SINGAPORE - The Singapore Medical Council (SMC) has imposed interim conditions on a doctor for alleged lapses in the care of a Covid-19 patient who was medically evacuated from Batam, Indonesia.

The 67-year-old Singaporean man was pronounced dead 30 minutes after arrival at Tan Tock Seng Hospital/National Centre for Infectious Diseases (TTSH/NCID), on June 7, 2021.

Later that month, the Ministry of Health (MOH) lodged a complaint with the SMC against Dr Kong Sim Guan @ Sim Heng Guan, alleging that, as the only doctor involved in the evacuation, he had failed to provide the standard of care required of a doctor.

The SMC convened a complaints committee, which is set up each time a complaint is received to decide if any action is needed, to look into MOH’s complaint.

As this committee “was concerned that there is a real and potential risk that similar incidents may occur in the future in respect of medical evacuation or transport assignments involving Dr Kong”, an interim orders committee (IOC) was convened to see if temporary measures were needed, pending the conclusion of the case.

Dr Kong was informed of the IOC inquiry on July 3, 2023, and he attended the hearing on July 28.

The IOC decided to impose interim conditions on how Dr Kong may continue practising medicine, in order to protect the public until the case against him is resolved, or for 18 months, whichever comes first.

Under the conditions, Dr Kong cannot offer or agree to act as a medical practitioner and/or provide medical services for any medical evacuation or medical transport assignment – except for immediate life-saving procedures.

He must also inform the SMC on where he intends to practise, and inform any employer of these conditions.

At the time of the incident, Dr Kong was the clinical director of a private ambulance operator (PAO) tasked with the medical evacuation. He was deployed by the PAO to evacuate the patient, who had tested positive for Covid-19.

The man, who had other medical problems, was enclosed in a portable mobile isolation unit for the transfer to Singapore. Dr Kong was the doctor in charge of the patient from Batam Ferry Terminal, via ferry and ambulance, to TTSH/NCID.

The names of the patient and the PAO were redacted from the IOC’s published decision.

Although Dr Kong knew that a complication from Covid-19 was breathlessness, “it slipped his mind to bring an oximeter”, according to his first statement. But he brought two oxygen cylinders. He said he had expected the PAO to provide him with all the necessary equipment.

While Dr Kong was on the ferry to Batam, a Mr F from the PAO called to tell him that the patient had cancer and heart diseases. Mr F later told him that the patient’s arrival at Batam Ferry Terminal had been delayed because he was breathless and needed to be stabilised before the transfer.

MOH’s complaint said Dr Kong did not monitor the patient’s medical status during the handover in Batam or during the ferry trip to Singapore. Dr Kong disputes this, saying he had watched the patient all the while.

The IOC statement said: “According to Dr Kong, it was his role to check or monitor the patient’s vital signs, including his oxygen level, but he did not monitor the patient’s pulse, blood pressure or oxygen level as he did not have the necessary equipment.”

Dr Kong said in his first statement that he observed the patient had a look of despair during the trip, pointed to his own chest, shook his head as if he was giving up, and attempted to talk to Dr Kong.

But Dr Kong did not check his status, nor did he record the patient’s vital signs after the ferry berthed in Singapore.

Dr Kong said that as the patient was also on his mobile phone, “his distress could be related to the conversations he was having or to how he felt about his symptoms”. As Dr Kong did not understand Malay, he was unable to figure out which it was.

A private ambulance from a different company was waiting for the patient at Tanah Merah Ferry Terminal. The complaint said Dr Kong had failed to identify that the patient was in a critical condition, which would have warranted an emergency ambulance from the Singapore Civil Defence Force.

He also allegedly did not tell the ambulance crew that he was a doctor, a point that Dr Kong disputes. He sat in the front seat of the ambulance, instead of being with the patient. An emergency medical technician was with the patient.

According to the MOH complaint, the patient’s condition had deteriorated, and he went into a medical emergency on the way to the hospital. As Dr Kong was seated at the front, he was not able to render assistance.

“On arrival at TTSH/NCID, the patient was noted to be pulseless, not breathing and unresponsive,” the complaint said. Medical personnel started cardiopulmonary resuscitation but stopped after 30 minutes, as the patient had died.

SMC said: “A delay in receiving timely and/or urgent medical treatment could potentially reduce a patient’s chances of survival, lead to the deterioration of the patient’s condition, or result in adverse outcomes and even death.

“The significance of any delay is further magnified if the patient suffers from a life-threatening or time-sensitive condition requiring urgent medical treatment, which is a very real possibility for patients undergoing a medical evacuation or transport.”

While disputing several points in the complaint, Dr Kong told the IOC at the hearing on July 28 that he was agreeable to the conditions being imposed on him as he intended to retire.

The IOC noted the conditions would not be a burden as Dr Kong had said his current medical licence allows him to only prescribe for himself and his family, and that he planned to retire.

However, the IOC added that it was nevertheless necessary to impose the conditions “as there would otherwise be nothing to stop Dr Kong from deciding in the future to upgrade his medical licence to a fully registered one, thereby being able to provide medical services for medical evacuation or medical transport assignments again”. 

An IOC judgment is not a finding of guilt but, rather, to impose interim measures if it deems it necessary to protect the public should the alleged claims be true. The conditions took effect on July 28, but the decision was made public on Monday.

Dr Kong is the fourth doctor in 2023 on whom interim orders have been imposed.