SINGAPORE - The Singapore Medical Council (SMC) has appealed for a more lenient sentence to be handed down to an orthopaedic surgeon, after a disciplinary tribunal had earlier slapped the maximum $100,000 fine on Dr Lim Lian Arn for failing to inform a patient about the side effects of a steroid injection.

The tribunal's decision led to disquiet among doctors who petitioned the Ministry of Health (MOH) to clarify its stand on the taking of patients' informed consent for routine procedures.

On Thursday (May 9), SMC's lawyer Chia Voon Jiet asked the Court of Three Judges, which hears cases of professional misconduct, to slash the fine down to not more than $20,000.

In February, MOH had asked the SMC to review the appropriateness of the sentence and to determine the subsequent steps to be taken.

The ministry said: "Whilst both Dr Lim and the SMC may have accepted the sentence, the decision in this case carries with it much wider professional practice implications and also has an impact on future cases.

"This case should not be viewed as or lead to the practice of defensive medicine which would have an adverse impact on patient and clinical safety".

The SMC said it filed the appeal after considering recent feedback from the medical profession and the sentencing guidelines for cases of professional misconduct by doctors.

Mr Chia said the tribunal did not have the opportunity to consider the wider implications of Dr Lim's sentence during his disciplinary inquiry in June last year.

After the tribunal's decision was made public in January, said Mr Chia, the SMC has come to learn of the concerns raised as to whether a doctor is required to inform a patient of all risks and complications arising from a procedure, and whether a failure to do so would necessarily attract the maximum penalty.

He added that public sentiment appears to be that the harshness of the fine was not proportionate to the nature of Dr Lim's error or the fact that the injection was a common procedure.

The fear of being subjected to disciplinary proceedings and the order to pay the maximum penalty could result in doctors practising defensive medicine to protect their own interest rather than that of the patient, said Mr Chia.

"There is therefore a real need for this honourable court to review the appropriateness of the fine and to reduce it accordingly to avoid the practice of defensive medicine and the attendant evils of higher medical costs and wastage of medical resources."

Dr Lim had given a patient a steroid injection on her left wrist in October 2014.

The patient experienced swelling and pain in the injection area for about two hours. Later, she developed a "paper-thin skin with discoloration, loss of fat and muscle tissues" at the area.

In January 2016, she filed a complaint against him for failing to advise her on the possible complications.

In June last year, Dr Lim pleaded guilty to a charge of professional misconduct for failing to obtain informed consent by not advising the patient of the possible complications.

The SMC sought a five-month suspension, while Dr Lim's lawyer, Mr Eric Tin, asked for the maximum $100,000 fine.

The tribunal concluded that a suspension was not warranted, saying that the harm caused was limited, that Dr Lim's culpability was low, and that there was no evidence the patient would not have received the shot if she was told of the risks.

On Thursday, Mr Chia said the SMC's sentencing position at the time was based on the facts of the case and sentencing precedents.

Shortly after the tribunal's decision in November last year, the court issued a landmark judgment in another case of professional misconduct, setting out the sentencing approach for such cases.

Applying the sentencing approach, a fine of not more than $20,000 would be more proportionate, said Mr Chia.

The court, comprising Chief Justice Sundaresh Menon and Judges of Appeal Andrew Phang and Judith Prakash, will give its decision at a later date.