Rising medical litigation costs may turn healthcare sickly

SINGAPORE needs to come up with a way to keep the cost of medical litigation reasonable without being unfair to either patient or doctor.

Otherwise healthcare here could go the way it has in some Western countries, where doctors either avoid risky cases or refuse to practise high-risk specialties - or do so in such a defensive way that it becomes detrimental to patients.

And, of course, costs will soar. Already, the cracks are appearing.

Obstetricians have had their coverage changed from this month so that it protects them only for reports made while they are members of the London-based Medical Protection Society (MPS).

Another step the Singapore Medical Council can take to keep a lid on the high cost of such hearings is to standardise the rate it pays experts for their time... At one disciplinary hearing, a medical expert charged $14,000 for one day at the hearing, while his more senior colleague charged less than half at $700 an hour. 

Previously, the MPS, which covers the vast majority of the 11,000 doctors here, covered them for any incident that occurred while they were members, even if the report was made after they ceased being members.

This means that doctors who deliver babies either have to remain members for an additional two decades or more after they retire, or face the risk of footing their own bills should a patient decide to sue them after they have retired.

Costs of medical litigation today can run into hundreds of thousands of dollars, regardless of the outcome. If a patient wins a case, the damages can be even more astronomical.

Other specialists fear they will face the same coverage problems in future.

In fact, Singapore Medical Association president Chin Jing Jih suggests that it is logical that the same thing will happen to other high-risk specialties, such as paediatric neurosurgery and neonatology.

This move by the MPS follows many years of rising subscriptions. Doctors who do high-risk aesthetic surgery now pay almost $37,000 a year in subscription fees to the MPS - more than neurosurgeons, who pay almost $33,000. The $37,000 cost - more than $100 a day - is passed on to patients, at least in the private sector.

Professor Chin suggests that Singapore learns from countries like Australia, which has changed its laws to give more protection to doctors who did their best.

He also likes the way Australia penalises lawyers who instigate suits that have no merit.

According to the MPS, it has successfully defended more than three in four claims made against doctors here. In other words, only one in four claims had merit and was successful.

Aside from civil claims, a number of disciplinary hearing verdicts by the professional watchdog, the Singapore Medical Council (SMC), have been overturned by the appeals court for being legally untenable.

These don't come cheap as even a disciplinary hearing can have teams of lawyers, sometimes headed by senior counsel, representing both parties.

Some of these cases, as pointed out by the three-judge courts that dealt with the appeals, should not have been even heard at the disciplinary level.

Two such cases were guilty findings by two disciplinary committees formed under the SMC against two doctors for aesthetic treatments performed before the guidelines were issued.

Such guidelines cannot be retroactive, so these doctors should not have been hauled up in the first place, never mind being found guilty and having to appeal to the High Court for justice.

This year, the High Court has also started making the SMC pay the costs incurred by doctors successful in their appeal against a guilty disciplinary verdict.

In the first case, the court accused the disciplinary committee of coming to a guilty verdict that was "contrary to the evidence" as well as "relying on facts that it should not have considered".

In the second case, the court again found the disciplinary committee selective in the evidence it looked at without giving reasons for dismissing other evidence.

It is unusual for a Court of Appeal to throw out a case because those sitting in judgment failed to adhere to basic law procedures.

It is good to know that the SMC now has a legally trained person as a member of the disciplinary tribunals who can, hopefully, ensure that judgments are in accordance with the law.

Another step the SMC can take to keep a lid on the high cost of such hearings is to standardise the rate it pays experts for their time.

Today, the bills can vary by huge amounts, as disclosed when they are up for taxation, which occurs when bills are disputed.

At one disciplinary hearing, a medical expert charged $14,000 for one day at the hearing, while his more senior colleague charged less than half at $700 an hour. Similarly, the more senior specialist charged $1,000 for preparing a trial report, while the other specialist charged $6,000.

Perhaps the SMC should discuss with doctors what are reasonable fees to pay such experts, based on their seniority, and establish them as standard fees for all disciplinary hearings to avoid such wildly disparate charges.

Fixing the issue of medical coverage for doctors, making sure the charges the SMC brings against doctors have legal merit and introducing more sanity into fees incurred in disciplinary hearings will go some way to keeping down the costs of medical litigation.