SINGAPORE - The $26 million bill that Dr Susan Lim charged for her medical services to a woman member of Brunei's royal family was eye-popping, to say the least.
That was for five months of services provided from Jan 15 to June 16, 2007.
But it appears that multi-million-dollar sums had been charged by Dr Lim and paid by the Brunei High Commission for several years.
The patient under the care of Dr Lim, a general surgeon in private practice, was Pengiran Anak Hajah Damit, the younger sister of Brunei's queen and a cousin of the sultan.
Dr Lim treated her for breast cancer from 2001 until she died in August 2007.
Documents filed in court provide details of the bills between 2004 and 2007, which total $40 million. Details of the charges for the earlier three years are not known.
The Bruneians paid all her bills, which she had submitted till March 27, 2007.
But after the patient died, Dr Lim was queried on the rest of the 2007 bill (from Jan 15 to June 16, 2007), which came up to $26 million. This is inclusive of GST, which was 5 per cent then.
She is now fighting to stop the decision of the Singapore Medical Council (SMC) to appoint a second disciplinary committee to investigate an accusation by the Health Ministry here that she overcharged her patient.
In the High Court on Wednesday, Senior Counsel Alvin Yeo, representing the SMC, cited the allegedly inflated bills to show there was a case for a new disciplinary committee.
Documents filed in court show that on the days for which services were rendered during this period, Dr Lim's charges per day allegedly ranged from $29,600 to $660,000 before GST.
Dr Tan Yew Oo, an oncologist at Gleneagles Cancer Centre who was an expert witness for the prosecution at the first disciplinary proceedings, said for non-procedural services, where the doctor does not perform procedures or surgery on the patient, fair daily professional fees of a senior practitioner may range from $10,000 to $15,000.
Procedural fees (for procedures and surgery) would carry a higher rate of $20,000 to $40,000.
For exceptional cases when a specialist is required to go beyond the call of duty, a rate of 50 per cent more than the norm may be justified.
He said that even if Dr Lim was given the benefit of her seniority, her daily professional fees appear to be completely out of range.
He said that even if Dr Lim's possible losses from not seeing her other patients were considered, her daily fees were still inordinately high.
Continued to see other patients
Submitted medical records showed that Dr Lim continued to see other patients in 2007.
She had also charged fees for cancellation of other professional commitments such as conferences.
These were on top of fees she charged for her services set out in the same invoice.
For example, she charged $180,000 for the cancellation of a conference in France on May 2, 2007. She also charged $158,000 for services rendered that same day.
It was alleged that Dr Lim had so far not produced any supporting documents to show the expenses incurred for the conferences.
As another example of inflation, the prosecution showed an invoice of $320,000 from Dr Lim stating "Emergency long-distance coordination with oncologist in United Kingdom".
This was for consultations with Professor Ian Smith, a top breast cancer specialist.
His bill covering three days in 2007 when he travelled to Singapore to see the patient (and no other patients) was 45,000 pounds ($135,000 in 2007).
Another expert witness for the prosecution at the disciplinary proceedings, Professor Soo Khee Chee, said Dr Lim should not compare her charges with that of Prof Smith as he is an internationally known figure.
Prof Soo, director of the National Cancer Centre Singapore, said: "In any case, Prof Smith charged 45,000 pounds for a period of three days...at 15,000 pounds per day, after flying into Singapore to examine the patient. This is far less than what Dr Lim charged the patient on a per-day basis."
She also allegedly inflated fees for services provided by other doctors, who were requested to send their invoices directly to Dr Lim's clinic.
According to court documents, Dr Lim said her role in relation to treatment provided by the other doctors was to organise, coordinate and manage their involvement in the patient's care. She did not provide the treatment herself.
Yet, her fees were many times in excess of what those doctors had charged.
An example is Dr Chin Kin Wuu, an anaesthetist, who had sent her an invoice for $15,000.
She then charged the patient more than $320,000 before GST.
"Very high bills"
In July 2007, the Brunei High Commission alerted Brunei's Ministry of Health (MOHB) to the "very high bills" from Dr Lim.
That month, two MOHB representatives came to Singapore and spoke to Dr Lim Cheok Peng, chief executive of Parkway Holdings, which runs the medical centres where Dr Lim has her clinics.
She then started to reduce her fees.
On Aug 1, she wrote off bills for services by the other doctors and gave a 25 per cent discount on her own bills. On Aug 18, she apologised to MOHB for the "inadvertent mistakes" made by her office.
But on Aug 27, MOHB asked Singapore's Health Ministry to intervene.
On Nov 12, Dr Lim offered to waive her fees from January to June 2007 as a goodwill gesture, suggesting that MOHB pay only $3.25 million.
In January 2009, she and her husband went to Brunei and offered to waive all her fees and third-party bills if MOHB was prepared to issue a "letter of good standing" stating that the Brunei government would not pursue the matter further and would take no issue with her bills. Her request was not taken up.
In a letter dated Jan 26 last year, MOHB said that as part of its review of Dr Susan Lim's 2007 bills, it also reviewed her bills issued before January 2007.
"We observed that there were numerous bills previously issued by Dr Lim in 2004 to 2006 for Dr Lim's services and other doctors' services that appeared similarly excessive.
"As stated earlier, we do not ordinarily question the reasonableness of the bills of doctors because we trust that they will render fair charges. This is especially when compared to the work carried out by the other doctors and their bills, which we were not aware of at that time."
According to court documents, Dr Lim said that she had informed the patient early on in their relationship that the close care and attention she needed would cost $100,000 to $200,000 a day.
She said her fees were reasonable, given her professional standing and the special identity of the patient.
She also said she had issued "omnibus" invoices covering the entire suite of services provided and they should be viewed on a "holistic" basis.
The hearing continues tomorrow.
WHAT DR LIM CHARGED BRUNEI PATIENT EARLIER
2004 $2.8 million
2005 $3.8 million
2006 $7.5 million
2007 Brunei paid all her bills till March 27, 2007
This article was first published in The New Paper.