Rathanamalah d/o ShunmugamPlaintiffIndividualClaim DismissedLost
Chia Kok HoongDefendantIndividualJudgment for DefendantWon

3. Judges

Judge NameTitleDelivered Judgment
Aedit AbdullahJudicial CommissionerYes

4. Counsels

Counsel NameOrganization
Palaniappan SundararajStraits Law Practice LLC
Ow Yan Rong DerekStraits Law Practice LLC
Christopher ChongDentons Rodyk & Davidson LLP
Ong Yee Ching YvonneDentons Rodyk & Davidson LLP

4. Facts

  1. Plaintiff underwent EVLT, Foam Sclerotherapy, and Phlebectomy on both legs performed by the Defendant.
  2. Plaintiff claimed she suffered permanent nerve injuries due to the Defendant's negligence.
  3. Plaintiff alleged the Defendant failed to properly advise her about the risks and complications of the procedures.
  4. Plaintiff claimed the Defendant did not obtain her consent for some aspects of the procedures.
  5. Defendant claimed he had explained the nature, process, and risks of the procedures to the Plaintiff.
  6. Defendant presented a signed consent form as evidence of the Plaintiff's informed consent.
  7. The court found that the Plaintiff had signed the consent form and that the Defendant had provided adequate advice.

5. Formal Citations

  1. Rathanamalah d/o Shunmugam v Chia Kok Hoong, Suit No 854 of 2013, [2017] SGHC 153

6. Timeline

DateEvent
Plaintiff consulted the Defendant
Plaintiff visited the Defendant’s clinic
Plaintiff visited the Defendant’s clinic
Defendant carried out medical procedures on the Plaintiff
Plaintiff was told that she suffered injuries to both of her saphenous nerves
Hearing took place
Hearing took place
Hearing took place
Judgment issued

7. Legal Issues

  1. Breach of Duty of Care
    • Outcome: The court held that the Plaintiff failed to prove that the Defendant breached his duty of care.
    • Category: Substantive
    • Sub-Issues:
      • Failure to obtain informed consent
      • Negligent conduct of surgery
      • Inadequate post-operative care
  2. Informed Consent
    • Outcome: The court found that the Defendant had obtained informed consent from the Plaintiff for all procedures.
    • Category: Substantive
    • Sub-Issues:
      • Failure to advise on risks and alternatives
      • Lack of consent for specific procedures
  3. Res Ipsa Loquitur
    • Outcome: The court held that the principle of res ipsa loquitur did not apply due to the inherent risks of nerve injury in the procedures.
    • Category: Procedural
  4. Damages
    • Outcome: The court indicated that even if liability were found, the Plaintiff had exaggerated her claimed damages and would have been awarded less.
    • Category: Substantive
    • Sub-Issues:
      • Assessment of pain and suffering
      • Causation of medical expenses
      • Proof of loss of earnings

8. Remedies Sought

  1. General Damages for pain and suffering
  2. Loss of amenities
  3. Loss of future earnings
  4. Future medical expenses
  5. Special Damages for medical expenses incurred
  6. Pre-trial loss of earnings

