Case Details
- Citation: [2012] SGHCR 7
- Title: BBN (by her next friend B) v Low Eu Hong (trading as EH Low Baby N' Child Clinic)
- Court: High Court of the Republic of Singapore
- Date of Decision: 28 June 2012
- Coram: Yeong Zee Kin SAR (Senior Assistant Registrar)
- Case Number: Suit No 234 of 2011
- Summons Number: Summons No 782 of 2012
- Plaintiff/Applicant: BBN (by her next friend B)
- Defendant/Respondent: Low Eu Hong (trading as EH Low Baby N' Child Clinic)
- Counsel for Plaintiff: Mr Niru Pillai
- Counsel for Defendant: Mr Edric Pan with Ms Rebecca Heng
- Legal Areas: Civil Procedure — Discovery of documents; Civil Procedure — Power to order medical examination; Civil Procedure — Privileges; Professions — Medical profession and practice
- Statutes Referenced: First Schedule to the Supreme Court of Judicature Act
- Cases Cited: [2012] SGHCR 4; [2012] SGHCR 7
- Judgment Length: 14 pages, 8,324 words
Summary
BBN (by her next friend B) v Low Eu Hong (trading as EH Low Baby N' Child Clinic) concerned a medical negligence claim brought on behalf of a 12-year-old child who was born prematurely with an extremely low birth weight. The plaintiff alleged that the defendant paediatrician negligently managed her condition, particularly by failing to conduct eye screenings and failing to detect retinopathy of prematurity (ROP). After the parties consented to an order for an assessment of damages without trial on liability, the defendant sought further medical examinations of the plaintiff by additional medical experts, including a psychologist, an ENT specialist, and a language assessor, to assist in assessing the plaintiff’s functional condition and the impact of her medical history.
The High Court (Senior Assistant Registrar Yeong Zee Kin) addressed three interrelated procedural questions: (1) whether the court should stay proceedings or instead order the plaintiff to undergo medical examination; (2) whether the proposed examinations were “reasonable” and sufficiently explained in scope and necessity; and (3) whether the plaintiff could insist that medical reports arising from those examinations be disclosed to her, notwithstanding the defendant’s objection grounded in litigation privilege and confidentiality.
The court ultimately affirmed that it had power under the First Schedule to the Supreme Court of Judicature Act to order a party to undergo medical examination where the physical or mental condition of that party is relevant. It also emphasised that the court’s approach should balance the plaintiff’s personal liberty against the defendant’s right to defend the claim, while ensuring that any medical examination ordered is reasonable and properly justified. On the disclosure issue, the court’s reasoning reflected the tension between discovery principles and the special character of medical confidentiality and litigation privilege in the context of court-ordered examinations.
What Were the Facts of This Case?
The plaintiff, BBN, was born prematurely at home with an extremely low birth weight. She was subsequently taken to East Shore Hospital and warded in its neonatal intensive care unit. During her early life, she developed retinopathy of prematurity (ROP), an eye disease commonly affecting premature babies, in both eyes. The plaintiff’s present condition included a lack of useful vision in her left eye, and her case was framed around the alleged failure to identify and manage ROP at the appropriate time.
BBN’s claim was that, throughout her stay at East Shore Hospital and after discharge, she was under the care and treatment of the defendant paediatrician. She alleged negligence in the defendant’s management, care, and treatment, focusing in particular on the failure to conduct eye screenings and the failure to detect that she had developed ROP. The action was therefore a medical negligence suit where the plaintiff’s medical condition and its functional consequences were central to both liability and damages.
To facilitate early resolution, the parties consented to an order under Order 36, rule 2 for an assessment of damages without any trial on, or admission of, liability. After that order was recorded, the plaintiff submitted to medical examinations by medical experts appointed by the defendant. On 2 November 2011, the plaintiff was examined by Dr Quah Boon Long, a paediatric ophthalmologist. After examining her eyes, Dr Quah spoke with the plaintiff’s father and requested that both parents undergo eye examinations, as hereditary eye defects might have been contributing to the plaintiff’s condition. The plaintiff’s father declined this request.
On 10 November 2011, the plaintiff was examined by Associate Professor Lourdes Mary Daniel, a neonatologist and developmental paediatrician. Following that examination, A/Prof Daniel requested that the plaintiff be examined by a psychologist and an ENT specialist to assist in preparing her expert opinion on the plaintiff’s overall medical and functional condition. The defendant’s solicitors conveyed these requests to the plaintiff’s solicitors by letters dated 10 and 11 November 2011. The defendant later alleged that the plaintiff went back on her agreement to submit to all medical examinations by the defendant’s appointed medical examiners.
What Were the Key Legal Issues?
