SINGAPORE - The doctor involved in the liposuction death of real estate firm boss Franklin Heng in 2009 has been struck off by the Court of Three Judges.
In its decision, the court warned this would be the presumptive penalty for doctors displaying serious misconduct or dishonest behaviour, unless there were exceptional circumstances.
A second doctor, who assisted Dr Wong Meng Hang in the procedure, was suspended for 18 months instead of the original six months, in a definitive judgment where the court laid a sentencing framework in disciplinary cases for dealing with professional misconduct by doctors that results in harm to patients.
The court, in a rare move, also ordered the case be reported to the Public Prosecutor so that Dr Wong and Dr Zhu Xiu Chun can be investigated for any relevant criminal offences that may have been committed, including that of causing death by a rash or negligent act.
"While we express no views at all on whether any criminal offence is disclosed on the facts before us, we consider it to be in the public interest that the matter be investigated," wrote Chief Justice Sundaresh Menon in issuing the court's judgment on Friday (Nov 23).
"This was among the most egregious cases of medical misconduct we have come across," added the court.
In setting out the appropriate approach when dealing with serious misconduct by doctors, the court highlighted "the importance of sentencing considerations such as general deterrence and the need to uphold public confidence in the medical profession, which might in certain cases be sufficiently compelling to override any personal mitigating circumstances that may be found to exist".
The court comprised Chief Justice Menon, and Judges of Appeal Andrew Phang and Judith Prakash.
In the case, Dr Wong had given Mr Heng too much sedative when conducting a liposuction procedure at his Orchard Road clinic in December 2009. Left unattended, the 44-year-old suffocated when his airway collapsed because of the heavy sedation.
The high-profile case was Singapore's first recorded death as a result of aesthetic treatment.
In 2014, Dr Wong, then 43, was fined $26,000 for breaching medical regulations. Dr Zhu, then 55, was fined $18,000. Two years later, Dr Wong and Dr Zhu, who is also known as Myint Myint Kyi, were ordered to pay $3.26 million in damages in total to Mr Heng's family in a civil suit.
Disciplinary proceedings were also brought against the two doctors, who each pleaded guilty to a charge of professional misconduct before the Singapore Medical Council (SMC).
They admitted that Mr Heng died as a result of their failure to adequately monitor him during the procedure. In December 2017, a disciplinary tribunal suspended Dr Wong for 18 months and Dr Zhu for six months.
SMC then appealed to the Court of Three Judges, seeking a three-year suspension for Dr Wong and a two-year suspension for Dr Zhu, while Dr Wong appealed to reduce his suspension to six months.
The court ruled the appropriate order was to strike Dr Wong off the register as his case involved "the most severe harm imaginable" and his actions were the sole and direct cause of the patient's death.
His misconduct was of a high degree of culpability in that his treatment of the patient was grossly unsatisfactory and strikingly deficient in every way, said the court.
"We find it difficult to conceive of a worse case of medical misconduct."
"From recklessly deciding to embark on a risky sedation procedure despite being untrained; to administering the sedative improperly by giving an excessive dosage; to wounding the patient by performing the liposuction improperly in circumstances where because of the incompetent and excessive dosage of the sedation, he had no way of even knowing he was inflicting unintended and potentially serious injuries on the patient; to leaving the patient unattended post-procedure as a result of which the patient asphyxiated and eventually died; and finally, to lying to the Accident & Emergency doctors, Dr Wong's treatment of the patient was grossly unsatisfactory and strikingly deficient in every respect."
The court added "Dr Wong's misconduct (was) among the worst of its kind and which must be punished with a sanction of sufficient severity".
In raising Dr Zhu's sentence to 18 months' suspension, the court found her misconduct was not as grave as Dr Wong's as she was only tasked to assist in the procedure under Dr Wong's direction and did not act dishonestly, among other things.
But it added: "For the same reasons as we have stated in respect of Dr Wong, Dr Zhu's personal mitigating circumstances such as her early plea of guilt and the inordinate delay in the proceedings are overridden by the public interest in upholding public confidence in the medical profession.
"The sentence to be imposed on Dr Zhu must also serve as a strong deterrent to other junior doctors faced with the wholly improper actions of their seniors."