A doctor who let a shuttle bus driver continue working when his eyesight did not meet the required standards has been suspended for three months.
The Singapore Medical Council's (SMC) disciplinary tribunal found Dr Sanjay Srinivasan of Khoo Teck Puat Hospital (KTPH) guilty of "serious negligence amounting to professional misconduct" for wrongly diagnosing the patient's eye condition and for letting him drive with affected eyesight.
The tribunal said that error of judgment by itself is not professional misconduct, and mere negligence, professional incompetence or deficiencies are not professional misconduct.
But Dr Sanjay's action "endangered the patient, the passengers and other road users".
In imposing the suspension, the tribunal wanted to send a message that "proper and careful clinical evaluation of a patient is vital" and for it to "serve as a general and specific deterrent".
The patient had gone to a polyclinic in October 2013 because of a sudden blurring of his right eye that had started two days before.
The doctor found his right vision to be 6/36 - which means that he can read letters at 6m that people with normal sight can read at 36m - and sent him to the eye clinic at KTPH that same day.
When Dr Sanjay, 45, examined him, he found the patient's right vision to be 6/24. To drive a bus, he needs vision of at least 6/12.
Dr Sanjay told the patient he had mild cataract and suggested that he get spectacles. He told him to return in six weeks for a review. He gave him medical leave only for that day.
The tribunal took issue with Dr Sanjay for not making it mandatory for the patient to get a pair of spectacles before going back to work.
It said Dr Sanjay assumed the patient "would be able to make a pair of prescription glasses in less than half a day after the consultation at KTPH". He also did not give instructions that the spectacles needed to provide the patient with at least 6/12 vision so he could continue driving a bus.
The next day, the patient returned to the polyclinic saying he had difficulty driving the bus because of his impaired vision.
This time, the doctor sent him to a hospital emergency department, which in turn sent him to an unnamed institution the following day where he was seen by an eye specialist.
The doctor there gave him laser treatment and 15 days of medical leave. A review a week later found his eyesight had improved to 6/18.
Because the driver wanted to get back to work fast, the doctor got an optometrist to help him get a pair of spectacles.
The tribunal also criticised Dr Sanjay's expert witness for being evasive and biased. The witness was the colleague of Dr Sanjay's supervisor. The tribunal said Dr Sanjay's supervisor would have "a vested interest in the outcome of this inquiry" and it was not lost on the witness that it would not be good for the place where they both worked if the supervisor was implicated in any way.
So the tribunal discounted his opinion, saying he lacked independence. The witness was also involved in processing Dr Sanjay's work application.
Dr Sanjay, who has more than 20 years' experience as a doctor, is from India.
The SMC had asked the tribunal to impose an $8,000 fine and a four-month suspension.
But given that Dr Sanjay is "a hardworking and dedicated doctor, and also a responsible and caring doctor", it decided on the minimum suspension term of three months.