TORT: Negligence - Medical negligence - Ectopic pregnancy - Deceased complained of abdominal pain - Condition of deceased - Conservative management approach - Whether deceased suitable for such approach - Failure to immediately deal with deceased's life-threatening condition - Deceased suffered from upper respiratory throat infection - Operation carried out under emergency situation - Deceased died about seven months later due to sepsis secondary to pneumonia and sacral sore - Deceased's consent for operation - Whether defendants absolved from liability - Whether deceased's death could be traced back to risk created by defendants in managing ectopic pregnancy - Whether damages awarded

TORT: Negligence - Damages - Medical negligence - Ectopic pregnancy - Deceased suffered from upper respiratory throat infection - Operation carried out under emergency situation - Deceased died about seven months later due to sepsis secondary to pneumonia and sacral sore - Whether deceased's death could be traced back to risk created by defendants in managing ectopic pregnancy - Claim for funeral expenses, bereavement, loss of support, nursing care, pain and suffering and medical expenses - Whether damages awarded

[CIVIL SUIT NO: 21NCVC-11-03-2012]

The deceased, who complained of bleeding and had spotting on her pad, was admitted to Hospital Sultanah Aminah Johor Bahru (`HSA') on 13 February 2009. After taking her medical history, the doctor's impression at HSA was to rule out ectopic pregnancy with differential diagnosis of early pregnancy. The deceased was seen and examined by the first defendant. After performing certain medical examinations, a decision was then made by HSA to manage her pregnancy conservatively or sometimes referred to as expectant management. It meant that the doctors at HSA did not operate on the deceased but instead, waited and watched on how the ectopic pregnancy evolved. On 14 February 2009, the deceased was reviewed and was noted to have the same abdominal pain with associated tenderness and vaginal bleeding. Whilst managing her conservatively, the plan was also to carry out an emergency laparotomy. Days passed by and the conservative management was proceeded with whereby the hospital waited for the ectopic pregnancy to rupture but the deceased's condition remained the same. On 20 February 2009, a scan which was conducted showed, inter alia, an empty uterus. The impression this time was failing ectopic pregnancy of unknown location. The deceased was then discharged. On 24 February 2009, the deceased was admitted at HSA where she complained of, inter alia, abdominal pain and on the following day, another transvaginal scan was done which showed that the deceased had considerable bleeding from the pregnancy. The deceased was then scheduled for a laparotomy as a leaking ectopic pregnancy case. On the same day, an operation was scheduled but after assessing her condition, the anaesthetist found that the deceased was having throat irritation and non-productive cough for two days prior to admission which was not noted by the doctors in the obstetrics and gynaecology ward earlier. The deceased was advised as to the danger of anaesthesia which was due to her upper respiratory throat infection (`URTI') but the paramount urgency for the laparotomy was also explained and she consented to the anaesthesia and surgery. During anaesthesia, difficulty in intubation was encountered. Unfortunately, complications set in and the deceased developed bronchospasm which eventually led to pneumonia. The deceased's condition worsened and she was managed in the intensive care unit where she was diagnosed as suffering from left lung collapse. On 4 March 2009, at the request of her husband, the deceased was sent to the Johor Specialist Hospital (`private hospital') where she was diagnosed as having post-operative nosocomial pneumonia with septicaemia. In view of the mounting expenses, the deceased was then transferred back by her husband to HSA. She remained in this hospital until 6 August 2009 when her husband was advised that her condition would not improve and there was to be no further treatment. She was then discharged and on 3 September 2009, the deceased was readmitted to Hospital Sultan Ismail where she passed away on 5 September 2009. The cause of her death was due to sepsis secondary to pneumonia and sacral sore. The plaintiffs filed a suit for negligence against the defendants and claimed for damages. The key issue that arose for determination was whether the deceased's death could be traced back to the risk created by the defendants in the way they managed the ectopic pregnancy during the period of her admission at HSA.

