Establishing Liability in Medical Negligence Claims
When medical treatment goes wrong, it is natural to wonder whether someone made a mistake. A poor result, however, does not automatically mean that a doctor or hospital was negligent. Complications can arise even where proper care was given. The legal question is whether the care fell below the standard reasonably expected of a competent healthcare professional, and whether that failure caused additional injury or loss.
What must a patient prove?
A claimant generally has to prove that a duty of care was owed, the applicable standard of care was breached, the breach caused or materially contributed to the injury, and legally recoverable loss followed. A doctor-patient relationship will usually establish the duty. The more difficult issues are commonly breach and causation.
Was the standard of care breached?
For diagnosis and treatment, Singapore courts apply the Bolam test together with the Bolitho qualification, as adopted by the Court of Appeal in Khoo James and another v Gunapathy d/o Muniandy and another appeal [2002] 1 SLR(R) 1024 ("Gunapathy"). Broadly, a doctor will not ordinarily be negligent if the approach taken was supported by a responsible body of medical opinion — but the court may reject an opinion that is not logically defensible or does not properly account for the risks and benefits involved (the Bolitho qualification).
A difference of professional opinion is therefore not enough by itself. An independent medical expert is normally needed to explain the proper standard, how the defendant departed from it, and why that departure mattered. Obvious errors may be treated differently, but most claims cannot be assessed fairly without specialist evidence.
What about informed consent?
A separate issue arises where the patient was not given enough information to make an informed decision. While Gunapathy originally applied the Bolam-Bolitho test to all aspects of the doctor-patient relationship including advice, the Court of Appeal departed from this in the context of medical advice in Hii Chii Kok v Ooi Peng Jin London Lucien and another [2017] SGCA 38, adopting a modified, patient-centred approach to what a doctor must disclose (while Gunapathy's Bolam-Bolitho test continues to govern diagnosis and treatment).
Under this patient-centred approach, relevant information may include:
• the diagnosis;
• the likely course of the condition with and without treatment; and
• material risks and reasonable alternatives.
The question is not decided solely by customary medical practice.
A failure to disclose information does not by itself establish liability. Breach of the duty to advise is a separate question from causation, and the patient must still separately establish that proper advice would probably have affected the decision and avoided the injury or loss — a more involved inquiry than a simple counterfactual about what the patient would have chosen.
Why causation matters
Even where the care was inadequate, the claim may fail if the same outcome would probably have occurred anyway. In a delayed-diagnosis case, for example, the evidence must show that earlier diagnosis or treatment would probably have produced a better outcome. Showing that the defendant made an error is not enough without proving what difference it made.
What should a patient do first?
Preserve the medical records, reports, scans, prescriptions, bills and correspondence. Prepare a clear timeline of symptoms, consultations, advice, treatment and later complications. An independent specialist opinion may be required before deciding whether proceedings are justified.
Medical negligence claims are also subject to a specific pre-action protocol in the State Courts Practice Directions. It provides a framework for obtaining records and reports and encourages early exchange of information and possible resolution. Non-compliance may affect case management and costs.
Do not overlook the deadline
For personal injury claims in negligence, the general limitation period under the Limitation Act 1959 is three years from the date the cause of action accrued or, if later, three years from the earliest date on which the claimant had the necessary knowledge of the injury and its cause (broadly reflecting the extended-knowledge provisions in the Act). Different rules may apply to minors, persons lacking capacity, and certain latent injuries, so delay is risky and the precise application should be confirmed with a lawyer.
Depending on the evidence, damages may include compensation for pain and suffering, additional medical expenses, loss of earnings, future treatment, rehabilitation, nursing care and other losses caused by the negligence. The amount depends on the injury and the extent to which each loss can be linked to the breach.
The practical takeaway
Medical negligence is not established simply because treatment failed or another doctor would have chosen differently. A viable claim requires evidence of breach (under Gunapathy's Bolam-Bolitho framework for diagnosis/treatment, or Hii Chii Kok's patient-centred test for advice), causation and loss. Early review of the records and specialist evidence can prevent time and costs being spent on a claim that cannot be proved.