The High Court has dismissed negligence claims against a hospital and three doctors by a woman who alleged that if a nodule in her lung had been detected as cancerous five years earlier, it would have made a difference.
After a 28-day trial, Justice Belinda Ang found that the nodule in the right lung of Ms Noor Azlin Abdul Rahman was benign when it was first detected in 2007 by the doctors at Changi General Hospital (CGH), and remained so through 2011.
"The plaintiff does not have any definitive medical evidence showing that she had cancer from 2007 to 2011," said the judge in decision grounds earlier this month.
Justice Ang found that the defendants were able to show - based on expert testimony and supported by radiological and other evidence - that the nodule "was initially benign".
It turned malignant some time after July 2011 and before early February 2012, she said.
Lung cancer was detected following a biopsy that Ms Azlin, 38, underwent on Feb 16, 2012.
"The medical evidence shows that (she) was diagnosed at the earliest possible stage of her cancer and received the full treatment available to her," wrote Justice Ang.
She noted that Ms Azlin " did not lose out on any opportunity to take advantage of any available treatments and did not undergo any treatment that could have been avoided".
Ms Azlin's lung cancer is now at stage four.
Through her lawyer V.K. Rai, she had sought damages from CGH and the three doctors for their alleged failure to diagnose and treat the nodule during her consultations for five years, before the cancer was diagnosed in 2012.
The doctors are respiratory specialist Imran Mohamed Noor, and two medical officers who attended to her at the accident and emergency department, Dr Yap Hsiang and Dr Jason Soh. All three attended to her at different times.
The hospital, defended by lawyer and now Senior Counsel Kuah Boon Theng, and the three doctors, represented by lawyer Lek Siang Pheng, disputed the claims.
The trial, which took place in several tranches last year, saw several experts testifying on both sides.
Justice Ang, in a 68-page judgment, said Ms Azlin's negligence claims failed because a causation was "simply not made out".
She noted that the lung cancer that Ms Azlin has is a very specific type of cancer known as an ALK-positive cancer. It occurs due to a rare gene fusion process, which can transform benign cells into malignant cells.
Based on the expert evidence, the nodule - which had been stable and dormant during the time the defendants examined her - became more aggressive only subsequently.
Although the judge held that CGH and Dr Imran, whom Ms Azlin was referred to in November 2007, had breached their duty of care in one aspect, this did not cause her cancer nor support her claim for compensation.
Justice Ang found that the hospital had failed to inform Ms Azlin of the results of April 2010 and July 2011 X-rays.
The judge suggested that the hospital have a patient notification system "as part of the safety net" to inform a patient of X-ray report results "even if it had decided that there was no need for further follow-up".
CGH declined comment when contacted by The Straits Times.
Ms Azlin, who is undergoing daily radiation treatment, intends to appeal.
She told The Straits Times that she was grateful for being employed as a part-time supervisor.
"I'm a gladiator," she added.