The Noor Azlin case is significant for its decision's analysis of hospitals' liability for systemic failures, two law professors say in the Singapore Academy of Law's (SAL) journal.
The decision by the Court of Appeal also made clear that "judges will not second-guess doctors", wrote National University of Singapore law professor K. Amirthalingam and Singapore Management University law professor Gary Chan in a recent joint article in the SAL's Annual Review for 2019 cases.
"Regardless of the niceties of the law, doctors should be reassured by the Singapore Court of Appeal's reaffirmation that in the areas of diagnosis, treatment and care, judges will defer to medical opinion in resolving the standard of care in cases involving genuine medical controversy unless the opinion is logically indefensible," they said in the article e-published in July.
The law professors listed the case as one of the 10 most significant judgments in the tort of negligence for 2019.
Ms Noor Azlin Abdul Rahman had sued Changi General Hospital (CGH) and its doctors, claiming their negligence had delayed the detection of her cancer and led to an adverse medical outcome.
The High Court judge found CGH negligent for failing to provide the appellant with the X-ray reports or its findings to enable her to determine for herself whether she needed a follow-up or to have a second opinion. The judge found the physician negligent for failing to schedule a follow-up to ensure that the opacity had cleared, but the accident and emergency (A&E) doctors were cleared of negligence.
Although CGH and the physician were held to have acted negligently, the judge dismissed the claim, holding that Ms Noor had failed to show that it was negligence that caused the damage.
The Court of Appeal reversed the judge's decision in relation to CGH, finding that its negligence had caused the loss. The top court upheld the decisions in relation to the three doctors.
"The court also emphasised that in determining the standard of care, it would take into account the specialisation of the doctor and the surrounding context; this is particularly relevant to emergency medicine," said the law professors in their article.
In relation to the hospital, the court had found its then system of routing radiological reports back to the A&E department to be unsafe as A&E doctors might be too busy with emergencies to review reports carefully.
Among other things , the court also found that CGH did not have a mechanism to consolidate all the patient's information to ensure an uninterrupted flow of information to all professionals dealing with the patient.
The court found Ms Noor had proved on a balance of probabilities that she was suffering from lung cancer by July 2011. This was based on the size of the nodule and the pace of its growth in size between 2010 and 2011 as well as the diagnosis of Stage IIA cancer in March 2012. Thus CGH was found liable as its negligence led to a delay in diagnosis and likely cure, wrote the law professors.