Doctor fined for secretly prescribing cough syrup to treat addicted patients who refused help at IMH

SINGAPORE — When some of his regular patients started consulting him more often to ask for a type of cough syrup containing codeine, which belongs to a class of drugs known as opioids, family doctor Jitendra Kumar Sen started getting suspicious that they might have become addicted to it.

Opioids are often used as painkillers and have an effect similar to opium or morphine, which can give rise to feelings of relaxation and euphoria, but they can be addictive.

Sen advised these patients to seek professional help for their addiction but they refused. So he took it upon himself to place them on his own “codeine weaning programme”. 

He would prescribe them up to four 90ml bottles of cough syrup a week, provided they promised to reduce their dependence on it.

He did all this covertly, collecting payments in cash and not keying in the consultations or prescriptions in the patient’s medical records to avoid the patients being legally implicated.

Codeine is a Class B controlled drug under the Misuse of Drugs Act. Under the law, doctors and pharmacists can only sell a limited quantity of the drug for a restricted period and they have to record the purpose of the treatment.

Sen, 58, who is the licensee of The Family Clinic@Towner located on Towner Road, was fined S$6,000 on Friday (Sept 2) after he pleaded guilty to three counts of failing to maintain proper medical records. Six similar charges were taken into consideration during sentencing.

The court heard that the family doctor had nine patients who were on this programme over various durations from 2016 to 2019.

Prosecutor Michelle Lu for the Ministry of Health (MOH) said that each time the patients went to him to get cough syrup, he would instruct his clinic assistant to dispense the bottles of unlabelled syrup and to collect payment in cash.

This money was kept separate from the clinic’s regular proceeds, she added.

The doctor’s covert programme was discovered when the Health Sciences Authority (HSA) received an anonymous tip-off in December 2018 that Sen was laxly supplying Dhasedyl, a type of cough syrup containing codeine.

‘GENUINE DESIRE’ TO HELP

Seeking a S$6,000 fine, which the judge eventually ordered, Ms Lu argued that Sen made a conscious choice and effort in the way he did not make records of the patients’ visits or label the bottles of Dhasedyl, and took only cash payments to conceal his wrongdoing.

Ms Lu added that Sen had committed the offences over a long period of time and had stopped only when he was being investigated by MOH. Two patients highlighted by the prosecution were each kept on the programme for more than two years.

Sen’s lawyer Christopher Chong sought a S$3,000 fine and stressed that his client had committed the offences out of a “genuine desire” to help his patients overcome their addiction, a point the prosecution acknowledged.

“These patients had been Sen’s patients for some time,” the lawyer from Dentons Rodyk and Davidson said. “If Dr Sen suspected that a patient was consulting him solely for the purpose of procuring codeine-containing cough medication, he would turn him or her away.”

Mr Chong said that Sen would always first ask patients with codeine dependency to seek help from the Institute of Mental Health (IMH), which had a programme to address their problem.

However, each of the nine patients he eventually put on his own programme had their own reasons for being reluctant to go to IMH.

“Not least where they had families and held jobs and were the breadwinners for their families, it was thought that a record of their dependency could result in their being investigated as drug abusers and negatively impact their employment,” Mr Chong added. 

Sen would make sure to tell each of his nine patients not to see any other doctors for the same medication and spent time counselling them to understand their individual circumstances.

Mr Chong also argued that the doctor's actions were not driven by financial gain. He charged his patients S$12 for a 90ml bottle of cough syrup and always waived his consultation fees. 

In one case where a patient had successfully weaned off his codeine addiction, Sen even refunded him S$500, which was the amount the patient had paid for the cough syrup prescribed over 10 months of treatment.

Mr Chong told the court that the doctor had an unblemished track record through his medical career spanning almost 30 years.

The court also received testimonials from relatives of two different patients and the lawyer said these showed how much of a caring and compassionate doctor Sen was.

The doctor had earlier faced separate charges from the HSA for issuing codeine cough syrup to patients more than once within a period of four days, but an HSA prosecutor said on Friday that those charges have been dealt with outside the court.

For each count of failing to record medication dispensed and maintaining proper medical records, he could have been jailed up to 12 months or fined up to S$2,000, or both.