Armstrong v Quest Laboratories: Negligence, Duty of Care, and Causation in Misdiagnosis of Melanoma
In Armstrong, Carol Ann v Quest Laboratories Pte Ltd, the Court of Appeal of Singapore heard appeals regarding a negligence claim against Quest Laboratories Pte Ltd and Dr. Tan Hong Wui for misdiagnosing Peter Traynor's melanoma, which led to his death. The plaintiff, Armstrong, sued as the executrix of Traynor's estate. The court found the defendants negligent and allowed the appeal in part, reversing the lower court's decision on the extent of damages, holding that damages should be calculated based on Traynor's full life expectancy.
1. Case Overview
1.1 Court
Court of Appeal of the Republic of Singapore1.2 Outcome
Appeal Allowed in Part
1.3 Case Type
Civil
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
The Court of Appeal addressed negligence in a melanoma misdiagnosis case, focusing on duty of care, causation, and damages. The court allowed the appeal, finding the misdiagnosis led to the patient's death.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Armstrong Carol Ann | Appellant, Respondent | Individual | Appeal Allowed in Part | Partial | |
| Quest Laboratories Pte Ltd | Respondent, Appellant | Corporation | Appeal Dismissed in Part | Partial | |
| Tan Hong Wui | Respondent, Appellant | Individual | Appeal Dismissed in Part | Partial |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Sundaresh Menon | Chief Justice | No |
| Andrew Phang Boon Leong | Judge of Appeal | Yes |
| Judith Prakash | Judge of Appeal | No |
| Tay Yong Kwang | Judge of Appeal | No |
| Belinda Ang Saw Ean | Judge | No |
4. Counsels
4. Facts
- In September 2009, Mr. Traynor had a mole on his back biopsied by the respondents.
- The respondents' pathology report indicated '[t]here is no malignancy'.
- In 2011, Mr. Traynor discovered a lump under his right armpit, which was metastatic melanoma.
- Mr. Traynor died from metastatic melanoma in December 2013 at the age of 49.
- The original slide from 2009 was recalled and re-examined, revealing malignant melanoma.
- The court found that the respondents had deeper, clearer portions of the specimen available in 2009 but did not examine them.
5. Formal Citations
- 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 anotherand other appeals, , [2019] SGCA 75
- Armstrong CAROL ANN (EXECUTRIX OF THE ESTATE OF TRAYNOR PETER, DECEASED AND ON BEHALF OF THE DEPENDENTS OF TRAYNOR PETER, DECEASED v QUEST LABORATORIES PTE LTD, Civil Appeal No 70 of 2018, Civil Appeal No 70 of 2018
- TAN HONG WUI v ARMSTRONG CAROL ANN (EXECUTRIX OF THE ESTATE OF TRAYNOR PETER, DECEASED AND ON BEHALF OF THE DEPENDENTS OF TRAYNOR PETER, DECEASED, Civil Appeal No 71 of 2018, Civil Appeal No 71 of 2018
- QUEST LABORATORIES PTE LTD v ARMSTRONG CAROL ANN (EXECUTRIX OF THE ESTATE OF TRAYNOR PETER, DECEASED AND ON BEHALF OF THE DEPENDENTS OF TRAYNOR PETER, DECEASED, Civil Appeal No 72 of 2018, Civil Appeal No 72 of 2018
- ARMSTRONG CAROL ANN (EXECUTRIX OF THE ESTATE OF TRAYNOR PETER, DECEASED AND ON BEHALF OF THE DEPENDENTS OF TRAYNOR PETER, DECEASED v QUEST LABORATORIES PTE LTD, Suit No 82 of 2015, Suit No 82 of 2015
6. Timeline
| Date | Event |
|---|---|
| Mr. Traynor consulted Dr. Huang about a mole on his back. | |
| Mr. Traynor noticed a bloodstain on his shirt. | |
| Mr. Traynor consulted Dr. Huang again; a shave biopsy was performed on the mole. | |
| Dr. Tan examined the tissue sections of the specimen. | |
| The 2009 pathology report was sent to Dr. Huang. | |
| Mr. Traynor discovered a lump under his right armpit. | |
| Mr. Traynor underwent a CT scan, a core biopsy, and a PET scan. | |
| Mr. Traynor started four rounds of chemotherapy. | |
