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Malayan Law Journal Reports/2007/Volume 1/Foo Fio Na v Dr oo Foo! Mun " #nor $ %2007& 1 MLJ '() $ 2(
De*em+er 200,
21 pages
%2007] 1 MLJ 593
Foo Fio Na v Dr Soo Fook Mun & Anor
FEDERAL COUR !"URAJA#A$
MO%AMED D&A'D'N C%'EF JUS'CE( A%MAD FA'RU& CJ !MALA#A$ AND S'' NORMA #AA)O* FCJ
C'+'L A""EAL NO 02,20 OF 2001!-$
29 D./.01.r 2002
Professions -- Medical practitioners -- Negligence -- Standard of care -- Test to be applied -- Negligence of
orthopaedic surgeon -- Whether Bolam Test applied -- Whether practitioner duty bound to inform patient of
risks of treatment
Tort -- Negligence -- Standard of care -- Medical negligence -- Negligence of Orthopaedic surgeon --
Whether Bolam Test applied -- Whether practitioner duty bound to inform patient of risks of treatment
Tort -- Negligence -- Professional negligence -- Standard of care -- Test to be applied -- Negligence of
orthopaedic surgeon -- Whether Bolam Test applied -- Whether practitioner duty bound to inform patient of
risks of treatment
-.e appellant was involve/ in an a**i/ent on 11 July 1(02 w.i*. resulte/ in .er +eing war/e/ at t.e se*on/
respon/ent .ospital 12t.e .ospital234 .e su55ere/6 inter alia6 a *lose/ /islo*ation 78 an/ 7' verte+rae wit.
+ilaterally lo*!et 5a*ets4 -.e 5irst respon/ent was t.e ort.ope/i* surgeon on /uty w.o treate/ t.e appellant4
Despite t.ree attempts6 t.e 5irst respon/ent 5aile/ to re/u*e t.e /islo*ate/ *ervi*al verte+rae an/ on 1( July
1(026 t.e 5irst respon/ent per5orme/ t.e 5irst o5 two operations to pla*e t.e /islo*ate/ verte+rae into t.eir
original positions4 -.is involve/ an open re/u*tion w.ere+y t.e nape o5 t.e appellant2s ne*! was surgi*ally
opene/ an/ t.e /islo*ate/ verte+rae move/ to t.eir normal positions an/ se*ure/ +y +one gra5ting an/ t.e
insertion o5 a loop o5 wire to sta+ilise t.e spinal *or/4 9$rays were ta!en a5ter t.e surgery4 :n5ortunately t.is
pro*e/ure too 5aile/ as t.e appellant +e*ame paralyse/ t.e /ay a5ter t.e operation4 Dr Mo.an/as6 a
neurosurgeon 5oun/ t.at t.e wire loop w.i*. was pla*e/ to *orre*t t.e /islo*ation o5 78 an/ 7' verte+rae
/uring t.e 5irst operation was pressuring t.e spinal *or/ an/ t.at was t.e *ause o5 t.e total paralysis4 #s a
result o5 t.is t.e 5irst respon/ent per5orme/ a se*on/ operation on t.e appellant on t.e same /ay w.ere+y
.e remove/ t.e wire loop4 ;ut t.is treatment too /i/ not remove t.e paralysis an/ t.e appellant *ontinue/ to
+e *on5ine/ to a w.eel *.air to t.is very /ay4 <n .er me/i*al negligen*e suit 5ile/ against t.e 5irst an/ se*on/
respon/ents in January 1(076 t.e appellant su**ee/e/ at t.e =ig. 7ourt in proving t.at> 113 .er paralysis
was *ause/ +y t.e 5irst operation per5orme/ +y t.e 5irst respon/ent an/ was not /ue to t.e motor *ar
a**i/ent? 123 t.e 5irst respon/ent was negligent in tying t.e wire loop w.i*. *ompresse/ t.e spinal *or/ an/
w.i*. le/ to t.e paralysis? 1)3 t.e 5irst respon/ent was
1 M! "#$ at "#%
also negligent in not /oing anyt.ing imme/iately a5ter t.e /is*overy o5 t.e paralysis to reme/y it? an/ 183 t.at
t.e 5irst respon/ent was negligent w.en .e per5orme/ t.e se*on/ operation in t.e a+sen*e o5 Dr Mo.an/as
w.o pointe/ out t.e *ause o5 t.e paralysis4 #s 5or t.e se*on/ respon/ent6 sin*e it was proven t.at t.e 5irst
respon/ent was at all material times its servant or agent6 t.e se*on/ respon/ent was .el/ vi*ariously lia+le
5or t.e negligent a*ts o5 t.e 5irst respon/ent4 @n t.e respon/ents2 appeal6 t.e 7ourt o5 #ppeal allowe/ +ot.
appeals6 set asi/e t.e or/ers o5 t.e =ig. 7ourt an/ or/ere/ t.at appellant +ear t.e *osts o5 +ot. appeals as
well as t.e trial4 Following t.is6 t.e appellant su**ess5ully applie/ 5or an/ o+taine/ leave to appeal to t.is
*ourt to /etermine t.e 5ollowing Auestion o5 law> B.et.er t.e Bolam Testas enun*iate/ in Bolam & 'riern
(ospital Management )ommittee %1('7& 2 #ll CR 110 in t.e area o5 me/i*al negligen*e s.oul/ apply in
Page )
relation to all aspe*ts o5 me/i*al negligen*e4
%.346 allowing t.e appeal>
1) -.e Bolam Test.as no relevan*e to t.e /uty an/ stan/ar/ o5 *are o5 a me/i*al pra*titioner in
provi/ing a/vi*e to a patient on t.e in.erent an/ material ris!s o5 t.e propose/ treatment4 -.e
pra*titioner is /uty +oun/ +y law to in5orm .is patient w.o is *apa+le o5 un/erstan/ing an/
appre*iating su*. in5ormation o5 t.e ris!s involve/ in any propose/ treatment so as to ena+le
t.e patient to ma!e an ele*tion o5 w.et.er to pro*ee/ wit. t.e propose/ treatment wit.
!nowle/ge o5 t.e ris!s involve/ or /e*line to +e su+De*te/ to su*. treatment 1see para )734
1) -.ere is a nee/ 5or mem+ers o5 t.e me/i*al pro5ession to stan/ up to t.e wrong /oings6 i5 any6
as is t.e *ase o5 pro5essionals in ot.er pro5essions4 <n so /oing people involve/ in me/i*al
negligen*e *ases woul/ +e a+le to o+tain +etter pro5essional a/vi*e an/ t.at t.e *ourts woul/
+e appraise/ wit. evi/en*e t.at woul/ assist t.em in t.eir /eli+erations4 @n t.is +asis t.e
*ogers & Whitaker test woul/ +e a more appropriate an/ a via+le test o5 t.is millennium t.an
t.e Bolam Test+@n t.at t.e Auestion pose/ to t.is *ourt was answere/ in t.e negative4 -.e
appeal was allowe/ an/ t.e or/ers o5 t.e =ig. 7ourt on Auantum are to +e restore/ 1see paras
71$7234
Perayu tela. terli+at /i /alam satu !emalangan pa/a 11 Julai 1(02 yang menye+a+!an +eliau /imasu!!an
!e wa/ /i .ospital respon/en !e/ua 1.ospital terse+ut34 ;eliau antara lainnya mengalami6 ter!e.el 78 /an
7' 2verte+rae2 /engan 2+ilaterally lo*!et 5a*et24 Respon/en pertama a/ala. pa!ar +e/a. ortope/i! yang
+ertugas yang merawat perayu4 Balaupun tiga *u+aan6 respon/en pertama gagal untu! mengurang!an
2*ervi*al verte+rae2 yang ter!e.el /an pa/a 1( Julai 1(026 respon/en pertama tela. menDalan!an
pem+e/a.an pertama /aripa/a /ua pem+e/a.an untu! memper+etul!an 2verte+rae2 yang ter!e.el !e posisi
yang se+enar4 <ni meli+at!an pemotongan ter+u!a /i mana teng!u! /aripa/a le.er perayu tela. /i+e/a.
se*ara ter+u!a /an 2verte+rae2 yang ter!e.el /iu+a. !e posisi yang normal /an /ilin/ungi /engan *antuman
tulang /an memasu!!an gelungan /awai untu!
1 M! "#$ at "#"
mensta+il!an sara5 tunDang4 9$ray tela. /iam+il selepas pem+e/a.an4 Balau +agaimanapun6 prose/ur ini
Duga gagal yang mana perayu menDa/i lumpu. se.ari selepas pem+e/a.an4 Dr Mo.an/as6 seorang pa!ar
+e/a. sara5 men/apati +a.awa gelungan /awai yang /iguna!an untu! memper+etul!an 78 /an 7'
2verte+rae2 yang ter!e.el semasa pem+e/a.an pertama tela. mene!an sara5 tunDang /an ia tela.
menye+a+!an lumpu. !eseluru.annya4 Dise+a+!an per!ara terse+ut respon/en pertama tela. menDalan!an
pem+e/a.an !e/ua ter.a/ap perayu pa/a .ari yang sama yang mana +eliau mengeluar!an gelungan /awai
terse+ut4 -etapi rawatan ini Duga ti/a! meng.ilang!an !elumpu.an /an perayu terus /i+atasi /engan !erusi
ro/a setiap .ari4 Di /alam tin/a!an !e*uaian peru+atannya yang /i5ail!an ter.a/ap respon/en pertama /a
!e/ua pa/a Januari 1(076 perayu +erDaya mem+u!ti!an /i Ma.!ama. -inggi +a.awa> 113 !elumpu.an +eliau
a/ala. /ise+a+!an ole. pem+e/a.an pertama yang /ila!u!an ole. respon/en pertama /an +u!annya
/ise+a+!an ole. !emalangan Dalanraya? 123 respon/en pertama a/ala. *uai /alam mengi!at gelungan /awai
yang mene!an sara5 tunDang /an menye+a+!an !elumpu.an? 1)3 respon/en pertama Duga *uai /alam ti/a!
mela!u!an apa$apa /engan segera selepas men/apati !elumpu.an terse+ut untu! memper+etul!annya?
/an 183 +a.awa respon/en pertama a/ala. *uai apa+ila +eliau mela!u!an pem+e/a.an !e/ua /engan
!etia/aan Dr Mo.an/as yang menunDu!!an se+a+ !elumpu.an4 -er.a/ap respon/en !e/ua6 apa+ila ianya
tela. /i+u!ti!an +a.awa respon/en pertama a/ala. pa/a setiap masa yang material a/ala. yang
+er!.i/mat atau agennya6 respon/en !e/ua tela. /iputus!an +ertanggungan vi!arius atas !e*uaian
respon/en pertama4 Di /alam rayuan respon/en$respon/en6 Ma.!ama. Rayuan mem+enar!an rayuan
!e/ua$/uanya6 mengenepi!an perinta. Ma.!ama. -inggi /an memerinta.!an perayu menanggung !os
!e/ua$/ua rayuan +egitu Duga /engan per+i*araan4 ;eri!utan /engan ini6 perayu +erDaya memo.on untu!
