'Lack of guidance' for disciplinary proceedings for doctors


SINGAPORE - There is "a lack of guidance" in Singapore for disciplinary action against errant doctors, a disciplinary tribunal convened by the Singapore Medical Council (SMC) said following a doctor's hearing last week.

It added that the council might want to consider creating its own set of guidelines.

This comes after a general practitioner in Bedok was fined $30,000 for failing to refer a patient, who had a corneal ulcer, to a specialist "in a timely manner". The patient later underwent surgery and permanently lost most of the sight in her left eye.

Said the disciplinary tribunal in its Grounds of Decision released to the media on Tuesday (Sept 26): "It appeared to us, throughout the course of these proceedings, that there was a lack of guidance in Singapore as regards the sentencing of doctors in disciplinary proceedings.

"Different sanctions (e.g. removal from the register, suspension, fine, censure etc) have different consequences on the public and on the medical practitioner. It is therefore important for there to be guidance based on case precedents and policy considerations so that medical practitioners may be aware of the severity of their misconduct."

This would ensure that sentences meted out by the disciplinary tribunals and courts are consistent with how the medical profession views instances of professional misconduct, the council added.

It noted that Medical Practitioners Tribunals in the UK are guided by the UK Sanctions Guidance which was developed by a steering group of tribunals and General Medical Council staff.

The UK Sanctions Guidance sets out the rationale for each sanction and the broad factors that might lead to each sanction being imposed.

Dr Sim Kwang Soon, 53, the general practitioner in Bedok, acknowledged that his failure to refer his patient to an eye specialist "in a timely manner" meant that he had breached the SMC's Ethical Code and Ethical Guidelines (2002 edition).

The section he breached states: "A doctor should practise within the limits of his own competence in managing a patient. Where he believes that this is exceeded, he shall offer to refer the patient to another doctor with the necessary expertise."

But Dr Sim was not suspended from practising.

Said the tribunal: "There was insufficient evidence to show that the harm caused to the patient was due to Dr Sim's failure to refer her to a specialist (in a timely manner)... The (tribunal) also considered and gave full credit to Dr Sim for pleading guilty at an early stage, for his long good standing in the medical profession, and the good testimonials tendered on his behalf."

In its report, the tribunal listed several factors that were considered when determining whether a suspension should be meted out.

"Based on its review of the relevant case law, the (disciplinary tribunal) found that a suspension order would generally be imposed if one or more of the following factors are present: serious and direct breach of the relevant rules and/or statutory provisions; negative consequences, including any pain and/or harm caused to the patient(s); and/or elements of dishonesty," the tribunal said.

The tribunal noted that these are "broad factors" and there is a "spectrum of gravity" for the offences within each factor.

Also, each case is unique, and in the past there have been "exceptional circumstances" resulting in the Courts and/or Tribunals not imposing suspension orders, even though one or more of these factors were present.

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