| Dr. Fong examined the original slide and issued findings. | |
| Dr. Tan learned that Dr. Huang had recalled the original slide from 2009. | |
| Dr. Tan issued a supplementary report. | |
| A third opinion was sought from Professor Lee Yoke Sun and Associate Professor Tan Hong Bing. | |
| PET and CT scans continued to show stable lymphadenopathy. | |
| Mr. Traynor underwent a bilateral axillary clearance and a wide excision. | |
| CT and PET scans were performed for subsequent monitoring. | |
| CT and PET scans were performed for subsequent monitoring. | |
| There was some suggestion that the cancer had relapsed. | |
| PET and CT scans showed nodule growths suspicious of metastatic deposits. | |
| Mr. Traynor was restarted on chemotherapy. | |
| PET and CT scans confirmed that distal metastasis had grown. | |
| Mr. Traynor passed away. | |
| ACB v Thomson Medical was heard. | |
| Armstrong, Carol Ann v Quest Laboratories Pte Ltd and another was decided by the High Court judge. | |
| Judgment reserved. | |
| Judgment delivered. |
7. Legal Issues
- Breach of Duty of Care
- Outcome: The court found that the respondents breached their duty of care by misdiagnosing Mr. Traynor's condition.
- Category: Substantive
- Causation
- Outcome: The court found that the respondents' negligence caused Mr. Traynor's death, reversing the lower court's finding that he only lost a 'fighting chance'.
- Category: Substantive
- Measure of Damages
- Outcome: The court remitted the determination of damages, holding that they should be calculated based on Mr. Traynor's full life expectancy.
- Category: Substantive
8. Remedies Sought
- Monetary Damages
- Dependency Claim
- Loss of Inheritance Claim
- Loss of Appreciation Claim
- Estate Claim
9. Cause of Actions
- Negligence
10. Practice Areas
- Medical Negligence
- Personal Injury
- Civil Litigation
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| ACB v Thomson Medical | Court of Appeal | No | [2017] 1 SLR 918 | Singapore | Cited as a case concerning assisted reproduction and medicine's ability to help bring life into the world. |
| Armstrong, Carol Ann (executrix of the estate of Peter Traynor, deceased and on behalf of the dependents of Peter Traynor , deceased) v Quest Laboratories Pte Ltd and another | High Court | No | [2018] SGHC 66 | Singapore | The judgment under appeal in the present case. |
| Gregg v Scott | House of Lords | No | [2005] 2 AC 176 | England and Wales | Cited for the minority's decision regarding the 'loss of a chance' doctrine in clinical negligence claims. |
| Bolam v Friern Hospital Management Committee | Queen's Bench Division | No | [1957] 1 WLR 582 | England and Wales | Cited in relation to the test for negligence. |
| Bolitho v City and Hackney Health Authority | House of Lords | No | [1998] 1 AC 232 | England and Wales | Cited in relation to the test for negligence. |
| Hii Chii Kok v Ooi Peng Jin London Lucien and another | Court of Appeal | Yes | [2017] 2 SLR 492 | Singapore | Cited for the application of the Bolam-Bolitho test in medical negligence cases. |
| Sunny Metal & Engineering Pte Ltd v Ng Khim Ming Eric | Court of Appeal | No | [2007] 3 SLR(R) 782 | Singapore | Cited for the 'but for' test in establishing causation. |
| Noor Azlin bte Abdul Rahman v Changi General Hospital Pte Ltd and others | Court of Appeal | No | [2019] 1 SLR 834 | Singapore | Cited regarding findings of fact and the Bolam test. |
| Vellino v Chief Constable of the Greater Manchester Police | English Court of Appeal | No | [2001] 3 All ER 78 | England and Wales | Cited in the context of dismissing a claim based on the turpitude doctrine. |