Held (allowing plaintiffs' claim; damages awarded accordingly):

(1) The third defendant's version that the location of the deceased's pregnancy could not be established was false as it went against all findings and recordings in the medical notes of the deceased. The undeniable truth was that the location of the pregnancy was known. The deceased had pain in her lower abdomen and she was bleeding via her vagina. It was clear that she was clinically symptomatic throughout her stay at HSA. The source of the pain and bleeding could not be anything else other than the ectopic pregnancy. (para 19)

(2) There was evidence of an ectopic pregnancy in the right fallopian tube during the six days of the deceased's admission. Hence, ample opportunity was there for HSA to deal with this life-threatening condition but they did not do so. Instead, the deceased was sent home on 20 February 2009 and when she came back four days later, they were forced to carry out the operation under an emergency situation when she already had an upper respiratory tract infection. Further, the deceased was not the right patient for conservative management approach since, inter alia, (i) there was repeated evidence (ultrascans) that it was an ectopic pregnancy; and (ii) from the time of her admission until her discharge, the deceased showed two cardinal symptoms of ectopic pregnancy, ie, constant complaint of pain in the right iliac fossa and continued bleeding through the vagina. (paras 23 & 24)

(3) The deceased was not managed appropriately by the doctors at HSA during the period of her admission. The deceased had suffered the consequences of a lost chance when the doctors failed to operate on her when the opportunity and indications were there to do so. Further, when the deceased came back to HSA after being discharged on 20 February 2009, it was obvious that her ectopic pregnancy had leaked and she was suffering from URTI. (para 25 & 33)

(4) The risk of anaesthetic complications was created by the defendants when they failed to operate on the deceased immediately or so soon after it was confirmed on 17 February 2009 that the deceased was having an ectopic pregnancy and when the condition was optimal for her to undergo the operation. Thus, it was negligence by omission. If surgery had been performed before her discharge on 20 February 2009, the anaesthetic complications would not have arisen and the surgery on 25 February 2009 would not have been necessary at all. While it was true that the URTI that the deceased contracted after her discharge on 20 February 2009 was something beyond the defendants' control, the necessity to perform the emergency operation on 25 February 2009 was something that could easily have been avoided. (para 39)

(5) By omitting to operate on the deceased before discharging her on 20 February 2009, the defendants had provided the causative link to the anaesthetic complications which eventually led to the deceased's death. Further, the throat irritation and non-productive cough for two days that the deceased was having prior to the emergency surgery should have been observed by the doctors on 24 February 2009 when the deceased was re-admitted. However, this was not done and no treatment was given for her URTI. The fact that bronchospasm was a risk of operation which had been explained to the deceased and that she had consented to go ahead with the operation could not absolve the defendants from liability if otherwise they were negligent in creating that risk. On a balance of probability, the defendants were liable in negligence for the death of the deceased. (paras 39)

(6) As for damages, the court awarded, inter alia, (i) RM5,000 for funeral expenses; (ii) RM10,000 for bereavement (s. 7(3A) and (3B) of the Civil Law Act 1956); (iii) RM43,200 for loss of support to the deceased's parents; (iv) RM86,400 for loss of support to the deceased's children; (v) RM3,400 for nursing care of the deceased; and (vi) RM150,000 for pain and suffering (s. 8 of the Civil Law Act 1956). The deceased suffered pain and suffering in the hospital for seven months until she died. (paras 41, 42, 43, 44 & 60)

(7) The deceased was not immediately taken to the private hospital and was admitted to a government hospital between 24 February 2009 to 4 March 2009 before the family, in desperation and disappointment with the care given there, decided to take her to the private hospital. Although the treatment at the private hospital could not be completed due to the family's inability to meet the costs and the deceased subsequently died, their attempt to save her by transferring her to the private hospital was still a reasonable action under the circumstances. Based on the Court of Appeal decision in Civil Appeal No. J-01-113-03/2012, this court allowed the plaintiff's claim for RM142,515 for the medical expenses incurred at the private hospital. (paras 51, 54, 56 & 62)

Case(s) referred to:

Bolam v. Friern Hospital Management Committee [1957] 2 All ER 118 (refd)

Chong Pik Sing & Anor v. Ng Mun Bee & Ors [1985] 1 CLJ 332; [1985] CLJ (Rep) 70 FC (refd)

