Goh Guan Sin v Yeo Tseng Tsai: Medical Negligence, Post-Surgery Care, Brain Tumour, Persistent Vegetative State
In Goh Guan Sin (by her litigation representative Chiam Yu Zhu) v Yeo Tseng Tsai and National University Hospital (Singapore) Pte Ltd, the High Court of Singapore dismissed the plaintiff's medical negligence claim against the defendants, a neurosurgeon and the hospital, for alleged failures in post-operative care following brain tumour removal surgery, which resulted in the plaintiff's persistent vegetative state. The court allowed the second defendant's counterclaim for unpaid hospital bills. The plaintiff had abandoned claims of pre-operative negligence. The court found no breach of duty in the post-operative monitoring or the decision not to evacuate a haematoma. The court also dismissed the plaintiff's claim of negligence related to a fractured knee.
1. Case Overview
1.1 Court
High Court of the Republic of Singapore1.2 Outcome
Plaintiff's claim dismissed; Second Defendant's counterclaim allowed.
1.3 Case Type
Civil
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
Medical negligence case: Failure to care for patient after brain tumour surgery led to persistent vegetative state. Counterclaim for unpaid bills.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Goh Guan Sin | Plaintiff | Individual | Claim Dismissed | Lost | Abraham Vergis, Bestlyn Loo, Seenivasan Lalita, Virginia Quek, Isabel Chew |
| Yeo Tseng Tsai | Defendant | Individual | Judgment for Defendant | Won | Lek Siang Pheng, Mar Seow Hwei, Aw Sze Min, Toh Cher Han |
| National University Hospital (Singapore) Pte Ltd | Defendant | Corporation | Counterclaim Allowed | Won | Kuah Boon Theng, Yong Shuk Lin Vanessa, Chain Xiao Jing, Felicia (Qian Xiaojing) |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Tan Siong Thye | Judge | Yes |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Abraham Vergis | Providence Law Asia LLC |
| Bestlyn Loo | Providence Law Asia LLC |
| Seenivasan Lalita | Virginia Quek Lalita & Partners |
| Virginia Quek | Virginia Quek Lalita & Partners |
| Isabel Chew | Virginia Quek Lalita & Partners |
| Lek Siang Pheng | Dentons Rodyk & Davidson LLP |
| Mar Seow Hwei | Dentons Rodyk & Davidson LLP |
| Aw Sze Min | Dentons Rodyk & Davidson LLP |
| Toh Cher Han | Dentons Rodyk & Davidson LLP |
| Kuah Boon Theng | Legal Clinic LLC |
| Yong Shuk Lin Vanessa | Legal Clinic LLC |
| Chain Xiao Jing, Felicia (Qian Xiaojing) | Legal Clinic LLC |
4. Facts
- Plaintiff underwent surgery to remove a brain tumour.
- Plaintiff developed a persistent vegetative state after the surgery.
- Plaintiff alleged negligence in post-operative care.
- Second Defendant counterclaimed for unpaid hospital bills.
- Plaintiff abandoned claims of pre-operative negligence at trial.
- First CT scan was carried out at 1829 hrs.
- The First Defendant decided to insert an external ventricular drain in the Plaintiff’s brain to relieve the acute hydrocephalus.
5. Formal Citations
- Goh Guan Sin (by her litigation representative Chiam Yu Zhu) v Yeo Tseng Tsai and another, Suit No 463 of 2017, [2019] SGHC 274
6. Timeline
| Date | Event |
|---|---|
| Plaintiff brought to NUH to see an orthopaedic doctor. | |
| Plaintiff had a brain MRI scan at RadLink Diagnostic Imaging (S) Pte Ltd. | |
| Plaintiff consulted Dr Timothy Lee at Gleneagles Hospital. | |
| Plaintiff sought another opinion at NUH. | |
| Plaintiff sought another opinion from Dr James Khoo at Mount Elizabeth Medical Centre. | |
| Plaintiff’s case was discussed at the NUH’s Division of Neurosurgery’s weekly peer review pre-operative discussion. | |
| Plaintiff brought to the Accident and Emergency department at NUH. | |
| Plaintiff returned to NUH for her appointment. | |
| Plaintiff was admitted to NUH. | |
| Plaintiff underwent tumour removal surgery at NUH (the First Surgery). | |
| Plaintiff underwent a second surgery for insertion of an external ventricular drain. | |
| First Defendant informed Plaintiff’s family that he would be away from Singapore from 4 June 2014 onwards. | |
| MRI scan was done. | |
| One of the Plaintiff’s daughters requested for an X-ray to be conducted on both the Plaintiff’s legs. | |
| X-ray showed a mildly displaced fracture at the right tibial tuberosity. | |
| Outstanding hospital bills amounted to S$397,478.78. | |
| Judgment reserved. |
7. Legal Issues
- Negligence
- Outcome: The court found that the defendants did not breach their duty of care and were not negligent.
