Psychiatrist who prescribed large amounts of drugs to patient with insomnia and anxiety suspended

SINGAPORE — The drugs were not recommended for treatment of insomnia and anxiety for more than four weeks, but a psychiatrist prescribed them to his patient for a whopping 243 weeks, or about four years and eight months.

He also prescribed multiple psychotropic drugs at the same time without sound medical reasons to do so.

Dr Siew Hin Chin, 63, was suspended for six months and fined S$15,000 last month for breaching ethical guidelines in his treatment of the unnamed patient between 2010 and 2014.

The patient, whose age was not disclosed in the disciplinary tribunal’s grounds of decision released on Wednesday (Feb 21), had chronic insomnia, generalised anxiety disorder and obsessive compulsive disorder.

Dr Siew, who is semi-retired, pleaded guilty to three charges of failing to adequately assess the patient, to prescribe medications “on clear medical grounds and in reasonable quantities”, and to maintain clear and accurate medical records.

He practised at Dr Simon Siew Psychological Medicine Clinic at Mount Elizabeth Medical Centre.

Besides the drugs to treat insomnia and anxiety – called benzodiazepines – the patient was also prescribed a host of other medications: Anti-depressants, anti-psychotics, anti-convulsants (used as mood stabilisers), sleep hormone, pain reliever, performance enhancement drugs and a type of drugs to treat insomnia called Z group hypnotics.

The patient’s mother lodged a complaint against Dr Siew in May 2014, stating she was concerned by the “high number of medications prescribed” and about her son’s welfare.

Dr Siew did not thoroughly evaluate the nature and severity of the man’s condition or his difficulties with his family members, wife and girlfriend, the disciplinary tribunal found.

Dr Siew did not assess the patient for any withdrawal symptoms or side effects arising from the drugs prescribed.

He did not follow up on the patient’s potential abuse of the medications although the man frequently went to collect his prescriptions ahead of schedule and his family members had raised concerns on five occasions.

The three-member tribunal – chaired by ear, nose and throat specialist Siow Jin Keat – found Dr Siew’s prescription of a wide range and large dosages of drugs “deeply troubling”. His misconduct was “serious”, it said.

The improper use of benzodiazepines can lead to dependency, and withdrawal symptoms include insomnia, agitation and hallucinations, the tribunal noted.

Dr Siew’s lawyers said he has taken steps to improve his practice and is unlikely to reoffend as he is planning to retire in the near future. His track record of nearly 40 years was unblemished, and the misconduct was not for financial gain, they added.

But the tribunal said Dr Siew, as a psychiatrist, ought to be held to a higher standard than doctors punished in similar cases, who were general practitioners.

It even considered if his sentence might be on the “lenient side”.

“It should be made clear that this case ought not to be seen as setting a sentencing benchmark for professional misconduct involving the inappropriate prescription of benzodiazepines and other hypnotics by a specialist in psychiatry,” the tribunal said. “In suitable and appropriate cases, the Singapore Medical Council should have the latitude to submit for a higher sentence.”