Forum Letters on Singapore Medical Council

SMA News Nov 2012 SMC Role

SMC shouldn’t confuse message with messenger

(11 Jan 2013)

I AM perplexed and disappointed by the Singapore Medical Council’s response (“Disciplinary cases fairly heard: SMC”; Wednesday) to feedback on its disciplinary processes.

While the council is fully entitled to defend its position, its comments about Dr T. Thirumoorthy and Dr Chua Boon Ling were uncalled for. These two doctors offered feedback to improve a process that the Court of Appeal had openly criticised, even using the words “legally embarrassing”.

Even if the council disagrees with the feedback, it should make a clear distinction between the message and the messenger.

It is appropriate to vigorously challenge the validity of comments or suggestions. It is inappropriate to cast aspersions on those offering these comments, and attack them rather than their ideas.

As a doctor, I am saddened by the conduct of the council and its treatment of fellow doctors offering feedback. As a Singaporean, I am alarmed at the hostility towards alternative perspectives.

Jeremy Lim (Dr)

 

SMC should relook its role

(11 Jan 2013)

I AM disappointed that the Singapore Medical Council (SMC), in its letter (“Disciplinary cases fairly heard: SMC”; Wednesday), chose to focus on the smaller point of financial considerations instead of its role as “prosecutor, judge and jury”.

The SMC has done a good job in most of the cases involving errant doctors peddling addictive medications for financial gain.

However, its track record in other cases is more spotty. Some doctors have the view that if they ever get called up for an SMC disciplinary hearing, they would be unlikely to get a fair trial. This has led, as Dr T. Thirumoorthy pointed out, to doctors resorting to defensive medicine (“Medical council: Prosecutor, judge, jury”; Dec 30).

It is good that the SMC now appoints non-member doctors to the disciplinary tribunal. But it should not give the impression that the doctors are appointed because they toe the official line, as this could fuel distrust on the ground.

There is also the question of whether the training for these ad hoc appointed doctors is sufficient. Medicine often is a matter of professional opinion rather than an impartial study of the facts of a case. The influence of a lawyer on the tribunal may or may not make a difference, depending on the individual.

The SMC and the Health Ministry should relook their roles. Having the ministry as the complainant, an independent non-appointed tribunal as the investigator and jury, and a fully elected SMC as judge is something worth exploring.

Peter Chen

 

Disciplinary cases fairly heard: SMC

(9 Jan 2013)

THE article (“Medical council: Prosecutor, judge, jury”; Dec 30) reports the opinions of Dr T. Thirumoorthy, suggesting that the Singapore Medical Council’s (SMC) concurrent roles of prosecutor, judge and jury cause conflicts of interest.

The SMC’s cases reported in the media recently were dealt with under the old Medical Registration Act as the complaints were made before the amendments came into force on Dec 1, 2010.

The SMC is now no longer bound by law to appoint its council members to the disciplinary tribunal. Experienced doctors and lawyers can now be appointed to the tribunal as members or as the chair. As the SMC continues to push for such changes, we hope that doctors will support these in the public interest.

The report cites Dr Thirumoorthy as pointing out that it is not in the SMC’s interest to lose a case, and “if a doctor is acquitted, SMC has to bear its own legal fees”. This suggests that disciplinary cases may be unfairly heard. Such a serious allegation must be corrected.

The tribunals and disciplinary committees (DCs) are formed to determine the truth through fair and independent hearings. The council never directs the outcomes of any hearing, nor has it made the issue of legal fees a factor influencing the decisions of the DCs. We hope that Dr Thirumoorthy, during his tenure as a council member, acted fairly, like all his colleagues on the council.

In his letter (“Lack of experience in ethics hinders SMC”; last Thursday), Dr Chua Boon Ling implied that the DCs lacked maturity and training in ethics to judge their peers. His insinuation can mislead the public. A doctor of the same name, Dr Chua Boon Ling, convicted by the DC for inappropriate prescribing in 2010, was in fact ably judged by three very senior doctors of high standing, namely, a former president of the Singapore Medical Association (SMA), a former executive director of SMA’s Centre for Medical Ethics and Professionalism, and a respected family physician.

It is important that the SMC lays out the facts correctly and responsibly in the media, as many senior doctors and laypersons sacrifice many hours serving on the DCs in the interest of the public. Their good work should not be discredited by frivolous comments.

Lau Hong Choon (Dr)

Executive Secretary

Professional Conduct & Professional Standards Division

Singapore Medical Council

Lack of experience in ethics hinders SMC

(3 Jan 2013)

I AGREE with Associate Professor T. Thirumoorthy (“Medical council: prosecutor, judge, jury”; Sunday) that there is clearly a conflict of interest in the disciplinary process of doctors. Most doctors would not see this conflict of interest until one is unfortunate enough to be involved in a disciplinary inquiry.

Another point is the competence of the doctors sitting in judgment of a colleague. The Singapore Medical Council (SMC) is made up of volunteer doctors, half of whom are elected by doctors working here and the rest appointed by the Health Ministry. They come from various disciplines of medicine and are distinguished in their specialised fields.

However, in a disciplinary hearing, the topic of debate is nearly always medical ethics, which was not extensively taught in medical schools in the past.

Although the council has a set of ethical codes and guidelines, sitting in judgment of one’s colleague requires more than just reading the ethical codes.

One has to have the maturity (in life and professional experience) and training in the field of ethics to be adequately equipped to judge one’s peers. This is true of Prof Thirumoorthy who regularly conducts courses on ethics for doctors.

