Improvements to the Singapore Medical Council's (SMC) disciplinary process were proposed by an official panel yesterday to ensure standards are better enforced and to enhance the integrity of the system.
These aim to bring about faster resolution of complaints and earlier closure for patients, as well as make the process more transparent.
The recommendations come after two high-profile cases this year in which the judgments by the SMC's disciplinary tribunals were declared potential or actual "miscarriages of justice" by the Court of Three Judges, which is the final body of appeal for cases dealt with by the disciplinary tribunal.
In issuing its recommendations, the Workgroup to Review the Taking of Informed Consent and SMC Disciplinary Process noted that there had been an "erosion of trust in the system" among doctors and patients.
It added: "If these pressing issues are not tackled swiftly and effectively, they will continue to fester and have serious ramifications."
The 29 recommendations - 23 of which relate to the disciplinary process - were based on views given at town halls and engagement sessions with various stakeholders, including more than 1,000 doctors.
Speaking at a press conference yesterday, the group's co-chair, Senior Counsel Kuah Boon Theng, said: "The aim is to improve the process so that it can consistently give us fair, expeditious as well as proportionate outcomes."
At present, a complaint received by the SMC will either be referred directly to a disciplinary tribunal (DT) or sent to a complaints committee (CC).
The CC can then choose to refer it to a DT, issue a letter of advice or warning, dismiss the complaint or recommend mediation. A complainant whose complaint was not referred to a DT and who disagrees with the CC's decision can appeal to the health minister.
In the current process, a new CC has to be formed each time a complaint is filed, with an SMC member as its chairman.
Consequently, some complaints can take up to six years to process owing to the amount of manpower and resources needed to tackle each case, as well as a lack of doctors to sit on the CCs and DTs, resulting in a backlog of cases.
Last year, SMC processed 417 complaints, out of which 279 were brought forward from past years.
Only 192 of these were concluded, while 217 were adjourned .
Aside from a lack of manpower, the workgroup found several key issues with the current process.
These included concerns that the CC and DT processes were not independent, as SMC was perceived to have played the role of the investigator, prosecutor and judge.
CC and DT members were also found to lack familiarity with their powers and how to properly exercise them, resulting in "serious injustice and a waste of resources".
Additionally, resources were spent on managing a significant number of complaints which were found to be without merit.
To tackle the problems, the workgroup proposed setting up an inquiry committee (IC) to filter out complaints that are frivolous, vexatious, misconceived or lacking in substance early.
The IC would be able to dismiss complaints, issue letters of advice, recommend mediation or refer them to the CC.
The group recommended removing the requirement that the chairman of a CC must be an SMC member. It also called for establishing an independent disciplinary commission which would in turn appoint a DT, thus preserving the latter's independence.
Other recommendations include setting a stricter timeline of 18 months as a target to dispose of complaints, and empowering the IC and CC to make cost orders against complainants lodging frivolous and vexatious complaints.
The group also recommended that mediation play a bigger role in the disciplinary process, by allowing the SMC to direct complainants and doctors to participate in mediation at an earlier stage.
Noting that only about 2 per cent of complaints each year are referred for mediation, Ms Kuah said many concerned minor lapses, failures of memory and poor record-keeping, and could have been resolved amicably.
Mediation would offer a forum for patients to seek answers and redress directly from the doctors in appropriate cases.
The group recommended that the right to appeal to the minister be replaced with the right to request that the decision be reviewed by a review committee.
It also proposed that members of ICs, CCs and DTs be provided with special training, as DTs have on several occasions made mistakes, like accepting a guilty plea without assessing whether a charge is supported by facts and evidence.
The Health Ministry has accepted the recommendations and the workgroup hopes they will be passed into law by mid-2020. Said SMC president Chee Yam Cheng: "SMC is optimistic that the recommendations put forth by the workgroup will help SMC strengthen the disciplinary processes."