/an men/apat!an !e+enaran merayu !e ma.!ama. ini untu! menentu!an persoalan perun/angan +eri!ut>
sama a/a ,-ian Bolamseperti mana yang /inyata!an /i /alam Bolam & 'riern (ospital Management
)ommittee %1('7& 2 #ll CR 110 /alam +i/ang !e*uaian peru+atan perlu /ipa!ai /i /alam !esemua aspe!
!e*uaian peru+atan4
Page 8
Di5u6u7kan6 mem+enar!an rayuan terse+ut>
2) ,-ian Bolama/ala. ti/a! releven !epa/a tugas /an piawaian pemeli.araan pengamal
peru+atan /alam menye/ia!an nasi.at !epa/a pesa!it /i atas risi!o yang material /an se/ia
a/a ter.a/ap rawatan yang /i*a/ang!an4 -ugas pengamal a/ala. teri!at /engan un/ang$
un/ang untu! mem+erita.u pesa!itnya yang mana mampu mema.ami /an meng.argai
ma!lumat risi!o yang a/a /i /alam apa$apa rawatan yang /i*a/ang!an untu! mem+ole.!an
pesa!it untu! mem+uat pemili.an sama a/a untu! menerus!an /engan rawatan yang
/i*a/ang!an /engan mengeta.ui risi!o yang a/a atau menola! ter.a/ap rawatan terse+ut
1li.at perenggan )734
2) #/ala. /iperlu!an untu! a.li pro5esion peru+atan untu! menga!ui !esilapan Di!a a/a6 seperti
mana !es pro5esional /alam pro5esion yang lain4 Dalam mela!u!an se/emi!ian6 mere!a yang
terli+at /i /alam !es !e*uaian peru+atan +ole. men/apat!an nasi.at pro5esional yang ter+ai!
/an ma.!ama. +ole. menilai /engan +u!ti yang mana +ole. mem+antu mere!a /i /alam
pertim+angan mere!a4 #tas /asar ini uDian *ogers & Whitaker a/ala. le+i. sesuai
1 M! "#$ at "#.
/an uDian yang +er/aya maDu untu! melenium ini /aripa/a ,-ian Bolam+Di /alam persoalan
yang /iaDu!an !e ma.!ama. ini a/ala. /iDawa+ se*ara negati54 Rayuan a/ala. /i+enar!an /an
perinta. Ma.!ama. -inggi +er!enaan !uantum a/ala. /i!e!al!an 1li.at perenggan 71$7234
No6.7
For *ases on me/i*al pra*titioner2s negligen*e6 see 10 Mallal/s 0igest18t. C/6 2002 Reissue3 paras 1'8,$
1'''4
For *ases on stan/ar/ o5 *are6 see 12 Mallal/s 0igest18t. C/6 2002 Reissue3 paras 1)08$1)0,4
For *ases on pro5essional negligen*e6 see 12 Mallal/s 0igest18t. C/6 2002 Reissue3 paras (8'$101)4
Ca7.7 r.8.rr.4 6o
1siah bte 2amsah & 0r *a-inder Singh 3 Ors %2002& 1 MLJ 1re5/3
Battersby & Tottman %1(08& )' #R '77 1re5/3
Best & Wellcome 'oundation td %1((8& ' Me/ LR 01 1re5/3
Blenkiron & 4reat )entral 4as )onsumers/ )o %10,0& 2 F " F 8)7 1re5/3
Bolam & 'riern (ospital Management )ommittee %1('7& 2 #ll CR 110 1not 5oll/3
Bolitho 5administrati6 of the estate of Bolitho 5deceased7 & )ity and (ackney (ealth 1uthority %1((7& 8 #ll CR
771 1re5/3
)hina 1irlines td & Maltran 1ir )orp Sdn Bhd and another appeal %1((,& 2 MLJ '17 1re5/3
)hin 2eo8 & 4o&ernment of Malaysia 3 1nor %1(,7& 2 MLJ 8' 1re5/3
9li:abeth )hoo & 4o&ernment of Malaysia %1(70& 2 MLJ 171 1re5/3
' & * %1(0)& )) #R 10( 1re5/3
'oo 'io Na & 0r Soo 'ook Mun 3 Ors %2002& 2 MLJ 12( 1re5/3
4ascoine & ;an Sheridan 3 )o %1((8& ' Me/ LR 8)7 1re5/3
(a-gato & ondon (ealth 1ssociation %1(02& ), @R12/3 ,,( 1re5/3
(or Sai (ong 3 1nor & ,ni&ersity (ospital 3 1nor %2002& ' MLJ 1,7 1re5/3
(ucks & )ole %1(()& 8 Me/ LR )() 1re5/3
!oyce & Wand8orth (ealth 1uthority %1(('& , Me/ LR ,0 1re5/3
Page '
2amalam a<p *aman 3 Ors & 9astern Plantation 1gency 5!ohore7 Sdn Bhd ,lu Tiram 9state= ,lu Tiram=
!ohore 3 1nor %1((,& 8 MLJ ,78 1re5/3
2o8 Nam Seng & Nagamah 3 Ors %1(02& 1 MLJ 120 1re5/3
ie8 Sin 2iong & 0r Sharon 0M Paulra- %1((,& ' MLJ 1() 1re5/3
Maynard & West Midlands *egional (ealth 1uthority %1(0'& 1 #ll CR ,)' 1re5/3
Na6akis & Western 4eneral (ospital 3 1nor %1(((& 1,2 #LR '80 1re5/3
* Bateman %1(2'& (8 L;E; 7( 1re5/3
*enal ink 527 Sdn Bhd & 0ato 0r (arnam Singh %1((7& 2 MLJ )7) 1re5/3
*ogers & Whitaker %1((2& 17' 7LR 87( 15oll/3
Sida8ay & Board of 4o&ernors of the Bethlem *oyal (ospital and the Maudsley (ospital 3 Ors %1(0'& 1 #7
071 1re5/3
S8amy & Matthe8s %1(,7& 1 MLJ 182 1re5/3
S8amy & Matthe8s %1(,0& 1 MLJ 1)0 1re5/3
Tan 1h 2au & The 4o&ernment of Malaysia %1((7& 2 #MR 1)02 1re5/3
L.9i73a6ion r.8.rr.4 6o
7ourts o5 Ju/i*ature #*t 1(,8 s 70113
1 M! "#$ at "#>
oh Sie8 )heang 5*a-ashree Suppiah and ee Sing Teong 8ith him7 5)heang 3 1riff7 for the appellant+
PS *an-an 5MS 0hillon 8ith him7 5PS *an-an 3 )o7 for first respondent+
4 1mbrose 51? @arughese 8ith him7 5)hooi 3 )o7 for second respondent+
Si6i Nor0a #aako1 FCJ !no: CJ !Ma3a;a$( 4.3iv.rin9 <u490.n6 o8 6=. /our6$>
?1] -.e Auestion o5 law t.at is pose/ to us in t.is appeal is *ou*.e/ in t.e 5ollowing wor/s4
B.et.er t.e Bolam Testas enun*iate/ in Bolam & 'riern (ospital Management )ommittee %1('7& 2 #ll CR 110 in t.e
area o5 me/i*al negligen*e s.oul/ apply in relation to all aspe*ts o5 me/i*al negligen*eF
?2] -o appre*iate t.e Bolam Testw.i*. is t.e tou*.stone o5 lia+ility 5or me/i*al negligen*e in Cnglan/6 it is
ne*essary t.at we 5irst *onsi/er t.e 5a*ts o5 t.e *ase itsel54
?3] -.e plainti55 in Bolam/s*ase6 one Jo.n =e*tor ;olam6 a salesman6 was a/mitte/ to Friern =ospital
su55ering 5rom t.e a5ter e55e*ts o5 a mental illness o5 t.e /epressive type4 =e was eGamine/ +y t.e *onsultant
psy*.iatrist atta*.e/ to t.e .ospital an/ was a/vise/ to un/ergo ele*tro$*onvulsive t.erapy w.i*. was
*arrie/ out +y pla*ing ele*tro/es on t.e .ea/ to allow an ele*tri* *urrent 5rom a ma*.ine to pass t.roug. t.e
+rain4 @ne o5 t.e results o5 t.e treatment was to *ause *onvulsion in t.e nature o5 a 5it4 -.e *onsultant
psy*.iatrist /i/ not warn ;olam o5 t.e ris!s involve/6 one o5 w.i*. was t.e ris! o5 5ra*ture4
?@] ;olam signe/ a 5orm *onsenting to t.e treatment an/ not.ing untowar/ .appene/ to .im w.en .e
re*eive/ t.e treatment 5or t.e 5irst time4 =owever on t.e se*on/ o**asion t.e treatment was a/ministere/ +y
Dr 7 #ll5rey6 a senior registrar at t.e .ospital4 #n initial s.o*! was passe/ t.roug. ;olam2s +rain 5or
approGimately one se*on/ an/ was 5ollowe/ wit.in approGimately 5our se*on/s +y a su**ession o5 5ive
momentary s.o*!s a/ministere/ 5or t.e purpose o5 /amping t.e amplitu/e o5 t.e Der!ing movements o5
;olam2s +o/y4 No 5urt.er s.o*!s were a/ministere/ an/ t.e *onvulsion was not unusually violent4 -.e
Page ,
voltage o5 t.e *urrent was 1'0 volts6 t.e 5reAuen*y 5i5ty *y*les per se*on/4
?5] During t.is treatment6 ;olam lay in a supine position wit. a pillow pla*e/ un/er .is +a*! an/ .is lower Daw
was supporte/ +y a mout. gag4 @t.erwise .e was not restraine/ in any way6 alt.oug. a male nurse stoo/ at
ea*. si/e o5 .im in *ase .e s.oul/ 5all 5rom .is +e/4 No relaGant /rugs were a/ministere/ to ;olam prior to
t.e treatment4
?2] <n t.e *ourse o5 t.is treatment6 ;olam sustaine/ severe p.ysi*al inDuries *onsisting in t.e /islo*ation o5
+ot. .ip Doints wit. 5ra*tures o5 t.e pelvis on ea*. si/e w.i*. were *ause/ +y t.e .ea/ o5 t.e 5emur on ea*.
