Pang Koi Fa v Lim Djoe Phing

• Jurisdiction: Singapore
• Judge: Amarjeet Singh JC
• Judgment Date: 02 July 1993
• Neutral Citation: [1993] SGHC 153
• Date: 02 July 1993
• Subject Matter: Whether defendant liable in negligence for plaintiff's psychiatric illness,Negligence,Psychiatric illness as a result of defedant's negligent acts,Tort,Nervous shock,Plaintiff's daughter treated by defendant neurosurgeon whose negligent diagnosis, operation and post-operative treatment resulted in plaintiff's daughter's death,Plaintiff suffered psychiatric illness as a result
• Docket Number: Suit No 1112 of 1988 (Consolidated
• Published date: 19 September 2003
• Defendant Counsel: Defendant absent
• Court: High Court (Singapore)
• Plaintiff Counsel: Nathan Isaac and Abdul Rohim Sarip (Nathan Isaac & Co)

Introduction

This case presents a rare and unique opportunity to review the law relating to liability for shock-induced psychiatric illness suffered as a result of negligent acts. In this case, the plaintiff sued the defendant, a neurosurgeon, on the basis that his negligence, which resulted in the death of her daughter, caused the plaintiff to suffer a psychiatric illness which persists even today. In Suit No 791 of 1987, consolidated with the present suit, I had found the defendant liable in negligence for the death of Miss Chong Yun Jing, aged 22. His negligence having been established, I turned to consider his liability in respect of the plaintiff. At the end of the trial, I found him liable in negligence for the plaintiff`s psychiatric illness and awarded damages accordingly. I now give my reasons.

As a preliminary I should like to point out that the defendant did not appear at the trial. His solicitors had applied for and obtained a discharge shortly before the hearing and an adjournment was sought at the trial by their replacement which I refused. No grounds were furnished to explain the defendant`s absence nor were satisfactory grounds furnished for the application for adjournment. When I denied the adjournment, the replacement solicitor withdrew as well. On my direction, the plaintiffs proceeded to prove their claim in the normal manner by calling all the relevant witnesses including specialist evidence. Due care has therefore been taken for the absence of the defendant. There was an appeal lodged against my decision, but it has since been discontinued.

The facts

Briefly, the facts relating to the death of the plaintiff`s daughter are as follows. She had been the plaintiff`s only daughter, and according to Chong Yuen Ching, PW6, the plaintiff`s only son, she was the plaintiff`s sole confidante with whom she shared all her worries. The deceased worked in the family`s two companies, at the same time studying part-time at the Singapore Polytechnic. At the time of her death, she was in the final year of the diploma course for production engineering technicians.

Sometime in March 1985, the deceased had a fainting spell. She visited her family doctor, Tham Pak On (`Dr Tham`) and was recommended to consult the defendant, a neurosurgeon practising under the name and style of Lim Neurosurgery at Mount Elizabeth Medical Centre. The deceased was then perfectly healthy, exhibited no signs of any illness in her brain, and save her single fainting spell, had no other medical problems.

The defendant had skull x-rays, EEG, CAT-scan and blood tests conducted on the deceased after which he told the plaintiff and the deceased that she had a tumour between her eyes. He told the plaintiff that the deceased had to undergo an operation immediately otherwise she would die or go blind. The plaintiff was gravely concerned at this news and having persuaded her reluctant daughter to submit to the operation, gave the go-ahead to the defendant. As a result, a transphenoidal operation (through the nose) was performed on the deceased on 6 June 1985 for the removal of what purported to be a microadenoma - a small tumour - of the pituitary gland.

As it turned out, the defendant had removed perfectly healthy tissue, and in the process had caused a tear in the deceased`s arachnoid membrane, one of the three meninges covering the brain. This was not detected and the deceased began to leak cerebro-spinal fluid (CSF) - essential brain fluid - through her nose. She developed meningitis - an inflammation of the meninges - and eventually died on 10 September after much pain and suffering, of meningitis and its concomitant complications.

The plaintiff`s psychiatric illness

The plaintiff`s psychiatric illness arose from the trauma of being at her daughter`s bedside throughout her suffering and the shock of her daughter`s death. According to her psychiatrist, Dr Lim Hsin Loh (`Dr Lim`), the plaintiff felt very guilty about the operation and felt responsible for it. The sequence of events which contributed to the shock she experienced at her daughter`s death were as follows.

