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Cardiologist cleared of professional misconduct

SINGAPORE — The Court of Three Judges urged the Singapore Medical Council on Friday (Oct 20) to avoid inordinate delays in disciplinary proceedings, as it cleared a cardiologist of failing to obtain informed consent from a patient before surgery 6.5 years ago.

The Court of Three Judges overturned the decision of a disciplinary tribunal to convict cardiologist Leslie Lam of failing to obtain informed consent before carrying out a medical procedure.  Photo: TODAY file photo

The Court of Three Judges overturned the decision of a disciplinary tribunal to convict cardiologist Leslie Lam of failing to obtain informed consent before carrying out a medical procedure. Photo: TODAY file photo

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SINGAPORE — The Court of Three Judges urged the Singapore Medical Council on Friday (Oct 20) to avoid inordinate delays in disciplinary proceedings, as it cleared a cardiologist of failing to obtain informed consent from a patient before surgery 6.5 years ago.

It took more than six years for the case involving Dr Leslie Lam Kwok Tai – who is in private practice – to reach the Court of Three Judges, noted Chief Justice Sundaresh Menon, who ruled alongside Judges of Appeal Andrew Phang and Steven Chong.

“It seems to us that this is an inordinately long time to dispose of such a matter,” said CJ Menon. “We urge the SMC to scrutinise its procedures to avoid such delays.”

The judges noted the court’s decision in a recent case involving oncologist Ang Peng Tiam, which said such delays could lead, in the event of a conviction, to a reduced sentence on account of prolonged uncertainty and strain endured by the doctor.

Dr Lam, 75, had his charge of professional misconduct overturned.

He had operated on the patient, an unnamed foreign national, in March 2011.

The patient, who had two stents inserted to unblock an artery, complained to the SMC in August 2011 saying the procedure was unnecessary and Dr Lam had failed to apply the requisite skill.

The SMC sent Dr Lam a notice of complaint in April 2012 and sent a notice of inquiry setting out charges against him in Sept 2015. The inquiry was conducted in June last year and the SMC-appointed disciplinary tribunal convicted him of a charge last November.

Dr Lam appealed against his conviction as well as the three-month suspension from practice.

The court ruled that Dr Lam’s conviction “cannot stand”. It took issue with the ambiguous framing of the charge and said the tribunal had erred in several ways.

While Dr Lam failed to properly document consent-taking from the patient, the tribunal failed to consider other pieces of evidence, said CJ Menon.

The patient had signed a form agreeing to an imaging procedure called the conventional angiogram and, if necessary, the procedure to unblock his artery. This “directly contradicted” the allegation against Dr Lam.

Moreover, the tribunal had found the patient – who underwent a similar procedure at Raffles Hospital in 2006 – to be knowledgeable.

The judges said the tribunal did not weigh the evidence carefully. Instead, it “treated the absence of documentation of consent-taking as virtually conclusive of the question of whether or not the patient’s informed consent had been obtained. This was where it made a serious error”, said CJ Menon.

“We reiterate that the present case concerns the taking of informed consent, and not the keeping of accurate and contemporaneous records,” he wrote.

The court added that in light of requirements from the SMC’s new Ethical Code and Ethical Guidelines – which came into force this year – doctors must “maintain clear, legible, accurate and contemporaneous medical records of sufficient detail”.

“We would expect that the SMC, moving forward, will consider preferring charges for failure to keep proper records in cases such as Dr Lam’s,” wrote CJ Menon.

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