Patient lost part of scrotum to gangrene after doctor failed to examine him

SINGAPORE - A diabetes patient who had a fever and a painful lump in his buttock ended up losing part of his scrotum to gangrene because the company doctor did not examine him and refer him to a hospital for treatment.

On Wednesday (March 6), Dr Mohd Syamsul Alam Ismail was suspended for 2½ years and fined $40,000 for professional misconduct.

The punishment was handed down by the Court of Three Judges after the Singapore Medical Council (SMC) appealed against the original three-month suspension imposed by a disciplinary tribunal.

Dr Syamsul, a Malaysian who is currently practising in Johor, was one of the doctors at a shipyard in 2013.

On May 14 that year, the patient went to see Dr Syamsul, complaining that he had a fever for five days and also a painful lump.

The patient also told him that he was diabetic but had not taken his medication for some time. People with diabetes have an increased risk of developing gangrene.

Dr Syamsul did not examine the patient and prescribed him antibiotics and gave him three days of medical leave.

The next day, the patient was admitted to hospital, where he was diagnosed with gangrene and underwent emergency surgery to remove a part of his scrotum.

The patient had two more operations and was hospitalised for more than a month.

In November 2014, the patient complained to the SMC, saying that he was unable to have sex for the rest of his life due to the pain.

The SMC brought two charges against Dr Syamsul.

One was for failing to undertake an adequate clinical evaluation of the patient and failing to provide competent, compassionate and appropriate care.

The other was for failing to keep clear and accurate records with sufficient detail.

Dr Syamsul became uncontactable in April 2017 despite attempts to contact him by telephone, e-mail and letter.

In October 2017, he e-mailed the SMC asking if he could continue working in Singapore. He said he did not intend to take part in his disciplinary inquiry.

A disciplinary tribunal convicted him, saying the patient should have been referred to a hospital, given his symptoms and diabetic condition. The tribunal imposed a three-month suspension and a $40,000 fine.

However, the SMC, represented by Mr Anand Nalachandran, appealed for a longer suspension.

The court, comprising Chief Justice Sundaresh Menon and Judges of Appeal Judith Prakash and Tay Yong Kwang, agreed that this was warranted.

Noting that Dr Syamsul's "scanty" consultation notes failed to record details of the patient's symptoms, the court concluded that he had not carried out any physical examination.

"This was serious negligence," said CJ Menon. "Dr Syamsul had failed to perform basic and elementary things that any competent doctor ought to have done."

The court said that Dr Syamsul's failure to examine the patient resulted in a loss of chance to arrest the onset and spread of gangrene.

His blatant lack of remorse was seriously aggravating, said the court, noting his communications with the SMC.

CJ Menon said the court maintained the fine to send a signal to errant doctors who are able to practise overseas that they cannot simply avoid punishment by waiting out the period of suspension.