The Egg-Shell Skull rule mandates that a tortfeasor is liable for the full extent of harm to a victim, regardless of any pre-existing vulnerabilities that may exacerbate the injury.

A. Introduction

[1] This judgment discusses, among others, the effect of the "Egg-Shell Skull" rule or "Thin Skull" rule (a tortfeasor takes the victim as the tortfeasor finds the victim) in medical negligence claims

B. Background

[2] I will refer to the parties as they were in the High Court.

[3] The plaintiff (Plaintiff) was pregnant with her second child in 2013. On 11 November 2013, the Plaintiff was referred to Hospital Sultanah Aminah, Johor Bahru (Hospital), from "Klinik Kesihatan". At that time-

(1) the foetus inside the Plaintiff's uterus was at about 33 weeks of gestation;

(2) the Plaintiff was diagnosed with "Placenta Praevia Type III Posterior" [PP Type 3 (Posterior)]; and

(3) the Plaintiff had no prior history of antepartum haemorrhage (bleeding from the genital tract prior to delivery of baby).

[4] The Plaintiff was scheduled for an elective Caesarean section (C-section) on 16 December 2013 [at 38 weeks' period of amenorrhoea (period of time without menstruation)]. While waiting for the elective C-section, the Plaintiff was warded in the Hospital for rest and monitoring.

[5] On 12 December 2013-

(1) the Plaintiff started to have contraction pain. Consequently, at 11.05am, she underwent an emergency C-section under general anaesthesia for the delivery of her second child;

(2) a baby boy was delivered at 11.17am weighing 3.1 kg;

(3) soon after delivery of the baby in the operating theatre (OT), the Plaintiff became bradycardic (slow heart rate) with a heart rate of 40 beats per minute (bpm). Oxygen saturation and capnograph (methods to record the Plaintiff's respiratory status) were not recordable;

(4) the Plaintiff subsequently developed Pulseless Electrical Activity, i.e., the Plaintiff's heart had stopped beating ( Plaintiff's Collapse). Cardiopulmonary resuscitation (CPR) was immediately administered on her. After five minutes of CPR, there was a return of spontaneous circulation with pulse rate of 145 bpm and blood pressure of 110/70 mmHg;

(5) the Plaintiff was diagnosed with Amniotic Fluid Embolism (AFE), namely, amniotic fluid (which surrounds the foetus in the uterus) had breached the placental barrier and entered the mother's bloodstream);

(6) the Plaintiff subsequently developed bleeding from vagina and puncture sites. She had Primary Postpartum haemorrhage (bleeding from the genital tract after delivery of baby) with Disseminated Intravascular Coagulopathy (formation of blood clots throughout the body's blood vessels). She suffered blood loss and was given, among others, a blood transfusion; and

(7) the emergency C-section lasted for about two hours. The care of the Plaintiff in the OT was provided by-

(a) a medical specialist and a medical officer (MO) from the Hospital's Obstetrics Department; and

(b) one specialist and one MO from the anaesthesia team in the Hospital.

[6] The Plaintiff was transferred to the Intensive Care Unit of the Hospital (ICU), where she was treated.

[7] The Plaintiff subsequently suffered severe and irreversible brain damage (Plaintiff's Brain Damage).

[8] The Plaintiff was discharged from ICU on 26 December 2013 but was warded in the Hospital for rehabilitation, including physiotherapy, occupational, and speech therapy.

[9] On 3 April 2014, the Plaintiff was discharged from the Hospital.

C. Proceedings In The High Court

[10] The Plaintiff filed this suit in the High Court (This Suit) through her husband and litigation representative, Encik Khairil Faiz bin Rahamat (PW5), against 17 defendants (Defendants), namely:

(1) 16 individual defendants ("1st Defendant" to "16th Defendant"). The 1st to 16th Defendants are-

(a) the doctors and nurses at the Hospital who were involved in the Plaintiff's C-section, treatment and management; and

(b) employed by the Government (17th Defendant); and

(2) the 17th Defendant owns and manages the Hospital.

[11] In This Suit-

(1) the Plaintiff claimed from the Defendants