9. Cause of Actions

  • Negligence
  • Breach of Contractual Duty of Care

10. Practice Areas

  • Personal Injury
  • Medical Malpractice
  • Civil Litigation

11. Industries

  • Healthcare
  • Insurance

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 opinion.
Bolitho v City and Hackney Health AuthorityN/AYes[1998] AC 232N/ACited for the principle that the court must be satisfied that experts have directed their minds to comparative risks and benefits and reached a defensible conclusion.
Khoo James and another v Gunapathy d/o Muniandy and another appealN/AYes[2002] 1 SLR(R) 1024SingaporeCited for the application of the Bolam-Bolitho approach across all aspects of a doctor's interaction with a patient.
Montgomery v Lanarkshire Health Board (General Medical Council intervening)N/AYes[2015] AC 1430N/ACited regarding the duty of doctors to ensure patients are aware of material risks of injury inherent in treatment.
In re F (Mental Patient: Sterilisation)N/AYes[1990] 2 AC 1N/ACited for the principle that performing a medical operation without consent is unlawful.
Roe v Minister of Health and AnotherN/AYes[1954] 2 QB 66N/ACited for the principle that the standard of care in medical negligence is judged in light of the knowledge available at the time of the event.
Tong Seok May Joanne v Yau Hok Man GordonN/AYes[2013] 2 SLR 18SingaporeCited regarding the joint responsibilities of the anaesthetist.
Lloyde v West Midlands Gas BoardN/AYes[1971] 1 WLR 749N/ACited for the common sense approach to the assessment of the effect of evidence in certain circumstances.
Scott v The London and St Katherine Docks CompanyN/AYes(1865) 3 H & C 596N/ACited for the conditions where the principle of res ipsa loquitur would apply.
BNJ (suing by her lawful father and litigation representative, B) v SMRT Trains Ltd and anotherN/AYes[2014] 2 SLR 7SingaporeCited for the conditions where the principle of res ipsa loquitur would apply.
Ratcliffe v Plymouth and Torbay Health Authority and anotherN/AYes[1998] PIQR P 170N/ACited for the principle that the usefulness of res ipsa loquitur will normally have long since been exhausted where expert and factual evidence has been called on both sides at a trial.
F v Chan TannyN/AYes[2003] 4 SLR(R) 231SingaporeCited for the principle that the fact that a baby is born damaged or deformed is no evidence of negligence on the part of the doctors or nurses attending the birth.
Denis Matthew Harte v Dr Tan Hun Hoe and anotherHigh Court of SingaporeYes[2000] SGHC 248SingaporeCited for the principle that the principle of res ipsa loquitur cannot help the plaintiff where there are other probable causes for the damage.
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 othersN/AYes[2010] 1 SLR 428SingaporeCited for the principle that the test of liability is not whether the Plaintiff’s case is more probable than the Defendant’s, but rather, whether the Plaintiff had proven that case on a balance of probabilities.
Clarke Beryl Claire (personal representative of the estate of Eugene Francis Clarke, deceased) and others v SilkAir (Singapore) Pte LtdN/AYes[2002] 1 SLR(R) 1136SingaporeCited for the principle that the test of liability is not whether the Plaintiff’s case is more probable than the Defendant’s, but rather, whether the Plaintiff had proven that case on a balance of probabilities.
Mei Yue Lan Margaret v Raffles City (Pte) LtdN/AYes[2005] 4 SLR(R) 740SingaporeCited as an analogy for the award of damages for bilateral saphenous nerve injury and Complex Regional Pain Syndrome.
Mykytowych, Pamela Jane v V I P HotelN/AYes[2016] 4 SLR 829SingaporeCited as an analogy for the award of damages for Complex Regional Pain Syndrome.
Khek Ching v SBS Transit LtdDistrict CourtYes[2010] SGDC 220SingaporeCited as an analogy for the award of damages for Complex Regional Pain Syndrome.
Quek Yen Fei Kenneth v Yeo Chye HuatN/AYes[2016] 3 SLR 1106SingaporeCited for the principle that sums reimbursed by the Plaintiff’s insurer did not have to be compensated by the Defendant.
Hii Chii Kok v Ooi Peng Jin London Lucien and anotherCourt of AppealYes[2017] SGCA 38SingaporeCited for the adoption of a modified Montgomery test to determine the standard of care required of doctors in their provision of advice to the patients.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
Evidence ActSingapore

15. Key Terms and Keywords

15.1 Key Terms

  • Endovenous Laser Therapy
  • EVLT
  • Foam Sclerotherapy
  • Phlebectomy
  • Saphenous Nerve Injury
  • Tumescent Anesthesia
  • Varicose Veins
  • Negligence
  • Duty of Care
  • Informed Consent
  • Res Ipsa Loquitur
  • Complex Regional Pain Syndrome
  • CRPS

15.2 Keywords

  • negligence
  • medical malpractice
  • varicose veins
  • nerve injury
  • EVLT
  • informed consent
  • Singapore
  • High Court

17. Areas of Law

Area NameRelevance Score
Medical Negligence95
Negligence90
Breach of Duty of Care85
Medical Procedures80
Personal Injury75
Standard of Care70
Informed consent65
Damages60
Measure of Damages50
Evidence40
Contract Law30
Breach of Contract30

16. Subjects

  • Medical Law
  • Tort Law
  • Civil Litigation