"tarnish the medical profession"

So it begins.

As promised, angry doc will now bring to his readers' attention this piece of news (emphasis mine):


A doctor's delinquency
Mismanagement of Subutex prescriptions results in $2,500 fine

A DOCTOR in Woodlands has been found guilty of failing to properly administer Subutex — the first such case since the medicine was listed as a controlled drug in August.

It is believed that several other doctors are under investigation for the same reason by the Singapore Medical Council (SMC).

Dr John Heng Kuo Leng was fined $2,500 by the SMC and given a stern warning for mismanaging 19 of his patients.

Incidentally, this is not the first time the 47-year-old general practitioner from First Medical Clinic and Surgery has been censured.

In 2004, he was suspended by the SMC for 18 months for dispensing addictive cough mixtures and sleeping pills too freely at his clinic in Woodlands Street 11.

This time round, one of the charges levelled at the doctor is that he did not record and provide sufficient patient details and results of the diagnosis.

A council disciplinary inquiry last week found him guilty of mismanaging the 19 patients between December 2002 and February 2004.

"The (council) unanimously found that the medical record of each of the patients concerned was very scanty and did not contain sufficient details of the patient's diagnosis, symptoms and conditions or any management plan such as to enable Dr Heng to assess properly the medical condition of the patient," said the SMC.

The council, however, was not in total agreement that he did not formulate a proper treatment plan for each of his 19 patients. But as a majority thought so, it was enough to censure him, a break from the past where convictions would be based on unanimous decisions.

Dr Heng, who has been practising since 1984, was also ordered to pledge in writing that he would not commit the same offence again. He now has to be supervised by a mentor.

Under Health Ministry guidelines, doctors must ensure proper care and supervision of their patients undergoing drug addiction treatment. They must also record all prescriptions of the drug to prevent a patient from doctor-hopping to get multiple dosages.

Dr Heng's case could be just the tip of the iceberg. In August, the SMC's executive secretary, Dr Lau Hong Choon, said the council was investigating "a number of doctors for wrongdoing in the prescription of addictive drugs like Subutex" so that errant doctors would not "tarnish the medical profession".

If found guilty, these doctors can be struck off the medical register and fined up to $10,000.

Subutex abuse came under the spotlight after heroin addicts — who were prescribed Subutex to wean them off their habit — sought highs by mixing the drug with sleeping tablet Dormicum and water, and injecting the mixture into the body.

After Subutex became a controlled drug on Aug 14, it was declared that anyone caught importing, distributing, possessing or consuming the drug faces jail and fines, unless he is a doctor or patient registered with the Government's Subutex Voluntary Rehabilitation Programme.

Doctors are no longer allowed to prescribe or dispense the drug as take-home medication.


angry doc will not comment of Dr Heng's actions, since he is not in possession of all the facts of the case.

Perhaps there will be more information in the SMC's annual report, perhaps not. The one piece of information angry doc is interested in knowing, however, is who the complainant was in this case.

As far as angry doc can make out from the Medical Registration Act, short of 'the conviction of a registered medical practitioner of any offence implying a defect in character which makes him unfit for his profession', or '[w]here a registered medical practitioner has been convicted in Singapore or elsewhere of an offence involving fraud or dishonesty or has contravened section 64, 65 or 67', the SMC is not supposed to initiate investigation on a doctor without a formal complaint by a named complainant.

Or, as the SMC website puts it:

'The Complaints Committee can only proceed with the investigation after it has received an official complaint in writing and supported by a Statutory Declaration.

The complainant must state the full facts of his case and his allegations clearly in his letter of complaint against the doctor.'

Now which patient would actually file a complaint with the SMC because his doctor kept poor records? How many Subutex abuser would actually care if their doctors kept good records? How many of them complained that they were being 'mismanaged' by their doctor (either in being given too much, or too little Subutex)?

Or, if the complaint was not filed by a patient, then who filed it, and what is this person's locus standi? (Does locus standi even apply to complaints to the SMC?)

Was it filed to protect patients (who can arguably be called 'victims' in this case) from the doctor's actions, or was it filed so as 'not to allow errant doctors to tarnish the medical profession'?

Does any of that change the material facts of the case? Probably not.

angry doc is no sympathiser of doctors who profit off the addiction of others, but nevertheless, he believes due process is important.

angry doc is not against the idea of a third party acting in the interest of those who cannot or will not defend themselves from the harmful actions of their doctors. He just prefers to know who they are.