Medical watchdog ‘should consider sentencing guidelines’ for errant doctors

SINGAPORE — A general practitioner has been fined S$30,000 for failing to refer a patient with a corneal ulcer to an eye specialist in a timely manner more than seven years ago.

Deciding last month that Dr Sim Kwang Soon’s actions did not warrant a suspension, the disciplinary tribunal noted a lack of guidance for the sentencing of doctors in disciplinary proceedings here.

In grounds of decision released on Tuesday (Sep 26), the tribunal – chaired by Professor Walter Tan and comprising Dr Arthur Tan Chin Lock and legal service officer Bala Reddy – said there should be guidance based on previous cases and policy considerations “so that medical practitioners may be aware of the severity of their misconduct”.

Guidance would ensure sentences meted out by disciplinary tribunals and courts are consistent with how the medical profession perceives instances of professional conduct, the tribunal said. In the United Kingdom, for instance, medical practitioners tribunals are guided by the UK Sanctions Guidance developed by a steering group, which sets out the rationale underlying each sanction and the broad factors which may lead to its imposition.

“The Singapore Medical Council (SMC) may wish to consider formulating its own set of guidelines,” the tribunal said.

It decided a fine and censure sufficed for Dr Sim, 53, because his breach of the ethical code and ethical guidelines, and the negative consequences caused to the patient were not so serious as to warrant a suspension.

A suspension order is generally imposed in instances where there is serious and direct breach of rules, where there are negative consequences including pain or harm caused to the patients and/or there is dishonesty, it noted.

Dr Sim’s unnamed patient consulted him in June 2010 for a corneal ulcer in her left eye. The condition may cause vision loss.

Dr Sim did not refer her to an eye specialist immediately but advised her that the corneal ulcer was small and would not affect her vision. He told her to return if her condition did not improve.

The patient was referred to the emergency department of a hospital the next day, but was not immediately referred to a specialist centre. She was later hospitalised for more than a fortnight and underwent a corneal transplant and cataract operation. She had only 20 per cent function in her left eye after surgery, and filed a complaint against Dr Sim in May 2013.

Experts in Dr Sim’s hearing differed on whether he should have referred her to a specialist on the same day – although they agreed that his decision to observe her condition for a few more days was wrong.

Dr Sim’s lawyer Charles Lin contended that the patient’s loss of vision was not caused by his delay in referral, but by her lack of response to eye drops and anti-fungal medication prescribed during hospitalisation. The SMC’s lawyers led by Mr Philip Fong, however, called for Dr Sim to be suspended for three to four months.

There was no evidence that Dr Sim withheld referral for personal gain or with total disregard for the patient’s wellbeing, the tribunal said. It added that it was also unclear if there was a “causal link” between his failure to refer her to a specialist on the same day, and the transplant and operation she later underwent.