SINGAPORE — A former aesthetic doctor, who was struck off the register of approved medical practitioners in 2018, was jailed for four months on Thursday (June 16) after causing the death of a patient in 2009.

Wong Meng Hang, now 46, had gone ahead with a liposuction procedure and incompetently used a potent sedative.

This led to the death of property management boss Franklin Heng Ang Tee, 44. It was the first fatality here arising from aesthetic treatment.

Wong pleaded guilty to a single criminal charge of causing Heng’s death by a rash act not amounting to culpable homicide.

He first admitted to the offence in March before Senior District Judge Ong Hian Sun.

However, his guilty plea had to be retaken on Thursday after it emerged that District Judge Ong was serving as Chief Prosecutor in the Attorney-General's Chambers when the incident happened. Principal District Judge Toh Han Li took over as the sentencing judge.

In 2009, Wong allegedly instructed his fellow doctor Zhu Xiu Chun, also known as Myint Myint Kyi, to administer an excessive dosage of the sedative propofol to Heng, and failed to adequately monitor the patient during and after the procedure.

During police investigations, he then gave inconsistent accounts of the amount of propofol he told Zhu to administer.

The powerful anaesthetic was the same one that killed pop star Michael Jackson, who was given a large dose of propofol by a doctor to treat his chronic insomnia but left him unattended.

Wong was struck off in November 2018 over the fatal incident, while Zhu was suspended from practice for 18 months.

The judges who removed him from the medical practitioner register said that it was difficult to conceive of a worse case of medical misconduct, and directed that the doctors be investigated for any relevant criminal offences. This led to the current prosecution.

In 2015, the High Court ordered the pair to pay more than S$5 million in damages to Heng’s family. The sum was reduced to S$3.26 million by the apex court in 2016.

Wong was also fined S$26,000 and Zhu was fined S$8,000 by the State Courts in 2014, after it emerged that they had failed to follow proper procedures for several other patients.

Zhu was charged alongside Wong in 2020, and her trial for allegedly similarly causing Heng's death by a rash act is set for later this year.

VASER LIPOSUCTION

On Dec 30 in 2009, Wong and Zhu performed the procedure on Heng, then the chief executive officer of YTL Starhill Global Reit Management, at Reves Clinic on Orchard Road

Reves Clinic has since been renamed Yume Aesthetic & Medical Clinic.

Without reviewing Heng’s medical records, Wong mistakenly thought that Heng had previously undergone a type of liposuction procedure known as a vibration amplification of sound energy at resonance assisted lipoplasty (Vaser liposuction).

He thus assessed the patient to be suitable for this procedure.

Wong chose to use propofol to sedate the patient, with Zhu assisting in the procedure.

They later admitted that they were neither anaesthetists nor intensivists (board-certified physicians who provides special care for critically ill patients).

They also administered the sedative using a complex technique.

The type of anaesthetic or sedative to be used in the procedure was not stated in the written consent. The doctors also did not need to use propofol to carry out the procedure, as they could have just used pethidine.

The use of propofol is “complex” and requires close monitoring of the patient and the appropriate response, prosecutors told the court.

Wong asked Zhu to administer propofol, not knowing if she had previously done so. This was her first time giving the sedative to patients.

The court heard that this violated the Singapore Medical Council’s ethical code and ethical guidelines, which requires doctors to delegate a patient’s care to another on his behalf only if the person was competent enough, and to practise within the limits of their own competence in managing a patient.

The pair also ignored an instruction sheet that stated propofol should be administered only by physicians trained in anaesthesia or in the care of patients in intensive care, and that circulatory and respiratory functions should be constantly monitored.

PUNCTURED INTESTINES

Heng entered a state of deep sedation to the point of general anaesthesia. This was after Wong allegedly instructed Zhu to increase the dosage of propofol when Heng showed any signs of movement or discomfort, or was responding to pain stimulation.

Throughout the three-hour procedure, Heng was given more than 90ml of propofol, which was excessive. Deep sedation was not required for the Vaser liposuction procedure.

Due to their lack of training and failure to monitor Heng adequately, Wong and Zhu also did not realise that Heng was deeply sedated, prosecutors told the court.

Wong inadvertently punctured Heng’s intestines multiple times, but this went unnoticed since Heng was unable to show any signs of pain.

After the procedure, the doctors left him around 4pm with an unregistered nurse.

Fifteen minutes later, Wong returned and realised that he could not rouse Heng, prompting him to activate “code blue” and perform cardiopulmonary resuscitation on the patient.

Zhu allegedly rushed back in to help and the clinic’s receptionist called for an ambulance at about 4.30pm. When paramedics arrived about 10 minutes later and asked Wong if he had administered any shocks or drugs to Heng, Wong lied that he had not.

Heng was taken to Tan Tock Seng Hospital where Wong told doctors that he had given just pethidine and local anaesthesia to Heng.

The patient was pronounced dead at around 6pm.

Expert anaesthetists concurred that propofol had placed Heng in a state of deep sedation. He could not maintain his own airway and developed airway obstruction, leading to his death from asphyxia after the procedure.

Wong returned to the clinic and amended some timings in his post-procedure notes. He shortened the period between his discovery of Heng’s drowsiness and Heng not being able to be aroused from 20 minutes to five minutes.

He also did not keep written records of Heng’s post-procedure state for at least 25 minutes, breaching licensing conditions that required a patient’s vital signs to be monitored for at least an hour after the procedure.

Deputy Public Prosecutors Kumaresan Gohulabalan, Andre Chong and Goh Qi Shuen sought four to six months' jail for Wong.

This included a "discount" for the delay in prosecuting him after the conclusion of a coroner’s inquiry, regulatory action by the Ministry of Health and Singapore Medical Council's proceedings.

For causing death by a rash act, Wong could have been jailed for up to five years or fined, or punished with both.