In this article, we examine the High Court’s unreported judgment in Loganathan Ail Thiagarajan v Dr Lee Mun Toong (Ipoh High Court Civil Suit No. AA-23NCvC-6-07/2019), focusing on the facts, the Court’s findings, and key takeaways from the decision.
In this case, a claim in medical negligence was brought by a 25-year-old mechanic who suffered a penetrating injury to his left eye at work. The suit was brought against an ophthalmologist from a private specialist hospital who had examined and treated him. The plaintiff alleged a failure to diagnose and timely remove an intraocular foreign body (IOFB), resulting in infection, loss of vision, and long-term complications, including glaucoma.
In allowing the claim, the High Court awarded approximately RM1.2 million in damages (excluding interest and costs), including RM500,000 in aggravated damages.
The court’s written grounds of judgment, which were released earlier this month, offer insight into the Court’s reasoning, both for its factual background and legal findings, on liability and damages in a case involving delayed diagnosis and ophthalmic injury. The matter is currently pending appeal before the Court of Appeal.
Summary of Clinical Facts
On 6.7.2011, the plaintiff sustained an injury to his left eye while repairing machinery at his workplace. He sought treatment at a private specialist hospital and was examined by the defendant ophthalmologist.
At the time of admission, the plaintiff had perfect vision but suffered a penetrating injury to the left eye with a 3 cm conjunctiva and scleral tear. However, the defendant did not order imaging to investigate the possibility of an intraocular foreign body. The defendant performed surgical repair the following day (7.7.2011) and assured the plaintiff that no foreign object was present in the eye.
The plaintiff continued to experience severe eye pain, swelling, and blurred vision. A CT scan was only ordered on 11.7.2011 – five days after the initial visit – despite persistent symptoms. The scan ultimately revealed the presence of a metallic intraocular foreign body. On the sixth day, the plaintiff’s left eye became severely infected, resulting in very poor vision, measured at 2/60.
The plaintiff was then referred to several government hospitals for further management, where the intraocular foreign body was surgically removed. The plaintiff’s natural crystalline lens was also removed and replaced with an artificial lens. By the time of the referral and subsequent surgery, the plaintiff had developed intense intraocular inflammation, endophthalmitis and later glaucoma, leading to permanent loss of vision in the affected eye.
Findings on Liability
The High Court held that the defendant failed to meet the standard of care expected of an ordinary, skilled ophthalmologist in detecting and treating the same injury.
Despite the injury’s severity and a scleral tear, the defendant did not arrange for immediate imaging to check for an intraocular foreign body (IOFB). The court dismissed the defendant’s argument that the plaintiff refused a CT scan due to a lack of supporting medical records.
The court also expressed concern over inconsistencies within the medical records, highlighting indications of retrospective alterations. Such discrepancies contributed to findings that the defendant’s version of events was unreliable.
Expert witnesses testified that the mechanism of injury should have strongly raised suspicion of an intraocular foreign body and warranted urgent imaging. Additionally, the failure to administer intravitreal antibiotics in intraocular foreign body cases was deemed a significant departure from accepted medical practice.
Ultimately, the Court found that the delayed diagnosis and inappropriate management were directly responsible for the plaintiff’s development of glaucoma and subsequent permanent loss of vision. It concluded that had the intraocular foreign body been detected and treated earlier, these complications could likely have been avoided. As a result, the High Court held the ophthalmologist liable for medical negligence.
Findings on Quantum
It was undisputed that the plaintiff had suffered complete loss of vision in his left eye. While the defendant suggested RM30,000 as general damages, citing the Bar Council’s Revised Compendium for Personal Injury Awards, the High Court held that the Compendium was not the appropriate reference point for medical negligence cases.
Instead, the court awarded RM200,000 in general damages for pain, suffering, and loss of vision, consistent with prior case laws involving comparable injuries.
The plaintiff suffered from glaucoma as a result of the delayed treatment. Recognising the need for ongoing treatment, medication, and future care, the court awarded RM250,000 for the management of glaucoma and associated complications, taking into account anticipated increases in medical costs.
In addition to physical injury, the plaintiff was diagnosed with major depressive disorder. The court awarded RM50,000 in damages for the plaintiff’s mental health condition.
The plaintiff also suffered a loss of income during his recovery, which included 110 days of medical leave and four months of unemployment. The court awarded RM22,056.80 for actual income loss, based on verified salary records from his prior and interim employment.
Due to permanent blindness in one eye, the plaintiff is no longer able to work as a mechanic. The Court awarded RM253,920 for partial loss of future earning capacity, related to the plaintiff’s loss of vision caused by the defendant’s negligence..
The court also awarded RM500,000 in aggravated damages, condemning the defendant’s conduct as “deplorable and offensive.” The court identified several aggravating factors, including amongst others:-
- deliberate tampering and fabrication of medical records;
- unjustified delays in disclosing medical records to the plaintiff’s solicitors;
- submission of incomplete medical records, which were only corrected after witness testimony, and
- attempts to mislead the court and shift blame, which caused inconvenience and unnecessary distress to the plaintiff.
Summary of Damages Awarded
Conclusion
This case underscores the critical importance of accurate history taking, proper documentation, and timely investigation, particularly in cases involving suspected intraocular foreign bodies. The High Court’s findings make clear that deviations from accepted medical practice, especially in emergency situations involving eye trauma, can result in irreversible harm to patients and substantial legal liability for healthcare providers.
Equally significant is the court’s strong stance on the integrity of medical records. The discovery of retrospective alterations and efforts to mislead the court contributed to a substantial award in aggravated damages, reflecting the judiciary’s intolerance for unethical conduct in clinical practice.
For medical professionals, this case serves as a sobering reminder of the high standards of care and professional integrity expected in the management of ocular injuries and the serious medico-legal consequences that may follow when those standards are not upheld.
By Jeremy Balang and Jason Lim
Note: This article does not constitute legal advice to any specific case. The facts and circumstances of each and every case will differ and therefore will require specific legal advice. Feel free to contact us for complimentary legal consultation.
