Changi General Hospital to pay S$326,620 to estate of woman who died after delay in lung cancer diagnosis

SINGAPORE: A court has awarded S$326,620 in damages to the estate of a woman who died after winning a court battle with Changi General Hospital (CGH), which was found liable for negligence in its delay of her lung cancer diagnosis.

In her judgment on Tuesday (Jan 19), Justice Belinda Ang awarded S$304,000 as general damages to the estate of Ms Noor Azlin Abdul Rahman, including for pain, suffering, loss of amenity and dependency claims, and another S$22,620 for special damages including medical expenses. 

As CGH has already paid an interim sum of S$200,000, it will have to pay only the balance.

Justice Ang found that CGH's negligence had caused Ms Azlin's eventual death at the age of 39, dismissing the hospital's argument that there was no guarantee that Ms Azlin would have been completely cured even with timely treatment.

Ms Azlin won her court case against CGH in February 2019 after an appeal, but died weeks later in April. She was suffering from fourth-stage lung cancer.

READ: Apex court grants woman's appeal against Changi General Hospital over delay in lung cancer diagnosis

The apex court found in February 2019 that CGH was in breach of its duty of care owed to Ms Azlin by failing to have in place a proper system for adequate follow-up of radiological results and patient management.

This resulted in a delay in diagnosing her with lung cancer. 

Ms Azlin first visited CGH in 2007, where a doctor assessed after three X-rays that an opacity in her chest appeared to be resolving or had resolved on its own.

Ms Azlin returned to CGH twice in 2010 and 2011, with chest X-rays performed and follow-ups recommended for the opacity in her chest, but none was carried out.

It was only when she was referred to CGH by Raffles Medical Clinic in late 2011 for coughing, breathlessness and blood in her phlegm that a nodule was found in her chest.

A biopsy in February 2012 confirmed that the nodule was malignant. The lung cancer progressed and spread to her brain by October 2016. Ms Azlin sued CGH and three doctors in January 2015, saying that their negligence had delayed the diagnosis and treatment of her lung cancer.

The Court of Appeal found that the two Accident & Emergency doctors in the case were not in breach of duty, but said the first CGH doctor Ms Azlin had seen had breached his duty of care for failing to schedule a follow-up appointment.

However, the judges found none of the doctors liable for negligence, finding instead that the hospital had caused a significant delay of at least seven months in diagnosis.

CGH's system to review radiological reports was also found to be "inadequate" as it did not allow comprehensive management of patients. Each time Ms Azlin visited the A&E department was treated as an isolated incident and there was no sharing of notes among the doctors.

CGH'S ARGUMENTS

CGH argued that even if Ms Azlin had been treated earlier, there is no guarantee that she would be completely cured and expected to have a normal life expectancy as if she never had cancer.

In response, Justice Ang said this submission is "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' (that is, have no relapse within a specified timeframe) and live to her full life expectancy," she said.

She found it "clear" that CGH's breach caused Ms Azlin to die in the way she did - by causing her cancer to progress from stage to stage such that her cancer cells entered her lymphatic system, increasing the risk of and causing a relapse of her cancer.

This caused her eventual death, said Justice Ang.

Both sides submitted various amounts for different kinds of damages. In particular, Ms Azlin's estate had sought about S$1 million in damages for Ms Azlin's pain, suffering and loss of amenity, while CGH asked for S$10,000, which the judge called "surprising".

This was because the S$10,000 figure was "so out of line with the precedents" or previous cases, and also because CGH did not appeal against the decision to award S$200,000 in interim payment.

"On the other hand, the estate's position - S$1,051,000 - is also completely at odds with the precedents and is manifestly excessive," said Justice Ang.

She ordered CGH to pay Ms Azlin's estate costs of S$105,000.