Peh Diana and Another v Tan Miang Lee

• Jurisdiction: Singapore
• Judge: Chao Hick Tin J
• Judgment Date: 03 January 1991
• Neutral Citation: [1991] SGHC 3
• Date: 03 January 1991
• Subject Matter: Damages,Head injury,Damages for pain and suffering, loss of amenities, loss of future support and loss of future earnings,Use of national average wage,Personal injuries cases,Determination of multiplicand,Measure of damages,Brain damage,Intellectual impairment, personality change, facial disfigurement
• Docket Number: Suit No 1486 of 1988
• Published date: 19 September 2003
• Defendant Counsel: Lawrence Chua (Lawrence Chua & Partners)
• Court: High Court (Singapore)
• Plaintiff Counsel: Abdul Rashid bin Abdul Gani (Khattar Wong & Partners)

Cur Adv Vult

On 20 February 1988, the first plaintiff (an infant) was travelling as a passenger in motor taxi No SHA 3558M driven by the defendant along the central carriageway of Nicoll Highway in the direction of Guillemard Road, when the said motor taxi went over the road divider onto the wrong side of the said highway and collided with an on-coming motor taxi No SH 7799R. The second plaintiff is the father of the first plaintiff.

The defendant conceded liability and an interlocutory judgment was entered against him, with damages to be assessed. Following a hearing on damages before a senior assistant registrar, it was ordered that:

(i) the defendant should pay to the first plaintiff a total sum of $691,699.85 as damages, together with interest accruing on $181,163.85 at the rate of 6% pa from the date of the writ, namely, 21 July 1988, up to the date of the order; and

(ii) the defendant should pay the second plaintiff a sum of $3,375 together with interest thereon at 6% pa from 21 July 1988 to the date of the order of court.

The sum of $691,699.85 awarded to the first plaintiff was made up as follows:

Pain and suffering and loss of amenities $150,000.00

Loss of future earnings $325,536.00

Future cost for a maid $180,000.00

Special damages $31,163.85

Future medication $5,000.00

This is an appeal by the defendant against the assessment of the senior assistant registrar only as regards the first three items, ie pain and suffering, loss of future earnings and future cost of a maid. The first plaintiff was 14 years old on the date of the accident and was 16 on the date of the assessment. She was born on 5 October 1973.

I will first set out the medical evidence. After the accident, the first plaintiff was brought to the Singapore General Hospital in an unconscious state. While the doctor who examined her on admission found no external injuries over the scalp, she diagnosed her to have a head injury. The first plaintiff was transferred to the Tan Tock Seng Hospital (TTSH) for further treatment.

At TTSH, she was found to have:

no spontaneous respiration, pulse rate was 79min, blood pressure was 126/56mmHg, cardiovascular system was normal, chest compression was negative. She was in coma 3, responded to pain; pupils were 7mm on the right side and 2mm on the left, both not reactive to light. Dolls eye sign present only on the right side. All jerks were present, plantar reflexes were both upgoing. There was a 3cm laceration over the medial aspect of the left ankle exposing the tendons.

There was, however, no fracture. A CT scan of the head showed some blood in the right ventricle but there was no haematoma. The first plaintiff was in coma for about 20 days. She clearly had a bad head injury which left her with a paresis of the left third and seventh (upper motor) nerves and a clumsy left hand. She also had problems of expressive aphasia and dyslexia, due to brain damage on the right side. Expressive aphasia means difficulty in expressing oneself. Dyslexia indicates reading disability. She was discharged from TTSH on 20 May 1988.

Dr Peh Lai Huat, the registrar at the Department of Psychological Medicine of the TTSH, stated in his report dated 7 December 1989 that the first plaintiff had an IQ level of 70 which was at the borderline of mental retardation. Her verbal IQ score was 79 and performance IQ score was 62. There was impairment in her recent memory and delayed recall. A CT scan of her brain done on 24 November 1989 showed marked cerebral atrophy, ie shrinking of the brain. She talked in a childish manner and showed poor concentration and was disorientated in time. There was also a personality change in the first plaintiff. She was no longer the obedient child she was before the accident. It was reported that she would refuse to take instructions from her parents, lose her temper and shout back at them. She also had other behavioural problems like locking herself in her room, cutting up her dresses and listening to radio with a high volume without consideration for others. In Dr Peh`s opinion the general lowering of her intellectual functioning, memory deficits and her change in personality were the result of the severe head injury sustained during the accident in February 1988. Dr Peh also told the court that in view of the fact that two years had passed since the accident, it was unlikely that her condition would improve. The brain has no regenerative power.