Devadass Raju v. Tham Soon Kum & Ors [2013] 7 CLJ 178 HC (refd)

Dominic Puthucheary & Ors v. Dr Goon Siew Fong & Anor [2007] 5 CLJ 38 CA (refd)

Foo Fio Na v. Dr Soo Fook Mun & Anor [2007] 1 CLJ 229 FC (refd)

Foong Yeen Keng v. Assunta Hospital (M) Sdn Bhd & Anor [2006] 1 CLJ 608 HC (refd)

Hum Peng Sin v. Lim Lai Hoon & Anor [2001] 4 CLJ 185 CA (refd)

Jennifer Anne Harper v. Timothy Theseira [2009] 2 CLJ 499 HC (refd)

Marappan Nallan Koundar & Anor v. Siti Rahmah Ibrahim [1990] 1 CLJ 32; [1990] 1 CLJ (Rep) 174 SC (refd)

Pang Ah Chee (M.W) v. Chong Kwee Sang [1985] 2 CLJ 221; [1985] CLJ (Rep) 236 FC (refd)

Payremalu Veerappan v. Dr Amarjeet Kaur & Ors [2001] 4 CLJ 380 HC (refd)

Rogers v. Whitaker [1992] 175 CLR 479 (refd)

Wilsher v. Essex Area Health Authority [1988] All ER 872 (refd)

Legislation referred to:

Civil Law Act 1956, ss. 7(3A), (3B) 8

Other source(s) referred to:

Atkins Court Forms Malaysia, Vol. 9, p. 152


For the plaintiffs - N Jegatheesan (R Jayabalan with him); M/s John Ang & Jega

For the defendants - Zaliha Mohd Janis (Pushpa Arasi Federal Counsel with her); M/s AG's Chambers

Reported by Kumitha Abd Majid

UTILITI-UTILITI: Pembekalan - Usikan meter - Tuntutan untuk bil kebelakang - Sama ada terdapat usikan pada pepasangan meter - Sama ada defendan bertanggungjawab terhadap usikan meter - Sama ada defendan bertanggungjawab membayar jumlah yang dituntut oleh plaintif - Sama ada pemeriksaan perlu dijalankan oleh seorang penyelia elektrik - Sama ada penyata bil kebelakang adalah keterangan prima facie berkenaan jumlah terhutang yang perlu dibayar - Sama ada tuntutan plaintif dibenarkan

[SAMAN NO: 52-1523-2011]
31 MEI 2012

Tuntutan plaintif terhadap defendan adalah berkenaan jumlah bil kebelakang yang dikira semula untuk tempoh tertentu bagi kegunaan elektrik yang tidak direkodkan akibat usikan pada pepasangan meter milik plaintif yang dipasang di premis defendan. Pada dua tarikh yang berasingan, pasukan penyiasat plaintif telah membuat pemeriksaan pada pepasangan meter di premis defendan. Hasil daripada dua pemeriksaan tersebut, plaintif mendapati bahawa terdapat usikan pada pepasangan meter tersebut yang menyebabkan meter gagal merekodkan penggunaan sebenar elektrik oleh pengguna. Lanjutan daripada dua pemeriksaan tersebut, plaintif telah membuat pengiraan semula untuk tujuan "back billing" dan menuntut jumlah penggunaan tenaga elektrik yang tidak direkodkan sebanyak RM107,905.21 termasuk kos operasi dan kos pembaikan. Defendan membuat bayaran sebanyak RM20,000 dan meninggalkan baki hutang sebanyak RM87,905.21 yang masih gagal dijelaskan oleh defendan. Plaintif memulakan tindakan ini dengan menuntut baki yang terhutang sebanyak RM87,905.21, faedah dan kos. Dalam pembelaannya, defendan menghujah, antara lain, bahawa (i) defendan tidak mempunyai pengetahuan yang jelas tentang dua pemeriksaan yang dijalankan oleh plaintif; (ii) defendan menafikan melakukan sebarang usikan pada pepasangan meter; (iii) jika meter gagal berfungsi dengan baik, ia disebabkan oleh kecuaian dan kesilapan plaintif; (iv) pegawai pemeriksa adalah orang yang tidak berkelayakan memandangkan beliau bukan berjawatan penyelia elektrik; dan (v) jumlah tuntutan dalam surat tuntutan berbeza dengan tuntutan dalam pernyataan tuntutan. Isu-isu yang dibangkitkan untuk pertimbangan adalah (i) sama ada terdapat usikan pada pepasangan meter di premis defendan; (ii) sama ada defendan bertanggungjawab terhadap usikan tersebut; dan (iii) sama ada defendan bertanggungjawab membayar jumlah yang dituntut oleh plaintif.

