SINGAPORE: A woman who sued her obstetrician for negligence after she sustained injuries following the birth of her child lost her case against the doctor.
In a judgment released on Thursday (Apr 3), Justice Choo Han Teck found that the obstetrician, Dr Khoo Chong Kiat, had not been negligent in his diagnosis, treatment and care of Ms Cherissa Cheng, who was in her first pregnancy.
Ms Cheng, 32, suffered a tear that led to her excreting faecal matter from her vagina for months, even after Dr Khoo repaired the wound with stitches.
Dr Khoo, 51, is a senior consultant obstetrician and gynaecologist practising at CK Khoo Clinic for Women & Laparoscopy under Royal Clinics of O&G.
Ms Cheng, previously a marketing communications executive in a funeral business, sued Dr Khoo and Royal Clinics of O&G for medical negligence, claiming that Dr Khoo failed to obtain her informed consent before performing several processes related to the childbirth.
She asked for damages for pain and suffering, the impact on her quality of life, and for her and her husband’s loss of future earnings.
The case was heard in a civil trial that began on Feb 4 this year.
Ms Cheng consulted Dr Khoo in September 2019 when she was pregnant.
At her first consultation, she purportedly told Dr Khoo that her mother experienced prolonged labour due to her cervix not dilating, and eventually received an emergency caesarean section. She expressed concerns about natural delivery but Dr Khoo assured her she would be able to deliver naturally.
On May 2, 2020, Ms Cheng was admitted to Mount Elizabeth Novena Hospital for labour to be induced at about 12.05am.
According to Ms Cheng, Dr Khoo informed that an emergency C-section was required at 9.25am on May 3, 2020 and she consented to it.
However, Dr Khoo then told her he wanted to “try something” to see if Ms Cheng could continue with natural birth. He then manually widened Ms Cheng’s cervix – in a process known as a cervical sweep – for a second time, according to Ms Cheng. Dr Khoo disputes this, saying all he did was a vaginal examination.
During the labour, Dr Khoo also made an incision to aid the birth and then applied pressure to Ms Cheng’s abdomen.
Ms Cheng gave birth to her baby through natural delivery at about 10.35am on May 3.
The actions that Dr Khoo took amounted to battery, according to Ms Cheng.
After being discharged, Ms Cheng noticed faecal matter coming out of her vagina. She informed Dr Khoo and saw him on May 6.
According to Ms Cheng, Dr Khoo said there were gaps in the stitching he had done, and that she had suffered an injury in the form of an abnormal connection between her rectum and vagina.
Ms Cheng underwent a surgery to repair her injuries about six months after her child’s birth.
She claimed that due to the incident, she developed post-partum depression and post-traumatic stress disorder, including difficulties bonding with her child.
Disputing Ms Cheng’s points, Dr Khoo said that he had “provided sufficient explanation” to Ms Cheng on the purpose and benefit of the cervical sweep, and that it was not standard practice for consent to be obtained.
Similarly, Dr Khoo said it was not standard practice to obtain formal consent to make an incision and to apply pressure as these were routine procedures of natural vaginal deliveries.
Both sides produced expert witnesses who gave their opinions on the procedures.
Justice Choo accepted Dr Khoo’s evidence that he had explained to Ms Cheng the purpose and process of a cervical sweep before proceeding with it.
He noted that medical procedures often involved numerous steps and routine actions.
“Requiring doctors to obtain explicit consent for each individual act within a medical procedure is impractical and would place an unreasonable burden on them,” he said.
The judge said that Dr Khoo should have noted down the tear and its repair procedure, but did not consider Dr Khoo’s account of events inconsistent.
“Medical notes and reports are prepared to ‘document critical facts about medical management’; they are not intended to be a foolproof shield against potential litigation. It is impossible for doctors to make contemporaneous notes of every step of every procedure they perform throughout the day as multiple events often occur simultaneously in medical practice,” noted Justice Choo.
He also found that Dr Khoo had not been negligent in applying pressure to Ms Cheng’s abdomen to help with her delivery, given her fatigue.
Justice Choo said it was unlikely that Dr Khoo’s application of pressure caused the tear, as the baby’s head was not in a position to cause such an injury.
The judge deemed that Dr Khoo fulfilled the required standard of care in repairing Ms Cheng’s tear.
“Overall, it is clear to me that Dr Khoo was not negligent as his diagnosis, treatment and care of Ms Cheng are supported by a respectable body of medical opinion,” said Justice Choo, referring to how Dr Khoo’s experts had considered the risks and benefits of the medical procedures in his case and produced a defensible opinion.
He found that Dr Khoo’s management of Ms Cheng’s labour and delivery did not constitute battery.
Dismissing Ms Cheng’s S$36,000 (US$26,800) claim for loss of earning capacity, Justice Choo noted there was no loss at all.
Ms Cheng’s manager at the funeral business clarified that her termination was not related to her medical condition but due to the company’s restructuring.
Ms Cheng had been offered a redesigned role, but had rejected it and was able to earn the same or higher incomes in subsequent jobs, the judge noted.
“The reason she left those jobs was not due to any disability or long-term effects from the injury sustained during her delivery, but because she found that the roles were ‘mundane’, ‘not as meaningful’ or ‘not a good fit’ for her. She is now a homemaker, but she admits that she can work and has been looking for a new job,” said the judge.
As to the other expenses, Justice Choo said these would have been incurred even if she had not sustained the injury during delivery.
“I find that Ms Cheng has failed to prove her case and the action is dismissed,” said Justice Choo.
