Biomedical Law and Ethics

Citation(2007) 8 SAL Ann Rev 65
Published date01 December 2007
Date01 December 2007

5.1 This year”s decisions may not be as dramatic as last year”s blockbuster on the decisional autonomy of incompetent patients. Nonetheless, they are important. The first set of cases relate to the very common practice of hospitals providing estimates of their fees to patients prior to admission, and the question that was before the courts was what the effect of such estimates should be when the final bill far exceeds the estimate. The second case concerns disciplinary matters.

Pre-admission fee estimates and their legal significance
Background to the case of Ms Sandar Aung

5.2 Most, if not all, hospitals require patients to undergo financial counselling prior to admission. As part of this counselling, an estimate of the likely fees that will be charged is usually issued. Particularly for elective (as opposed to emergency) surgeries, financial counselling makes eminent sense. From the hospital”s perspective, this helps to ensure that patients select the type and level of medical care appropriate to their needs and within their means so that the hospital is not saddled with bad debts. Especially with rising medical costs, financial counselling also helps to manage patients” cost expectations. Patients, too, benefit from this process. They are able to make informed decisions on the most cost-effective procedures and hospital care appropriate to their needs so that they are not also saddled with bad debts.

5.3 But it is unfortunately in the nature of medical operations that complications arise. Who should bear this risk? According to the Court of Appeal in Sandar Aung v Parkway Hospitals Pte Ltd[2007] 2 SLR 891, it is the hospital, not the patient or his guarantor, that should foot the bill.

5.4 The case facts are these. Ms Aung was a guarantor for her mother, who was admitted to hospital for an angioplasty. The anticipated hospital charges were approximately $15,000. Complications arose and the total bill rendered was some $343,000 (not including doctors” fees which the hospital sued for but which should have been brought separately since these doctors had individual contracts with the patient; and not including expenses incurred post 1 October 2004 when

the hospital was restructured but without notice to Ms Aung of the assignment of the contract to the subsequent owner).

5.5 The main substantive issue was whether Ms Aung should be liable for the additional expenses arising from the complications.

The High Court judgment

5.6 The High Court relied on the following clauses in the agreement between the hospital and Ms Aung (‘the main agreement’). The first was the ‘Financial Obligation’ clause, which reads:


The undersigned is liable to pay the account of the hospital immediately upon his discharge in accordance with the prevailing rates and terms of the hospital. In the event that the undersigned fails to pay any sum due to the hospital on the date of his/her/the patient”s discharge, the hospital reserves the right to charge interest at the hospital”s then prevailing rate on the said sum from the date of the tax invoice until payment of the said sum is made in full to the hospital, subject to a minimum interest payment of S$10.00. For the avoidance of doubt, the hospital”s right to claim interest as aforesaid shall not affect or prejudice its right to payment of the said sum immediately upon his/her/the patient”s discharge.

The undersigned should obtain an estimate of his/her/the patient”s attending physician”s/specialist”s charges from them. The hospital shall assume upon the receipt of this signed conditions of services/hospital policies form that the undersigned has familiarised himself/herself with the hospital charges and fees and charges of his/her/the patient”s attending physician/specialist and that the undersigned appreciates and is fully aware of the financial obligations that he/she is undertaking in relation to his/her/the patient”s hospitalisation and treatment.

[emphasis added]

5.7 The...

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