Noor Azlin v Changi General Hospital: Negligence in Lung Cancer Diagnosis
Noor Azlin Binte Abdul Rahman sued Changi General Hospital Pte Ltd, Dr. Imran bin Mohamed Noor, Dr. Yap Hsiang, and Dr. Soh Wei Wen Jason in the High Court of Singapore, alleging negligence in failing to diagnose and treat a nodule in her right lung, leading to a delayed cancer diagnosis. The court, presided over by Belinda Ang Saw Ean J, dismissed the plaintiff's claim, finding that the nodule was initially benign and turned malignant after the plaintiff's consultations with the defendant doctors. The claim was for negligence.
1. Case Overview
1.1 Court
High Court of Singapore1.2 Outcome
Plaintiff's action dismissed.
1.3 Case Type
Civil
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
A lung cancer patient sues Changi General Hospital and doctors for negligence in failing to diagnose a nodule. The court dismissed the action.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Noor Azlin Binte Abdul Rahman | Plaintiff | Individual | Action dismissed | Lost | |
| Changi General Hospital Pte Ltd | Defendant | Corporation | Action dismissed | Won | |
| Imran Bin Mohamed Noor | Defendant | Individual | Action dismissed | Won | |
| Yap Hsiang | Defendant | Individual | Action dismissed | Won | |
| Soh Wei Wen, Jason | Defendant | Individual | Action dismissed | Won |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Belinda Ang Saw Ean | Judge | Yes |
4. Counsels
4. Facts
- Plaintiff sued the hospital and doctors for negligent failure to diagnose and treat a nodule in her right lung.
- The nodule was first noted in October 2007.
- Plaintiff was diagnosed with non-small cell lung cancer in 2012.
- The plaintiff's cancer was found to be ALK-positive in 2014.
- The court found that the nodule was initially benign and turned malignant after July 2011.
- The plaintiff had no symptoms related to the nodule during her consultations with the defendant-doctors.
5. Formal Citations
- Noor Azlin Bte Abdul Rahman v Changi General Hospital Pte Ltd and others, Suit No 59 of 2015, [2018] SGHC 35
6. Timeline
| Date | Event |
|---|---|
| Nodule in plaintiff's lung first noted. | |
| Plaintiff consulted Dr. Imran. | |
| Plaintiff consulted Dr. Yap. | |
| Plaintiff consulted Dr. Soh. | |
| Plaintiff consulted Dr. Melvyn Wong. | |
| Biopsy revealed plaintiff had lung cancer. | |
| Plaintiff underwent a right lobectomy. | |
| Plaintiff suffered a relapse of her cancer. | |
| Analysis revealed cancer was ALK-positive. | |
| Plaintiff started on Ceritinib and Nivolumab. | |
| Plaintiff treated with Lorlatinib. | |
| Judgment reserved. |
7. Legal Issues
- Breach of Duty of Care
- Outcome: The court found that Dr. Imran and the Hospital breached their duty of care, but Dr. Yap and Dr. Soh did not.
- Category: Substantive
- Causation
- Outcome: The court found that the plaintiff failed to prove that the defendants' breaches caused her loss, as the nodule was initially benign.
- Category: Substantive
- Standard of Care for Doctors
- Outcome: The court applied the Bolam test with the Bolitho addendum to determine the standard of care.
- Category: Substantive
8. Remedies Sought
- Monetary Damages
9. Cause of Actions
- Negligence
10. Practice Areas
- Personal Injury
- Medical Malpractice
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Hii Chii Kok v Ooi Peng Jin London Lucien | Court of Appeal | Yes | [2017] SGCA 38 | Singapore | Cited for the standard of care applicable to doctors in diagnosis, treatment, and advice. |
| Bolam v Friern Hospital Management Committee | N/A | Yes | [1957] 1 WLR 582 | N/A | Cited for the Bolam test in determining the standard of care for doctors. |
| Bolitho v City and Hackney Health Authority | N/A | Yes | [1998] AC 232 | N/A | Cited for the Bolitho addendum to the Bolam test. |
| Hucks v Cole | N/A | Yes | [1993] 4 Med LR 393 | N/A | Cited for the proposition that a doctor should exercise caution when faced with a potentially lethal condition, but distinguished on the facts. |
| Jacqueline Lee Freestone v Murrumbidgee Local Health District | N/A | Yes | [2016] NSWDC 53 | New South Wales | Cited as an example of a radiologist being held negligent for failing to spot a lesion, but distinguished on the facts. |
| Mulholland v Medway NHS Foundation Trust | English High Court | Yes | [2015] EWHC 268 (QB) | England and Wales | Cited for features of A&E practice. |
| FB (by her mother and litigation friend, WAC) v Princess Alexandra Hospital NHS Trust | N/A | Yes | [2017] EWCA Civ 334 | N/A | Cited for the proposition that history taking is a basic skill expected of hospital doctors. |
| Wilsher v Essex Area Health Authority | N/A | Yes | [1987] 1 QB 730 | N/A | Cited for the standard of care for junior doctors and the effect of seeking advice from senior doctors. |
| Management Corporation Strata Title Plan No 3322 v Tiong Aik Construction Pte Ltd and another | Court of Appeal | Yes | [2016] 4 SLR 521 | Singapore | Cited for the two-stage test for determining whether a non-delegable duty would arise. |
| Woodland v Swimming Teachers Association | N/A | Yes | [2014] AC 537 | N/A | Cited for the five features outlined in determining whether a non-delegable duty would arise. |
| Hii Chii Kok v Ooi Peng Jin London Lucien and another | High Court | Yes | [2016] 2 SLR 544 | Singapore | Cited for the question of whether Singapore law should recognise a non-delegable duty in such a scenario. |
| Djemal v Bexley Health Authority | N/A | Yes | [1995] 6 Med LR 269 | N/A | Cited for the proposition that A&E doctors are still expected to make reasonable enquiries, take a history from the patient, conduct basic investigations and take reasonable care in reaching their diagnosis. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Evidence Act (Cap 97, 1997 Rev Ed) | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Nodule
- Opacity
- ALK-positive lung cancer
- Breach of duty
- Causation
- Standard of care
- Medical negligence
- Emergency medicine
- Routine reporting
- Non-delegable duty
15.2 Keywords
- Lung cancer
- Negligence
- Medical malpractice
- Diagnosis
- Standard of care
- Causation
- Hospital
- Doctor
- Singapore
17. Areas of Law
| Area Name | Relevance Score |
|---|---|
| Negligence | 90 |
| Medical Malpractice | 85 |
| Causation | 80 |
| Breach of Duty of Care | 70 |
| Personal Injury | 60 |
| Medical Diagnosis | 50 |
| Civil Litigation | 30 |
16. Subjects
- Medical Law
- Tort Law
- Negligence
- Cancer Diagnosis