Pappa w/o Veeramuthu v National University Health Services Group Pte. Ltd.

• Jurisdiction: Singapore
• Judge: Clement Seah Chi-Ling
• Judgment Date: 28 November 2022
• Neutral Citation: [2022] SGDC 280
• Citation: [2022] SGDC 280
• Court: District Court (Singapore)
• Published date: 01 December 2022
• Docket Number: District Court Suit No 890 of 2020, District Court Appeal No 39 of 2022
• Plaintiff Counsel: Sundararaj Palaniappan and Ranita Yogeeswaran (K&L Gates Straits Law LLC)
• Defendant Counsel: Vanessa Yong Shuk Lin and Lee Pei Pei (Legal Clinic LLC)
• Subject Matter: Tort,Negligence,Breach of Duty,Unwitnessed Fall in Hospital,Patient falling while transferring from Visitor's Chair to bed,Whether patient self-ambulated from bed to Visitor Chair or left on Visitor's Chair by nurse,Whether call bell left within patient's reach,Whether adequate fall prevention measures in place,Evidence,Burden of Proof,Conflict of testimonies
• Hearing Date: 20 September 2022,19 August 2022,19 May 2022,30 March 2022,31 March 2022

District Judge Clement Seah Chi-Ling: Introduction

The Plaintiff is a 79-year-old female who was previously admitted into Ng Teng Fong General Hospital (“NTFGH”) after she suffered a fall at home, fracturing her thigh bone.

The Plaintiff underwent surgery at NTFGH and was thereafter recuperating at the Defendant’s hospital, Jurong Community Hospital (“JCH”), where she suffered another fall on 10 April 2017 and fractured her hip (the “Fall”). The Fall formed the subject of the present lawsuit.

The Plaintiff brought the present action, both under the tort of negligence and under contract, against the Defendant who manages JCH. The Plaintiff contended that the Fall could have been avoided if the Defendant had taken reasonable care when it provided medical services to her.

At the conclusion of the trial, I found that the Plaintiff had not discharged her burden of proving that the Defendant had fallen below the standard of care required of it. Accordingly, I dismissed the Plaintiff’s claim. The Plaintiff is unhappy with my decision and has filed the present appeal.

Background Facts The Parties

The Plaintiff is presently 79 years of age. She was 74 years old at the time of the incident. She is Tamil speaking and unable to converse in English. The Plaintiff is legally aided in these proceedings.

The Defendant owns and manages JCH, which provides medical, nursing and hospital services to patients. The Defendant employs doctors, nurses and medical staff to provide medical, nursing, treatment and/or rehabilitation care to patients.

Events leading to the Plaintiff’s Fall

On 12 March 2017, the Plaintiff presented herself at the Emergency Department of NTFGH after she suffered a fall at home. An X-ray of her femur, pelvis and right hip joint showed she sustained a hip fracture. The Plaintiff was admitted to NTFGH for further treatment.

The Plaintiff underwent a right hip fixation with dynamic hip screw surgery the next day, on 13 March 2017. After the surgery, she underwent daily physiotherapy and occupational therapy sessions, and was assessed to require rehabilitative care post-operatively to help her regain her functional status.

On 20 March 2017, the Plaintiff’s care was transferred to JCH for inpatient rehabilitation. When the Plaintiff was transferred to JCH, she was initially admitted into an eight-bed ward at Ward C8, Bed 24. Subsequently, on or around 28 March 2017, the Plaintiff suffered from an infection that required her to be isolated, and she was transferred to a single bed isolation room at Ward C8, Bed 14 (the “Room”)¹.

The Room was a double-barrel room, i.e. it had two consecutive doors. The inner room, where the bed was situated, had doors which led to another room which had another set of doors which led to the corridor of the ward. One had to walk through two sets of doors to move from the inner room to the corridor of the ward. The Room had: (a) a call bell that was hanging from the bed; (b) a visitor’s chair (the “Visitor’s Chair”); (c) a larger chair (the “geriatric chair”) and (d) a table on rollers that had an adjustable height (the “cardiac table”)².

During her hospitalisation at JCH, the Plaintiff was recorded as being a patient at risk of falling and that precautions needed to be taken to ensure that she did not fall. The Plaintiff scored 50 on the Morse Fall Risk Assessment on 10 April 2017 prior to the Fall, and on all days leading up to the Fall when the assessment was conducted, except on two days. The two days were 20 March 2017 and 1 April 2017, when the Plaintiff scored 40 on the Morse Fall Risk Assessment³. The Morse Fall Risk Assessment is a worldwide assessment through which a patient’s risk for falls is assessed. A score of more than 25 meant that a patient is a fall risk patient⁴.

The Fall

The Plaintiff’s Fall happened on 10 April 2017 at or around 0853 hours in the Room.

At around 0740 hours on 10 April 2017, the Plaintiff pressed the call bell. Patient Care Assistant Myat Swe Zin Myint (“Ms Myat”) attended to the Plaintiff. The Plaintiff informed Ms Myat that she needed to use the toilet. Ms Myat proceeded to transfer the Plaintiff to the toilet on a commode chair, where she assisted the Plaintiff with her oral hygiene care and a shower.