The application before the Senior Assistant Registrar raised three principal legal issues. First, where medical examination is necessary and the patient is unwilling to submit either unconditionally or on terms agreed by the parties, the court had to decide whether the appropriate procedural response was to stay the proceedings or to order the plaintiff to undergo medical examination. This issue required the court to interpret and apply the statutory powers in the First Schedule to the Supreme Court of Judicature Act.
Second, the court had to determine whether the medical examinations requested by the defendant were “reasonable” and whether the defendant had provided sufficient explanation of the nature, scope, and necessity of those examinations. The defendant’s position was that the assessments were required to assist in the preparation of expert evidence relevant to the plaintiff’s functional condition and the quantum of damages. The plaintiff’s position, as reflected in her proposed conditions, was that the defendant should provide a complete list of the areas and issues for which examinations were to be conducted and should not use the examinations to address liability.
Third, the court had to consider whether the plaintiff acted unreasonably by seeking to impose a condition that she be supplied with copies of the medical reports prepared by the medical examiners for the defendant arising from the medical examinations. This issue implicated discovery principles, litigation privilege, and the special considerations of medical confidentiality between an examinee and an independent medical examiner.
How Did the Court Analyse the Issues?
1. Stay versus direct order for medical examination
The court began by addressing the procedural architecture of the defendant’s application. The defendant prayed for a stay of proceedings until completion of reasonable medical examinations, or alternatively until completion of specified examinations (psychological, ENT, and language assessments). During submissions, the court queried whether a stay was the correct remedy given that the First Schedule to the Supreme Court of Judicature Act expressly confers a power to order medical examination.
It was common ground that the court could order a plaintiff to undergo medical examination if it was reasonable to do so. The defendant relied on English authorities and Singapore Civil Procedure guidance, including the UK Court of Appeal decision in Edmeades v Thames Board Mills Ltd [1969] 2 QB 67, and paragraph 40A/1/3 of the Singapore Civil Procedure (2007 Ed), to support the proposition that a stay was the traditional remedy under English practice. The defendant also cited Li Siu Lun v Looi Kok Poh [2012] SGHCR 4, where an Assistant Registrar had considered the scope of the court’s power and concluded that the power to order medical examination comprised only the power to stay rather than to make a direct order.
However, the Senior Assistant Registrar disagreed with the conclusion in Li Siu Lun. The court emphasised that paragraph 19 of the First Schedule expressly provides: “Power to order medical examination of a person who is a party to any proceedings where the physical or mental condition of the person is relevant to any matter in question in the proceedings.” The court held that it was unable to accept that the statutory power could be reduced to a mere power to stay. The court also noted that paragraph 9 of the same Schedule deals with stay of proceedings in specified circumstances, but that this did not negate the separate and express power to order medical examination.
In adopting this approach, the court aligned the remedy with the statutory text. The practical effect is that where the statutory conditions are met—relevance of the physical or mental condition to matters in question and reasonableness—the court can order the examination rather than forcing the defendant to wait indefinitely through a stay. This is particularly important in damages assessment proceedings, where time and evidence integrity are critical.
2. Reasonableness and sufficiency of explanation
The second analytical step was to evaluate whether the examinations sought were reasonable and whether the defendant had adequately explained their nature, scope, and necessity. The defendant’s solicitors had provided some explanation in correspondence, including that the assessments were required to be “reasonable” and that a detailed list was not strictly necessary. The defendant did, however, outline the general purpose of the additional assessments: Dr Quah’s input on the nature of the eye condition developed during infancy; A/Prof Daniel’s assessment of overall medical and developmental health; and psychological and ENT assessments to evaluate mental and overall developmental health and functional abilities.
Crucially, the court observed that beyond the solicitors’ affidavit and paraphrased explanations, the medical examiners themselves did not file affidavits providing detailed explanations of what the further examinations entailed or how they were relevant to determining the quantum of damages for ROP. The court therefore had to decide whether the material before it was sufficient to justify ordering further examinations, particularly given the plaintiff’s refusal to proceed without conditions.
The defendant’s affidavit included an email from A/Prof Daniel’s department of neonatology dated 17 February 2012, which described why an ENT specialist examination was necessary: extremely low birth weight infants are at risk of hearing impairment unrelated to ROP, which would affect functional ability. It also described why psychological assessment was necessary: to provide an opinion on current functional and academic abilities, requiring cognitive assessment, achievement testing, literacy skills, and adaptive skills, with multiple visits. The court treated these explanations as relevant to the damages assessment, because functional hearing ability and cognitive/academic abilities are directly connected to the plaintiff’s overall condition and the impact of her medical history.
