Toon Chee Meng Eddie v Yeap Chin Hon

• Jurisdiction: Singapore
• Judge: Goh Phai Cheng JC
• Judgment Date: 13 March 1993
• Neutral Citation: [1993] SGHC 56
• Docket Number: Suit No 834 of 1990
• Date: 13 March 1993
• Published date: 19 September 2003
• Year: 1993
• Plaintiff Counsel: Yap Gim Chuan (Yap Gim Chuan & Co)
• Citation: [1993] SGHC 56
• Defendant Counsel: Abdul Rashid (Khattar Wong & Partners)
• Court: High Court (Singapore)
• Subject Matter: Victim's awareness of pain and distress,Future nursing care,Wheelchair bound,Loss of speech,Restricted use of limbs,Purpose of compensation,Damages,Pain and suffering,Costs of home nursing care as opposed to institutional nursing care,Loss of future earnings Determining multiplier and multiplicand,Whether there was overlap between future nursing care and loss of future earnings to warrant discount in award,Loss of amenities,Infant victim,Determining multiplier and multiplicand,Costs of engaging maid to assist in nursing care at home as opposed to engaging private nurse,Using national mean commencing salaries of all occupations for young workers to arrive at fair and reasonable multiplicand,Assessment of damages,Severe head injury,Brain damage,Life expectancy

Cur Adv Vult

On 12 May 1987, the plaintiff, aged 71U2, was standing at the side of the car park of Block 17 Ghim Moh Road when a motor vehicle EK8717D driven by the defendant collided into him. As a result of the accident, the plaintiff suffered severe injuries and irreparable brain damage.

Liability was admitted and interlocutory judgment was entered on 14 June 1991 against the defendant with damages to be assessed. The assessment of damages came on for hearing before an assistant registrar in July 1991 and January 1992. On 28 April 1992 the learned assistant registrar assessed the damages in the sum of $945,401.34 which, together with interest assessed at $23,128.80, produced an award for $968,530.14 for which sum judgment was entered.

The sum of $945,401.34 is made up as follows:

Agreed special damages $ 21,101.34

Pain and suffering and loss of amenities $160,000.00

Loss of future earnings $140,400.00

Past nursing care $ 50,000.00

Future nursing care $480,600.00

Cost of diapers /continent pads $ 54,000.00

Future medical and hospital fees $ 39,300.00

$945,401.34

The defendant appealed against the assessment of the learned assistant registrar in respect of:

(a) pain and suffering and loss of amenities in the sum of $160,000 together with interest thereon at the rate of 6%pa from the date of service of the writ up to the date of the order;

(b) loss of future earnings in the sum of $140,400; and

(c) future nursing care in the sum of $480,600.

Injuries suffered by the plaintiff

First, I will set out the medical evidence and the nature of the injuries suffered by the plaintiff. After the accident the plaintiff was brought to Tan Tock Seng Hospital (`TTSH`). Dr Charles KF Seah, Senior Registrar of the Department of Neurosurgery of TTSH who examined him on the day of the accident (ie 12 May 1987) described the plaintiff`s condition as follows:

(1) Unconscious, bleeding from left ear.

(2) Responding to painful stimuli.

(3) Right pupil dilated and fixed, left pupil reactive.

(4) Moving four limbs with hyper reflexes.

(5) (a) 5cm diameter haematoma (ie accumulation of blood with the tissues that clots to form a solid swelling) in the left parieto-occipital region of the skull with surrounding abrasion.

(b) 15cm x 10cm diameter abrasion left calf lateral aspect.

(c) 2cm diameter abraded wound over the left lateral malleolus (ie protuberance on the outer side of the ankle).

(d) Small abrasion over the upper part of the left foot.

(e) Small scratches over the left thigh.

Dr Seah`s evidence was as follows. Skull X-rays showed a fracture of the parieto-temporal bone. A CT brain scan showed a fractured left skull with underlying brain damage contusion and the circulation of blood of this part of the brain was not functioning well and there was a swelling of the brain. Because of the injury causing tears of the blood vessels on the surface of the brain there was an accumulation of blood clots sitting on the brain at the right forehead and temporal region of the head with mid-line shift to the left.

The plaintiff was immediately operated upon to remove the blood clot, otherwise he would die. After his operation the plaintiff developed a lung infection and there was an accumulation of water in the brain due to the brain injury or intra-cranial haemorrhage. A second operation was performed on the plaintiff the next day on 13 May 1987 to drain out the water and this was done by way of a ventriculo-peritoneal shunting (`VP-shunt`)(ie a tube with a valve was inserted into the abdomen while the other end was inserted into the brain cavity) so that the pressure caused by the accumulation of water in the brain can be relieved.

The plaintiff`s condition after the operation did not improve much. He remained retarded, his limbs were spastic and rigid. He was unable to talk, unable to call for toilet needs but was able to swallow when fed by someone. Dr Seah said the plaintiff is different from a quadriplegic in that a quadriplegic cannot move his limbs at all whereas the plaintiff`s limbs can be moved but they were very rigid and force must be used to move them.