While Ms Myat was still assisting the Plaintiff in the toilet, another nurse entered the room and placed the Plaintiff’s breakfast on the cardiac table⁵.

The sequence of events after this was severely disputed. What was undisputed was that after the Plaintiff exited the toilet accompanied by Ms Myat, she proceeded to have her breakfast (though the location where she had her breakfast was disputed). Ms Myat thereafter left the room. At or around 0835 hours, Staff Nurse Hou Wenfeng (“SN Hou”) entered the Room to give the Plaintiff, who was by then sitting on the Visitor’s Chair, her medication. SN Hou left the Room less than five minutes later. The Plaintiff was left seated in the Visitor’s Chair in the Room alone. After SN Hou left the Room, no one else entered the Room until after the Plaintiff’s Fall.

At around 0900 hours, a staff nurse noticed a call bell alert coming from the Plaintiff’s room. Upon entering the Room, the staff nurse found the Plaintiff lying on the floor. The Plaintiff complained of pain at her left hip. More nurses entered the room and transferred the Plaintiff to the bed. The Plaintiff’s vital signs and oxygen saturation level were checked and noted to be stable. The ward doctor, Dr Yong Kuan Yew, was alerted to review the Plaintiff.

On examination, Dr Yong found the Plaintiff’s left lower limb to be externally rotated. No other external injuries were seen, and the Plaintiff complained of pain over her left hip. An X-ray of the left hip was ordered and revealed that the P had sustained an intertrochanteric fracture of the left proximal femur.

The Plaintiff was referred to the NTFGH Orthopaedic team for further treatment and management of the fracture. She subsequently underwent a left hip fracture fixation surgery at NTFGH on 11 April 2017. The Plaintiff’s post-operative recovery was uneventful and she continued to received medical, nursing and rehabilitative care at NTFGH until her transfer to St Luke’s Hospital on 18 April 2017⁶.

Plaintiff’s version of the events

The Plaintiff’s version of the events leading up to the Fall, as adapted from the Plaintiff’s Closing Submissions (“PCS”), were as follows.

The Plaintiff asserted that after Ms Myat had finished assisting the Plaintiff with her toileting needs, Ms Myat assisted the Plaintiff from her bed to the Visitor’s Chair in the Room, where the Plaintiff had her breakfast. The Plaintiff’s breakfast was placed on the cardiac table. The Visitor’s Chair was placed on the left side of the bed, away from the window, and was approximately one metre away from the bed. According to the Plaintiff, the bed was not within the Plaintiff’s reach from the Visitor’s Chair. Ms Myat left the Room after seating the Plaintiff on the Visitor’s Chair for her breakfast⁷.

When SN Hou came in to give the Plaintiff her medication, she saw the Plaintiff on the Visitor’s Chair. Other than giving Plaintiff her medication, SN Hou did not interact with the Plaintiff. In particular, SN Hou made no effort to move the Plaintiff back to the bed after serving the Plaintiff her medication and clearing her plates⁸.

By 0840 hours, the Plaintiff had been seated in the same position in the Visitor’s Chair for quite some time. She started to feel immense and unbearable pain in her back. There was no one in the Room and no one came back to check on her. She tried to reach out whilst seated to press the emergency call bell (the “call bell”) for assistance. However, the call bell was placed on the bed, approximately one metre away, and was out of her reach. Unable to press the call bell for assistance, she shouted for help, but no one responded⁹.

Sometime at or around 0850 hours, the Plaintiff’s back pain continued to worsen and it became intolerable for her to stay seated in the same position any longer. By this time, no one had come to her aid and the Plaintiff did not know how long it would be until someone would come into the Room. As the pain was unbearable, and the call bell was out of her reach, the Plaintiff slowly pushed the cardiac table away from her and stood up from the Visitor’s Chair to move to the bed so that she could rest. The Plaintiff held onto the left side of the Visitor’s Chair to stand up. However, as the Visitor’s Chair was not sturdy enough, she lost her balance and fell together with the Visitor’s Chair onto her left side¹⁰.

Upon falling to the floor, the Plaintiff shouted in pain and cried for help. No one came to her aid. As she was unable to stand up after the Fall, she crawled towards the call bell that was on the bed with much difficulty. She pulled the cord of the call bell that was hanging against the side of the bed close to the floor. The call bell fell to the floor and she pressed the call bell at or around 0855 hours¹¹.

According to the Plaintiff, approximately 10 to 15 minutes later, a nurse came into the Room and saw the Plaintiff on the floor. She left the Room and returned with some other nurses who then transferred the Plaintiff from the floor to the bed¹².

The Fall was not witnessed by anyone. However, the Plaintiff related the events surrounding the Fall to her son V Thiruchelvam (“Thiruchelvam”) at around 1040 hours, about an hour and half after the incident on the same day. Thiruchelvam affirmed an affidavit narrating the information provided to him by the Plaintiff about the Fall¹³.

Defendant’s version of the events

The Defendant’s version of the events leading up to the Fall was that at around 0810 hours, Ms Myat assisted the Plaintiff back to her bed to have her breakfast after assisting the Plaintiff with her toileting needs. As the Plaintiff indicated that she...