si/e +eing /riven t.roug. t.e a*eta+ulum or *up o5 t.e pelvis4
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?7] <n *laiming /amages 5or .is inDuries against t.e management o5 t.e .ospital6 ;olam *onten/e/ t.at t.e
.ospital was vi*ariously negligent in permitting Dr #ll5rey to a/minister ele*tro$*onvulsive t.erapy wit.out t.e
previous a/ministration o5 a relaGant /rug w.i*. woul/ .ave eG*lu/e/ t.e ris! o5 5ra*ture altoget.er or
wit.out restraining .is *onvulsive movements +y manual *ontrol an/ in 5ailing to warn .im o5 t.e ris! .e was
ta!ing in *onsenting to .ave t.e treatment4
?A] -.e me/i*al evi/en*e at t.e trial s.owe/ t.at *ompetent /o*tors .el/ /ivergent views on t.e /esira+ility
o5 using relaGant /rugs an/ restraining t.e patient2s +o/y +y manual *ontrol an/ also on t.e Auestion o5
warning a patient o5 t.e ris!s o5 ele*tro$*onvulsive t.erapy4 -.e ot.er me/i*al evi/en*e t.at was most
signi5i*ant was t.at t.e ris! o5 5ra*ture was 1 in 1060004
?9] <n t.e *ourse o5 .is summing up to t.e Dury6 t.e trial Du/ge6 M*Nair J6 ma/e t.e 5ollowing remar!s on t.e
stan/ar/ o5 proo5 in a me/i*al negligen*e suit>
;ut w.ere you get a situation w.i*. involves t.e use o5 some spe*ial s!ill or *ompeten*e6 t.en t.e test w.et.er t.ere
.as +een negligen*e or not is not t.e test o5 t.e man on t.e top o5 a 7lap.am omni+us6 +e*ause .e .as not got t.is
spe*ial s!ill4 -.e test is t.e stan/ar/ o5 t.e or/inary s!ille/ man eGer*ising an/ pro5essing to .ave t.at spe*ial s!ill4
?10] Later w.en analyHing t.at stan/ar/ o5 proo5 t.e learne/ Du/ge ma/e t.e 5ollowing *on*lusive statement
regar/ing a /o*tor2s /uty o5 *are>
# /o*tor is not guilty o5 negligen*e i5 .e .as a*te/ in a**or/an*e wit. a pra*ti*e a**epte/ as proper +y a responsi+le
+o/y o5 me/i*al men s!ille/ in t.at me/i*al a*t444 Putting it t.e ot.er way roun/6 a /o*tor is not negligent6 i5 .e is a*ting
in a**or/an*e wit. su*. pra*ti*e6 merely +e*ause t.ere is a +o/y o5 opinion t.at ta!es a *ontrary view4
?11] Relying on t.at /ire*tion w.i*. is now a**epte/ as t.e Bolam Testor Bolam Principlean/ t.e /ivergent
me/i*al evi/en*e6 t.e Dury 5oun/ t.at t.e .ospital was not negligent4 -.ere are two lim+s to t.e Bolam Test4
-.e 5irst is t.e reAuirement o5 a pro5essional person in t.is *ase a /o*tor6 to eGer*ise reasona+le *are in
un/erta!ing t.e tas! asso*iate/ wit. .is parti*ular pro5essional *alling4 -.e se*on/ +eing *ommonly invo!e/6
is t.e assertion t.at a /e5en/ant /o*tor will not +e lia+le un/er t.e 5irst lim+ i5 .e .as *omplie/ wit. a
responsi+le pro5essional pra*ti*e6 allowing 5or t.e possi+ility t.at t.ere may +e more t.an one su*. pra*ti*e4
?12] -.e legal position as enun*iate/ +y M*Nair J t.ere5ore *ontains t.e important elements t.at t.e /o*tor
must .ave a*te/ in a**or/an*e wit. an accepted medical practice? an/ t.at t.e a**epte/ pra*ti*e must +e
regar/e/ as proper +y a responsible body of medical menin t.at art4
Bolam/s*ase is /istinguis.a+le 5rom t.e 5ollowing 5a*tors4
3) -.e me/i*al evi/en*e s.owe/ t.at t.e ris! o5 5ra*ture was 1 in 106000?
1 1 M! "#$ at "##
3) Cle*tro$*onvulsive t.erapy was a +rea! t.roug. in t.e treatment o5 a person su55ering 5rom a
parti*ular type o5 /isor/er w.ere +e5ore su*. a person .a/ little or no .ope o5 re*overy
w.atsoever4 -o/ay .e .as a real *.an*e o5 re*overy?
1) -.e .ospital2s allege/ negligen*e *an +e summariHe/ into t.e 5ollowing t.ree *ategories>
1. Failure to give ;olam a warning o5 t.e ris!s involve/ in ele*tro$*onvulsive t.erapy so
t.at .e mig.t .ave .a/ a *.an*e to /e*i/e w.et.er .e was going to ta!e t.ose ris!s or
not?
Page 7
1. Failure to use any relevant /rugs w.i*.6 i5 use/6 *oul/ .ave eG*lu/e/ t.e ris! o5 5ra*ture
altoget.er?
1. -.at i5 relevant /rugs were not use/ t.en at least some 5orm o5 manual *ontrol +eyon/
s.oul/er *ontrol6 support o5 t.e *.in an/ pla*ing a pillow un/er t.e +a*! s.oul/ .ave
+een use/4
1
?13] ;olam testi5ie/ .e was not given any warning as to ris!s6 nor as!e/ w.et.er .e woul/ not un/ergo
treatment as t.ere is a one in 106000 ris! involve/4
?1@] <n t.e instant appeal6 t.e 5a*ts inso5ar as t.ey were not /ispute/ .appene/ in t.e 5ollowing manner4
?15] -.e appellant was a 5ront seat passenger in a motor *ar t.at *ras.e/ into a tree on t.e nig.t o5 11 July
1(024 -.e *ar was /riven +y .er +oy5rien/ an/ t.ere were two ot.er passengers in t.e +a*! seat4 -.e
a**i/ent .appene/ near #ssunta =ospital 12t.e .ospital23 w.ere t.e appellant an/ .er two *ompanions were
+roug.t to an/ w.ere t.e appellant was su+seAuently war/e/ 5or t.e 5ollowing inDuries4
4) +ruises on t.e lower a+/ominal wall?
4) +ruises on t.e rig.t +reast?
2) +ruises on +ot. anterior ilia* spine areas?
1) *lose/ /islo*ation 78 an/ 7' vete+rae wit. +ilaterally lo*!e/ 5a*ets4
?12] <nDury No 1836 t.e most serious o5 .er inDuries *ause/ mu*. pain to .er ne*! ea*. time s.e move/ .er
.ea/4 Dr 7eline Pereira6 t.e /o*tor on /uty6 pres*ri+e/ t.e initial treatment +y .aving 9$rays ta!en o5 .er
ne*! an/ pla*ing a *ervi*al *ollar aroun/ it4 Dr 7eline Pereira t.en *onta*te/ t.e ort.opae/i* surgeon on
/uty Dr oo Foo! Mun6 t.e 5irst respon/ent6 w.o was at .ome at t.at time an/ s.e was a/vise/ t.at t.e
*ollar s.oul/ remain an/ t.e appellant sta+ilise/ +y !eeping .er in +e/ an/ pla*ing san/+ags on eit.er si/e
o5 .er .ea/ to prevent .er 5rom moving .er .ea/ an/ to re/u*e t.e ris! o5 paralysis4 -.is was a**or/ingly
/one4
?17] -.e 5irst respon/ent saw t.e appellant 5or t.e 5irst time t.e 5ollowing morning an/ a5ter eGamining .er6
pres*ri+e/ t.e 5irst treatment +y pla*ing .er on tra*tion wit. weig.ts in a 5urt.er attempt to re/u*e t.e
/islo*ate/ *ervi*al verte+rae4 -.is prove/ to +e unsu**ess5ul an/ on 18 July 1(026 t.e 5irst respon/ent
per5orme/ a manipulation or *lose/ re/u*tion pro*e/ure un/er general anaest.eti* to unlo*! t.e
1 M! "#$ at .BB
lo*!e/ 5a*et Doint4 Despite t.ree attempts6 t.e 5irst respon/ent 5aile/ to re/u*e t.e /islo*ate/ *ervi*al
verte+rae an/ on 1( July 1(026 t.e 5irst respon/ent per5orme/ t.e 5irst o5 two operations to pla*e t.e
/islo*ate/ verte+rae into t.eir original positions4 -.is involve/ an open re/u*tion w.ere+y t.e nape o5 t.e
appellant2s ne*! was surgi*ally opene/ an/ t.e /islo*ate/ verte+rae move/ to t.eir normal positions an/
se*ure/ +y +one gra5ting an/ t.e insertion o5 a loop o5 wire to sta+ilise t.e spinal *or/4 9$rays were ta!en
a5ter t.e surgery4
?1A] :n5ortunately6 t.is pro*e/ure too 5aile/ as t.e appellant +e*ame paralyse/ t.e /ay a5ter t.e operation4
uspe*ting t.at t.e paralysis mig.t +e /ue to vas*ular in5ar*tion6 ie w.en +loo/ supply to t.e spinal *or/ is
interrupte/ an/ *ut$o556 t.e 5irst respon/ent pres*ri+e/ a *ourse o5 me/i*ation to t.e appellant +y t.e inDe*tion
o5 /eGamet.asone 5or over 5our /ays4 B.en t.e appellant2s *on/ition s.owe/ no signs o5 improvement t.e
5irst respon/ent *alle/ in a neurosurgeon6 Dr Mo.an/as6 to eGamine t.e appellant4 Following .is
eGamination6 Dr Mo.an/as /i/ a myelogram test on .er on ' #ugust 1(02 an/ .e 5oun/ t.at t.e wire loop
w.i*. was pla*e/ to *orre*t t.e /islo*ation o5 78 an/ 7' verte+rae /uring t.e 5irst operation was pressuring
t.e spinal *or/ an/ t.at was t.e *ause o5 t.e total paralysis4 #s a result o5 t.is t.e 5irst respon/ent per5orme/
a se*on/ operation on t.e appellant on t.e same /ay w.ere+y .e remove/ t.e wire loop4 ;ut t.is treatment
too /i/ not remove t.e paralysis an/ t.e appellant *ontinue/ to +e *on5ine/ to a w.eel*.air to t.is very /ay4
?19] <n .er me/i*al negligen*e6 suit 5ile/ against t.e 5irst an/ se*on/ respon/ents in January 1(076 t.e
appellant su**e/e/ in proving t.at>
Page 0
5) .er paralysis was *ause/ +y t.e 5irst operation per5orme/ +y t.e 5irst respon/ent an/ was not
/ue to t.e motor *ar a**i/ent?
5) t.e 5irst respon/ent was negligent in tying t.e wire loop w.i*. *ompresse/ t.e spinal *or/ an/
w.i*. le/ to t.e paralysis?
