JUDGMENT

Faizah Jamaludin J:

A. Introduction

[1] The plaintiff and the defendant are consultant cardiologists practising at Sunway Medical Centre ("SMC").

[2] At the material time, the defendant was the Head of the Cardiology Department at SMC.

[3] The plaintiff has brought this action in libel against the defendant in respect of a letter dated 14 November 2017 (the "Letter"), written by the defendant and addressed to Dr Khoo Chow Huat ("Dr Khoo"), who at the material time was the Deputy Managing Director / Chief Executive Officer of SMC.

[4] The said Letter was copied to the persons, who were named in the cc. list at the said Letter. They are:

The Plaintiff's Case

[5] The plaintiff pleads in para 4 of the Statement of Claim that the following words ("the Impugned Words") in the said Letter are defamatory of the plaintiff.

1. Patient GHC (MRN345103). This was an old patient of Dr Samuel Ong, who was attended to by Dr LBC when he was on-call on 10 September 2017 (Sun), when Dr Samuel Ong was away. As documented in the notes (on 26 October 2017), the patient requested for Dr Sam Ong the following day (on 11 September 2017), but was not referred back to him. Dr LBC went on to perform a coronary angiogram on the patient on 11 September 2017, even though Dr SO was back on that day'.

2. Patient Mr MS (MRN 144298) - I received a phone call complaint from Dr Tamil Selvam (Senior Consultant cardiologists at Damansara Specialist Hospital) who is a relative of this patient. According to the patient, he was asymptomatic when he came for Health Screening check-up on 20 June 2017, was told to have an abnormal stress test, and saw Dr LBC on the same day. He was apparently told by Dr LBC that he needed an urgent coronary angiogram on that day itself, or he would have a heart attack. The patient complained that he was "pressured" by Dr LBC to have the procedure, even though he was asymptomatic'.

3. This issue of cases being done as emergencies after hours appears to be a common practice for Dr LBC, and of the 27 cases done (non on-call after hours cases) from Jan to October 2017, the majority have been Dr LBC's cases'.

4. In the Cardiac Department meeting on 29 September 2017, where we routinely reviewed the preceding months' angioplasty cases, of the 5 cases of Dr LBC, we are of the opinion that 4 out of 5 cases of Dr LBC's angioplasty cases were not appropriate, and did not meet the American College of Cardiology guidelines of 70% stenosis or more. In fact, in 2 out of the 4 cases highlighted, Dr LBC himself reported the lesions as less than 70%'.

5. In all my years (as well as my colleagues) working here in Sunway Hospital, I had not performed any emergency procedures on any of my colleagues' patients, without speaking to the primary Consultant personally. The case of GHC, Dr SO's patient was not the first time that Dr LBC performed a procedure on other Consultant cardiologists' patients without reference to the appropriate Consultants'.

6. Pressuring patients to have procedures urgently (unless clinically appropriate) will have long-term detrimental effect not only to the reputation of cardiologists but also to the reputation of the hospital as a whole (which I pointed out to Dr LBC). Not only will cardiologists outside Sunway Hospital find out but also patients as well. I recently had a patient who also complained to me personally that when he saw Dr LBC, he was asked to immediately undergo a coronary angiogram procedure, which I felt was not clinically indicated".

7. Inappropriate coronary angioplasties will affect Sunway Hospital eventually. As highlighted to you & the Management previously, in the United States & other European countries, successful medico-legal cases have been brought against cardiologists & hospitals who do not practise according to ACC guidelines (70% or more lesions). Medical insurers have also successfully sued hospitals who condone such practices. I sincerely believe that it will be a matter of time before such medico-legal cas