An inexperienced member of the council stands the risk of being overly influenced and reliant on the prosecution lawyers, who also may not be well-versed in medical ethics.

Coupled with the conflict of interest in the disciplinary process highlighted by Prof Thirumoorthy, this means there may not be a fair trial. The recent cases where the appeal court overturned the SMC verdict clearly show the need to review this process.

Chua Boon Ling (Dr)

 

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2 comments

  1. Missed a letter from Dr. Thirumoorthy and Dr. Wong Chiang Yin of the SMA:
    Doctors’ concerns not frivolous: SMA (11 Jan 2013)
    POINTING out that there may be a perception of conflict of interest is not tantamount to alleging intentional wrongdoing on anyone’s part (“Disciplinary cases fairly heard: SMC” by the Singapore Medical Council; Wednesday). The rules of natural justice encourage an absence of conflict of interest such that justice is not just done but has to be seen to be done.
    Other than the director of medical services, all SMC members are unpaid volunteers. They make great sacrifices for the public and the profession when they serve on the SMC, and we are grateful to them. However, we still need to examine how things are done at the administrative and prosecuting levels within the SMC.

    We let the following facts speak for themselves:

    The law has always required the majority of SMC members to be appointed by the Government or publicly owned medical schools. As such, the need to guard against perceptions of conflict of interest still remains even though the SMC is now able to appoint non-council members such as senior doctors and lawyers to the disciplinary tribunal.
    Doctors’ annual subscriptions were raised on April 1 last year by 33 per cent (from $300 to $400), which implies costs are increasing rapidly since the SMC’s running costs are largely funded by doctors’ subscriptions.
    A disconcerting number of SMC judgments have been overturned by the courts on appeal in recent years. The drafting of charges in a recently overturned case was described by the courts to be “legally embarrassing”.
    In the last SMC election, each of the some 8,000 doctors fully registered with the SMC had to cast three votes. Despite a very respectable slate of candidates, about 10,000 votes, or 40 per cent, were cast for no candidate.
    The SMC announced almost three months ago that it would appoint a review committee. If indeed all is well within the SMC, as its letter seems to imply, there would be no need to make this announcement. To date, this committee has not been formed.

    We urge the SMC to do so quickly. We suggest that for objectivity:
    The committee should not consist of current or recent SMC members and senior administrative staff. However, they can act as resource persons; and
    The findings of this committee should be reported to the Health Minister and thereafter made public.
    The concerns expressed by doctors should be seen as a hope for change and improvement, and not be characterised by the SMC as “frivolous comments”.

    T. Thirumoorthy (Dr)
    Director Centre for Medical Ethics and Professionalism
    Singapore Medical Association

    Wong Chiang Yin (Dr)
    Chairman Ethics Committee
    Singapore Medical Association

  2. Response from SMC published in the Straits Times today. I wish we could agree on a body of facts before starting to debate. Did think that while 3 out of 83 is not a “disconcerting number”, 3 successful appeals out of 8 concluded processes is.

    http://www.straitstimes.com Published on Jan 23, 2013
    Very few verdicts get overturned: SMC
    WE REFER to the reply by the Singapore Medical Association’s Dr T. Thirumoorthy and Dr Wong Chiang Yin (“Doctors’ concerns not frivolous: SMA”; Jan 11). The Singapore Medical Council (SMC) welcomes this opportunity to let the facts speak for themselves.
    Their observation on the last SMC election, in which about 98 per cent of members voted, was erroneous. Only 20 per cent cast blank votes for all candidates, whereas 80 per cent voted for one or more candidates.
    Not all doctors may be familiar with every nominee, and may not want or need to exercise their vote if they cannot judge who is the most suitable in the very respectable slate of candidates. Many jurisdictions, for example, Britain, Australia and even American states, do not even practise election of council members.
    With regard to the “disconcerting number of SMC judgments… overturned”, the SMC issued 83 verdicts in the past five years, including three acquittals. Eleven cases appealed to the High Court, which upheld the Disciplinary Committees’ (DC) decision in five cases and set aside two cases (Dr Gobinathan Devathasan and Dr Low Chai Ling). The SMC did not contest in one (Dr Georgia Lee). One appeal was withdrawn by the appellant and two appeals are pending.
    Thus, only three of 83 verdicts can be said to have been set aside by the High Court. This is not a “disconcerting number”.
    Under the Medical Registration Act (MRA), appeals serve as checks and balances in our system since no system is perfect. Instances of successful appeals in our judiciary put “judgments overturned” in better perspective.
    We note last Thursday’s article (“Doctor, heal thyself – with outside help”) regarding the confidentiality of hearings.
    We have published the DCs’ grounds of decision on our website since 2011 for those found guilty of misconduct.
    However, the grounds of decision for those who were acquitted and whose appeals were successful are not published.
    Doctors who were already subjected to the ordeal of a hearing, if not proven guilty, need not be subject to publicity. Publicity is neither perfect nor absolutely neutral and impartial.
    As the current MRA comes into full play, we look forward to better remediation and regulation that improve practice and care for the patient.
    The review committee, which includes senior lawyers and senior doctors, should also be given the unbiased opportunity to review the current MRA provisions and disciplinary processes.

    Lau Hong Choon (Dr)
    Executive Secretary
    Professional Conduct and Professional Standards Division
    Singapore Medical Council

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