The Court of Three Judges has ordered that the doctor involved in the liposuction death of real-estate firm boss Franklin Heng in 2009 be struck off the register.
In its judgment grounds yesterday, it warned that this would be the presumptive penalty for doctors displaying serious misconduct or dishonest behaviour, unless there are exceptional circumstances.
A doctor who had 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 courtalso ordered that the case be reported to the Public Prosecutor so 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 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," Chief Justice Sundaresh Menon wrote in issuing the judgment.
Said the court: "This was among the most egregious cases of medical misconduct we have come across."
In setting out the appropriate approach when dealing with serious misconduct by doctors, it 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 in a liposuction procedure at his Orchard Road clinic in December 2009. Left unattended, the 44-year-old suffocated when his airway collapsed due to the heavy sedation. It was Singapore's first recorded death as a result of aesthetic treatment.
In 2016, Dr Wong and Dr Zhu, who is also known as Myint Myint Kyi, were ordered to pay $3.26 million in total damages 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, and in December last year, they were suspended for 18 months and six months respectively.
The Singapore Medical Council 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 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. Dr Wong recklessly decided to embark on a risky sedation procedure despite being untrained; administered the sedative improperly by giving an excessive dosage; and lied to the accident and emergency doctors.
The court found Dr Zhu's misconduct not as grave as Dr Wong's in explaining why she was suspended for 18 months, noting she did not act dishonestly.
But it made clear Dr Zhu's personal mitigating circumstances "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."