Diputuskan (membenarkan tuntutan plaintif dengan kos):

(1) Keterangan yang diberikan oleh juruteknik tingkatan biasa yang telah berkhidmat dengan plaintif adalah selari dengan gambar-gambar yang diambil berhubung usikan yang dibuat pada pepasangan meter. Oleh itu, plaintif berjaya membuktikan bahawa terdapat usikan pada pepasangan meter milik plaintif di premis defendan. (perenggan 29)

(2) Defendan bertanggungjawab terhadap usikan-usikan yang dilakukan pada pepasangan elektrik itu. Tambahan, defendan gagal membuktikan terdapat kesilapan dan kecuaian oleh plaintif semasa memasang pepasangan elektrik itu. Sebaliknya, plaintif telah membuktikan bahawa selepas meter baru dipasang, terdapat usikan dilakukan pada meter tersebut berdasarkan kepada pemeriksaan yang dijalankan. (perenggan 30 & 31)

(3) Tiada peruntukan undang-undang yang menghendaki pemeriksaan rutin yang dijalankan oleh plaintif perlu dibuat oleh penyelia elektrik. Mana-mana pegawai atau kakitangan plaintif yang diberi kuasa oleh plaintif boleh melakukan pemeriksaan rutin. (perenggan 33)

(4) Pihak yang mendapat keuntungan hasil usikan meter adalah defendan sendiri dan plaintif tidak mempunyai apa-apa kepentingan untuk mengusik meter tersebut. Malah, sekiranya plaintif melakukan usikan pada meter, plaintif akan mengalami kerugian apabila meter gagal mencatat kegunaan sebenar elektrik. (perenggan 34)

(5) Plaintif berhak menuntut jumlah RM87,905.21 berdasarkan peruntukan di bawah s. 38(5) Akta Bekalan Elektrik 1990 yang memberi kuasa kepada pemegang lesen, iaitu plaintif, untuk menuntut sebarang kerugian akibat kesalahan di bawah s. 37 Akta yang sama. Oleh itu, penyata bil kebelakang yang dikemukakan oleh plaintif adalah keterangan prima facie berkenaan jumlah terhutang yang perlu dibayar oleh defendan kepada plaintif. Beban pembuktian telah berpindah kepada defendan untuk mempertikaikan kesasihan butir-butir dalam "back billing" tersebut. (perenggan 36, 38 & 50)

(6) Surat tuntutan bukanlah sebahagian daripada pliding dan tidak mengikut kepada jumlah tuntutan yang ingin dituntut oleh plaintif. Maka, pembelaan defendan hanyalah penafian semata-mata dan hujahan yang dikemukakan oleh defendan adalah tidak bermerit. (perenggan 49 & 53)

Kes-kes yang dirujuk:

Chin Hong Trading & Packaging Sdn Bhd v. Tenaga Nasional Berhad [2011] 1 LNS 1431 HC (dirujuk)

Claybricks & Tiles Sdn Bhd lwn. Tenaga Nasional Bhd [2006] 4 CLJ 892 CA (dirujuk)

Everhome Furniture Manufacturing (M) Sdn Bhd v. Tenaga Nasional Berhad [2009] 1 LNS 602 HC (dirujuk)

Perundangan yang dirujuk:

Electricity Supply Act 1990, ss. 37, 38(4), (5)


Bagi pihak plaintif - Abd Rahim Ali; T/n Shahrizat Rashid & Lee

Bagi pihak defendan - Ibrahim Haikal Razak; T/n Hanif & Co

Dilaporkan oleh Kumitha Abd Majid