Adequate grounds to expect senior doc to diagnose Kawasaki disease

We thank Dr William C.L. Yip and Dr Andrew Yam Kean Tuck for their letters (Difficult to diagnose Kawasaki disease in first week of illness, July 5; and SMC punishment of doc more appropriate for wilful misconduct; July 7).

Under the Medical Registration Act (MRA), a complaint must be investigated by a Complaints Committee (CC). The CC obtains an expert opinion from a senior doctor before it refers the matter to a Disciplinary Tribunal (DT), which is independent of the Singapore Medical Council.

We wish to explain the proceedings in Dr Chia Foong Lin's case.

The patient was hospitalised on Feb 25, 2013 after coming down with high fever and other symptoms from Feb 23.

On Feb 27, besides having fever for five days, the patient had maculopapular rash, conjunctivitis and red lips. There were spikes in his fever as well as other symptoms throughout his stay in hospital.

When the patient was discharged on March 1, 2013, his fever had still not settled.

On March 3, Dr Chia reviewed the patient and her diagnosis remained that of viral fever, despite the patient having fever the preceding two nights.

The DT heard Dr Chia's case over five days, including testimony from expert witnesses.

It considered the nature of Kawasaki disease (KD) and accepted that the diagnosis of KD was not straightforward, but was of the view that there were adequate grounds to expect a senior paediatrician to be able to diagnose KD and provide the treatment.

The DT found that although Dr Chia entertained the possibility of KD, she failed to order supportive tests to diagnose KD or incomplete KD and to verify the symptoms. She also failed to discuss or advise the parents about the possibility of the patient having KD.

The DT noted that there were at least three occasions of serious lapses: on Feb 27 or 28, 2013; when Dr Chia discharged the patient on March 1; and on March 3, when Dr Chia reviewed him.

Dr Chia, therefore, fell short of the reasonable standard of due care and attention expected of her.

Dr Chia appealed to the High Court, which issued its judgment on June 27 this year, affirming the DT's decision. Under the MRA, there is no appealing against the High Court's decision, and therefore, the DT cannot consider withdrawing the order of suspension.

The DT's grounds of decision and High Court's judgment provide the basis for the decisions.

Cheryl Loh (Ms)

Deputy Head, Corporate Communications

Singapore Medical Council

A version of this article appeared in the print edition of The Straits Times on July 13, 2017, with the headline 'Adequate grounds to expect senior doc to diagnose Kawasaki disease'. Print Edition | Subscribe