The Scientific Statement by the American Heart Association on Kawasaki disease (KD) published in 2004 indicated that fever of five days or more with the presence of two or three clinical criteria would require assessment for KD (1,000 docs petition to revoke paediatrician's suspension; July 13).
Over the course of the one-year-old boy's hospitalisation, he displayed clinical features that fulfilled the association's criteria.
The Disciplinary Tribunal ruled that Dr Chia Foong Lin's failure to order the supportive investigations and advise the parents when she considered the possibility of KD fell short of the reasonable standard of care and attention expected of an experienced paediatrician.
The decision of the Disciplinary Tribunal (as upheld by the High Court) should not be taken to support defensive medicine.
The judgments relied on published international clinical guidelines for the evaluation of KD.
With regard to the tribunal's sentence for Dr Chia , the Disciplinary Tribunal noted that the preponderance of similar cases cited by the Singapore Medical Council (SMC) were dealt with by suspension rather than a fine.
Finally, the SMC would like to clarify the role of expert witnesses in tribunal inquiries.
Regardless of which party appointed them, expert witnesses are accountable solely to the Disciplinary Tribunal, to assist the tribunal on matters which are within their expertise. The final decision on whether a doctor is guilty of the charge or whether his or her management is wholly or partially unacceptable is solely the tribunal's to make.
In this regard, the council highlights that it was the Disciplinary Tribunal and not the SMC's expert, Associate Professor Chao Sing Ming, who wrote that Dr Chia's management of the patient "amounted to serious negligence".
Cheryl Loh (Ms)
Singapore Medical Council
Correction note: There was an editing error in a previous version of this letter, which said that it was the Disciplinary Tribunal's and not the SMC's expert, Associate Professor Chao Sing Ming, who wrote that Dr Chia's management of the patient "amounted to serious negligence". We have corrected it to say that it was the Disciplinary Tribunal and not the expert who had written that Dr Chia's management of the patient "amounted to serious negligence". We are sorry for the error.