The plaintiff was subsequently transferred to St Andrew`s Hospital for intensive physiotherapy. He was readmitted to the department of paediatrics on

25 October 1987 because of fever and cough and was subsequently transferred to the department of rehabilitation in TTSH.

When Dr Seah examined the plaintiff on 21 October 1989, one and a half years later, he found that the plaintiff was conscious but not able to obey commands or talk. He could not take care of himself and requires someone to take care of him. His limbs were spastic and rigid. He was unable to stand or walk. The plaintiff had no control over his arms or legs and he could not feed himself.

The plaintiff was readmitted to TTSH on 21 December 1990 for a cranioplasty to close up the right frontal temporal skull defect.

On 7 November 1991, the plaintiff was again admitted to the department of neurosurgery of TTSH for a malfunctioning of the right VP-shunt and an infection of the right cranioplasty site. He underwent revision of the right VP-shunt the same day and had wound debridement and removal of the cranioplasty template on 9 November 1991. He made an uneventful post-operative recovery and was discharged on 18 November 1991. Dr Seah said the plaintiff would require a cranioplasty to close up the right frontal temporal defect in the future.

Dr Seow Wan Tew, FRCS, Registrar of the Dept of Neurosurgery of TTSH, who examined the plaintiff on 12 September 1991 gave the following medical report:

[The plaintiff] was brought to [my] clinic on his wheelchair.

On examination, he was conscious, alert but unable to appreciate the going-ons in the clinic. He was unable to verbalize but could make incomprehensible sounds to attract attention and in attempt to vocalize. He had a right spastic hemiparesis

[ie paralysis of the right side] with a contracture deformity of the right ankle

[ie shrinkage of muscle due to disuse of the leg]. He could move his left sided limbs purposefully to simple commands. He is, however, unable to feed himself and requires assistance for this.

He is unable to walk and is wheelchair bound. He requires long term medication to reduce the spasticity on the right side. Release of the right ankle contracture will be necessary at a later state.

He is able to respond to visual and auditory stimuli but it is not possible to quantify these senses in him.

He is aware of bladder and bowel fullness but requires assistance to micturate and defecate. Without assistance, he is incontinent.

In summary, this patient has sustained a severe head injury and as a result, is severely disabled. He will require full nursing care and support for the rest of his life. His life expectancy is definitely reduced in view of his disabilities and the amount of reduction will be inversely proportional to the quality of nursing care that he will receive in future.

Dr Seow told the court that the plaintiff`s chance of speaking again is very slim or nil as he had undergone speech therapy with no progress and with the best nursing care he expected the plaintiff to live up to the age of 40. If the plaintiff gets frequent recurrent chest or urinary tract infections, his life expectancy can be reduced.

Dr Tang Kok Foo, a neurologist and physician, in his medical report dated

27 September 1991 expressed the following opinion:

In summary [the plaintiff] has suffered severe brain damage with loss of speech, impaired vision, paralysis and contracture of the right upper and lower limbs, post-traumatic epilepsy, dystonia secondary to the brain damage and loss of his higher intellectual abilities. His functional level is similar to a six-month to one-year-old child.

It is my professional opinion that he can feel the emotions of joy, anger, frustration and happiness - mainly in response to bodily needs and their satisfaction but also to a minor degree in human interaction with his mother.

I do not think he is able to fully appreciate the extent of his injuries and disability. This is in part due to the severity and extent of these injuries but also in part due to the young age at which he suffered these injuries.

As it has been more than four years since these injuries (and he has gone through a prolonged course of rehabilitation) I do not think he will show any future significant improvement in physical or intellectual performance.

The plaintiff`s disabilities can be summarized as follows:

(a) He is unable to walk or stand and is wheelchair bound.

(b) He has paralysis on the right side.

(c) Shrinkage of the muscle of the right ankle due to disuse of the leg.

(d) He is unable to speak but can make incomprehensible sounds to attract attention and in an attempt to speak. The chance of him speaking again is very slim or nil as he has undergone speech therapy with no progress.

(g) Intermittent involuntary movements whereby the right hand and the right leg and the head, neck and sometimes even the body twist and turn in various unnatural movements.

(h) He is able to respond to visual and auditory stimuli but it is not possible to quantify these senses in him. He has some vision but interest and concentration usually is poor.

(i) Post-traumatic epilepsy requiring treatment with an anti-epileptic drug for life.

(j) He is aware of bladder and bowel fullness but has minimal control and requires assistance to micturate and defecate. Without assistance, he is incontinent.

(k) The plaintiff would remain with the same intellectual ability of a six-month to one-year-old child for the rest of his life.

Principle applicable to the review

In his written submission Mr Yap, counsel for the plaintiff, devoted nine pages to the appellate court`s approach on hearing an appeal on the quantum of damages assessed by a trial...