3) t.e 5irst respon/ent was also negligent in not /oing anyt.ing imme/iately a5ter t.e /is*overy o5
t.e paralysis to reme/y it? an/
2) t.at t.e 5irst respon/ent was negligent w.en .e per5orme/ t.e se*on/ operation in t.e a+sen*e
o5 Dr Mo.an/as w.o pointe/ out t.e *ause o5 t.e paralysis4
?20] #s 5or t.e se*on/ respon/ent6 sin*e it was proven t.at t.e 5irst respon/ent was at all material times its
servant or agent6 t.e se*on/ respon/ent was .el/ vi*ariously lia+le 5or t.e negligent a*ts o5 t.e 5irst
respon/ent4
?21] Pursuant to t.e 5in/ing o5 5ault on t.e part o5 +ot. respon/ents an/ t.e awar/ o5 /amages against t.em
separate noti*es o5 appeal were 5ile/ +y t.e 5irst respon/ent against t.e appellant an/ se*on/ respon/ent
an/ +y t.e se*on/ respon/ent against t.e appellant an/ 5irst respon/ent to t.e 7ourt o5 #ppeal4
?22] ;ot. appeals were .ear/ toget.er at t.e en/ o5 w.i*. t.e 7ourt o5 #ppeal allowe/ +ot. appeals6 set
asi/e t.e or/ers o5 t.e =ig. 7ourt an/ or/ere/ t.at appellant +ear t.e *osts o5 +ot. appeals as well as t.e
trial4 Following t.is6 t.e
1 M! "#$ at .B1
appellant su**ess5ully applie/ 5or an/ o+taine/ leave to appeal to t.is *ourt to /etermine t.e Auestion o5 law
w.i*. is alrea/y state/ at t.e +eginning o5 t.is Du/gment4
?23] <n granting su*. leave6 teve .im 7J 1a+a. " arawa!36 #+/ul Male! an/ Mo!.tar #+ulla. F7JJ6
.ave in t.eir unanimous Du/gment reporte/ at %2002& 2 MLJ 12(6 *on5ine/ t.at Auestion o5 law to the
particular aspect of medical negligence CthatD relates more specifically to the duty and standard of care of a
medical practitioner in pro&iding ad&ice to a patient on the inherent or material risks of the proposed
treatment+
?2@] #t *ommon law6 t.e /uty o5 *are owe/ +y a /o*tor arises out o5 .is relations.ip wit. .is patient4 Bit.out
t.e /o*tor an/ patient relations.ip6 t.ere is no /uty on t.e part o5 t.e /o*tor to /iagnose6 a/vi*e an/ treat .is
patient4
?25] -.at /uty o5 *are .as +een aptly /es*ri+e/ +y Lor/ =ewart 7J in * Bateman %1(2'& (8 L;E; 7( to +e
as 5ollows>
<5 a person .ol/s .imsel5 out as possessing spe*ial s!ill an/ !nowle/ge an/ .e is *onsulte/6 as possessing su*. s!ill
an/ !nowle/ge +y or on +e.al5 o5 a patient6 .e owes a /uty to t.e patient to use /ue *aution in un/erta!ing t.e
treatment an/ t.e patient su+mits to .is /ire*tion an/ treatment a**or/ingly6 .e owes a /uty to t.e patient to use
/iligen*e6 *are6 !nowle/ge6 s!ill an/ *aution in a/ministering t.e treatment4 No *ontra*tual relation is ne*essary6 nor is
it ne*essary t.at t.e servi*e +e ren/ere/ 5or rewar/4
?22] =owever in t.e eGer*ise o5 .is /uty o5 *are6 t.e /o*tor is eGpe*te/ to maintain a stan/ar/ w.i*. un/er
t.e *ommon law is a*.ieve/ +y t.e stan/ar/ satis5ie/ +y t.e .ypot.eti*al reasona+le man4 =owever6 *ase
law .as re/e5ine/ t.at stan/ar/ to +e t.at o5 t.e Bolam Principlew.i*. in su+stan*e restrains t.e *ourts 5rom
s*rutiniHing an/ evaluating t.e pro5essional *on/u*t o5 a /o*tor possesse/ o5 a spe*ial s!ill an/ *ompeten*e
an/ t.at .e is not negligent i5 .e .as a*te/ wit.in a pra*ti*e a**epte/ as proper +y a +o/y o5 .is own peers
w.o possess similar s!ill an/ *ompeten*e as t.e /o*tor in Auestion4 <t matters not t.at t.ere eGists anot.er
+o/y wit. a /i55ering opinion t.at /oes not a**ept t.e a*tion ta!en +y t.e /o*tor4 <t is enoug. t.at .e .a/
a*te/ in a**or/an*e wit. one o5 t.e +o/ies o5 opinion an/ t.e *ourts *an never /e*lare .is a*tion to +e in
any way negligent4 -.is over prote*tive an/ /e5erential approa*. per.aps *on5orm to t.e well !nown p.rase
t.at /1 doctor kno8s best/+
?27] <n t.e instant appeal6 t.e trial Du/ge /i/ not apply t.e Bolam Principle=pre5erring instea/ to Auestion6
analyHe an/ *on*lu/e t.at on t.e evi/en*e +e5ore .im6 t.e 5irst respon/ent t.at *ause/ t.e paralysis an/
5ree/ t.e 5irst respon/ent o5 any lia+ility 5or t.e appellant2s mis5ortunes4 Respon/ent was negligent in
a/ministering a *ause o5 treatment t.at le/ to t.e appellant2s paralysis4 -.e 7ourt o5 #ppeal w.ilst steering
*lear o5 ma!ing any pronoun*ement on t.e Bolam Principlenonet.eless /isagree/ wit. t.e =ig. 7ourt an/
Page (
*on*lu/e/ t.ere was no evi/en*e to esta+lis. wit. *ertainty t.at it was t.e 5irst surgery per5orme/ +y t.e 5irst4
1 M! "#$ at .BE
?2A] <t *annot +e /ispute/ t.at t.e 5irst respon/ent was un/er a /uty to a/vise t.e appellant on t.e *ourse o5
treatment to +e un/erta!en an/ t.e ris!s involve/ an/ t.e issue is w.et.er t.ere .as +een a +rea*. o5 t.at
/uty4
?29] <t is t.e 5irst respon/ent2s *ase t.at t.e ne*! inDuries su55ere/ +y t.e appellant were as a result o5 t.e
motor*ar a**i/ent an/ i5 le5t unatten/e/ woul/ lea/ to paralysis sooner or later4 <t was un/er t.ese
*ir*umstan*es t.at w.en t.e *onservative treatment prove/ to +e negative t.at t.e 5irst operation was
per5orme/ an/ w.en t.at prove/ unsu**ess5ul t.e se*on/ operation was un/erta!en an/ on +ot. o**asions
t.e 5irst respon/ent .a/ t.e eGpresse/ *onsents o5 t.e appellant to per5orm +ot. operations4
?30] -.e eGpresse/ *onsents re5er to two *onsent 5orms eGe*ute/ +y t.e appellant4 -.e 5irst was signe/ +y
.er at t.e time o5 .er a/mission w.en it was not even *ontemplate/ t.at surgery was ne*essary4 -.e se*on/
*onsent 5orm s.owe/ .er t.um+ print on t.e 5orm an/ +earing a /ate a5ter t.e 5irst operation4 -.e trial Du/ge
Auestione/ t.e voluntariness o5 t.e t.um+ print as it was not eGe*ute/ in t.e presen*e o5 a witness as +y t.at
time s.e .a/ lost all sensation to .er lim+s4
?31] ;ut t.e issue .ere is not so mu*. on t.e *onsents given 5or t.e two operations +ut on t.e ris!s involve/
an/ w.et.er t.e appellant was warne/ o5 su*. ris!s4 .e .a/ testi5ie/ t.at .a/ s.e +een warne/ o5 t.e ris!s
involve/ s.e woul/ not .ave rea/ily agree/ to un/ergo t.e 5irst operation4
?32] -.ere was *on5li*ting evi/en*e on t.is an/ t.e trial Du/ge ma/e t.e 5ollowing 5in/ing w.en /ealing wit.
t.e appellant2s 5irst eGpresse/ *onsent4
<t woul/ also +e *on*lu/e/ t.at at t.e time w.en t.at *onsent was signe/ +ot. /e5en/ants /i/ not !now w.et.er t.e
plainti55 really nee/e/ t.e operation4 #s su*. < am o5 t.e view t.at it woul/ not +e possi+le 5or t.e se*on/ /e5en/ant to
eGplain t.e pro*e/ure an/ t.e ris!s o5 t.e operation w.en t.e *onsent in t.e a+ove$state/ 5orm was given or signe/4
For t.at reason < +elieve t.e plainti55 w.en s.e sai/ t.at t.e se*on/ /e5en/ant tol/ .er t.at t.e 5irst operation 1open
re/u*tion3 w.i*. too! pla*e on 1( July 1(02 was a minor operation to *orre*t t.e little pro+lem o5 t.e ne*! t.at s.e was
su55ering4 <n ot.er wor/s s.e was not tol/ o5 t.e ris! o5 paralysis *oming 5rom t.at operation4
?33] <t must also +e remem+ere/ t.at t.e appellant su55ere/ total paralysis a5ter t.e 5irst operation an/ it was
to *orre*t t.is situation t.at t.e se*on/ operation was per5orme/4 <n t.is respe*t6 t.e trial Du/ge ma/e t.e
5ollowing o+servations>
#s to t.e 5irst operation6 it is *lear to me t.at t.e se*on/ /e5en/ant .a/ /one somet.ing w.i*. *ause/ t.e paralysis4 <
am satis5ie/ t.at t.e paralysis was *ause/ +y t.e wire loop *ompressing t.e spinal *or/ an/ w.en t.e wire loop was
remove/ /uring t.e se*on/ operation t.e plainti55 was a+le to move .er upper lim+s4 <t /oes not matter w.at
eGplanation t.e se*on/ /e5en/ant gave 5or removing operation was t.e *ause o5 t.e paralysis4 -.e se*on/ /e5en/ant
was again negligent w.en .e /i/ not ta!e any step to reme/y t.e paralysis imme/iately4 <nstea/ .e waite/ 5or two
wee!s to /o t.e reme/ial operation an/ all t.at time .e !ept on assuring t.e plainti55 t.at s.e woul/ re*over 5rom t.e
paralysis w.i*. was only temporary in nature4 <n my view t.e a+ove s.ows t.at t.e se*on/ /e5en/ant 5aile/
1 M! "#$ at .B$
to eGer*ise t.e *are an/ s!ill o5 an or/inary *ompetent pra*titioner in t.at pro5ession as state/ +y t.e Fe/eral 7ourt in
t.e *ase o5 2o8 Nan Seng & Nagamah 3 Ors+ %1(02& 1 MLJ 120
?3@] -.e se*on/ /e5en/ant re5erre/ to +y t.e =ig. 7ourt is t.e 5irst respon/ent +e5ore us4 -.is is a 5in/ing o5
5a*t an/ t.e law on appellate inter5eren*e against 5in/ings o5 5a*ts is well settle/ as to /eter us 5rom upsetting
su*. a 5in/ing4 Moreover6 t.ere is su55i*ient evi/en*e +e5ore t.e *ourt to Dusti5y it in *on*lu/ing as it /i/4 ee
t.e *ases o5 113 *enal ink 527 Sdn Bhd & 0ato/ 0r (arnam Singh %1((7& 2 MLJ )7)6 123 )hina 1irlines td
& Maltran 1ir )orp Sdn Bhd and another appeal %1((,& 2 MLJ '17 an/ 1)3 Maynard & West Midlands
*egional (ealth 1uthority %1(0'& 1 #ll CR ,)'
?35] More importantly6 t.e 5a*ts o5 t.e instant appeal /i55er vastly wit. t.e 5a*ts in Bolam*ase in t.at>
6) ;olam was a mental patient6 an/ unli!e t.e appellant6 w.o .as +een /es*ri+e/ as 2a +rig.t
young la/y2 +y t.e 7ourt o5 #ppeal6 it is /ou+t5ul w.et.er .e was in a position to give any
*onsent to any treatment to +e given to .im?