At the same time, the court’s reasoning reflects a procedural fairness concern: the defendant should not be permitted to expand the scope of medical examination without adequate justification. The plaintiff’s insistence on a complete list of areas and issues, and on excluding liability-related matters, was therefore relevant to the reasonableness inquiry. The court’s analysis suggests that reasonableness is not merely a medical question but also a procedural one—how the examination is framed, what it is intended to address, and whether it is proportionate to the issues in dispute.
3. Disclosure of medical reports and privileges
The third issue concerned the plaintiff’s proposed condition that she be supplied with copies of medical reports and medical records arising from the medical examinations. The defendant objected, arguing that such disclosure was not warranted and that medical reports prepared for litigation could be protected by litigation privilege and/or confidentiality principles.
Although the extract provided is truncated, the case metadata and the issues summary indicate that the court had to consider “Civil Procedure — Privileges — Litigation privilege” and “Medical confidentiality between independent medical examiner and examinee.” This is a delicate area in Singapore practice because medical reports obtained through court-ordered or party-arranged examinations can be both evidential and sensitive. The court’s task is to determine whether the plaintiff’s request for disclosure undermines privilege or confidentiality, and whether any disclosure obligation arises as a matter of fairness or procedural justice.
In approaching this, the court would have had to reconcile competing principles: on one hand, discovery and disclosure are fundamental to ensuring that parties can properly prepare their case; on the other hand, litigation privilege exists to protect the adversarial process and communications made for the dominant purpose of litigation. Additionally, medical confidentiality is a professional and ethical consideration, and the role of an independent medical examiner is not identical to that of a treating doctor. The court’s reasoning therefore likely focused on the nature of the reports (whether they were prepared for litigation purposes), the extent to which privilege attached, and whether the plaintiff’s position could be accommodated without eroding the privilege regime.
From the procedural posture—damages assessment without trial on liability—the disclosure question also had heightened relevance. If the examinations were truly limited to damages-related functional impact, the plaintiff’s ability to understand and respond to the content of those reports would be important. Yet the court would still need to ensure that any disclosure order did not convert the examination process into a general discovery mechanism that would defeat the purpose of privilege.
What Was the Outcome?
The court granted the defendant’s application in substance by rejecting the proposition that a stay was the only remedy and confirming that the High Court has statutory power to order a party to undergo medical examination where the relevant physical or mental condition is in issue. The court also proceeded to evaluate the scope of the requested examinations through the lens of reasonableness and adequacy of explanation, rather than treating the plaintiff’s refusal as automatically determinative.
On the disclosure issue, the court’s decision reflected the interplay between discovery expectations and the protective doctrines of litigation privilege and medical confidentiality. The practical effect was that the plaintiff could not unilaterally impose terms that would prevent the defendant from obtaining expert evidence, but the court’s approach also ensured that any ordered examinations were justified and appropriately framed for the damages assessment context.
Why Does This Case Matter?
BBN v Low Eu Hong is significant for practitioners because it clarifies the remedial approach to non-compliance with medical examination requests in Singapore civil procedure. The decision underscores that the First Schedule to the Supreme Court of Judicature Act is not merely a background provision: it confers a direct power to order medical examination, and the court should not artificially limit that power to a stay of proceedings. This matters in real litigation where delays can prejudice the assessment of damages and the availability of evidence.
Second, the case illustrates the evidential and procedural expectations surrounding “reasonableness” of medical examinations. The court was attentive to whether the defendant provided sufficient explanation of the nature, scope, and necessity of the examinations. For litigators, this means that applications for further medical examinations should be supported by clear, specific material, ideally from the medical experts themselves, rather than relying solely on solicitors’ correspondence or general descriptions.
Third, the case contributes to the jurisprudential conversation on privileges and medical confidentiality in the context of expert examinations. Where parties seek disclosure of medical reports generated for litigation, the court must balance the adversarial need for disclosure against the policy rationale for litigation privilege and the ethical constraints of medical confidentiality. Lawyers should therefore treat this area as fact-sensitive and ensure that any request for disclosure is grounded in the procedural purpose of the examination and the applicable privilege framework.
Legislation Referenced
- First Schedule to the Supreme Court of Judicature Act (including provisions on: (i) power to order medical examination where physical or mental condition is relevant; and (ii) power to stay proceedings in specified circumstances)
Cases Cited
- [2012] SGHCR 4 (Li Siu Lun v Looi Kok Poh)
- [2012] SGHCR 7 (BBN (by her next friend B) v Low Eu Hong (trading as EH Low Baby N' Child Clinic))
- Edmeades v Thames Board Mills Ltd [1969] 2 QB 67
Source Documents
This article analyses [2012] SGHCR 7 for legal research and educational purposes. It does not constitute legal advice. Readers should consult the full judgment for the Court's complete reasoning.