| Shalini a/p Kanagaratnam v Pusat Perubatan Universiti Malaya (formerly known as University Hospital) & Anor [2016] 3 MLJ 742
Court of Appeal, Putrajaya
Tort – Negligence – Medical negligence |
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| Facts | 1. Shalini a/p Kanagaratnam (“the Appellant”) was diagnosed with immature teratoma, a type of tumour classified as malignant by the second respondent, a medical practitioner.
2. As a result, a surgical procedure was carried out to remove the Appellant’s left ovary, ultimately rendering her unable to conceive.
3. The Appellant claimed that she had been misdiagnosed and filed a medical negligence suit against the Respondents. The Appellant’s claim is based on a recent cancer marker report interpreted by a witness (PW1), which indicated that she no longer had cancer at the time of the proceedings.
4. However, no other expert testimony supported her assertion that she had never had cancer in the years 2000 and 2006.
5. The trial court dismissed her claim, leading to this appeal.
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| Issues | 1. Whether the Appellant can rely on the doctrine of res ipsa loquitur in a medical negligence claim?
2. Whether the Appellant prove that there was a breach of the standard of care and establish her case on the balance of probabilities?
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| Ratio | 1. Whether the Appellant can rely on the doctrine of res ipsa loquitur in a medical negligence claim?
(a) The Court of Appeal ruled that the doctrine of res ipsa loquitor was not applicable in this case. This doctrine allows negligence to be inferred from the mere occurrence of an incident.
(b) The doctrine of res ipsa loquitur is a rule of evidence, not a rule of law. This means that its purpose is to assist in proving negligence rather than automatically establishing liability. The mere occurrence of an accident does not automatically mean that the defendant was negligent.
(c) In ordinary negligence cases, the plaintiff must prove three key elements. Firstly, the defendant owed a duty of care, second, the defendant breached that duty and third, that the breach caused harm or damages.
(d) The doctrine of res ipsa loquitur can sometimes shift the burden of proof onto the defendant, requiring them to prove that they were not negligent.
(e) This principle is commonly applied in road traffic accident cases. If a driver is involved in an accident and does not provide an explanation or evidence to counter a negligence claim, the court may presume that they were at fault.
(f) This doctrine is generally not used in medical negligence cases unless there is strong supporting evidence. The Appellant did not present authoritative case law to support her argument.
(g) The Court of Appeal viewed the Appellant reliance on res ipsa loquitur as a misunderstanding of legal principles.
2. Whether the Appellant prove that there was a breach of the standard of care and establish balance of probabilities?
(a) Court of Appeal ruled that the Appellant must prove that the medical professional breached the required standard of care in medical negligence cases and must be supported by expert evidence.
(b) The burden of proof lies on the Appellant to establish this on a balance of probabilities, meaning it must be more likely than not that the negligence occurred.
(c) The Appellant relied on a medical report from a doctor in India, but this doctor was not called as a witness to verify the findings. The only other expert testimony presented was from PW1, who merely interpreted a recent cancer report, which only indicated that the Appellant no longer had cancer at the time of the proceedings.
(d) However, this did not prove that she had been wrongly diagnosed in the past. The Appellant also failed to produce any other expert witnesses to support her claim that she did not have cancer in 2000 and 2006.
(e) Meanwhile, the Respondents successfully demonstrated that they had followed the required medical standard. They provided evidence showing that their diagnosis and treatment decisions were based on operative findings, histopathological and radiological reports, and accepted medical practices.
(f) The trial judge accepted the Respondents’ evidence and ruled that the Appellant had not discharged her burden of proof.
(g) In this case, the Appellant did not provide sufficient expert testimony to demonstrate that the doctor had misdiagnosed her or acted negligently.
(h) The Court of Appeal upheld this decision, affirming that the Appellant had not established her case on a balance of probabilities since the Appellant failed to provide sufficient expert evidence to prove that the doctor had breached the standard of care.
(i) Therefore, the Appellant’s claim was dismissed.
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| Decision | The Court of Appeal upheld the High Court’s decision and dismissed the appeal. |
| Key Takeaways | 1. In medical negligence cases, the burden of proof lies with the plaintiff, who must establish the standard of care and show its breach through expert evidence.
2. The doctrine of res ipsa loquitur is generally not applicable in medical negligence claims without strong supporting evidence.
3. Courts will not entertain claims based on speculative or insufficient evidence, and expert testimony is crucial in proving medical malpractice.
4. Trial courts’ findings based on factual evidence and legal principles will be upheld unless there is a clear misdirection or legal error.
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