Tan Juay Mui (by his next friend Chew Chwee Kim) v Sher Kuan Hock and another (Liberty Insurance Pte Ltd, co-defendant; Liberty Insurance Pte Ltd and another, third parties)

• Jurisdiction: Singapore
• Court: High Court (Singapore)
• Judge: Judith Prakash J
• Judgment Date: 08 May 2012
• Neutral Citation: [2012] SGHC 100
• Citation: [2012] SGHC 100
• Docket Number: Suit No 693 of 2008(Registrar’s Appeal Nos 280 and 285 of 2011)
• Subject Matter: personal injuries cases,Damages,measure of damages,special damages,remoteness,inadequate damages
• Defendant Counsel: NK Rajarh (M Rama Law Corporation)
• Plaintiff Counsel: Balasubramaniam (Balasubramaniam & Associates)
• Hearing Date: 11 October 2011,20 January 2012
• Published date: 16 May 2012
• Date: 08 May 2012

Judith Prakash J: Introduction

This case involves an appeal and a cross-appeal against an assessment of damages in a personal injury case.

On 15 June 2006, the plaintiff, Mdm Tan Juay Mui, who was then almost 48, was knocked down by a bus driven by the first defendant. The second defendant is the employer of the first defendant. After proceedings were commenced, the defendants consented to judgment being entered against them for damages to be assessed on the basis that they were fully responsible for the accident.

Initially, the plaintiff suffered the following serious injuries: A severe injury to her left foot with an extensive section of her skin torn off the underlying tissue, severing the blood supply; and Severe brain injury with blood collecting between the layers of the brain. She was admitted to hospital and underwent emergency surgery to remove the blood in the brain. A right intracranial pressure monitor was inserted in her head during the operation because her condition had deteriorated and the size of the haematoma had increased. Due to the serious nature of the injury to her left foot, it could not be saved despite extensive wound debridement and, on 17 June 2006, the plaintiff underwent an amputation of her left leg below the knee in order to save her life.

I will detail the further treatments administered to the plaintiff and her subsequent complaints and ailments later in this judgment. It is important to note here, however, that the plaintiff lost her ability to manage herself and her affairs and her husband had to be appointed her litigation representative to undertake and conduct the proceedings on her behalf.

Decision below and appeals

After a lengthy hearing, Assistant Registrar Ang Feng Qian (“the AR”) made the following awards of damages in favour of the plaintiff:

1. Pain and suffering and loss of amenity: $230,000.00
	a. Head injury	$170,000.00
	b. Leg injury	$60,000.00
2. Special Damages: $167,639.01
	a. Loss of earnings before trial	$15,500.00
	b. Caregiving arrangements before trial	$86,000.00
	c. Pre-trial medical expenses	$32,897.87
	d. Transport expenses	$3,829.65
	e. Renovation	$3,250.00
	f. Pre-trial nursing costs	$4,518.64
	g. Medical equipment and consumables	$9,609.05
	h. Legal costs of obtaining Order for
	Appointment of Committee of Person	$12,033.80
3. Future expenses: $493,030.00
	a. Loss of future earnings	$24,000.00
	b. Costs of future care: (components are listed as annual costs with multiplier of 17)	$469,030.00
		(i) Costs of hiring maid and daycare	$18,888.00
		(ii) Future medical expenses
		1. Medication	$1,200.00
		2. Laboratory tests	$400.00
		3. Costs of consultations	$200.00
		4. Diapers, wipes and underpads	$1,300.00
		5. Wheelchair and servicing	$200.00
		6. Prosthesis and servicing	$1,140.00
		7. Commode and special chair	$417.00
		8. Quad stick	$5.00
		9. Physiotherapy and psychological therapy	$2,400.00
		10. Diabetes-related expenses (excluding medication)	$1,200.00
		(iii) Future transport expenses	$240.00
				____________
			Total Award is	$890,669.01
				===========

The plaintiff’s appeal is for the following: An increase in the amounts awarded for the head and leg injuries; An award to be made in respect of the plaintiff having become a diabetic after the accident; An award to be made in respect of the loss of housekeeping services/cost of a maid prior to trial; Variation of the award made in respect of care-giving arrangements before trial; Variation of the award made in relation to pre-trial nursing costs; An increase in the multiplier for the cost of future care; An increase in the amount awarded in respect of the future costs of hiring a maid and providing day care; An increase in the amount provided for future medical expenses; and That an award for provisional damages be made.

