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\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs16\insrsid8421204 \tab Lila Wati v Attorney-General (HC)}{\fs16\insrsid8421204\charrsid933470 \tab }{\field{\*\fldinst {\cs16\fs16\insrsid8421204\charrsid12604364  PAGE }}{\fldrslt {
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\par }{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Damages for personal injuries \endash  negligence \endash  evidence - whether surgeons negligent in performing a thyroidectomy \endash 
 whether staff negligence in post-operative treatment and care \endash  onus on Plaintiff to establish positive acts of negligence \endash  no case submission of no affirmative evidence of negligence}{\i\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 
 }{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par The Plaintiff suffered for 2 years from thyroid swelling commonly known as goitre and was referred to the CWM Hospital from a private medical practit
ioner. After 15 months of reviews and cancellation of initial operation, a surgeon performed a subtotal thyroidectomy.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
The result was a possibility of vocal cord palsy and 3 days later, another surgeon performed a fibre optic bronchoscopy.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
Her wheezing c
ontinued and she was prescribed medication but complained that her condition deteriorated, resulting in noisy breathing, inability to eat solid foods, her speech was barely audible, sleep was possible only in a foetal position, suffered embarrassment abou
t eating or breathing in public, inability to fend for herself and inability to find gainful employment. A specialist testified that the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s difficulty swallowing was a result of laryngeal nerve damage sustained during her operation, and breathing p
roblems occurred due to nerve damage after surgery, which could be controlled with medication. The Court found that this was not a case based on the failure of surgeons to inform the Plaintiff of potential complications of undergoing surgery nor based on 
}{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 res ipsa locquitor}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  that the Plaintiff
 felt worse after an operation due to something gone wrong during its performance. Neither was this a case of the standard of care extended to the Plaintiff pre and post operation. This case was to establish whether surg
eons performed some positive acts of negligence and that the negligence caused nerve damage and vocal cord palsy, or that the surgeon negligently failed to take some precaution which would have obviated or minimized the risk of injuries occurring. The 
Defendant made a no-case submission that there was no affirmative evidence of negligence.
\par 
\par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Held \endash  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 to succeed, the Plaintiff
 must establish: 1) that there were some acts of negligence on the part of the surgeon who operated on the Plaintiff in initial surgery, and 2) that the negligence caused nerve damage and vocal cord palsy that the Plaintiff suffered.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 evidence failed to positively establish any negligence (beyond misadventure) on the part of the surgeon who operated on the Plaintiff nor any negligence in the Plaintiff}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s care afterward, from which it may be reasonably inferred that there was negligence on the part of the staff of the hospital.

\par 
\par A }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 No case}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  submission upheld. Judgment for the Defendant.
\par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par Cases referred to in Ruling }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6319170\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 appl }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Jones v General Western Railway Co. }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
[1930] 47 TLR 39
\par foll }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Roe v Ministry of Health}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  (2) [1954] 2 All ER 131
\par foll }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Bolam v Friern Hospital Management Committee}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  [1957] 2 All ER 118
\par ref }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Hunter v Hanley}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  [1955] SLT 213
\par foll }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Hicks v Cole}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  [1968] 118 New LJ 469
\par 
\par }{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Ram Chand for the Plaintiff
\par Sunil Kumar & Yashveen Singh for the Defendant
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\par Fatiaki, J}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\b\fs24\lang2057\langfe1033\langnp2057\insrsid6319170\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 In this action the Plaintiff claims special and general damages for injuries she allegedly suffered as a result of the negligent performance of a thyroidectomy by surgeons at the 
Colonial War Memorial Hospital (}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 CWM}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 ) on 4th October 1993.
\par 
\par The Statement of Claim sets out no less than seven (7) alleged particulars of negligence both during and after the Plaintiff had been operated upon.
\par 
\par The Statement of Defence whilst admitting that a duty of care was owed to the Plaintiff nevertheless denies that there was any breach of that duty by the surgeons and doctors who attended to the Plaintiff before, during and after her operation.