The first time the plaintiff saw her daughter after the operation was when she was in intensive care. She could not open her right eye. A nose pad covered the nasal dissection. The next day she was moved into a ward and the plaintiff was told to get a private nurse. She hired two nurses on 12-hour shifts. A few days later, the nose pad was removed. The deceased started dripping from the nose. She complained of blurred vision and had a high fever. She drank a lot water and urinated frequently. She also complained of pain and severe headache. Painkillers were prescribed for her. All this time, the plaintiff was at her daughter`s bedside taking care of her, and hence she observed her daughter`s pain and suffering. On 10 June, four days after the operation, the plaintiff found that her daughter had become confused and irrational.

The deceased`s poor post-operative condition continued from 10 June to 24 June. The plaintiff began to have serious doubts about the operation. On 24 June, despite the fact that the plaintiff had not asked for her discharge, and despite the poor condition of the deceased, the defendant discharged the deceased from the hospital. She was brought home in an ambulance, with a intravenous drip still set in her. The plaintiff was very upset at this.

At home, the deceased continued complaining of headaches. She still dripped from her nose and her condition remained poor. The plaintiff called the defendant several times to ask for advice, as did the private nurses still caring for the deceased, as well as the deceased herself. The defendant refused to visit her and even admonished the plaintiff for calling him at night. This aroused great indignation in the plaintiff.

Two days later, on the advice of the private nurses, the deceased was re-admitted. The defendant was informed and paged by the matron but he did not respond until the evening of her re-admission. In the meantime the plaintiff made her own efforts to find another doctor. The next day, the plaintiff told the defendant in desperation that she wanted a change of doctors as he was not treating the deceased. For a short while, Dr HI Tong, a consultant neurologist, treated the deceased. The plaintiff then found Dr James Khoo, PW2, (`Dr Khoo`), also a consultant neurologist, and, with difficulty, managed to persuade him to take over the care of her daughter.

When Dr Khoo took over the management and care of the plaintiff`s daughter, he found her very ill. From her discussions with Dr Khoo and other doctors enlisted to care for her daughter, the plaintiff discovered that the defendant had been negligent and the operation had never been necessary and further that the fluid dripping out of her daughter`s brain was essential brain fluid. Dr John Thambyah, PW3, a consultant physician and a specialist in endocrinology, testified that the leakage could have been repaired had immediate steps been taken and with the help of antibiotics, the infection would have been avoided. As it turned out, the plaintiff had to sit through two additional operations by Dr Ong Peck Leng, head of neurosurgery at the Tan Tock Seng Hospital, in which he had attempted to repair the damage caused by the defendant. Throughout the operations, she blamed herself constantly for having allowed and even persuaded her daughter to submit to the defendant`s operation in the first place. All this while, she still had hopes for her daughter`s recovery.

When her daughter died, the plaintiff was distraught. The plaintiff had watched her in severe pain and agony and upon her death, she was on the verge of a breakdown and almost committed suicide. In September 1985 she complained to Dr EA Heaslett of palpitations of the heart, breathlessness, insomnia, episodes of crying, loss of interest in her work and social life and pre-occupation with memories of her daughter. He treated her for a severe depression until January 1988. Her family observed that she had undergone a personality change. Her relationship with her son and husband were strained. She was constantly preoccupied with her daughter`s death and preserved her daughter`s desk at the office as well as her room at home.

Her son, PW6, testified that the plaintiff had undergone a personality change after the death of his sister. She stopped cooking for the family and became over-protective of him, she reacted badly when she saw other families going out in groups, and she quarrelled frequently with her husband. Prior to her daughter`s death, they had not quarrelled as much. She also went to Dr Tham`s office and abused him, smashing some glass and banging some cupboards although she had ordinarily been a mild lady.

The plaintiff`s psychiatrist, Dr Lim, testified that she consulted him from January 1988 and another psychiatrist very briefly. He continued the treatment. He saw her often, sometimes every fortnight, sometimes monthly, sometimes after long periods in the last five years. She related to Dr Lim a history of how her daughter had been hospitalized and then succumbed to her injuries, and how she had been at her daughter`s bedside throughout and the traumatic effect the entire experience had on her.

Dr Lim diagnosed her to be suffering from post-traumatic stress disorder and pathological grief. Dr Lim was of the opinion that the plaintiff suffered from a mood disorder, a depressive illness secondary to grief arising out of the circumstances surrounding her daughter`s death, in particular, whether her daughter had a brain tumour and whether the operation had been necessary. Her tendency to preserve her daughter`s room at home and desk in the office was known as `mummification` and was a symptom of a severe grief reaction. Dr Lim was of the opinion that the plaintiff had become a psychiatric patient. He also referred to medical reports of the other doctors.

The law on nervous shock -...