Angry Doctor

Thursday, December 21, 2006

"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.

Labels:

8 Comments:

  • I think the "complainant" was MOH lah.

    Or maybe the Singapore Police Force? Narcotics division?

    By Blogger Dr Oz bloke, At December 22, 2006 1:23 pm  

  • Well, poor medical records isn't really under police jurisdiction, and until August Subutex wasn't under CNB jurisdiction either.

    I wouldn't mind if MOH was the complainant (assuming a ministry can be a complainant in this case), but I would like to know who or which department in the ministry filed the complaint.

    By Blogger angry doc, At December 22, 2006 5:51 pm  

  • If you look at the bigger picture I think there is a more serious problem.

    Doctors pedddling drugs (albeit legally by prescription) are not dealt with under the normal judiciary.

    They are dealt with by SMC. SMC can at the most strike off a doctor from the register and issue a $10,000 maximum fine.

    No jail. No cane. No death penalty.

    Looking at how this was abused, frankly I think that should change from now on. What do you think?

    By Blogger Dr Oz bloke, At December 23, 2006 9:13 am  

  • Actually, I'm not sure doctors peddling drugs is at all outside police or CNB jurisdiction.

    Subutex aside (it not being a controlled drug previously), I don't see anything in the Misuse of Drugs Act that specifically say you cannot charge a doctor for trafficking controlled drugs or abetting someone in the consumption of controlled drug.

    While a doctor may make the excuse that he is treating the patient with the drug, if the SMC finds his treatment inappropriate then I don't see why an agressive DPP shouldn't try to make the case that the doctor was aware that his patient was abusing the drug and that his actions amounted to abetting.

    In other words, I don't think the law protects a doctor from being charged for trafficking or abetting, but it's probably a case of the law not being used on doctors for traditional reasons. Maybe the CNB or DPP don't think it's easy to prove the case? I might be wrong though.

    By Blogger angry doc, At December 23, 2006 1:30 pm  

  • Yes the law doesn't seem to protect the doctor.

    But SMC does.

    Face it. If SMC is only going to fine a repeat offender $2500 accompanied by some stern warnings....well....how do you expect the DPP to open a case?

    In any case, SMC would say it is hard to prove that there was trafficking etc etc etc

    SMC is not a court. They don't have resources eg police at their disposal.

    Hence it is clear to everyone that doctors are very protected from such punishment. I think the narcotics division in the police are aware of this and have made many appeals to MOH to change the laws/system.

    Put it this way. If doctors were to be not lazy and document whatever they need to document (even if it is a lie) that they are treating a patient properly, then basically you have no case against them.

    It's a rather dangerous idea, but could it be possible that sometimes the documentation might be there for specific purposes of not getting into trouble but not really reflect the truth?

    I know it brings the whole "tarnishing/bringing disrepute to the profession by suggesting doctors are liars" but then can we really be sure?

    Just playing the devil's advocate here.

    I personally think repeat offenders should be dealt with a lot more severely. Instead the trend seems to be as you are more often in the SMC's radar, the punishments get more lenient!

    I gather that's a signal to the younger generation of doctors.

    By Blogger Dr Oz bloke, At December 24, 2006 11:35 pm  

  • There is a distinction between a court of law and a disciplinary hearing by SMC. Although the latter has some of the trappings of a trial, the rules on evidence and standard of proof are not quite similar. As this case illustrates, the SMC could decide to shift from the need for a unanimous decision to a majority decision to censure. A judge in a court cannot change the standard of proof as and when he likes.

    As for the complainant and locus standi, the usual rules do apply. I do not know who the complainant is in this particular case but it could be another doctor in the neighborhood who suspects something, the narcotics officer who discovers that the same doctor has been providing an unusually large number of drug addicts with Subutex, intelligence from drug pushers etc..When I was in the army I raised a complaint to the SMC over irregular MCs that were issued by a GP to a serviceman, which led to his suspension by the SMC.

    Now that Subutex has been re-classified as a controlled drug, we can well expect doctors who double as drug pushers may be charged with a criminial offence. The absence of good medical records may be cited as evidence that the doctor is selling controlled drugs under the guise of a prescription. It is then up to the judge to decide if if the doctor is a criminal or just sloopy.

    By Anonymous Anonymous, At December 29, 2006 2:51 am  

  • Indeed. Not only is the SMC Disciplinary Committee held to a lower standard of proof, it is also at once the investigating officer, prosecution, judge, and jury – which was why I was concerned that it should not also be the plaintiff. In any case, a letter from the SMC today revealed that the complainant in this case was the Ministry.

    Dec 29, 2006
    Doc's Subutex offences pre-dated first SMC inquiry

    I REFER to the letter, 'Why let errant doc dispense Subutex?' (ST, Dec 23), by Ms Maria Loh Mun Foong.

    Following a Singapore Medical Council (SMC) disciplinary inquiry in April 2004, Dr John Heng was found guilty of overprescribing cough mixtures and sleeping tablets.

    At the recent inquiry against Dr Heng, he was charged with failing to formulate and/or adhere to a management plan for the patients for whom he had prescribed Subutex.

    We wish to clarify that at the time of the first disciplinary inquiry in April 2004, Dr Heng had already committed the Subutex-related offences and the Ministry of Health had then referred him to SMC. These were for offences for which he was found guilty at the recent second hearing.

    Dr Lau Hong Choon
    Executive Secretary
    Singapore Medical Council

    By Blogger angry doc, At December 29, 2006 5:29 pm  

  • It won't succeed as a matter of fact, that's exactly what I think.
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    By Anonymous Anonymous, At January 04, 2013 8:50 pm  

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