Asia (Page 3,182)

SINGAPORE: A woman sued her surgeons over jaw surgeries she had sought to correct her protruding mouth and lips, claiming that their medical negligence resulted in her having to undergo surgery “so many times”.

The 39-year-old woman represented herself at trial, claiming damages including S$1.6 million (US$1.2 million) in estimated loss of wages and almost S$100,000 for her medical expenses.

In a judgment published on Tuesday (Apr 25), a district court dismissed her claim with costs, saying she had persisted in her claim despite being advised on her lack of supporting evidence.

THE CASE

Ms Angelina Leong Xiu Ting was 32 in July 2015 when she consulted orthodontist Dr Alfred Cheng and was told she had a dental malocclusion with bimaxillary jaw protrusion.

Dr Cheng referred her to Dr Winston Tan Kwong Shen, who was practising at OMP Alliance at Mount Elizabeth Novena Specialist Centre.

Dr Tan assessed Ms Leong and found that she had significant functional dentofacial deformities, with a protrusive mouth and lips. 

He recommended surgery on both her upper and lower jaws, which involved cutting the jaw bones and repositioning them to address the protrusion and correct the misalignment of the teeth and jaw. The bones would be secured with bone plates, screws and wires.

Ms Leong agreed and the procedure was carried out in December 2015 at the Mount Elizabeth Novena Hospital by Dr Tan and a second surgeon – Dr Lye Kok Weng.

While the surgery significantly corrected Ms Leong’s dentofacial deformities, it resulted in minor facial asymmetry, which caused Ms Leong to seek a second jaw surgery about six months after the first one. After this, she sought a third jaw surgery.

Ms Leong later sued the two surgeons, claiming that they had been negligent in the medical care, treatment and advice given to her. She claimed that their mistakes had caused her to undergo jaw surgery so many times, and alleged that she suffered pain and discomfort from the operations.

She also attributed injuries to the surgeons – including chronic pain in her jaw and mouth, periodontitis or gum disease, inability to open her mouth completely and difficulties speaking properly.

In her lawsuit, she claimed damages that included her loss of income and the cost of any future treatments and surgeries she might require.

The surgeons were represented by lawyers Audrey Sim and Lydia Yeow from Dentons Rodyk & Davidson.

They argued that the first surgery had successfully corrected Ms Leong’s dentofacial deformities, and the resulting minor residual asymmetry was “well within expectations of surgical outcomes”.

The surgeons said they had repeatedly emphasised to Ms Leong that the aesthetic outcome of such surgeries can never be predicted with absolute certainty, and it was unrealistic to expect perfect symmetry when dealing with a complex structure like the human face.

They added that even after the jaw deformities were corrected and Ms Leong’s looks improved, she insisted on proceeding with the second and third surgeries, “seemingly due to her quest for aesthetic perfection”. 

JUDGE’S DECISION

District Judge Tan May Tee dismissed Ms Leong’s claims. Ms Leong had failed to procure an expert opinion to show that the surgeons’ acts or omissions were not in accordance with accepted practices in the field, she said.

“Without such expert evidence, the plaintiff’s case simply cannot get off the ground,” said Judge Tan. “Her reliance on materials sourced from the Internet does not assist her case given their doubtful provenance.”

In contrast, the surgeons obtained the opinion of experienced oral maxillofacial surgeon Dr Andrew Ow Tjin-Chiew as their expert witness.

He said Ms Leong had a severe and complex dentofacial deformity which was one of the more difficult conditions to treat. He found that the post-surgical care and management of Ms Leong after each of the surgeries were reasonable, appropriate and in accordance with the proper standard of care.

Judge Tan found on the evidence that Ms Leong’s gum disease was “caused by her lack of dental hygiene” and not by the three surgeries. 

Her claim of being unable to open her mouth completely was limited to a “mere 5mm” and she rejected an offer for chronic pain management, so her condition may not be as serious as alleged, said Judge Tan.

Despite claiming that she had difficulty speaking, Ms Leong had no supporting medical evidence and did not exhibit any such impediment at trial, said the judge.

“She was articulate and her voice was clearly audible despite being masked even though this was no longer a requirement at the time,” said Judge Tan. 

She said Ms Leong had “no basis whatsoever” to blame the surgeons for her alleged injuries, and her case on negligence fails on this point alone.

Although Ms Leong had made a claim for loss of wages of S$1.6 million for the period June 2016 to August 2022, she did not give any evidence to support this.

She did not call her previous employer, World First Asia, to give evidence. Instead, it appears from documents that she had voluntarily resigned in May 2016 and accepted an ex gratia lump sum payment.

“Hence, any loss of income would have been self-induced,” said the judge.

On Ms Leong’s claim of about S$100,000 for her debt to the bank for her medical expenses, Judge Tan said there was no evidence as to how it was attributable to the surgeons’ alleged breaches of duty. 

Ms Leong also disclosed at trial that her medical bills were in fact covered by insurance, so her “entire claim appears suspect”, said the judge.

The judge noted that while Ms Leong might be accorded “some measure of indulgence” as a self-represented litigant, she is nonetheless subject to the same rules and procedures of the court.

She directed parties to file written submissions on the issue of costs.

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