Page 10
6) .a/ a warning o5 ris! +een *ommuni*ate/ to .im6 it is also /ou+t5ul w.et.er .e was in a
position to *ompre.en/ t.e true nature o5 t.e ris!s involve/?
4) t.e ris! o5 inDury in t.e nature o5 a 5ra*ture to ;olam was one in ten t.ousan/4 -.e same *annot
+e attri+ute/ to t.e appellant as t.e ris! o5 paralysis was present an/ real?
3) unli!e Bolam/s*ase t.ere is no *on5li*ting +o/y o5 me/i*al opinion a//u*e/ in t.e instant
appeal to esta+lis. w.et.er t.e appellant s.oul/ or s.oul/ not +e warne/ o5 t.e ris!s o5
paralysis4
?32] -.at sai/6 we are o5 t.e opinion t.at t.e Bolam Test.as no relevan*e to t.e /uty an/ stan/ar/ o5 *are o5
a me/i*al pra*titioner in provi/ing a/vi*e to a patient on t.e in.erent an/ material ris!s o5 t.e propose/
treatment4 -.e pra*titioner is /uty +oun/ +y law to in5orm .is patient w.o is *apa+le o5 un/erstan/ing an/
appre*iating su*. in5ormation o5 t.e ris!s involve/ in any propose/ treatment so as to ena+le t.e patient to
ma!e an ele*tion o5 w.et.er to pro*ee/ wit. t.e propose/ treatment wit. !nowle/ge o5 t.e ris!s involve/ or
/e*line to +e su+De*te/ to su*. treatment4
?37] 7ase law on t.is aspe*t o5 me/i*al negligen*e .as not +een *onsistent in t.e appli*ation o5 t.e Bolam
Principle+y t.e Cnglis. *ourts4 @ne su*. *ase relates to t.e =ouse o5 Lor/s2 /issenting Du/gment o5 Lor/
*arman in Sida8ay & Board of 4o&ernors of the Bethlem *oyal (ospital and the Maudsley (ospital 3 Ors
%1(0'& 1 #7 0714 -.e learne/ Du/ge eGpresse/ .is o+servations in t.e 5ollowing manner>
<n my view t.e Auestion w.et.er or not t.e omission to warn *onstitutes a +rea*. o5 t.e /o*tor2s /uty o5 *are towar/s
.is patient is to +e /etermine/ not eG*lusively +y re5eren*e to t.e *urrent state o5 responsi+le an/ *ompetent
pro5essional opinion an/ pra*ti*e at t.e time6 t.oug. +ot. are6 o5 *ourse6 relevant *onsi/erations6 +ut +y t.e *ourt2s
view as to w.et.er t.e /o*tor in a/vising .is patient gave t.e *onsi/eration w.i*. t.e law reAuires .im to give to t.e
rig.t o5 t.e patient to ma!e up .er own min/ in t.e lig.t o5 t.e relevant in5ormation w.et.er or not s.e will a**ept t.e
treatment w.i*. .e proposes4
1 M! "#$ at .B%
?3A] <n t.at *ase6 Mrs i/away su55ere/ personal inDuries as a result o5 a surgi*al operation /one +y a neuro$
surgeon6 Mr Fal*oner w.o /ie/ 5ive years +e5ore t.e trial o5 .er a*tion4 .e /i/ not allege negligen*e on t.e
per5orman*e o5 t.e operation +ut reste/ .er *ase on t.e 5ailure o5 Mr Fal*oner to in5orm .er o5 t.e ris!
in.erent on t.e operation 5or .a/ s.e +een so warne/ s.e woul/ not .ave *onsente/ to t.e operation4
?39] -.e *ase o5 (ucks & )ole %1(()& 8 MCD LR )()6 suggests a s.i5t in attitu/e w.en /etermining a /o*tor2s
lia+ility in a given *ase4 -.e Du/ges in t.at *ase a/opte/ a pragmati* approa*. to t.is issue an/ .el/ t.at it
was appropriate 5or t.e Du/ges to reDe*t me/i*al eGpert evi/en*e i5 t.ey /o not really stan/ up to analysis4
-.e /e5en/ant in t.at *ase was a general pra*titioner in omerset w.o possesse/ a /iploma in o+stetri*s4
Mrs =u*!s .a/ +een one o5 t.e patients in a maternity .ospital an/ a5ter giving +irt. to .er *.il/6 su55ere/
5rom 5ulminating septi*aemia6 w.i*. *ause/ various sores an/ yellow sports on .er 5ingers an/ toes4 Dr 7ole
put t.e patient on a 5ive$/ay *ourse o5 anti+ioti*s !nown as tetra*y*line an/ it was ta!en o55 as t.e sores
were improving4 -.e neGt /ay6 Mrs =u*! *ontra*te/ septi*emia6 puerperal 5ever4 .e sue/ Dr 7ole 5or
negligen*e6 alleging t.at .e s.oul/ .ave treate/ .er wit. peni*illin4 -.e /e5en/ant *onten/e/ t.at .e .a/
a*te/ in a**or/an*e wit. t.e reasona+le pra*ti*e o5 ot.er /o*tors wit. o+stetri* eGperien*e4
?@0] #t t.e trial6 Lawton J 5oun/ Dr 7ole to .ave +een negligent an/ t.e 7ourt o5 #ppeal up.el/ .is 5in/ing4
-.oug. t.e *ourt un/erstoo/ Dr 7ole2s a*tion *ou*.e/ wit. a sense o5 se*urity6 t.e *ourt was willing to apply
t.e test o5 reasona+le *are6 as to w.et.er t.e /e5en/ant .a/ a*te/ in a**or/an*e wit. approve/ pra*ti*e4
;ase/ on t.e evi/en*e6 Dr 7ole was 5oun/ to +e negligent +e*ause .e /i/ not ta!e 2every pre*aution2 to
prevent t.e out+rea! o5 puerperal 5ever an/ it mattere/ not i5 ot.er /o*tors woul/ .ave a*te/ as .e /i/4 @n
appeal a*. LJ opine/ t.at>
B.en ris!s o5 greater /anger are !nowingly ta!en as a matter o5 pro5essional pra*ti*e t.en6 .owever small t.e ris!s6
t.e *ourt must *are5ully eGamine t.e pra*ti*e6 parti*ularly w.ere t.e ris!s *an +e easily an/ ineGpensively avoi/e/4
?@1] -.e /e*ision in (uckswas 5ollowe/ in 4ascoine & ;an Sheridan 3 )o %1((8& ' Me/ LR 8)7 an/ in
anot.er *ase6 !oyce & Wand8orth (ealth 1uthority %1(('& , Me/ LR ,0 w.ere @veren/ J *ommente/ t.at>
-.e me/i*al pra*ti*e must stan/ up to analysis an/ +e unreasona+le in t.e lig.t o5 me/i*al !nowle/ge at t.at time4
Page 11
?@2] =owever6 a maDority o5 t.e *ases 5ollowe/ t.e prin*iples set out in Sida8ayin w.i*. t.e *ourts .ave
e55e*tively allowe/ a /o*tor2s lia+ility to +e /etermine/ +y me/i*al Du/gment4 Nevert.eless6 t.e legal position
.as somew.at *.ange/ wit. t.e =ouse o5 Lor/s2 /e*ision in Bolitho 5administrati6 of the estate of Bolitho
5deceased7 & )ity and (ackney (ealth 1uthority %1((7& 8 #ll CR 771
?@3] <n t.at *ase6 t.e plainti55 a two year ol/ +oy6 w.o .as a past .istory o5 .ospital treatment 5or *roup6 was
rea/mitte/ to .ospital un/er t.e *ase o5 Dr = an/ Dr R4 @n t.e 5ollowing /ay6 t.e plainti55 .a/ two episo/es
/uring w.i*. .e turne/ w.ite
1 M! "#$ at .B"
an/ *learly .a/ /i55i*ulty in +reat.ing4 Dr = was *alle/ in t.e 5irst instan*e an/ s.e /elegate/ Dr R to atten/
in t.e se*on/ instan*e +ut neit.er atten/e/ t.e plainti554 #t a+out 24)0pm6 t.e plainti55 su55ere/ total
respiratory 5ailure an/ a *ar/ia* arrest resulting in severe +rain /amage an/ su+seAuently /ie/4 -.e mot.er
*ontinue/ .is pro*ee/ings 5or me/i*al negligen*e as t.e a/ministratriG o5 .is estate4 -.e /e5en/ant a**epte/
t.at Dr = .a/ a*te/ in +rea*. o5 .er /uty o5 *are to t.e plainti55 +ut *onten/e/ t.at t.e *ar/ia* arrest woul/
not .ave +een avoi/e/ i5 Dr = or some ot.er suita+le /eputy .a/ atten/e/4
?@@] Lor/ ;rowne$Bil!inson /elivering t.e Du/gment o5 t.e =ouse o5 Lor/s eGpresse/ .is 5in/ings at p 770 o5
t.e report as 5ollows4
444 <n my view t.e *ourt is not +oun/ to .ol/ t.at a /e5en/ant /o*tor es*apes lia+ility 5or negligent treatment or
/iagnosis Dust +e*ause .e lea/s evi/en*e 5rom a num+er o5 me/i*al eGperts w.o are genuinely o5 opinion t.at t.e
/e5en/ant2s treatment or /iagnosis a**or/e/ wit. soun/ me/i*al pra*ti*e4 4444 <n parti*ular6 in *ases involving6 as t.ey
so o5ten /o6 t.e weig.ing o5 ris!s against +ene5its6 t.e Du/ge +e5ore a**epting a +o/y o5 opinion as +eing responsi+le6
reasona+le or respe*ta+le6 will nee/ to +e satis5ie/ t.at6 in 5orming t.eir views6 t.e eGperts .ave /ire*te/ t.eir min/s to
t.e Auestion o5 *omparative ris!s an/ +ene5its an/ .ave rea*.e/ a /e5ensi+le *on*lusion on t.e matter4
