It is difficult for disciplinary tribunals to mete out sentences when taking action against errant doctors because there is a lack of guidance on relevant penalties.
A disciplinary tribunal (DT) suggested in its 31-page grounds of decision on a hearing against a doctor, released yesterday, that the Singapore Medical Council (SMC) set up guidelines to ensure sentences meted out are consistent.
The tribunal chaired by Professor Walter Tan, a plastic surgeon and medical director of Raffles Hospital, said: "Different sanctions 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 will also ensure that sentences meted out by the DTs and courts are consistent with how the medical profession perceives instances of professional misconduct."
The tribunal said Britain has such guidance "which sets out the rationale underlying each sanction and the broad factors which may lead to the imposition of each sanction".
The UK Sanctions Guidance was developed by a steering group of tribunals and General Medical Council staff.
Ms Joan Pereira, a member of the Government Parliamentary Committee for Health, agreed that guidelines "promote consistency in the treatment of doctors". She added: "Should there be any proven transgressions on the part of individual members, our society would want to see that the appropriate penalties are meted out."
Amount the tribunal fined Dr Sim Kwang Soon to reflect his "lower culpability".
The tribunal's comments arose from a disciplinary hearing against Dr Sim Kwang Soon, a general practitioner, for failing to refer a female patient to an eye specialist the day he diagnosed a corneal ulcer.
Because it was small and did not affect her vision, he advised her to return if her condition did not improve. Instead, she consulted another doctor the next day and was referred to a specialist.
She subsequently needed a transplant and cataract operation. A few months after consulting Dr Sim, she made a complaint against him to the SMC, the medical professional watchdog.
The tribunal said it was "unable to make a finding as to whether Dr Sim ought to have referred the patient to a specialist on the same day". It noted that he had intended to do so should her condition deteriorate. It also said "it was unclear if there was a causal link" between the one-day delay in her referral to an ophthalmologist and her corneal transplant.
This is because she had been discharged after her eye improved, and the transplant was done 18 days later, more than a month from the time she saw Dr Sim.
The tribunal said: "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 timeously."
It also "gave full credit" to the doctor for pleading guilty and had found no evidence of dishonesty on his part.
The tribunal researched older cases to try to ascertain the threshold for imposing a suspension. It also looked at how judgment is made in Britain and Australia.
It highlighted three factors that could lead to a suspension: a serious and direct breach of relevant rules; pain or harm to the patient; and dishonesty. It said the presence of one or more of these factors does not automatically mean a suspension has to be imposed.
The tribunal fined Dr Sim $30,000 to reflect his "lower culpability".