Prominent cardiologist Leslie Lam completely cleared of professional misconduct by court

The Court of Three Judges overturned the decision of a disciplinary tribunal to convict Dr Leslie Lam of a charge over failing to obtain informed consent before carrying out a procedure.
The Court of Three Judges overturned the decision of a disciplinary tribunal to convict Dr Leslie Lam of a charge over failing to obtain informed consent before carrying out a procedure. PHOTO: ST FILE

SINGAPORE - Prominent doctor Leslie Lam has been completely cleared of all allegations of professional misconduct brought by a patient whose condition improved after the cardiologist carried out a procedure to unblock a coronary artery with a stent.

In a 50-page written judgement released on Friday (Oct 20), the Court of Three Judges overturned the decision of a disciplinary tribunal to convict Dr Lam of a charge of failing to obtain informed consent before carrying out the procedure, known as a percutaneous coronary intervention (PCI), in 2011.

Dr Lam had faced three charges of misconduct after the patient, who did not suffer any harm from the procedure, complained to the Singapore Medical Council (SMC).

In November last year, after a five-day hearing, a disciplinary tribunal cleared him of two charges over advising the patient to undergo a conventional angiogram and PCI without clinical evaluation, and for failing to perform the PCI and stenting with proper skill and care.

The tribunal convicted him of a third charge of failing to adequately advise the patient of all the risks and alternatives, and imposed a three-month suspension.

Dr Lam, who contested all three charges, appealed in July.

In a statement to the media on Friday, he said he felt "vindicated" by the decision, which found that he had appropriately obtained his patient's consent before carrying out the procedure. 

He added that he always aims to "advise my patients as best as I can on their treatment options".

On Friday, the court, led by Chief Justice Sundaresh Menon, took issue with the "ambiguous" manner in which the third charge had been framed, pointing out that it was open to at least two possible interpretations.

The court also said the tribunal was wrong in principle to convict Dr Lam almost entirely on the fact that he had failed to document the taking of the patient's consent.

"In the present case, we do not find Dr Lam's record-keeping satisfactory, but... failure to maintain proper documentation is not what Dr Lam was charged with," the chief justice wrote.

"In our judgement, despite Dr Lam's failure to fulfil the latter obligation, reasonable doubt was raised in the SMC's case in respect of the former obligation."

The court said that in light of the new requirement in the 2016 edition of the SMC Ethical Code and Ethical Guidelines that doctors had to keep "clear, legible, accurate and contemporaneous medical records of sufficient detail", it would expect the SMC to consider preferring charges over failure to keep proper records in cases like Dr Lam's.

The court added that a doctor's obligation to ensure that the patient was aware of the benefits and risks of a procedure as well as any alternatives, did not mean that the doctor had to mechanically recite such information to the patient without regard to what the patient already knew.

In the current case, the patient, who had previously undergone the PCI procedure in 2006, had "considerable knowledge" of the benefits, risks, complications and alternatives, said the court.

While the issue of sentence did not arise as Dr Lam was fully acquitted, the court made some observations on the sentencing approach, which should have been adopted in this case.

The court noted that it had taken "an inordinately long time" for the patient's complaint to reach the court, and pointed out that a delay of this nature could lead to a reduction in sentence in a case where a doctor was convicted.

"We urge the SMC to scrutinise its procedures to avoid such delays," said the court.

In his statement, Dr Lam noted that it was also pointed out by the Court of Three Judges that his consistent practice in relation to consent-taking was unchallenged evidence. 

Dr Lam said he would not and did not "railroad" the patient into consenting to the treatment.

"Unfortunately, this baseless allegation had adversely affected my reputation and how some of my patients viewed me," he added.