?@5] <n t.e *ourse o5 .is spee*. an/ a5ter /is*ussing some /e*i/e/ *ases6 t.e learne/ Du/ge also ma/e t.e
5ollowing pertinent remar!s>
-.ese /e*isions /emonstrate t.at in *ases o5 /iagnosis an/ treatment t.ere are *ases w.ere6 /espite a +o/y o5
pro5essional opinion san*tioning t.e /e5en/ant2s *on/u*t6 t.e /e5en/ant *an properly +e .el/ lia+le 5or negligen*e 1<
am not .ere *onsi/ering Auestions o5 /is*losure o5 ris!34 <n my Du/gment t.at is +e*ause6 in some *ases6 it *annot +e
/emonstrate/ to t.e Du/ge2s satis5a*tion t.at t.e +o/y o5 opinion relie/ on is reasona+le or responsi+le4 <n t.e vast
maDority o5 *ases t.e 5a*t t.at /istinguis.e/ eGperts in t.e 5iel/ are o5 a parti*ular opinion will /emonstrate t.e
reasona+leness o5 t.at opinion4 <n parti*ular6 w.ere t.ere are Auestions o5 assessment o5 t.e relative ris!s an/ +ene5its
o5 a/opting a parti*ular me/i*al pra*ti*e6 a reasona+le view ne*essarily presupposes t.at t.e relative ris!s an/ +ene5its
.ave +een weig.e/ +y t.e eGperts in 5orming t.eir opinions4 ;ut i56 in a rare *ase6 it *an +e /emonstrate/ t.at t.e
pro5essional opinion is not *apa+le o5 wit.stan/ing logi*al analysis6 t.e Du/ge is entitle/ to .ol/ t.at t.e +o/y o5 opinion
is not reasona+le or responsi+le4
?@2] <t woul/ appear t.at Bolitho/e*i/e/ t.at i5 it *an +e s.own t.at t.e pro5essional opinion relie/ upon was
not *apa+le o5 wit.stan/ing logi*al analysis6 t.e Du/ge is entitle/ to .ol/ t.at t.e +o/y o5 opinion was not
reasona+le or responsi+le4
?@7] 7ommonwealt. Duris/i*tions .ave also /e*line/ to 5ollow t.e Bolam Test4 @ne su*. *ase is t.e
#ustralian *ase o5 *ogers & Whitaker %1((2& 17' 7LR 87(6 w.ere t.e 5a*ts /is*lose t.at B.ita!er w.o was
almost totally +lin/ in t.e rig.t eye *onsulte/ Rogers6 an op.t.almi* surgeon4 -.e latter a/vise/ .er t.at an
operation on .er rig.t eye woul/ not only improve its appearan*e +ut woul/ pro+a+ly restore signi5i*ant sig.t
to it4 B.ita!er agree/ to un/ergo surgery +ut it /i/ not.ing to .er rig.t eye +ut /evelope/ in5lammation to .er
le5t eye an/ t.is le/ to t.e loss o5 sig.t o5 t.at goo/ eye4 <n t.e upreme 7ourt o5 New out. Bales Rogers
was .el/ lia+le in t.at .e .a/ 5aile/ to warn B.ita!er t.at as a result o5 t.e surgery6 s.e mig.t
1 M! "#$ at .B.
/evelop a *on/ition !nown as sympat.eti* opt.almia in .er le5t eye4 Rogers2 appeal to t.e 7ourt o5 #ppeal
was /ismisse/ an/ in a55irming t.at /e*ision an/ 5ollowing Lor/ *arman2s ruling in i/away6 t.e =ig. 7ourt
ma/e t.e 5ollowing pronoun*ements>
<n #ustralia6 it .as +een a**epte/ t.at t.e stan/ar/ o5 *are to +e o+serve/ +y a person wit. some spe*ial s!ill or
*ompeten*e is t.at o5 t.e or/inary s!ille/ person eGer*ising an/ pro5essing to .ave t.at spe*ial s!ill4 ;ut6 t.at stan/ar/
is not /etermine/ solely or even primarily +y re5eren*e to t.e pra*ti*e 5ollowe/ or supporte/ +y a responsi+le +o/y o5
opinion in t.e relevant pro5ession or tra/e4 Cven in t.e sp.ere o5 /iagnosis an/ treatment6 t.e .eartlan/ o5 t.e s!ille/
me/i*al pra*titioner6 t.e Bolam Principle.as not always +een applie/4 Furt.er6 an/ more importantly6 parti*ularly in t.e
Page 12
5iel/ o5 non$/is*losure o5 ris! an/ t.e provision o5 a/vi*e an/ in5ormation6 t.e Bolam Principle.as +een /is*ar/e/ an/6
instea/6 t.e *ourts .ave a/opte/ t.e prin*iple t.at6 w.ile evi/en*e o5 a**epta+le me/i*al pra*ti*e is a use5ul gui/e 5or
t.e *ourts6 it is 5or t.e *ourts to a/Du/i*ate on w.at is t.e appropriate stan/ar/ o5 *are a5ter giving weig.t to the
paramount consideration that a person is entitled to make his o8n decisions about his life+
?@A] -.e /e*ision in *ogerswas 5ollowe/ +y t.e upreme 7ourt o5 out. #ustralia in t.e *ase o5 ' & * %1(0)&
)) #R 10( an/ Battersby & Tottman %1(08& )' #R '77 w.i*. reDe*te/ t.e notion t.at t.e *ourt is
automati*ally +oun/ +y evi/en*e as to t.e pra*ti*e o5 t.e me/i*al pro5ession4 -.e *ourt .as an o+ligation to
Auestion an/ s*rutiniHe t.e pro5essional pra*ti*e6 to ensure t.at t.e stan/ar/ set +y law is attaine/4 <n ' & *
%1(0)& )) #R 10( at p 1(16 Eing 7J outline/ t.e s*ope o5 t.e /uty to /is*lose in t.e 5ollowing manner>
Determination o5 t.e s*ope o5 t.e /o*tor2s /uty to /is*lose involves *onsi/eration o5 two values w.i*. are sometimes in
*on5li*t6 namely t.e /uty o5 t.e /o*tor to a*t in w.at .e *on*eives to +e t.e +est interests o5 .is patient an/ t.e rig.t o5
t.e patient to *ontrol .is own li5e an/ to .ave t.e in5ormation ne*essary to /o so4
B.at is in Auestion is t.e s*ope o5 t.e /o*tor2s /uty o5 *are4 =e is reAuire/ to a*t reasona+ly6 not only in .is a*tual
treatment o5 t.e patient6 +ut also in relation to t.e /is*losure o5 in5ormation4 <n )hatterton & 4erson ;ristow J4 .el/ t.at
it is the duty of a doctor to e6plain 8hat he intends to do= and its implications= in the 8ay a careful and responsible
doctor in similar circumstances 8ould ha&e done4 <t is my opinion t.at t.at is a *orre*t statement o5 t.e law6 an/ t.at
t.e /uty eGten/s6 not only to t.e /is*losure o5 real ris!s o5 mis5ortune in.erent in t.e treatment6 +ut also any real ris!
t.at t.e treatment6 espe*ially i5 it involves maDor surgery6 may prove ine55e*tive4
B.at a *are5ul an/ responsi+le /o*tor woul/ /is*lose /epen/s upon t.e *ir*umstan*es4 -.e relevant *ir*umstan*es
in*lu/e t.e nature o5 t.e matter to +e /is*lose/6 t.e nature o5 t.e treatment6 t.e /esire o5 t.e patient 5or in5ormation6 t.e
temperament an/ .ealt. o5 t.e patient6 an/ t.e general surroun/ing *ir*umstan*es4
?@9] -.is is 5ollowe/ +y t.e 5ollowing warning 5rom t.e learne/ Du/ge as to t.e reality o5 t.e situation>
;ut pro5essions may a/opt unreasona+le pra*ti*es4 Pra*ti*es may /evelop in pro5essions6 parti*ularly as to /is*losure6
not +e*ause t.ey serve t.e interest o5 t.e *lients6 +ut +e*ause
1 M! "#$ at .B>
t.ey prote*t t.e interests or *onvenien*e o5 mem+ers o5 t.e pro5ession4 -.e *ourt .as an o+ligation to s*rutinise
pro5essional pra*ti*es to ensure t.at t.ey a**or/ wit. t.e stan/ar/ o5 reasona+leness impose/ +y t.e law4
?50] <n t.e realm o5 /iagnosis6 treatment an/ t.e /uty to warn6 t.e ruling o5 t.e =ig. 7ourt o5 #ustralia in
Na6akis & Western 4eneral (ospital 3 1nother %1(((& 1,2 #LR '80 was a+le to settle t.e ongoing /ou+t
w.i*. eGiste/ in *ogers &Whitaker=as to6 w.et.er *ogerswas restri*te/ to *ases relating to negligent a/vi*e
only4
?51] <n Na6akis=a 12 year ol/ +oy6 Paras!evas NaGa!is was stru*! on t.e .ea/ +y .is s*.oolmate2s s*.ool
+ag4 =e *ollapse/ an/ was a/mitte/ +y a general pra*titioner to t.e Bestern Ieneral =ospital 5or .ea/
inDury4 #t t.e .ospital6 t.e appellant 5ell into unarousa+le un*ons*iousness 5or 5ive minutes an/ was
unresponsive to pain5ul stimuli4 # preliminary /iagnosis was ma/e o5 a su+ara*.noi/ 1traumati*ally *ause/3
.aemorr.age *ause/ +y t.e +low to t.e .ea/4 =e remaine/ in .ospital 5or nine /ays un/er t.e supervision o5
t.e se*on/ respon/ent6 Mr Jensen6 a senior neurosurgeon at t.e .ospital4 # 7#- s*an was *arrie/ out w.i*.