\par 
\par The background facts are not seriously disputed and are briefly as follows:}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The Plaintiff
 a 44 year old housewife was first referred to the CWM by a private medical practitioner on 23rd July 1992 with a history of thyroid swelling more commonly known as }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 goitre}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 , extending over two (2) years and which was }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 increasing in size}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 She had complained at the time of }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 cough while eating any sort of food}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The referral letter also stated that the Plaintiff had }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 a family history of goitre}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 On 10th August 1992 on being reviewed at the CWM it wa
s noted that }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 she feels very lazy and doesn}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 t feel like doing normal duties}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  and }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 also sleeps more than before}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par The reviews continued uneventfully until 14th April 1993 when the Plaintiff complained of }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 hoarseness when tries to speak loud}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
On that occasion she also signed a consent to undergo a }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Subtotal Thyroidectomy}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  to remove the goitre but the operation was not performed owing to a shortage of compatible blood.
\par 
\par Finally on 3rd October 1993 a second consent form was completed by the Plaintiff and this time she was admitted in the CWM and was operated upon by Dr. Etika Vudiniabola on the morning of 4th October 1993.
\par 
\par After the operation the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s hospital record indicates on the afternoon of 4th October that }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 inspiratory stridor with expiratory wheeze could be heard}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The reviewing doctor (Dr. Maen) assessed a possibility of: }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Vocal cord palsy}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Subsequently on 7th
 October a Fibre Optic Bronchoscopy conducted by Dr. Karim revealed that there was:}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 oedema of the vocal cords}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  which were }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 both mobile}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par The Plaintiff remained in CWM until her discharge on 13th October 1993.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
During that time her condition was continuously monitored including the inspiratory stridor}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
(or wheezing sounds) in her chest and, occasionally, she had to be put on a}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 nebulizer to relieve her breathing problems.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The hospital record also indicates that the Plaintiff
 was initially unable to swallow water without coughing it out and had to be maintained on a drip feed for several days, then slowly introduced to a fluid diet and finally a soft diet just prior to her discharge from CWM.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Thereafter the Plaintiff
 continued to attend the asthma clinic as an out-patient and was prescribed medication for her continuing medical problems.
\par 
\par The Plaintiff in her evidence described in some
 detail how her condition had deteriorated after her operation - She could no longer eat any solid food; her breathing was very noisy and painful; she suffers from permanent shortness of breath and lethargy and her speech is barely audible; s
leep is only p
ossible in a foetal position and she is often embarrassed by her noisy breathing in public and when eating, and, unlike before her operation, when she was gainfully employed as a house-girl, now she has to be cared for by a sister as she is unable to fend
 for herself.
\par 
\par In cross-examination she said: }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 I feel worse now after my operation than before it}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  and in re-examination: }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 I cannot eat solids anymore and have difficulty speaking and my breathing is noisy.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 ' }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 She does acknowledge however that since the operation she no longer suffers from }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 goitre}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par Dr. Pradeep Kumar Narayan an ear, nose and throat (ENT) specialist testified that he had examined the Plaintiff in February 1998 at the request of her counsel and had found }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 ... that there was palsy (paralysis) of both vocal cords.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
No movement at all}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  which accounted for her difficulty in speaking and breathing.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 He could not explain however, why the Plaintiff
 had difficulty swallowing other than as a result of laryngeal nerve damage sustained during her operation. 
\par 
\par From having examined the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s hospital records he formed the view that the Plaintiff}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s breathing problems occurred after surgery due to nerve damage.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 When asked in-chief: }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Is this a normal after effect of surgery?
