Does an attending physician have a duty to inform or warn a patient to give accurate answers to questions posed during history-taking exercise?

DR PREMITHA DAMODARAN v. GURISHA TARANJEET KAUR & ANOR AND ANOTHER APPEAL [2022] 3 CLJ 797

• The First Plaintiff in this case is Baby Gurisha Taranjeet Kaur (“Baby Gurisha”) who is the second child of the Second Plaintiff, Madam Baljeet Kaur (“Baljeet”).
• The First Defendant in this case is Dr Premitha Damodaran (“Dr Premitha”), a consultant Obstetrician and Gynaecologist with a medical practice at Pantai Hospital Kuala Lumpur.
• Baljeet consulted Dr Premitha as a patient during her pregnancy with Baby Gurisha.
• Baljeet had opted for a normal delivery for the birth of Baby Gurisha.
• According to Dr Premitha, the birth weight of Baljeet’s first child, Soheil (“Soheil”) was an important factor to be considered in the management of her pregnancy and delivery of Baby Gurisha, and to this, Baljeet responded that Soheil weighed 4.54 kg at the time of his birth.
• According to Dr Premitha, this information would help determine whether Baljeet would be able to deliver Baby Gurisha, whose weight was estimated at between 3.8kg to 4kg, by normal vaginal delivery.
• Baljeet was later admitted into the hospital for induction of labour.
• However, due to Baljeet being unable to deliver normally during labour, forceps were used by Dr Premitha.
• Baby Gurisha’s head was delivered but the umbilical cord was wound around Baby Gurisha’s neck. The umbilical cord was then cut and separated by Dr Premitha.
• There was no further descent at this point and Baby Gurisha’s shoulders were stuck in a transverse lie.
• According to Dr Premitha, the McRoberts manoeuvre was initiated, and she had rotated the stuck baby using her hand and managed to deliver her.
• As a result of the complications during the delivery, Baljeet suffered a tear to her perineum whilst Baby Gurisha suffered brachial plexus injury to her left shoulder.
• Dr Premitha examined Baljeet’s tear, noted it as a small vaginal tear and sutured the same.
• Baljeet contended that she experienced pain and bleeding some two weeks after delivery.
• Having had lost trust and confidence in the care given by Dr Premitha, Baljeet went to see another doctor (‘’Dr Hu’’) at another hospital for her post-natal follow-up whereby Dr Hu found (i) a midline poorly healed scar close to her anus; (ii) second-degree perineum muscle defect 1.5cm width and 2cm long hole in the perineum muscle; (iii) first-degree high vagina tear where active bleeding was seen; and (iv) Nabothian abscess and cervicitis.
• It was later discovered that the birth weight of Soheil was in fact only 3.8 kg.
• An action was commenced based on medical negligence at the High Court against Dr Premitha and the Second Defendant, Pantai Medical Centre, the company that owned and managed the hospital.
• One of the claim against Dr Premitha was for failure to give adequate advice, information and/or warning on the need to provide an accurate birth weight of her first child so as to advise her of the appropriate delivery options.
• On this point, Dr Premitha testified at trial that had she known that Soheil weighed only 3.8kg at birth, she would have insisted on a C-Section and would not have recommended a vaginal delivery.
• On the other hand, both Madam Baljeet and her husband testified that they had not told Dr Premitha that Soheil’s weight at birth was 4.54 kg and instead, they had told her that it was “approximately 4kgs”.
• The High Court allowed Baljeet and Baby Gurisha’s claim against Dr Premitha and in arriving at the said decision, the trial judge found that Dr Premitha should have informed Baljeet that providing Soheil’s birth weight accurately was important to advice on the appropriate delivery options.
• Dr Premitha appealed to the Court of Appeal against the High Court’s decision.

• The Court found that whilst a physician is required by law to take the patient’s history, there is no principle in law that imposes an additional burden on the physician to explain to the patient that giving an accurate and truthful history is important.
• The law does not and would not impose such an onerous general duty on physicians that would have a crippling effect on the medical profession as a whole.
• It is implicit in the history taking exercise itself that the history that is given by the patient must be accurate, otherwise it may mislead and misdirect the physician in his treatment and management of the patient.
• If Dr Premitha had neglected to ask Baljeet about her medical history, Soheil’s birth weight and the mode of delivery in the course of antenatal consultations, then it could be said that Dr Premitha had breached her duty of care.
• However, here, Dr Premitha specifically asked for Soheil’s birth weight and mode of delivery, and Baljeet had described his birth weight right down to the decimals, and the same was recorded by Dr Premitha in her notes, thereby showing no uncertainty surrounding this information.
• The Court found that Dr Premitha was entirely justified in relying on the information given by Baljeet in formulating her treatment plan and advising on the delivery options.
• The Court of Appeal found no breach of duty in this regard by Dr Premitha.