Medical practitioners must adhere to established standards of care, and failure to do so, resulting in patient harm, mandates liability for damages.

Facts

[1] This is a claim by the plaintiff for medical negligence in respect of injury she had suffered during the birth of her first child, Zahra Afrina binti Mohd Zahir, on 7 March 2014 at Hospital Bentong and the subsequent medical treatment she received at the Hospital Sultan Haji Ahmad Shah, Temerloh ("Hospital Temerloh"). Both hospitals are owned and operated by the Government of Malaysia through the Ministry of Health Malaysia.

[2] The plaintiff suffered a third to fourth degree perineal tear during the delivery of her baby. She was sutured by the doctors at Hospital Bentong and discharged the next day on 8 March 2014.

[3] The plaintiff's baby also suffered injury during the delivery. She suffered asphyxia and underwent resuscitation and recovery in the neonatal intensive care unit. The baby was transferred from Hospital Bentong to Hospital Temerloh on the day of her birth.

[4] After sending the plaintiff home, there was no follow-up treatment by the defendants. The plaintiff's perineal tear resulted in an infection. On 10 April 2014, the plaintiff went to the Hospital Temerloh. She complained that her wound had broken down for two weeks and she felt pain on defecation. Vaginal examination revealed an episiotomy wound of 2.4cm which had broken down with serious discharge. The plaintiff was referred to the hospital's obstetrics unit where it was discovered that the plaintiff suffered from "a gaping episiotomy wound 4 x 3cm with slough and serious discharge". She was seen by the hospital's consultant obstetric and gynecologist ("O & G consultant") who noted that there was "loss of anal spin on anterior part; no vaginal and rectal mucosa; stool seen seeping through vagina". The O & G consultant diagnosed the plaintiff as suffering from anovaginal fistula - third degree tear, which is an abnormal passageway between her vagina and anus.

[5] The plaintiff was then referred by Hospital Temerloh to Hospital Selayang, which has a center with a colorectal team.

[6] On 22 May 2014, the plaintiff was seen by Dr Wong Sze Ming ("SP1"), a general and colorectal surgeon at Hospital Selayang. She was found to have "a thin tissue between the fistula opening in vagina and anus, 0.5cm. 1 cm opening in the lower end of the vagina." SP1 testified that he had to treat the infection first before undertaking the surgical repair on the plaintiff.

[7] On 1 June 2014, the plaintiff was admitted to Hospital Selayang for "repair of anovaginal fistula KIV colostomy." SP1 carried out the rectovaginal repair and sigmoid colostomy on 2 June 2014. She was discharged on 6 June 2014.

[8] In undertaking the sphincter repair, SP1 performed a colostomy on the plaintiff, which involved making "a small cut in the abdomen and the intestinal is pulled out and an opening is made in it. The intestine is sutured to the abdominal wall." SPI testified that he does not normally perform a colostomy for sphincter repair. However, SP1 said that a colostomy was necessary in the plaintiff's case as "the defect involved almost the whole of the anal sphincter muscle. The repair was complex and hence a colostomy was needed. If colostomy was not done, the repair might break down. Normally, I do not routinely do a colostomy for sphincter repair."

[9] On 14 July 2014, the plaintiff underwent a reversal of colostomy, which was carried out by SP1. The plaintiff was discharged from Hospital Selayang on 18 July 2014.

[10] SP1 subsequently left the employ of Hospital Selayang for Tropicana Medical Centre, a private hospital. SP1 saw the plaintiff at Tropicana Medical Centre on 6 September 2014 and treated her with antibiotics. He last sa