An obstetrician and gynaecologist facing disciplinary action for starting a Caesarean section on a patient without making sure the anaesthesia had taken effect offered tampered records as evidence in his defence.
The move has backfired, with the Court of Three Judges finding that the "want of probity" on the part of Dr Lee Kim Kwong was an aggravating factor in determining the punishment for his professional misconduct.
In written grounds explaining its decision in May to suspend Dr Lee from practice for five months, the court said it was "perturbed" by how he had tried to mislead the Singapore Medical Council disciplinary committee.
Dr Lee had asked the operating theatre manager of Mount Alvernia Hospital to write the words "patient is in supine position after epidural anaesthesia at 0800 hrs" on a copy of the nursing record.
He then offered the modified record as "evidence" to support his version of events - that the epidural had been given at 8am.
Another aggravating factor was that the court found Dr Lee's haste in carrying out the procedure, even though it was not an emergency situation, to be "unacceptable". It said sentencing precedents suggested a starting point of three months' suspension but the appropriate period for the doctor was five months.
Dr Lee was found guilty of professional misconduct last year by the disciplinary committee, which handed down a nine-month suspension and a $10,000 fine.
On his appeal, the court upheld his conviction but cut the suspension, saying nine months was manifestly excessive. Dr Lee, who practised at Lee Women's Clinic & Surgery, was scheduled to perform the Caesarean section at Mount Alvernia Hospital at 8am on Aug 17, 2010.
After the patient was wheeled into the operating theatre, the anaesthetist, Dr Lim Eng Siong, administered the epidural - which takes at least 15 minutes to take effect. At about 8.20am, when Dr Lee made a cut on the patient's abdomen, she screamed.
Dr Lim gave the patient a mixture of oxygen and nitrous oxide for about a minute to sedate her.
The operation ended at 8.45am and the patient delivered a baby girl.
Dr Lee insisted that the epidural was given at 8am and would have taken effect by the time he made the cut. But Dr Lim said that it was given at 8.10am.
However, the contested time was of "secondary importance", said the court. Whatever the time, Dr Lee was guilty of misconduct as long as he made an incision without first testing if the epidural had taken effect.
This article was first published on August 2, 2014.
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