SINGAPORE — The issue of how much a doctor can and should charge dominated prominent surgeon Susan Lim’s five-hour-long appeal hearing before the Court of Three Judges yesterday.

Senior Counsel Lee Eng Beng, Dr Lim’s lawyer, questioned if charging fees beyond the “intrinsic value” of the medical services provided, and irrespective of the costs in providing them or the agreement of the patient, amounted to professional misconduct.

Dr Lim was found guilty last July by a Singapore Medical Council (SMC) disciplinary committee (DC) of 94 charges of professional misconduct for overcharging and making false representations in her invoices for her treatment of a royal patient from Brunei. She charged S$24 million for half a year’s care, before halving it to S$12.1 million with a discount.

Dr Lim was suspended from practice for three years, fined and censured but continues to practise pending the outcome of her appeal.

Mr Lee yesterday wondered if there was an “ethical limit” to the quantum of fees a doctor may charge. There is currently no such rule in the SMC Ethical Code, he noted.

Further, Mr Lee pointed out that the Health Ministry’s current published policy for fees in private practice stated: “It is better to leave fees to competition and market forces.”

Complaints were never made by the patient or the family or the Bruneian authorities, who were paying the bills, that Dr Lim behaved unethically, and all parties had entered the contract without ethical breaches, Mr Lee added.

However, Judge of Appeal V K Rajah, one of the three judges who presided over the hearing, noted that a profession is more than just a business, and a concept of ethical charging should exist. “I think it’s inherent in a profession that there must be a just and fair limit,” he said.

Dr Lim’s contention that she can charge whatever she wishes because it is a “free market” fails to appreciate the issue as a matter of ethics, not commerce, and is incorrect in law, argued the SMC’s lawyer, Senior Counsel Alvin Yeo.

He added that Dr Lim’s excuse of her ignorance of the existence of such a rule prohibiting overcharging “is both unbelievable and shocking”.

Mr Yeo argued that the punishment was “justified of the circumstances” and that the committee felt it needed “to send a strong message that such behaviour should not be condoned”.

Further, Dr Lim “has never expressed any remorse or contrition”, but instead “vigorously argued that she never thought she had done anything wrong” as she purported that there was a “fee arrangement” between her and the Bruneian royal patient, said Mr Yeo.

Dr Lim was not present during yesterday’s hearing but her husband, Mr Deepak Sharma, was spotted in the packed courtroom. Ashley Chia