- Category: Substantive
- Sub-Issues:
- Breach of duty of care
- Failure to obtain informed consent
- Misinterpretation of CT scan
- Failure to evacuate haematoma
- Failure to adequately monitor patient
- Causation
- Informed Consent
- Outcome: The court found that the plaintiff's informed consent was obtained for the first surgery.
- Category: Substantive
- Sub-Issues:
- Adequacy of information provided
- Disclosure of risks
- Disclosure of alternative treatments
- Res Ipsa Loquitur
- Outcome: The court found that res ipsa loquitur did not apply to the plaintiff's claim regarding the fracture.
- Category: Procedural
- Causation
- Outcome: The court found that the plaintiff failed to establish causation.
- Category: Substantive
- Sub-Issues:
- But-for causation
- Material contribution to damage
- Loss of chance
8. Remedies Sought
- Monetary Damages
9. Cause of Actions
- Negligence
- Breach of Duty of Care
10. Practice Areas
- Medical Malpractice
- Commercial Litigation
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Singapore Medical Council v Dr Lim Lian Arn | High Court | Yes | [2019] SGHC 172 | Singapore | Cited for the principles regarding relevant and material information that must be disclosed to a patient to obtain informed consent. |
| Hii Chii Kok v Ooi Peng Jin London Lucien and another | Court of Appeal | Yes | [2017] 2 SLR 492 | Singapore | Cited for the principles regarding relevant and material information that must be disclosed to a patient to obtain informed consent. |
| D’Conceicao Jeanie Doris (administratrix of the estate of Milakov Steven, deceased) v Tong Ming Chuan | High Court | Yes | [2011] SGHC 193 | Singapore | Cited to explain that it is acceptable for other members of the medical team to advise on the risks of surgery. |
| Bolam v Friern Hospital Management Committee | N/A | Yes | [1957] 1 WLR 582 | N/A | Cited for the Bolam test, which considers whether the defendant doctor’s practice is supported by a responsible body of opinion within the profession. |
| Bolitho v City and Hackney Health Authority | N/A | Yes | [1998] AC 232 | N/A | Cited for the Bolitho addendum, which imposes a threshold test of logic on the Bolam test. |
| Noor Azlin bte Abdul Rahman v Changi General Hospital Pte Ltd and others | Court of Appeal | No | [2019] 1 SLR 834 | Singapore | Cited for the principle that the Bolam-Bolitho test applies even to “pure diagnosis” cases. |
| Elliott v Bickerstaff | N/A | Yes | [1999] NSWCA 453 | New South Wales | Cited to illustrate the scope of the duty owed by the First Defendant. |
| 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 to explain the nature of non-delegable duties in tort. |
| Longyuan-Arrk (Macao) Pte Ltd v Show and Tell Productions Pte Ltd and another suit | High Court | No | [2013] SGHC 160 | Singapore | Cited as an example of a case where a lay factual witness purported to give expert opinion. |
| Goh Yeow Hwee v Tan Buck Chye | District Court | No | [2008] SGDC 378 | Singapore | Cited as an example of a case where there was insufficient evidence on the credentials of a party who was to have given evidence by way of a statement on the authenticity of a painting. |
| JU and another v See Tho Kai Yin | N/A | No | [2005] 4 SLR(R) 96 | N/A | Cited as an example of a case where the court found that the individual concerned was not even qualified to be an expert. |
| Sim Cheng Soon v BT Engineering Pte Ltd and another | N/A | No | [2007] 1 SLR(R) 148 | N/A | Cited for the rationale that allowing lay witnesses to give opinion evidence would offend the general rule that inferences and interpretation of facts must be made by the court and not the witness. |
| Attorney-General v Au Wai Pang | N/A | Yes | [2015] 2 SLR 352 | N/A | Cited for the principle that the fact that a person has a particular opinion may be admissible if it is relevant, as when it is adduced to explain his conduct. |
| Khoo James and another v Gunapathy d/o Muniandy and another appeal | N/A | Yes | [2002] 1 SLR(R) 1024 | N/A | Cited for the principle that defendant medical practitioners have routinely been allowed to explain their thoughts, theories, and rationales for their actions at the material time as part of their defence. |