The defendants’ appeal is for the awards for pain and suffering, special damages and future expenses to be reviewed downwards to more reasonable sums.

Medical Evidence

Five medical experts gave evidence on behalf of the plaintiff. They were Dr Pauline Sim Li Ping, a psychiatrist, Ms Zena Kang, a clinical psychologist, Dr Karen Chua, a rehabilitation specialist doctor, Dr Ernest Wang, a neurosurgeon, and Dr Lee Chung Horn, an endocrinologist. There were also two doctors who testified for the defendants, Dr R Nagulendran, a psychiatrist and Dr Lee Soon Tai, an orthopaedic surgeon.

According to the medical reports, when the plaintiff was first admitted, urgent CT scans of her brain showed an acute right frontal subdural haematoma with multiple hemorrhagic contusions in the right frontal and right temporal lobes without skull fracture. Dr Wang noted that subsequent to her arrival at the hospital, the plaintiff’s condition deteriorated neurologically. A decision was therefore made for a surgical decompression of the acute subdural hematoma with the insertion of an intracranial pressure monitor. This was done on the day of her admission.

Subsequent to her treatment for bleeding and swelling in the brain and the amputation of her left leg, the plaintiff’s recovery was complicated by sepsis (bacterial infection of the blood stream), low blood pressure, coagulopathy and right-sided posterior and anterior celebral artery and occipital lobar infarction due to increased intracranial pressure which resulted in paralysis of the left side of her body. Due to prolonged artificial ventilation and ICU care, she required an operation to cut open her throat for a tube to be inserted to help her breathe. This was done on 21 June 2006. She was transferred to the general ward the next day but was unable to speak or obey commands. On 30 June 2006, the plaintiff was transferred for in-patient brain injury rehabilitation at Tan Tock Seng Hospital Rehabilitation Centre. On 31 July 2006, she was transferred to Ang Mo Kio Community Hospital for further rehabilitation.

At the time the plaintiff entered the Tan Tock Seng Hospital Rehabilitation Centre, she was found to be in a post-traumatic amnesiac state with significant retrograde amnesia, impaired orientation and poor short-term memory. She could not move her left upper and lower limbs and could not see things on her left side. She also had left-sided phantom limb pain. She was incontinent of urine. The vision in her left eye was impaired with a dark patch in the visual field.

After spending almost two months in hospital, the plaintiff was discharged from Ang Mo Kio Community Hospital on 7 September 2006. Subsequently, she was readmitted to hospital for a titanium cranioplasty to cover the defect in her skull. This operation took place on 22 November 2006.

The plaintiff’s husband testified that shortly after the accident, the plaintiff was unable to recognise him and the family and could not recall what had happened. About three weeks later, she was able to talk but could not remember many things. When she became aware of her amputation and paralysis, she became very upset. In the following months she continued to be depressed. After she returned home, she had difficulty sleeping and was often frustrated and depressed about her condition. She was embarrassed about her incontinence, appearance (sunken head, amputated leg, paralysis, blindness) and helplessness. The family noticed personality changes and that she suffered from delusions.

In May 2007, the psychologist in Ang Mo Kio Community Hospital noticed that the plaintiff had paranoid delusions about her maid. Subsequently, the plaintiff was examined by Dr Sim. In her report of June 2008, Dr Sim noted that the plaintiff was depressed and suicidal, and that she was suffering from post-traumatic personality changes as a result of her traumatic brain injury. Her depression was secondary to the loss of her left lower leg, her immobility and stroke that she had suffered. Dr Sim noted that the plaintiff’s husband was her main caregiver as she was suspicious of, and abusive towards, her maids. Subsequently, in May 2009, Dr Sim examined the plaintiff again and reported that her cognitive function had deteriorated. The plaintiff still suffered from post-traumatic personality change and had paranoid delusion and persecutory ideas. The plaintiff was incapable of managing herself and her financial affairs.

Ms Zena Kang conducted a psychometric assessment of the plaintiff. In her report of 12 May 2009, she concluded as follows: the plaintiff’s skills in solving non verbal problems, in working quickly and efficiently with visual information, were classified as being “Extremely Low”; her skills in understanding verbal information, verbal reasoning and expressing thoughts in words were ranked in the ninth percentile, which means that her score was better than only 9% of individuals her age – “Extremely Low”; her performance on the Working Memory Index was classified as “Low Average”...