Muddying the malpractice claims waters

By Mike Griffiths, Regional Director, Healthcare

A car accident in Malaysia and a medical tourist from Bangladesh have each raised red flags for Singapore’s malpractice claims environment.

For owners of high-performance sports cars, living in Singapore must be frustrating. Our speed limits go no higher than 90kph, there are no real stretches of long open roads, and speed bumps, roundabouts and tight corners abound. You could probably drive a Ferrari or Maclaren around Singapore all day and never get past second gear. To put their sports cars to the test, owners here routinely drive over the causeway into Malaysia where there are long, straight open roads, few police, and much lower fines for those unlucky enough to get caught. 

Of course, driving at high speed on public roads comes with obvious dangers. There have been serious collisions in Malaysia involving sports cars driven by Singaporeans. In fact, AIG Insurance recently announced that it would no longer insure Maclaren owners who drove their cars into Malaysia, following a well-publicized accident that wrote off three of these $900,000 cars. Owning a sports car is one thing, being able to drive one is evidently something else.

In February 2018, Mr. Lim Chun Yong was being driven along Malaysia’s North-South Expressway. He had hired a car and driver to take him and his wife to Senai Airport for a flight to Sabah. According to court evidence the driver was handling the car, a Toyota, recklessly when it crashed into the rear of a truck carrying a shipping container. To make matters worse, a BMW that had been following was unable to stop in time and crashed into the rear of the Toyota, propelling it further into the rear of the truck.

Lim had been seated in the front passenger seat. He suffered very serious injuries and was evacuated to Singapore, where he was diagnosed with irreversible brain damage that would prevent him from working and would necessitate specialist care for the rest of his life. Lim’s wife brought negligence claims in Singapore against the drivers of the truck, the Toyota and the BMW, and the owners of the car-hire and trucking companies. Interestingly, the Singapore High Court agreed to hear the case. The accident had happened in Malaysia, and the drivers were all Malaysian, yet the Singapore courts believed they had jurisdiction. It appears that where the financial consequences are felt primarily in Singapore and witnesses such as medical experts are located here, the Singapore courts are prepared to accept the case. 

The red flag for malpractice insurance claims came with the scale of damages. The High Court awarded Lim $4.7 million, close to the largest malpractice claim award Singapore has seen. Readers may recall that the descendants of Franklin Heng successfully sued for $5.3 million in 2015, following a botched liposuction treatment. However, Heng had been a high net worth individual. Lim, by contrast, earned only $3,500 per month working for a local charity. The damages awarded to Lim included the future cost of full-time care in a nursing home rather than the cost of hiring a live-in maid. This paves the way for potentially higher malpractice claims in cases where patients are so seriously injured as to require indefinite nursing care.

The second red flag involves Mr. Noor Alam, a businessman from Bangladesh who came to Singapore’s Gleneagles Hospital for neck pain treatment. Alam alleges that he was left paralyzed after Dr James Tan Siah Heng, a neurosurgeon, injected local anaesthetic into his spinal cord in July, 2022. Alam has ben hospitalized in Gleneagles ever since, accruing a medical bill of over $1million. Gleneagles recently brought legal action against Alam seeking to collect on the outstanding bill. In response, Alam has counterclaimed, arguing that Dr Tan was acting as the agent of Gleneagles Hospital and that therefore Gleneagles is responsible for his alleged negligence and not entitled to payment.

The idea that hospitals can be vicariously liable for the actions of supposedly independent doctors has been tested in other jurisdictions, so it was perhaps inevitable that it would emerge in Singapore as well. Alam is arguing that Gleneagles had represented Dr Tan as being sufficiently integrated into their organization that it was reasonable to conclude that he was either an agent or employee. He may have a point, as a casual browse through the Gleneagles website for international patient includes multiple references to “our doctors” and “our specialists”. The relationship between private hospitals and medical specialists is, of course, often misunderstood outside medical circles. 

We will have to wait for this case to come to judgment before we know what the courts will say about the relationship between Gleneagles and Dr Tan. Should Alam’s claim be successful, Singapore’s hospitals will likely respond by requiring doctors to indemnify them against vicarious liability claims, and doctors in turn will ask their malpractice insurance to cover such indemnities. In our experience this may be possible but will inevitably result in increased premiums for doctors. 

Authored by:

Mike Griffiths
Regional Director, Healthcare
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