in/i*ate/ t.at .e was su55ering 5rom su+ara*.noi/ 1traumati*ally *ause/3 .aemorr.age4 =owever6 .is
*on/ition improve/ an/ t.e appellant was /is*.arge/4 -wo /ays later t.e appellant *ollapse/ an/ was ta!en
to t.e Royal 7.il/ren2s =ospital w.ere .e was atten/e/ to +y Mr Elug6 /ire*tor o5 neurosurgery4 #n
angiogram *on/u*te/ reveale/ t.at t.e appellant su55ere/ a maDor intra*ranial +lee/ 5rom a +urst aneurysm4
#n operation was per5orme/ to insert a ventri*ular peritoneal s.unt to /rain *ere+rospinal 5lui/ an/ a
*raniotomy was per5orme/ to *lip t.e aneurysm4 -.e appellant +roug.t an a*tion in t.e upreme 7ourt o5
Vi*toria against t.e senior neurosurgeon an/ t.e .ospital 5or 5ailure to properly /iagnose an/ t.at .is
negligen*e .a/ le/ .im to su55er serious an/ permanent p.ysi*al an/ intelle*tual impairment4 -.e trial Du/ge
a**epte/ a no *ase to answer4 -.e appellant2s appeal was unsu**ess5ul w.en t.e 7ourt o5 #ppeal .el/ t.at
t.ere was no +asis 5or t.e *laim t.at t.e neurosurgeon 5aile/ to *onsi/er t.e possi+ility o5 an aneurysm4
?52] Iau/ron J6 spea!ing 5or t.e =ig. 7ourt o5 #ustralia rea55irme/ t.e reDe*tion o5 t.e Bolam Testwit. t.e
5ollowing remar!s at p 8 o5 t.e report>
Page 1)
444 it is important to +ear in min/ t.at t.e test 5or me/i*al negligen*e is not w.at ot.er /o*tors say t.ey woul/ or woul/
not .ave /one in t.e same or similar *ir*umstan*es 444 -o treat w.at ot.er /o*tors /o or /o not /o as /e*isive is to
a/opt a variant to t.e /ire*tion given to t.e Dury in Bolam & 'riern (ospital Management )ommittee 5the Bolam rule7+++
-.e Bolam rule=w.i*. allows t.at t.e stan/ar/ o5 *are owe/ +y a /o*tor to .is or .er patient is a matter of medical
-udgment6 was reDe*te/ +y t.is 7ourt in *ogers & Whitaker+
?53] M*=ug. J6 anot.er mem+er o5 t.e panel eGpresse/ t.e same sentiments at p 12 o5 t.e report>
<n my opinion6 t.at evi/en*e o5 Mr Elug was su55i*ient to get t.e plainti552s *ase to t.e Dury6 irrespe*tive o5 w.et.er Mr
Jensen /i/ or /i/ not *onsi/er per5orming an angiogram4 4444 <5 t.ere is evi/en*e upon w.i*. t.e Dury *oul/ reasona+ly
5in/ negligen*e on t.e part o5 a /o*tor6 t.e issue is 5or t.em to /e*i/e irrespe*tive o5 .ow many /o*tors t.in! t.at t.e
1 M! "#$ at .BA
/e5en/ant was not negligent or *areless4 Nor is it to t.e point t.at t.is evi/en*e o5 Mr Elug also s.ows t.at a
respe*ta+le +o/y o5 me/i*al opinion woul/ not .ave per5orme/ an angiogram in t.e *ir*umstan*es o5 t.is *ase4 -o
allow t.at +o/y o5 opinion to +e /e*isive woul/ re$intro/u*e t.e Bolam Testinto #ustralian law4 <n *ogers & Whitaker=
t.is *ourt reDe*te/ t.e Bolam Testan/ .el/ t.at a 5in/ing o5 me/i*al negligen*e may +e ma/e even t.oug. t.e *on/u*t
o5 t.e /e5en/ant was in a**or/ wit. a pra*ti*e a**epte/ at t.at time as proper +y a responsi+le +o/y o5 me/i*al
opinion4
?5@] -.e Auestion +e5ore t.e =ig. 7ourt o5 #ustralia was not w.et.er t.e /e5en/ant2s *on/u*t a**or/e/ wit.
t.e pra*ti*e o5 t.e me/i*al pro5ession or some parts o5 it6 +ut w.et.er it *on5orme/ to t.e stan/ar/ o5
reasona+le *are /eman/e/ +y t.e law4 -.at was t.e Auestion 5or t.e *ourt6 an/ t.e /uty o5 /e*i/ing it *oul/
not +e /elegate/ to any pro5ession or group in t.e *ommunity4
?55] <n Malaysia6 t.e Bolam Principle.as +een applie/ eGtensively +y t.e *ourts in me/i*al negligent *ases
w.en /etermining t.e stan/ar/ o5 *are4 u*. *ases in*lu/e>
7) S8amy & Matthe8s %1(,7& 1 MLJ 182
7) S8amy & Matthe8s %1(,0& 1 MLJ 1)0
5) )hin 2eo8 & 4o&ernment of Malaysia and 1nother %1(,7& 2 MLJ 8'
4) 9li:abeth )hoo & 4o&ernment of Malaysia %1(70& 2 MLJ 171
1) 2o8 Nam Seng & Nagamah 3 Ors %1(02& 1 MLJ 120
?52] <n t.e last mentione/ *ase6 t.e appellant applie/ a *omplete plaster *ase to t.e leg o5 t.e se*on/
respon/ent an/ /ue to la*! o5 proper s!ill an/ *are in t.e appli*ation o5 t.e *ast6 *ause/ ina/eAuate +loo/
*ir*ulation to t.e leg6 t.at le/ to gangrene6 ne*essitating t.e amputation o5 t.e se*on/ respon/ent2s leg4 -.e
se*on/ respon/ent *laime/ /amages against t.e appellant6 t.ir/ respon/ent an/ t.e government4 -.e
appellant a/mitte/ lia+ility as regar/s t.e roa/ a**i/ent +ut /enie/ it as regar/s t.e amputation4 -.e trial
Du/ge a+solve/ t.e me/i*al o55i*er an/ t.e government 5rom any +lame an/ .el/ t.e appellant solely to
+lame4 alle. #+as FJ in /elivering Du/gment 5or t.e Fe/eral 7ourt sai/ at p 1)0>
-.ere may +e /i55eren*es o5 opinion as to t.e types o5 plaster *asts to +e applie/ in t.e treatment o5 t.e type o5 inDuries
sustaine/ +y t.e respon/ent6 +ut t.e *.oi*e o5 a treatment w.i*. is t.e stan/ar/ me/i*al pra*ti*e is not +y itsel5 a
negligen*e6 Bolam & 'riern (ospital Management )ommittee %1('7&2 #ll CR 110 an/ 9li:abeth )hoo & 4o&ernment of
Malaysia %1(70& 2 MLJ 171
?57] <n 1siah bte 2amsah & 0r *a-inder Singh 3 Ors %2002& 1 MLJ 8086 t.e plainti55 /elivere/ .er se*on/
*.il/ on 10 @*to+er 1(00 at t.e -elo! <ntan Distri*t =ospital4 Due to suspi*ion o5 5oetus /istress6 s.e
un/erwent a lower se*tion *aesarian operation /one un/er general anaest.esia4 :n5ortunately6 s.e /i/ not
re*over 5rom t.e operation an/ su55ere/ permanent irreversi+le +rain /amage4 -.e plainti55 *laime/ /amages
against t.e /e5en/ants4 <n /e*i/ing w.et.er t.e /o*tor an/ t.e anaest.etist were negligent6 t.e *ourt relie/
on t.e Bolam Principle4 James Foong J 1as .e t.en was3 *on*lu/e/ as 5ollows at p 80( o5 t.e report4
1 M! "#$ at .B#
4444 < 5in/ no evi/en*e to support a 5in/ing t.at t.is /o*tor was negligent in t.is surgery going +y t.e test set out in t.e
esta+lis.e/ *ase o5 Bolam & 'riern (ospital Management )ommittee %1('7& 2 #ll CR 110
Page 18
?5A] Later at p 8(8 o5 t.e same report6 t.e learne/ Du/ge ma/e t.e 5ollowing 5in/ing as against t.e se*on/
/o*tor sue/ in t.at a*tion4
4444 < 5in/ t.e se*on/ /e5en/ant is guilty o5 negligen*e sin*e .e /i/ not a*t in a**or/an*e wit. t.e pra*ti*e a**epte/ as
proper +y a responsi+le +o/y o5 me/i*al men s!ille/ in t.is parti*ular art $$ a test as set 5ort. in Bolam/s*ase4
?59] Later in t.e same year6 t.e *ourt in (or Sai (ong 3 1nor & ,ni&ersity (ospital 3 1nor %2002& ' MLJ 1,76
applie/ t.e Bolam Principlein /e*i/ing w.et.er t.e /o*tor was negligent in .an/ling t.e +irt. o5 t.e se*on/
plainti552s *.il/4 Following t.e /e*ision o5 t.e *ogers2 *ase in 1((26 *on5li*ting Du/gments .ave +een /elivere/
in our *ourts over t.e pre5eren*e an/ appli*ation o5 t.e *ogers & Whitaker test to t.e Bolam Test+
?20] <n ie8 Sin 2iong & 0r Sharon 0M Paulra- %1((,& ' MLJ 1()6 t.e plainti55 sue/ t.e /e5en/ant 5or
aggravate/ or punitive /amages 5or negligen*e pertaining to t.e operation o5 .is rig.t eye w.i*. was lost to
post$operative in5e*tion4 -.e plainti55 also allege/ t.at a eton pro*e/ure6 w.i*. t.e plainti552s 5irst /o*tor .a/
re*ommen/e/ s.oul/ .ave +een *arrie/ out6 an/ not a repeat tra+e*ule*tomy w.i*. t.e /e5en/ant .a/
per5orme/4
?21] <an 7.in J 5ollowe/ Sida8ayan/ 5oun/ t.at t.e plainti55 .a/ 5aile/ to prove t.at t.e /e5en/ant .a/ not
a*te/ in a**or/an*e wit. t.e stan/ar/s o5 a *ompetent op.t.almologist4 -.e /e5en/ant was .el/ not lia+le
an/ in so /e*i/ing6 t.e learne/ Du/ge ma/e t.e 5ollowing remar!s at p 20( o5 t.e report4
< am o5 t.e view t.at t.e /e5en/ant .a/ trea/e/ on well tro//en pat. an/ s.e *annot +e sai/ to +e guilty o5 negligen*e
1Bolam & 'riern (ospital Management )ommittee %1('7&2 #ll CR 1106 =L34 Put in anot.er way6 t.e plainti55 .as 5aile/ to
prove t.at t.e /e5en/ant /i/ w.at no s!ille/ op.t.almologist woul/ /o 1(unter & (anley %1(''& 7 206 9li:abeth )hoo
& 4o&ernment of Malaysia 3 1nor %1(70& 2 MLJ 171
?22] -.e *ogers & Whitaker test was 5ully en/orse/ in Malaysia 5or t.e 5irst time in t.e *ase o5 2amalam a<p
*aman 3 Ors & 9astern Plantation 1gency 5!ohore7 Sdn Bhd ,lu Tiram 9state= ,lu Tiram= !ohore 3 1nor
%1((,& 8 MLJ ,78 -.e +rie5 5a*ts in t.is *ase are t.at t.e t.e late Mr Dinasan a/l Pa/man+at.an6 t.e
