Plaintiffs must prove negligence and causation in medical malpractice claims, with the burden of proof being on them to show that the healthcare provider's actions directly caused harm.

[1] Nik Rosemawati binti Nik Mohamed ("the deceased") was unhappy with her appearance. She went for an abdominal liposuction procedure at a plastic surgery clinic. Minutes after the procedure was completed, she suffered a cardiac arrest. She was then transferred to Gleneagles Intan Medical Centre. Two days later she died. She was 44 years old.

[2] The 1st plaintiff was the husband and the 2nd and 3rd plaintiffs the children of the deceased. They have filed this claim as dependants of the deceased within the meaning of s. 7 of the Civil Law Act 1956 . They are claiming for loss of support. They are alleging negligence on the part of the defendants while treating the deceased during the liposuction procedure. The 1st defendant is a consultant plastic surgeon who, at the material time, practiced as such at the Springvale Plastic Surgery Clinic ("Springvale Clinic") and at Gleneagles Intan Medical Centre ("GIMC"). The 2nd defendant is a consultant anaesthetist. They deny any negligence on their part.

The Facts

[3] From the evidence adduced at the trial, the following facts emerged. The deceased had her first consultation with the 1st defendant in his clinic at GIMC on 16 July 2003. She had wanted to improve the shape of her abdomen. She was advised to have full abdominoplasty with liposuction. She was advised of the procedure and the associated risks. She and her husband, the 1st plaintiff, were also advised to seek a second opinion.

[4] The deceased had a second consultation with the 1st defendant on 5 April 2004. Her options were reviewed. She opted for an abdominal liposuction instead of an abdominoplasty. On 19 June 2004, the deceased was assessed by the 2nd defendant. She signed a form which indicated that she was aware of the risks and consented to local anaesthesia, general anaesthesia or sedation as may be required. She was also reviewed by the 1st defendant. Abdominal liposuction was then scheduled for 21 June 2004 in the afternoon. The procedure was to take place at the 1st defendant's Springvale Clinic which was located at the 1st floor of a shop-lot premise at 23-1, Jalan Telawi Dua, Bangsar Baru, Kuala Lumpur.

[5] On 21 June 2004, the deceased along with the 1st plaintiff went to the Springvale Clinic. They arrived at the clinic at 2.15pm. The deceased's blood pressure was high and medication was given to control the same. At about 3pm, the defendants decided to proceed as the blood pressure was under control.

[6] The abdominal liposuction was to be carried out in two parts - the first was at the lower abdomen and the second was at the upper abdomen. Before the procedure began, sedation was given to the deceased by the 2nd defendant via intravenous injection. This was followed by a local anaesthetic given by the 1st defendant by way of a drip through an infiltration cannula that had been introduced into the lower abdomen. Liposuction of the deceased's lower abdomen was carried out successfully with about 200 mls of fat extracted.

[7] The 1st defendant then proceeded to prepare the deceased's upper abdomen with local anaesthetic. However, infiltration of anaesthetic proved difficult as the deceased appeared uncomfortable and was moving. Despite multiple attempts the 1st defendant could not infiltrate the upper abdomen with local anaesthetic by means of the infiltration cannula. A decision was then made to convert to general anaesthesia. After general anaesthesia, the liposuction of her upper a