SINGAPORE — Changi General Hospital (CGH) has been ordered by a judge to pay $326,620.61 as damages to the estate of a woman who died following her treatment at CGH after it was ruled to be negligent in her cancer diagnosis.
Noor Azlin Abdul Rahman, 39, died on 1 April 2019 from fourth stage lung cancer a month after the Court of Appeal ruled that there was negligence on the part of CGH.
The order was made in a written judgement issued by Judge of the Appellate Division Belinda Ang Saw Ean on Tuesday (19 January), after an assessment of damages hearing which was conducted from 24 August to 4 September last year.
Azlin had earlier successfully applied for CGH to pay her an interim sum of $200,000, which was ordered on 23 September 2019. Her older brother, Azmi Abdul Rahman, is the executor of her estate.
Taking the interim sum into account, the hospital now only has to pay the balance.
The judge awarded Azlin’s estate $250,000 for pain and suffering, and loss of amenity, $54,000 for dependency claim, $22,620.61 for special damages comprising medical expenses and transport expenses.
Due to CGH’s negligence, Azlin’s lung cancer progressed from stage I to stage IIA, a nodule in her lung grew, and she also experienced nodal metastasis, the Court of Appeal had found in February 2019.
The action that Azlin brought against CGH arose after her visits to CGH’s Accident and Emergency department over several years.
During one visit, a nodule in her right lung was picked up in an X-ray. While Azlin sued three doctors employed by CGH, all were found not to be negligent, and no vicarious liability was found on the part of CGH.
However, Azlin succeeded on an independent cause of action against CGH for the hospital’s failure to have in place an adequate patient management system to ensure that incidental findings in radiology reports are followed up, said the Court of Appeal.
Due to CGH’s failure to maintain such a system, there was a delay in the diagnosis and treatment of Azlin’s lung cancer. The apex court found that CGH had failed to ensure that there was proper follow-up in Azlin’s case even though radiological reports in April 2010 and July 2011 recommended follow-up on the opacity of a nodule in the right mid-zone of her chest.
Azlin’s estate had sought a claim of $13,464,100.75 in damages, including for $1,051,000 for pain and suffering, another $1,501,703.50 for medical expenses, and $35,700 for transport. The biggest component was for aggravated or punitive damages, which Azlin put in as $8,943,046.70.
CGH had argued that even if Azlin had been diagnosed and treated at the first stage of her cancer, she might not have been cured, and might still have died from the disease. There was no guarantee that she could have had a normal life expectancy, as if she never had cancer, said the hospital.
However, JAD Ang said that CGH’s argument was besides the point.
“The statistical evidence showing that there is never any 100 per cent chance of a complete cure is only one factor in the entire mix of factors to consider if Ms Azlin would more likely than not have been ‘cured’ (i.e. have no relapse within a specified timeframe) and live to her full life expectancy,” she said.
JAD Ang found that CGH’s negligence, which contributed to the cancer progressing from Stage IB to stage IIA, led to the cancer cells to enter Azlin’s lymphatic system, causing her relapse in August 2014 and then her death on 1 April 2019.
Said the judge, “Besides the ALK-positive lung cancer, she did not have any other known major illness. Thus, it is self-evident that, on balance, but for CGH’s breach, Ms Azlin would not have suffered a diminution of her full life expectancy, having passed away at the young age of 39 years old.”
Commenting on the damages sought by Azlin, the judge noted that the estate’s most recent claim for damages has ballooned despite a reduction of its claim upon the death of Azlin, which was $4,471,523.35 after the claims for transport, take home earnings and cost of nursing care, amongst others, had dwindled.
The judge noted that the claim for aggravated and punitive damages overshadowed the original claim of $6,701,406.91, and that the new claim for aggravated and punitive damages read as “simply contrived in the absence of supporting evidence, amongst other things”.
The judge ordered CGH is to pay costs of $105,000 to Azlin’s estate.
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