Dr Robert Don (PW2), a specialist in rehabilitation medicine, examined the first plaintiff on 30 October 1989 for half an hour. He noted that she was very vocal and appeared orientated as to time. He, however, observed that her behaviour was inappropriate and she laughed without reason. He also found neurological evidence of `left III and VII (UMN) cranial nerve lesions with diplopia`, which meant she had double vision. Her face and mouth were slanted. In his opinion her behaviour would be unpredictable. She could be dangerous to herself as she had come to realize that she was `cosmetically impaired`. He felt that she would need a principal care giver like a maid. However, Dr Don agreed that the first plaintiff could feed and dress herself. A person was required just in case she got into one of her moods. When asked if the first plaintiff would be able to take care of herself after she had undergone rehabilitation, he said this question should be put to a psychiatrist.

Dr Aw Soh Choo, a consultant psychiatrist with the Child Psychiatric Clinic of the Ministry of Health, examined the first plaintiff on four occasions in November/December 1989. She had also spoken to Dr Peh. In her report dated 23 December 1989 Dr Aw stated, inter alia, the following:

On examination, Diana is a tall, plump-looking adolescent who had a squint over the left eye and an asymmetrical smile. Her mood varied from disinhibition to inappropriate, cheerfulness to misery. In her talk, she was preoccupied with two main themes: (1) her physical appearance and bodily changes due to the accident; (2) her feelings of monotony in her present life as she is now unable to attend normal school. There was no evidence of psychosis. Cognitive assessment revealed intellectual impairment and deterioration including short-term memory.

Physical examination

This revealed the following findings: Her general condition was good. She had scars on the front of her neck due to tracheostomy and a scar on the left medial ankle. The cardiovascular and respiratory systems were normal. Her central nervous system was normal except for a III nerve palsy of her left eyelid muscles, and a VII cranial nerve palsy causing her to smile in a crooked manner.

Diagnosis

Diana has suffered a personality change following head injury. She also has intellectual and memory impairment. Some of her symptoms indicate adjustment reaction due to the sequelae of head injury. Adjustment has been made more difficult for Diana and her family, in particular her parents, as she is also at the stage of development in adolescence with needs of a good self-identity and of independence and freedom.

Dr Aw told the court that, due to her intellectual impairment, it was almost impossible for the first plaintiff to go to a normal school. In her assessment Dr Aw found that the first plaintiff`s previous personality of being outgoing and wanting to have friends had not changed. She liked to look nice and to travel. Dr Aw said that the first plaintiff was still outgoing. Dr Aw also said these to the court:

Her physical disabilities would affect her ...

Her eyes looked terrible. Her smile is crooked and she had fat legs. Her emotional state is expected to present difficulty. However, it is amenable to treatment in the long term. She would definitely have to be seen by a child psychiatrist ...

Other than the child psychiatrist, I would include school or vocation centre or a person who could teach her simple skills in order for her to learn simple trade in the future.

I am aware that lately she had become violent and beat up her parents. I conclude she has a low threshold to frustrations after the head injury. She reacts easily and irritably to frustration.

Dr Aw also said that the symptoms displayed by the first plaintiff could either taper off or she could adjust to her condition after she has passed the adolescent stage. She agreed that some of the symptoms displayed are those displayed by uninjured adolescents. With motivation and proper help, things could improve. However, she added that since it would be difficult to correct her physical appearance, that would be a great hindrance to the first plaintiff`s development.

According to Dr ES Tan, Head of the Department of Rehabilitation Medicine, TTSH, the first plaintiff could do simple tasks like pressing lift buttons. But she would not be able to undertake tasks that needed dexterity. Physically she had fully recovered. She had also recovered from aphasia and dyslexia though her speech was slightly slurred. In Dr Tan`s opinion there was no likelihood of any shortening of her life expectancy.

The mother of the first plaintiff told the court that when the first plaintiff was in hospital, she had, on the recommendation of the ward doctor, hired a night nurse to look after the first plaintiff. After her discharge from hospital, a maid was engaged to take care of the first plaintiff as she was then unable to walk properly. The mother said the first plaintiff was aggressive towards the maid so much so that the maid refused to work for them any more. The first plaintiff even assaulted her parents. The mother said that the first plaintiff was never left alone at home. She could not take care of herself.

From the medical evidence, it is clear that physically there was minimal impairment.

The principle on which an appellate court acts in reviewing an assessment of damages by a lower...