By Tang Li

SINGAPORE'S determination to showcase itself as a government that puts up a watertight case when it comes to prosecution is under intense scrutiny because of a sensational court case that has put a history-making surgeon on a collision course with a medical panel set up by the government. On the surface, this is a straightforward allegation of "overcharging" by a medical professional.

Dr Susan Lim, who went into the record books as the first Asian to perform a liver transplant operation, is in the dock -- accused by the Singapore Medical Council of overcharging a patient from the royal family of Brunei for breast cancer treatment for six months in 2007. The bill came up to S$24.8 million.

It is not just the bill that is raising eyebrows in Singapore. The different roles played by the director of Medical Services, Prof K. Satku, the sudden decision of the prosecuting panel to step down and the change of an administration rule have all made this case a subject of much talk in the cocktail circuit.

And to add to this tantalising mix is the behaviour of the Brunei royal patient whose demands were out of the ordinary, to put it mildly.

The story goes back to 2001 when Pengiran Damit, the cousin of Brunei's sultan and sister of his queen, approached Dr Lim for treatment for breast cancer.

Dr Lim attended to Pengiran Damit's medical needs. The bill up to 2006 came to S$12 million and was paid without a fuss.

It was a nightmare treating the Brunei patient, court documents reveal. At one time, she had refused to fly to Singapore for treatment. Dr Lim had to set up an intensive care unit infrastructure in Singapore and fly it by private jet to Brunei.

Then, there was a request for a massage chair to be installed in her hotel suite at the Hyatt Hotel in Singapore before the visit of the sultan, only to be removed an hour later.

Dr Lim had to be on 24/7 standby and had to be available at a moment's notice if Pengiran Damit wanted to see her.

This extended to the time when Dr Lim had undergone eye surgery and was recovering in a hospital bed. Pengiran Damit insisted that the doctor be by her side, despite the possibility that Dr Lim could be blinded in one eye if she moved around too much. Dr Lim had to be transported in that state to attend to Pengiran Damit.

Read also: The $20 million medical bill controversy

After the death of the patient in 2007, Brunei went to Singapore's Health Ministry to get Dr Lim to give a discount on her S$24.8 million bill for the intensive treatment the patient had received from January to July.

According to court documents, Brunei's Ministry of Health approached its Singapore counterpart to get a discount from Dr Lim.

When the matter reached Satku, he advised the Brunei government not to pay up and that he would look into the matter.

Satku ordered Dr Lim's clinic to be raided five times and patient records to be seized. He then made a complaint to the medical council, of which he is the registrar, and the council appointed a disciplinary committee to prosecute Dr Lim.

The investigation collapsed after all three panel members stepped down over accusations of "pre-judging". This took place when the council decided to change the rules and freed the disciplinary committee from revealing legal advice it had received on the matter.

A second disciplinary committee was formed. It was at this point that Dr Lim decided to take the matter to the High Court to stop the second inquiry from proceeding.

In his four-hour submission on March 1, the lawyer for the medical council argued that it was necessary to allow the second disciplinary committee to do its work.

He argued that if found guilty, Dr Lim would not get off scot-free, but if she was innocent, the facts would emerge.

That same day, the medical council made a curious announcement. It said Prof Chew Suok Kai had been appointed deputy registrar and he would be taking over Satku's duties. This is a post which previously did not exist. A provision was made in the law and sanctioned in the Singapore Parliament in January last year.

As Singaporeans await the next instalment of this curious case when the High Court resumes its hearing today, the scrutiny has also thrown up other issues that will be debated in the weeks and months to come: Is there a limit to what a doctor can charge? To what extent is medicine a business?

Why did the Ministry of Health decide on prosecution when the Bruneians were only seeking a discount? And will this case affect Singapore's push to become a medical tourism hub?

Tang Li is a freelance writer based in Singapore.