The Court of Three Judges, in a rare move, has asked the Attorney-General to probe the case of a doctor who falsely certified the deaths of two patients.
It made clear that the case raised questions on whether the doctor had done it to conceal illicit acts. It also said that the offence was serious enough for the doctor to be struck off the medical register had more information been available.
The referral to the Attorney-General came when the three-judge court increased the doctor's suspension from three to 36 months.
This is after the Singapore Medical Council (SMC) appealed to the court against the decision of the disciplinary tribunal of the SMC that probed the case.
The SMC tribunal had suspended Kwan Kah Yee, 64, for three months after he pleaded guilty last October to two charges of wrongfully certifying the cause of death in two cases, in 2010 and 2011.
We remain disturbed by these unresolved issues, and have therefore referred the matter to the Attorney-General to consider what, if any, further steps should be taken to investigate this matter.
COURT OF THREE JUDGES
The SMC had called the sentence "far too lenient", pointing out that the tribunal's sentencing powers had been enhanced in 2010 and that the case should depart from past precedents involving wrongful certification of death.
In 2010, Kwan had stated the cause of death of a 26-year-old man based on alleged chest X-rays from the Singapore Anti-Tuberculosis Association (Sata). But Sata did not have any such medical records.
In the following year, he certified a 32-year-old woman's cause of death as ischaemic heart disease. He had based this on an alleged complaint of chest pains in May 2007 made by the woman and medical data he allegedly retrieved from various polyclinics and clinics.
It later emerged that there were no such medical records.
Prior to these offences, Kwan had wrongly stated a patient's cause of death in 2009. For that, he was suspended for three months and fined $5,000 in 2011.
For the current case, SMC's counsel Philip Fong called for a heavier sentence, given Kwan's dishonesty.
Kwan, who defended himself, denied being dishonest, claiming that he was a hospice doctor who certified deaths only if asked by next of kin.
The Court of Three Judges - which is the final panel of appeal for cases dealt with by the SMC's disciplinary tribunal - found that Kwan showed no remorse.
It said that public interest considerations weighed heavily in favour of imposing a stern sentence.
The court stressed that issuing a false death certificate is a "very grave" breach of a doctor's ethical and professional duties.
"We would also add that (Kwan) could well have been struck off the the medical register," wrote Chief Justice Sundaresh Menon. But the court, which included Judges of Appeal Chao Hick Tin and Andrew Phang, did not do so as there were too many questions left unanswered at the end of the investigation and tribunal proceedings.
It pointed out, however, that it could do so even without the extra information, given Kwan's dishonesty and the seriousness of the charge, but declined as it needed details on whether the usual penalty for dishonesty in doctors should be the same as that for lawyers. Among the issues that should have been raised was the incentive for the doctor to falsely certify the two deaths.
"The consequences might have been quite different, depending on whether he had done it to conceal some other illicit act, for profit, or for some other less egregious reasons such as sympathy for a bereaved family."
The court added, among other things, that the circumstances of his explanation in the second case were "highly suspicious".
It stressed that his plea of guilt did "nothing to quell the concerns about these questions which should have been addressed".
"We remain disturbed by these unresolved issues, and have therefore referred the matter to the Attorney-General to consider what, if any, further steps should be taken to investigate this matter."
The case is believed to be the first time an errant doctor brought before the court has been referred to the Attorney-General for further investigation.