}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  He answered: }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Sometimes does happen but can control it through medication.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
But nerve damage is nowadays becoming increasingly rare but then it can happen and a patient must be routinely informed of such an event.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par He was unable to comment generally on the quality of the treatment the Plaintiff received at the CWM other than to say inspiratory stridor can be made voluntarily and that the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s stridor (noisy breathing) was only treated }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 symptomatically}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  during her confinement at CWM since, in his opinion, her vocal cord palsy was not diagnosed until 1998 when the Plaintiff
 was referred to an ENT specialist. Even then, the success rate of surgically treating the condition }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 is unpredictable}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par In cross-examination Dr. Narayan accepted that }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 some complications are expected in su
rgery but nerve injury during thyroid surgery is becoming increasingly rare}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 
 }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 In answer to the court}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s question Dr. Narayan said: }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 I cannot say that there was anything negligent in the actual procedure carried out.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 In fact surgery carried out by very experienced surgeon.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 In 1993 Dr. Etika was the most eminent surgeon in this country.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  He also could not say with any certainty that the Plaintiff }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
was not informed of this possible complication prior to surgery}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  a procedure which he accepted }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 is a normal treatment for goitre}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par In re-examination Dr. Narayan accepted that nerve injury can occur during surgery but }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
this should be explained as a potential complication to the patient}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 He also described two (2) techniques for carrying out the operation without damaging the nerve.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 But even then he said }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 nerve damage may be caused}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid6319170 . }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par 
\par In this latter regard it should be noted that the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s case is not one of negligence based upon a failure to inform the 
Plaintiff of the potential complications of undergoing the surgical procedure (i.e. thyroidectomy) nor is it pleaded on the basis of }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 res ipsa locquitor}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  that the Plaintiff
 felt worse after the operation and therefore something must have gone wrong during its performance.
\par 
\par Needless to say the Plaintiff herself accepted that she had signed both consent to undergo operation forms and she testified that: }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 ... the operation was explained to me that they would remove the goitre and I would be ok}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Furthermore she agreed that before the operation }{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 (the medical staff) changed my clothes.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 They checked my vital signs thoroughly.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
They checked whole body and dressed me up}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  and rendered her unconscious before the operation.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 At the end of her cross-examination, the Plaintiff 
agreed that the doctors had given her all the care they could provide and had tried their best to cure her.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
Certainly no specific complaint was made in her evidence regarding the post-operative treatment or care she received at the hands of the hospital staff at CWM.
\par 
\par Given the nature of the evidence led by the Plaintiff, State Counsel made a }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 no-case}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
 submission to the Court on the basis that there was no affirmative evidence of negligence either in the operative procedures carried out or in the post operative treatment given to the Plaintiff
 at the CWM nor, Counsel submits, ought an inference of negligence be drawn from the evidence produced since the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
s claim was pleaded as one of positive negligence i.e. }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 not by omission but by commission}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 .
\par 
\par In this latter regard I remind myself of what Viscount Hailsham said in }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkstart Jones_v_General_West_Rly_Lila_Wati_v_AG}Jones v General Western Railway Co.}{
\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkend Jones_v_General_West_Rly_Lila_Wati_v_AG}[1930] 47 T.L.R.39 at p.41:}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
It is not enough that the evidence affords material for conjecturing that (the injury) may have been caused by the Defendant}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
s negligence unless it furnishes data from which an inference can reasonably be drawn that, as a matter of fact, it was so occasioned.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par In dealing with the submission I remind myself that in order to succeed in her claim the Plaintiff must establish two (2) things, firstly that there was some act(s) of negligence on the part of the surgeon who operated on the Plaintiff at the CWM on 4th
 October 1993, and secondly, that that negligence caused the nerve damage and vocal cord palsy that the Plaintiff
 suffered, or at least that the surgeon negligently failed to take some precaution which would have obviated or minimised the risk of those injuries occurring.
