Armstrong v Quest Laboratories: Negligence, Causation, and Damages in Medical Tort

In Armstrong Carol Ann v Quest Laboratories Pte Ltd, the High Court of Singapore heard a case concerning the negligence of Quest Laboratories and Dr. Tan Hong Wui in misdiagnosing a mole sample from Peter Traynor as non-malignant, which later proved to be cancerous. Peter Traynor's widow, Carol Ann Armstrong, sued on behalf of his dependants, arguing that the misdiagnosis led to a delay in treatment and ultimately caused his death. The court, presided over by Choo Han Teck J, found Dr. Tan negligent and awarded damages for the dependency claim and loss of inheritance claim.

1. Case Overview

1.1 Court

High Court

1.2 Outcome

Judgment for the Plaintiff

1.3 Case Type

Civil

1.4 Judgment Type

Judgment

1.5 Jurisdiction

Singapore

1.6 Description

Medical negligence case where a pathologist's misdiagnosis led to delayed cancer treatment and the patient's death. Court found negligence and awarded damages.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Armstrong Carol AnnPlaintiffIndividualJudgment for the PlaintiffWon
Quest Laboratories Pte LtdDefendantCorporationJudgment against the DefendantLost
Tan Hong WuiDefendantIndividualJudgment against the DefendantLost

3. Judges

Judge NameTitleDelivered Judgment
Choo Han TeckJudgeYes

4. Counsels

Counsel NameOrganization
Edmund KronenburgGoh Phai Cheng LLC
Christopher Goh Seng LeongGoh Phai Cheng LLC
Benavon LeeGoh Phai Cheng LLC
Lek Siang PhengDentons Rodyk & Davidson LLP
Mar Seow HweiDentons Rodyk & Davidson LLP
Priscilla Wee Jia LingDentons Rodyk & Davidson LLP
Kang YixianDonaldson & Burkinshaw LLP
Emily Su XianhuiDonaldson & Burkinshaw LLP
Sarah NairDonaldson & Burkinshaw LLP

4. Facts

  1. Dr. Huang removed a piece of skin from Peter Traynor's mole on 14 September 2009.
  2. Dr. Tan reported the specimen as ‘Ulcerated intradermal naevus’ with ‘no malignancy’ on 16 September 2009.
  3. In January 2012, Peter Traynor was diagnosed with ‘Malignant melanoma with ulceration’.
  4. Peter Traynor died on 6 December 2013 due to the spread of cancer.
  5. Dr. Tan's second report in 2012 suggested melanoma after examining a deeper section of the specimen.
  6. Expert dermatologists disagreed on whether the initial specimen indicated malignancy.
  7. The court found that Dr. Tan should have investigated further after seeing the ulceration.

5. Formal Citations

  1. Armstrong, Carol Ann(executrix of the estate of Peter Traynor, deceased and on behalf of the dependents of Peter Traynor, deceased)vQuest Laboratories Pte Ltd and another, Suit No 82 of 2015, [2018] SGHC 66

6. Timeline

DateEvent
Dr. Christopher Huang removed a piece of skin from Peter Traynor's mole.
Dr. Tan Hong Wui signed a pathology report diagnosing the specimen as ‘Ulcerated intradermal naevus’.
Peter Traynor saw an oncologist, Dr. Ang Peng Tiam, for a swollen armpit.
A pathology report diagnosed Peter Traynor with ‘Malignant melanoma with ulceration’.
Dr. Tan examined a deeper section of the same specimen and reported that the specimen was “ulcerated atypical melanocytic lesion, suggestive of a melanoma”.
Peter Traynor died.
Suit No 82 of 2015 filed.
Trial began (16 – 19, 23 – 25 January 2018).
Judgment reserved.
Judgment issued.

7. Legal Issues

  1. Negligence
    • Outcome: The court found that Dr. Tan was negligent in sending a report indicating a clean bill of health when the circumstances required further examination.
    • Category: Substantive
    • Sub-Issues:
      • Breach of duty of care
      • Failure to conduct further examination
  2. Causation
    • Outcome: The court held that Dr. Tan’s negligence caused Peter Traynor to lose a fighting chance and probably caused him to die years earlier than he would have done.
    • Category: Substantive
    • Sub-Issues:
      • Loss of chance of survival
      • Delayed diagnosis
  3. Damages
    • Outcome: The court awarded damages for the dependency claim and the loss of inheritance claim.
    • Category: Substantive
    • Sub-Issues:
      • Dependency claim
      • Loss of inheritance claim
      • Loss of appreciation claim

8. Remedies Sought

  1. Monetary Damages

9. Cause of Actions

  • Negligence

10. Practice Areas

  • Medical Malpractice
  • Personal Injury

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Zhu Xiu Chun (alias Myint Myint Kyi) v Rockwills Trustee Ltd (administrators of the estate of and on behalf of the dependants of Heng Ang Tee Franklin, deceased) and other appealsCourt of AppealYes[2016] 5 SLR 412SingaporeCited for the principle of applying different discount rates for dependency and loss of inheritance claims due to the difference in accelerated receipt.
Sulastri bte Achmad v Tan Hee Hang and anotherHigh CourtYes[2017] SGHC 7SingaporeCited for the principle that the claimant must prove the value of the benefits received by him or her from the deceased when the traditional method of assessment is employed.
Hanson Ingrid Christina and others v Tan Puey Tze and another appealUnknownYes[2008] 1 SLR(R) 409SingaporeCited for the principle that the percentage deduction method is a good guide when a stable pattern has been established in a marriage and virtually all net earnings are spent on living expenses.
Gregg v ScottHouse of LordsYes[2005] 2 AC 176United KingdomDistinguished from the present case; the court disagreed with the dismissal of the loss of a chance of survival as a legitimate loss that the law ought to recognise.
Mallett v McMonagleUnknownYes[1970] AC 166United KingdomCited for the principle that probabilities have no meaning when we are dealing with possibilities of what might have been.
Tabet v GettHigh CourtYes240 CLR 537AustraliaDistinguished from the present case; the court disagreed with the holding that the loss of chance is not compensable damage.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
No applicable statutes

15. Key Terms and Keywords

15.1 Key Terms

  • Negligence
  • Malignant melanoma
  • Ulceration
  • Misdiagnosis
  • Causation
  • Dependency Claim
  • Loss of Inheritance Claim
  • Sentinel node biopsy
  • Cancer staging

15.2 Keywords

  • Negligence
  • Medical malpractice
  • Misdiagnosis
  • Cancer
  • Damages
  • Singapore
  • High Court

17. Areas of Law

Area NameRelevance Score
Negligence95
Medical Negligence90
Medical Malpractice85
Breach of Duty of Care75
Causation70
Personal Injury70
Damages Assessment65
Wrongful Death60
Pathology50
Measure of Damages40
Contract Law30

16. Subjects

  • Medical Negligence
  • Tort Law
  • Damages