/e*ease/6 w.o was employe/ +y t.e 5irst /e5en/ant at t.e time o5 .is /eat.6 was su55ering 5rom
.ypertension4 =e *omplaine/ o5 gi//iness an/ 5its an/ 5ainte/ at wor!4 =e was t.en atten/e/ +y t.e
/e5en/ant2s /o*tor w.o eGamine/ .im an/ pres*ri+e/ me/i*ation an/ su+seAuently /is*.arge/ .im4 =e was
5urt.er eGamine/ +y t.e /e5en/ant2s /o*tor on two ot.er o**asions4 # /ay a5ter .is last eGamination6 t.e
/e*ease/ was a/mitte/ to t.e Eluang =ospital as a result o5 gi//iness an/ 5its4 -.e /e*ease/ /ie/ at t.e
Eluang =ospital t.e /ay a5ter4
1 M! "#$ at .1B
?23] Ri*.ar/ -alalla J6 at p ,0, o5 .is Du/gment .a/ t.is to say>
-.e law appli*a+le in t.is *ase an/ w.i*. +in/s me is to +e 5oun/ in t.e maDority /e*ision o5 ;ara!+a. LP in t.e
Fe/eral 7ourt *ase o5 S8amy & Matthe8s 3 1nor %1(,0& 1 MLJ 1)0 at pp 1)( an/ 180 w.ere it was state/> 2# man or a
woman w.o pra*ti*es a pro5ession is +oun/ to eGer*ise t.e *are an/ s!ill o5 an or/inary *ompetent pra*titioner in t.at
pro5ession $$ +e it t.e pro5ession o5 an a**ountant6 a +an!er6 a /o*tor6 a soli*itor or ot.erwise4
Furt.er6 at p ,6 .is Lor/s.ip went on to say>
444 t.at t.e *urrent state o5 t.e law6 +y way o5 ela+oration may +e 5oun/ in t.e /e*ision o5 t.e =ig. 7ourt o5 #ustralia
given in )hristoper *ogers & Whitaker %1((2&17' 7LR 87(
Finally6 at p ,6 .is Lor/s.ip *on*lu/e/ as 5ollows>
For my part < see Bolam/s*ase an/ t.at o5 CliHa+et. 7.oo +eing re5erre/ to +y t.e learne/ Du/ge not 5or a proposition
t.at t.ere +eing /i55eren*es o5 opinion as to treatment6 *.oi*e o5 a treatment w.i*. is t.e stan/ar/ me/i*al pra*ti*e is
not itsel5 negligen*e4 < /o not see t.e learne/ Du/ge as .aving a//resse/ .imsel5 to t.e Bolam principlean/ upon /oing
so applying it4 #**or/ingly6 < /o not 5in/ mysel5 +y re5eren*e to 2o82s *ase +eing 5ettere/ +y t.e Bolam Principle+ut on
t.e *ontrary +oun/ +y t.e ruling o5 alle. #+as FJ6 set out a+ove w.i*. ruling *orrespon/s wit. t.e ruling +y t.e t.en
Lor/ Presi/ent in wamy2s *ase an/ < propose to a/opt +y way o5 ela+oration o5 t.ose rulings t.e a+ovementione/
/i*ta eGtra*te/ 5rom t.e /e*ision in t.e *ogers2 *ase4 < s.oul/ emp.aHise t.at w.ile /ue regar/s will +e .a/ to t.e
evi/en*e o5 me/i*al eGperts6 < /o not a**ept mysel5 as +eing restri*te/ +y t.e esta+lis.ment in evi/en*e o5 a pra*ti*e
a**epte/ as proper +y a responsi+le +o/y o5 me/i*al men s!ille/ in t.at parti*ular art to 5in/ing a /o*tor is not guilty o5
negligen*e i5 .e .as a*te/ in a**or/an*e wit. t.at pra*ti*e4 <n s.ort < am not +oun/ +y t.e ;olam prin*iple4 Rat.er /o <
see t.e Du/i*ial 5un*tion in t.is *ase as one to +e eGer*ise/ as in any ot.er *ase o5 negligen*e6 uns.a*!le/6 on t.e
Page 1'
or/inary prin*iples o5 t.e law o5 negligen*e an/ t.e overall evi/en*e4
*ogers & Whitaker was again applie/ in t.e *ase o5 Tan 1h 2au & The 4o&ernment of Malaysia %1((7& 2
#MR 1)024 <n t.is *ase6 t.e servant an//or agent o5 t.e /e5en/ant *arrie/ out a surgi*al operation on t.e
plainti55 w.o .a/ a .istory o5 an inDury to .is +a*! *ause/ +y a pie*e o5 woo/4 -.e provisional /iagnosis was
t.at o5 a prolapse/ /is*4 #n ort.ope/i* surgeon eGamine/ t.e plainti55 an/ ma/e a provisional /iagnosis o5
intra spinal tumor at t.e level o5 t.e t.ora*i* verte+ra D11 an/ D124 #5ter numerous tests6 t.e *ause o5 t.e
tumor was as*ertaine/ as low gra/e astro*ytoma4 =e was *ompletely paralyse/ waist /own4 -.e plainti55
soug.t /amages 5rom t.e /e5en/ant 5or t.e allege/ negligen*e an//or +rea*. o5 pro5essional /uties4
?2@] <n applying t.e *ogers & Whitaker test6 Low =op ;ing J 1as .e t.en was3 arrive/ at t.e 5ollowing
*on*lusion at p 1802 o5 .is Du/gment4
<n t.e instant *ase6 w.ere t.e ris! o5 paralysis was very real6 more so t.an t.e tumor was intrame/ullary6 it was
a+solutely essential 5or t.e atten/ing surgeon su*. as DB1 or any /o*tor assisting .im to warn t.e patient o5 t.e
5oreseea+le ris! o5 even a 5in/ing o5 intrame/ullary tumor4
?25] Finally6 we ma!e re5eren*e to Mi*.ael Jones2 +oo! on Medical Negligence%1((,& e/6 p (' t.at seems to
suggest t.at t.ere is a /istin*tion +etween t.e test o5
1 M! "#$ at .11
negligen*e +ase/ on t.e reasona+le *ompetent man an/ t.at o5 t.e or/inary s!ille/ man4 -.e 5ormer ma!es
it *lear t.at negligen*e is *on*erne/ wit. t.e /epartures 5rom w.at oug.t to .ave +een /one in t.e
*ir*umstan*es w.i*. is measure/ +y re5eren*e to a .ypot.eti*al 2reasona+le /o*tor2 an/ t.e latter pla*es
*onsi/era+le emp.asis on t.e stan/ar/s w.i*. are in 5a*t a/opte/ +y t.e pro5ession4 =e emp.asiHes t.at
t.e point is 5or t.e *ourt to /etermine w.at t.e reasona+le /o*tor woul/ .ave /one6 not t.e pro5ession4 B.at
t.e pro5ession /oes in a given situation will +e an important in/i*ator o5 w.at oug.t to .ave +een /one6 +ut it
s.oul/ not ne*essarily +e /eterminative4 <n t.e 5inal analysis6 t.e *ourt s.oul/ set t.e stan/ar/ o5 *are in
negligen*e6 /rawing upon t.e evi/en*e presente/4 -.e Bolam Test5ails to ma!e t.is important /istin*tion
+etween t.e reasona+le *ompetent /o*tor an/ t.e or/inary s!ille/ /o*tor4
?22] <n Blenkiron & 4reat )entral 4as )onsumers/ )o %10,0& 2 F " F 8)76 7o*!+urn 7J6 sai/>
Ieneral pra*ti*e .as always +een ta!en into a**ount in /etermining t.e stan/ar/ o5 *are6 +ut it is not *on*lusive
+e*ause 2no one *an *laim to +e eG*use/ 5or want o5 *are +e*ause ot.ers are *areless as .imsel524 4444 <n/ee/ it is not
so mu*. t.e universal +e.aviour o5 man!in/ in a parti*ular 5iel/ to w.i*. t.e law gives weig.t6 as t.e stan/ar/ o5
*on/u*t w.et.er uni5ormly 5ollowe/ or not6 w.i*. is generally a**epte/ as *orre*t4
?27] <n (a-gato & ondon (ealth 1ssociation %1(02& ), @R12/3 ,,(66 an a*tion in negligen*e in respe*t o5
personal inDuries sustaine/ /uring post$operative *ase6 7allag.an J6 at p ,() o5 .is Du/gment eGpresse/ .is
*on*ern in t.e 5ollowing manner>
<n my view .owever6 a *ourt .as a rig.t to stri!e /own su+stan/ar/ approve/ pra*ti*es w.en *ommon sense /i*tates
su*. a result4 No pro5ession is a+ove t.e law an/ t.e *ourts on +e.al5 o5 t.e pu+li* .ave a *riti*al role to play in
monitoring an/ pre*ipitating *.anges w.ere reAuire/ in pro5essional stan/ar/s4
?2A] <n t.e <ris. *ase o5 Best & Wellcome 'oundation td %1((8& ' Me/ LR 016 Finlay 7J eGpresse/ t.e same
*on*ern an/ /e5ine/ t.e /function 8hich a court can and must perform in the trial of a case in order to
acFuire a -ust result= is to apply common sense and a careful understanding of the logical and likelihood of
e&ents to conflicting opinions and conflicting theories concerning a matter of this kind/+
?29] -.ere5ore6 t.ere is a nee/ 5or mem+ers o5 t.e me/i*al pro5ession to stan/ up to t.e wrong /oings6 i5 any6
as is t.e *ase o5 pro5essionals in ot.er pro5essions4 <n so /oing6 people involve/ in me/i*al negligen*e *ases
woul/ +e a+le to o+tain +etter pro5essional a/vi*e an/ t.at t.e *ourts woul/ +e appraise/ wit. evi/en*e t.at
woul/ assist t.em in t.eir /eli+erations4 @n t.is +asis6 we are o5 t.e view t.at t.e *ogers & Whitaker test
woul/ +e a more appropriate an/ a via+le test o5 t.is millennium t.en t.e Bolam Test+-o +orrow a Auote 5rom
Lor/ Bool5e2s inaugural le*ture in t.e new Provost eries6 /elivere/ in Lon/on in 20016 t.e p.rase /0octor
kno8s bests.oul/ now +e 5ollowe/ +y t.e Auali5ying wor/s /if he acts reasonably and logically and gets his
facts right/+
Page 1,
1 M! "#$ at .1E
?70] @n t.at 5in/ing6 we answer t.e Auestion pose/ to us in t.e negative an/ or/er t.at t.is appeal is allowe/
wit. *osts .ere6 in t.e 7ourt o5 #ppeal an/ in t.e =ig. 7ourt to +e +orne +y t.e respon/ents an/ t.e or/ers
o5 t.e =ig. 7ourt on Auantum are to +e restore/4 -.e /eposit is to +e re5un/e/ to t.e appellant4
?71] Finally6 we wis. to a// t.at t.is Du/gment is /elivere/ pursuant to 7ourts o5 Ju/i*ature #*t 1(,8 s
70113as t.e 7.airman o5 t.e panel .as sin*e retire/4
1ppeal allo8ed+
Reporte/ +y Loo Lai Mee