Found negligent over cancer patient who later died, CGH ordered by High Court to pay S$326,000 in damages to her estate

• While she was alive, Noor Azlin Abdul Rahman had won a court case in February 2019 against CGH
• The Court of Appeal ruled that CGH’s negligence led to a delay in her lung cancer diagnosis
• She died on April 1, 2019 aged 39
• The damages will be paid to her estate, executed by her brother

SINGAPORE — The High Court on Tuesday (Jan 19) ordered Changi General Hospital (CGH) to pay S$326,620 in damages to the estate of a patient who died in April 2019. About a month before Noor Azlin Abdul Rahman's death, an earlier court ruling had found that the hospital’s negligence had caused a delay in her cancer treatment.

As CGH has already paid an interim sum of S$200,000 to the family of Noor Azlin, the hospital will now have to pay the remaining damages, with interest, which are awarded for medical expenses, her pain and suffering, among other categories of damages.

In February 2019, the late Noor Azlin won an appeal against CGH for not detecting her lung cancer earlier.

If not for CGH’s negligence, she would have been diagnosed and received treatment earlier, the Court of Appeal ruled then, disagreeing with an earlier decision by a High Court judge.

Noor Azlin died from the disease on April 1, 2019 in the fourth stage of her cancer, at the age of 39.

The damages will be paid to her estate, which is being executed by her brother, Mr Azmi Abdul Rahman.

The amount of damages to be paid was assessed by Justice Belinda Ang who on Tuesday awarded S$250,000 to Noor Azlin’s estate for her pain, suffering and loss of amenity.

The estate was also awarded S$54,000 for dependency claim, S$19,620.61 for medical expenses and S$3,000 for transport expenses.

CGH was also ordered to pay Noor Azlin’s estate S$105,000 in legal costs in addition to the damages.

At the trial, Noor Azlin had originally claimed about S$6.7 million in general damages. Her brother later more than doubled the amount and sought about S$13.5 million in total damages during a six-day trial last year to assess the damages.

The hospital's position was that the estate was entitled to S$20,800.

CGH will have to pay her estate a 5.33 per cent annual interest on the damages, with the interest backdated to various dates depending on the category of damages.

‘OUTLANDISH POSITIONS’ ON DAMAGES

CGH’s lawyers argued that there was no guarantee that Noor Azlin would have been completely cured if she had been treated earlier.

Justice Ang found that their submission was “beside 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’,” she said.

Instead, Justice Ang said it was clear that CGH’s breach of duty caused Noor Azlin’s cancer to worsen, causing a relapse in 2014 and her eventual death in 2019.

In her judgement, she noted the large disparity between the sums proposed by both the plaintiffs and the defence, particularly for Noor Azlin’s pain, suffering and loss of amenity, which formed the bulk of the damages.

CGH had argued for an awarding of S$10,000 for this portion of the damages while Ms Noor Azlin’s estate sought S$1.05 million.

Justice Ang said that CGH’s submission was “out of line with the precedents” and called the estate’s S$1.05 million submission “manifestly excessive”.

“The court is not assisted when parties take such outlandish positions that are clearly unsupported by the precedents or the evidence,” she said.

THE CASE

Noor Azlin was diagnosed with lung cancer in February 2012.

She sued CGH and three doctors who attended to her over a four-year period from 2007 to 2011, arguing that their negligence caused a delay in the detection of her cancer and denied her a better medical outcome.

Her claim was dismissed by the High Court in 2018, but she appealed.

In 2019, the Court of Appeal ruled that she likely suffered from first-stage lung cancer in July 2011 — when she visited CGH’s emergency department for a third time — and should have been diagnosed and given the appropriate treatment then or shortly after.

The delay in diagnosis allowed the aggressive lung cancer to progress to stage 2A, involving a lymph node, the court ruled.

The Court of Appeal found the three doctors not liable in negligence.

However, it found that there were serious inadequacies in CGH’s system to ensure the proper follow-up of patients.

The hospital had failed to ensure the proper follow-up in Noor Azlin’s case even though radiological reports in April 2010 and July 2011 recommended looking into the opacity of a lump in her chest.

CGH therefore breached its duty to Noor Azlin, the Court of Appeal said.