| DN (by his father and litigation friend RN) v London Borough of Greenwich | English Court of Appeal | Yes | [2004] EWCA Civ 1659 | England and Wales | Cited for the views expressed in that case are also worth bearing in mind. |
| Hayes v Royal Col Hospital | N/A | Yes | [2001] BCSC 1047 | British Columbia | Cited for the principle that the combined formal and informal assessments were effectively equivalent to the Protocol requirements. |
| 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 others | N/A | No | [2010] 1 SLR 428 | Singapore | Cited for the principle that the evidentiary burden shifts to CGH to show that it did follow up in some way. |
| Chia Foong Lin v Singapore Medical Council | N/A | No | [2017] 5 SLR 334 | Singapore | Cited for the principle that a CT scan was simple to undertake and the consequence of failing to diagnose an extra-axial haematoma could be severe. |
| Re T (Adult: Refusal of Medical Treatment) | N/A | Yes | [1992] 3 WLR 782 | England and Wales | Cited for the principle that the next of kin has no legal right either to consent or to refuse consent. |
| Re LP (adult patient: medical treatment) | N/A | Yes | [2006] 2 SLR(R) 13 | Singapore | Cited for the principle that a third party may apply to the court under the Mental Disorders and Treatment Act for a Committee of Person to be appointed for the purpose of acting in place of the patient and to give or withhold consent as the case may be. |
| Pang Koi Fa v Lim Djoe Phing | N/A | No | [1993] 2 SLR(R) 366 | Singapore | Cited for the principle that a neurosurgeon owes a duty of care to a patient’s mother to avoid inflicting “nervous shock” on her. |
| Spandeck Engineering (S) Pte Ltd v Defence Science & Technology Agency | N/A | No | [2007] 4 SLR(R) 100 | Singapore | Mentioned as a case that pre-dated Spandeck. |
| R (Burke) v General Medical Council | N/A | Yes | [2005] 3 WLR 1132 | England and Wales | Cited for the principle that a patient cannot demand that a doctor administer a treatment which the doctor considers is not warranted or is averse to the patient’s clinical needs. |
| Aintree University Hospitals NHS Foundation Trust v James | N/A | Yes | [2013] 3 WLR 1299 | England and Wales | Cited for the principle that a patient cannot demand that a doctor administer a treatment which the doctor considers is not warranted or is averse to the patient’s clinical needs. |
| Grace Electrical Engineering Pte Ltd v Te Deum Engineering Pte Ltd | Court of Appeal | Yes | [2018] 1 SLR 76 | Singapore | Cited for the requirements for the doctrine of res ipsa loquitur to apply. |
| Rathanamalah d/o Shunmugam v Chia Kok Hoong | N/A | Yes | [2018] 4 SLR 159 | Singapore | Cited for the requirements for the doctrine of res ipsa loquitur to apply. |
| Cassidy v Ministry of Health | N/A | Yes | [1951] 2 KB 343 | England and Wales | Cited as an example of a medical negligence case where res ipsa loquitur was invoked. |
| Mahon v Osborne | N/A | Yes | [1939] 2 KB 14 | England and Wales | Cited as an example of a medical negligence case where res ipsa loquitur was invoked. |
| Ratcliffe v Plymouth and Torbay Health Authority | N/A | Yes | [1998] PIQR P 170 | England and Wales | Cited for the explanation of the relevance of the maxim res ipsa loquitur to medical negligence cases. |
| BNM (administratrix of the estate of B, deceased) on her own behalf and on behalf of others v National University of Singapore and others and another appeal | N/A | No | [2014] 4 SLR 931 | Singapore | Cited for the operation of the but-for test. |
| Bonnington Castings Ltd v Wardlaw | N/A | Yes | [1956] 2 WLR 707 | N/A | Cited for the material contribution to damage test. |
13. Applicable Rules
| Rule Name |
|---|
| Order 40A of the Rules of Court |
| Order 38 r 2(3) of the Rules of Court |
| Order 38 r 2(4) of the Rules of Court |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| No applicable statutes | |
15. Key Terms and Keywords
15.1 Key Terms
- Persistent Vegetative State
- Brain Tumour
- Medical Negligence
- Post-Operative Care
- Haematoma
- External Ventricular Drain
- Cushing Reflex
- Hydrocephalus
- Venous Infarct
- Res Ipsa Loquitur
15.2 Keywords
- Medical Negligence
- Brain Tumour
- Surgery
- Persistent Vegetative State
- Haematoma
- Singapore
- High Court
- Civil Case
16. Subjects
- Medical Law
- Negligence
- Civil Litigation
17. Areas of Law
- Tort
- Medical Negligence
- Civil Procedure