In one of several medical negligence trials heard before the Singapore High Court in the past few years, the High Court dismissed a claim against a Singapore public hospital and its doctors.

The case is principally concerned with the treatment undertaken at a public hospital for the Plaintiff’s mother, a 74-year-old patient with a history of multiple medical conditions, including chronic ischaemic heart disease and chronic kidney disease. The claim was mounted on the basis that the patient was not diagnosed correctly, that there was a failure to obtain informed consent when the doctors withheld her long-term medications, and that there was a delay in the resuscitation when the patient collapsed in the ward.

The Dentons Rodyk team led by Mar Seow Hwei, senior partner at the firm’s litigation practice, successfully defended the hospital and its doctors. The full judgment of Chia Soo Kiang (personal representative of the estate of Tan Yaw Lan, deceased) v Tan Tock Seng Hospital Pte Ltd and others [2022] SGHC 259 can be found here.

On the issues of diagnosis and resuscitation, the High Court rejected the Plaintiff’s claims, and in essence, the Plaintiff’s expert evidence. It was said that the Defendants’ witnesses had methodically refuted the Plaintiff’s various allegations.

As part of his decision on the consent issue, Justice Choo Han Teck observed that a doctor cannot commence treatment without his patient’s consent, but it has never been contemplated until now that a doctor cannot stop treatment without the patient’s consent. This is because the cessation of medication is a strictly clinical decision: if a doctor finds that a given medication is not working, he will stop it. If the patient refuses to stop the drug, the doctor is entitled to say that he will not prescribe it. The doctor cannot be expected to prescribe a drug that he had just advised should not be used.

On our reading of the judgment, a doctor’s duty of care does not extend to advising and obtaining consent from a patient on every medication that would be withdrawn, although there are exceptions, e.g., where major treatment is involved, such as those for cancer.

The High Court also noted that it is inconceivable to expect a doctor, for example, to ask a patient if he would like a Panadol. He may have to check if the patient has any relevant allergies, but does not have a duty to ask if the patient consents to a pain-killer, an anti-inflammatory, an anti-histamine, or such other drugs, though he might tell the patient to stop taking the medication once he feels better.

Those familiar with case law on consent in the context of medical negligence claims will appreciate that whether there had been a breach of duty of care to advise is a fact-sensitive inquiry. The facts of this case are that the patient had been admitted into the hospital, and the aspirin, losartan and Lasix that were stopped were for her chronic ailments. The reason for temporarily withholding the medications is that they had the potential to cause complications given the patient’s acute condition of sepsis.

As the Plaintiff’s claim on consent included allegations against the on-call consultant, the High Court also held that no duty of care arose between the patient and the on-call consultant, who was not contacted by the on-call team or reviewed the patient.

The findings and rulings in this case should offer some reassurance for doctors and nurses practising in public healthcare institutions, who may have had concerns about the breadth of the Plaintiff’s allegations in this case and the implications on their practice as healthcare workers.