\par 
\par Having said that it is well to bear in mind the salutary observations of Denning L.J.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 in }{
\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkstart Roe_v_Ministry_of_Health_Lila_Wati_v_AG}Roe v Ministry of Health}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  
{\*\bkmkend Roe_v_Ministry_of_Health_Lila_Wati_v_AG}(2) [1954] 2 All ER}{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214  131 where he said at p.139:}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
... we should be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Doctors would be led to think more of their own safety than of the good of their patients.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Initiative would be stifled and confidence shaken.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
A proper sense of proportion requires us to have regard to the conditions in which hospitals and doctors have to work.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
We must insist on due care for the patient at every point, but we must not condemn as negligence that which is only a misadventure.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Earlier at p.137}{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214  his lordship said:}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
Every surgical operation is attended by risks.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 We cannot take the benefits without taking the risks.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Every advance in technique is also attended by risks.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par The }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 locus classicus}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  of the test for the standard of care required of a doctor is to be found in the oft-cited direction given to the jury by}{
\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 McNair J. in }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
{\*\bkmkstart Bolam_v_Friern_Lila_Wati_v_AG}Bolam v Friern {\*\bkmkend Bolam_v_Friern_Lila_Wati_v_AG}Hospital Management Committee}{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 [1957] 2 All ER 118 where he said at p.121}{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214 :}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
... where you get a situation which involves the use of some special skill or competence, then the test whether there has been negligence or not is not the test of the (ordinary) man ... the test is the standard of the ordinary skilled man exercising a
nd professing to have that special skill.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 A man need not possess the highest expert skill at the risk of being found negligent.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising th
at particular art.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par Then, after referring to the dictum of Lord Clyde in }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkstart Hunter_v_Hanley_Lila_Wati_v_AG}Hunter v Hanley}{
\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkend Hunter_v_Hanley_Lila_Wati_v_AG}[1955] S.L.T.213 at 217 McNair J. said (ibid at p.122):}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par With the above in mind I have carefully considered the evidence led in the case before me and although I confess to entertaining some considerable sympathy for the Plaintiff}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 s condition, I have reluctantly come to the conclusion that the evidence fails to positively establish any negligence (beyond misadventure) on the part of the surgeon who operated on the 
Plaintiff on 4th October 1993, or, in her care and treatment thereafter, nor is the evidence of a nature and quality from which it may be reasonably inferred that there was negligence on the part of any of the staff of CWM.
\par 
\par As was said by Lord Denning M.R. in }{\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 {\*\bkmkstart Hicks_v_Cole_Lila_Wati_v_AG}Hicks v Col{\*\bkmkend Hicks_v_Cole_Lila_Wati_v_AG}e}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  [1968] 118 New L.J. 469: }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid16524214\charrsid2907850 
\par }\pard \ql \li720\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid2907850 {\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
A charge of professional negligence against a medical man was serious.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
It stood on a different footing to a charge of negligence against the driver of a motor car. The consequences are far more serious. It affected his professional status and reputation.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The burden of proof was correspondingly greater.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
As the charge was so grave, so should the proof be clear.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 With the best will in the world, things sometimes we
nt amiss in surgical operations or medical treatment.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 A doctor was not to be held negligent simply because something went wrong.}{
\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 He was not liable for mischance or misadventure; or for an error of judgment.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  
}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 He was not liable for taking one choice out of two or for favouring one school rather than another.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 He was only liable when he}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
fell below the standard of a reasonably competent practitioner in his field so much so that his conduct might be deserving of censure or inexcusable.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }\pard \ql \li0\ri0\nowidctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2907850 {\b\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The Plaintiff having failed to establish any negligence on the part of the operating surgeon or}{\b\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850  }{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 in her post-operative aftercare, I am constrained to uphold the }{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{
\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 no-case}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850 '}{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
 submission and accordingly judgment will be entered for the Defendant and I order accordingly.}{\fs24\lang2057\langfe1033\langnp2057\insrsid2907850  }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 The question of costs is reserved.

\par }{\i\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 
\par Action dismissed.
\par  
\par }{\fs24\lang2057\langfe1033\langnp2057\insrsid4619011\charrsid2907850 Marie Chan}{\fs24\lang2057\langfe1033\langnp2057\insrsid1972231\charrsid16524214 
\par }}