Explainer: What happens when a complaint is filed against a Singapore doctor, and how this could change

SINGAPORE — After two disciplinary tribunal rulings triggered an outcry in the medical community, the authorities last week named a 12-member workgroup to review the disciplinary process for doctors here.

Helmed by Associate Professor Ng Wai Hoe, deputy group chairman of SingHealth’s medical board and Senior Counsel Kuah Boon Theng of Legal Clinic LLC, the group will review the disciplinary process of the Singapore Medical Council (SMC). It will also look at how doctors obtain informed consent from their patients.

It is expected to complete its work by the year’s end.

News of the workgroup’s appointment came as the SMC reviewed the “appropriateness” of its disciplinary tribunal’s judgements against orthopaedic surgeon Lim Lian Arn and psychiatrist Soo Shuenn Chiang.

Both cases drew heated debate and responses from doctors here, with thousands petitioning against the harshness of the fines meted out.

But what happens to a complaint that is lodged against a doctor? And how is a disciplinary tribunal set up?

Here is a look at the current disciplinary process and how some doctors feel it should change:

STEP 1: A COMPLAINT IS FILED

An individual submits a complaint in writing, along with a statutory declaration, as required under the Medical Registration Act.

The complaint will be submitted to the chairman of the SMC’s complaints panel, who then appoints a committee to review it.

The complaints panel comprises 100 doctors and 50 “laypersons” recommended by healthcare institutions and professional bodies, said a spokesperson for the SMC.

STEP 2: COMMITTEE PROBES COMPLAINT

An SMC council member chairs the committee — which investigates every complaint — comprising another senior doctor and a layperson drawn from the complaints panel.

Apart from combing through the complaint, the committee will ask the doctor in question for a written explanation and obtain relevant documents where necessary, before deciding on the next move.

The committee may at times seek expert opinion on whether a doctor’s professional conduct or treatment had been appropriate, said the SMC spokesperson.

There are several possible outcomes after the committee’s investigation, which could include referring the case for mediation or to a disciplinary tribunal.

STEP 3: REFERRAL TO A DISCIPLINARY TRIBUNAL

About one-tenth of the 170 complaints that the SMC receives on average yearly are referred to a disciplinary tribunal.

A senior doctor with at least 20 years’ standing or a senior lawyer with no less than 15 years’ experience will chair the disciplinary tribunal.

Those presiding over tribunals are drawn from a pool of tribunal chairmen whom the Health Minister appoints. To maintain the tribunal’s independence, none of the 22 SMC council members will take part in it.

If a doctor chairs the tribunal, its other members will include another doctor from the complaints panel and a legal service officer. If a lawyer is at the helm, three other doctors from the complaints panel will form the tribunal.

STEP 4: PRE-INQUIRY CONFERENCE

The doctor at the centre of a complaint will be served a notice of inquiry, with a date for a “pre-inquiry conference”. This hearing involving lawyers for the SMC and the doctor, or the doctor himself if he is not represented, is to settle matters such as whether the doctor is contesting the charge or charges and to set the inquiry dates.

STEP 5: INQUIRY

At the close of each inquiry, the tribunal will exercise one or more of its powers under the Medical Registration Act, depending on whether the doctor is found guilty of professional misconduct.

The possible outcomes include a fine or a suspension, or even removal from the register of medical practitioners.

STEP 6: APPEAL

The doctor or the SMC may appeal to the High Court against a disciplinary tribunal’s judgement within a 30-day deadline. If this deadline has passed, the SMC must apply to the court to seek a time extension to file an appeal.

This occurred in Dr Lim and Dr Soo’s cases, with the SMC requesting extensions to file appeals to reduce the fines meted out.

The court will review the appeal if an extension is granted and give the parties a hearing date.

ABOUT THE REVIEW

The workgroup reviewing the disciplinary process will give its recommendations, including how complaints are considered and how tribunal proceedings are carried out.

Its review will go beyond the scope of a “sentencing guidelines committee” that the SMC set up in January to ensure that sentences are fair and consistent.

Doctors whom TODAY spoke to suggested that at least one member of each disciplinary tribunal be drawn from the same field as the subject of a complaint.

Dr Ong Kian Chung, a specialist in respiratory medicine at the Mount Elizabeth Medical Centre, questioned the extent to which members of the tribunal understood the concerns of doctors, who come from an array of specialties and backgrounds and vary widely in age.

“I don’t know how much the doctors who form the tribunal would have an idea of what goes on in the specialties that they are not involved in. For instance, if you have a specialist trying a general practitioner, how representative is that?” he asked.

However, Dr Ong acknowledged that it might be hard to get doctors from certain specialties and it would not be ideal if tribunals were delayed further as a result.

Agreeing, a psychiatrist in the public healthcare sector who declined to be named said there are intricacies unique to certain specialties, such as mental health legislation in psychiatry.

She proposed that the complaints committee seek more input from practitioners within the practice setting before it decides to refer a case to a disciplinary tribunal.

“Doctors practise differently in different settings, (such as) whether they are in the private or public sector,” she said.

The SMC should also step up its investigations into complaints before it decides on their validity, she said. In Dr Soo’s case, it appeared that more views from fellow psychiatrists could have been sought, she added.

She also called for more details of how disciplinary tribunals arrive at the penalties meted out to doctors, beyond what is stated now in published judgements.

Dr Ong also hoped that more light could be shed on how the complaints committee determines cases to require an inquiry.