| Neindorf v Junkovic | High Court of Australia | No | (2005) 222 ALR 631 | Australia | Cited for the specificity of inquiry into how the incident occurred and the way in which damage was sustained. |
| Sienkiewicz v Greif (UK) Ltd | UK Supreme Court | No | [2011] UKSC 10 | United Kingdom | Cited for the distinction between fact probability and belief probability. |
| McLean v Weir | British Columbia Supreme Court | No | [1977] BCJ No 935 | Canada | Cited for the court's role in accepting or rejecting expert evidence. |
| Muhammad Jefrry v Public Prosecutor | Court of Appeal | No | [1996] 2 SLR(R) 738 | Singapore | Cited for the court's role in accepting or rejecting expert evidence. |
| Saeng-Un Udom v Public Prosecutor | Court of Appeal | No | [2001] 2 SLR(R) 1 | Singapore | Cited for the duties of a judge in dealing with expert opinion. |
| Sakthivel Punithavathi v Public Prosecutor | Court of Appeal | No | [2007] 2 SLR(R) 983 | Singapore | Cited for considerations of consistency, logic, and coherence in expert evidence. |
| Public Prosecutor v Choo Peng Kuen | High Court | No | [2018] SGHC 230 | Singapore | Cited for scrutiny of the expert's methodology and the objective facts he had based his opinion upon. |
| Khoo James and another v Gunapathy d/o Muniandy and another appeal | Court of Appeal | No | [2002] 1 SLR(R) 1024 | Singapore | Cited for the right of the trial judge to make a finding of fact preliminary to the application of the Bolam test. |
| Gul Chandiram Mahtani and another (administrators of the estate of Harbajan Kaur, deceased) v Chain Singh and another | High Court | No | [1998] 2 SLR(R) 801 | Singapore | Cited for the central principle in assessing a dependency claim. |
| Hanson Ingrid Christina and others v Tan Puey Tze and another appeal | High Court | No | [2008] 1 SLR(R) 409 | Singapore | Cited for the two methods for assessing a dependency claim. |
| Sulastri bte Achmad v Tan Hee Hang and another | High Court | No | [2017] SGHC 7 | Singapore | Cited for the traditional method of calculating a dependency claim. |
| Harris v Empress Motors Ltd | English Court of Appeal | No | [1984] 1 WLR 212 | England and Wales | Cited for the conventional percentages used in the percentage deduction method. |
| Zhang Xiao Ling (personal representative of the Estate of Chan Tak Man, deceased) v Er Swee Poo and Another | High Court | No | [2004] SGHC 21 | Singapore | Cited for the rejection of the plaintiff’s estimate of the living expenses spent on her and their children. |
| 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 appeals | Court of Appeal | No | [2016] 5 SLR 412 | Singapore | Cited for the observation that there does not have to be distinct evidence of pecuniary advantage in existence, and it suffices that there is some basis of fact from which such an inference of such an advantage can be drawn. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Civil Law Act (Cap 43, 1999 Rev Ed) | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Melanoma
- Misdiagnosis
- Negligence
- Duty of Care
- Causation
- Pathology Report
- Metastatic Melanoma
- Sentinel Lymph Node Biopsy
- Dormancy
- Haematological Spread
15.2 Keywords
- Negligence
- Medical Misdiagnosis
- Melanoma
- Causation
- Damages
- Singapore Law
- Duty of Care
17. Areas of Law
| Area Name | Relevance Score |
|---|---|
| Negligence | 95 |
| Causation | 90 |
| Medical Misdiagnosis | 85 |
| Measure of Damages | 80 |
| Dependency Claim | 75 |
| Loss of Inheritance Claim | 70 |
| Personal Injury | 70 |
| Expert evidence | 70 |
| Statistical Evidence | 65 |
| Evidence | 60 |
| Wrongful Death | 60 |
| Civil Procedure | 50 |
16. Subjects
- Medical Negligence
- Tort Law
- Civil Litigation