Health ministry asks medical council to review surgeon’s S$100,000 fine

SINGAPORE — Amid an outcry among local doctors, the Ministry of Health (MOH) has tasked the Singapore Medical Council (SMC) to apply to the court to review a S$100,000 fine recently imposed on orthopaedic surgeon Lim Lian Arn “and for the appropriate revisions to be made”.

This is the first time the MOH has asked the SMC — which regulates doctors here — to review a disciplinary tribunal’s decision, the ministry said on Wednesday (Feb 20).

Dr Lim had pleaded guilty to failing to inform a patient of the risks or complications that could arise from a steroid injection he was administering, and was handed the maximum fine.

Doctors here questioned the severity of the fine and sought clarifications on whether they were expected to list every possible risk of treatments or drugs when dealing with patients.

A spokesperson from the SMC told TODAY it filed an application to the High Court to seek an extension of time to file an appeal. This is because the 30-day deadline — provided under the Medical Registration Act — for Dr Lim or the SMC to file an appeal against the tribunal's order has passed.

CASE HOLDS WIDER IMPLICATIONS

As the case had raised such widespread concern among the local medical community, MOH said it had the potential to affect how medicine was practised here.

“We are concerned that this case should not be viewed as or lead to the practice of defensive medicine, which would have an adverse impact on patient and clinical safety,” it said in its statement.

“There have also been questions raised about the liability imposed in this case.”

It added: “Whilst both Dr Lim and the SMC may have accepted the sentence, the decision in this case carries with it much wider professional practice implications and also has an impact on future cases. MOH is of the view that this decision should be reviewed.”

Sentences have to be commensurate with the circumstances of each case, the ministry said.

“MOH will continue to engage with healthcare professionals to have greater clarity and balance in the practice and processes in the medical community, so as to enhance patient safety and, at the same time, also keep overall healthcare costs affordable.”

It added: “In future cases, MOH will consider providing our inputs to SMC should there be similar wider professional practice implications.”

THE BACKGROUND

Dr Lim had failed, in Oct 2014, to tell a patient with pain in her left wrist of any risks or complications from a steroid injection. The treatment, however, was appropriate.

The patient later developed “paper-thin skin” with discolouration and loss of fat and muscle on her wrist, and lodged a complaint.

The SMC had sought a five-month suspension, while Dr Lim’s lawyer had asked for the maximum S$100,000 fine in lieu of suspension, or a three-month suspension if warranted.

After the tribunal’s ruling, fellow orthopaedic surgeon Tho Kam San started a petition calling for the MOH to clarify its stand on the need for doctors to obtain informed consent from patients for minor procedures.

Shortly after, the SMC clarified that doctors need to convey only “relevant and material” information to their patients and do not need to inform them of all possible complications of a treatment or procedure.

But the uproar continued. Last week, Members of Parliament raised the matter in the House. Among the questions, Dr Lim Wee Kiak (Sembawang Group Representation Constituency) asked whether the case could be reopened.

In his response to the MPs, Senior Minister of State for Health Lam Pin Min reiterated SMC’s message that doctors do not have to lay out “every possible side effect and potential complications” of a drug or treatment, and added that there could be a review of disciplinary processes and the sentencing framework for errant doctors.