Medical council: prosecutor, judge, jury

A senior doctor has called for the setting up of an independent body to take over the disciplinary process for doctors - much like what is done in Britain - to avoid any possible conflict of interest.

The Singapore Medical Council (SMC) is the body that currently licenses doctors, sets guidelines and runs the disciplinary process.

Associate Professor T. Thirumoorthy of the Duke-NUS Graduate Medical School pointed out that the president and many members of the council are appointed by the Ministry of Health (MOH).

The council, a statutory board, has 24 members, half of whom are elected by doctors working here. The rest are appointed by the ministry.

They serve voluntarily for a three-year term.

The registrar of the council is also the director of medical services at MOH. Yet, the ministry is a "major complainant" against doctors, he wrote in an article published in the November edition of a journal by the Singapore Medical Association.

Under the current system, when the council receives a complaint, it appoints a committee to decide if the case merits an inquiry, and appoints the disciplinary tribunal and the prosecuting counsel. It also collects the fines paid by doctors found guilty.

"In effect, the SMC is the investigator, prosecutor, judge and jury in the disciplinary process," Prof Thirumoorthy said. He pointed out that in Britain, "significant concerns" over the General Medical Council's adjudication processes have led to the creation of an independent tribunal service.

Prof Thirumoorthy, a former elected member of the council, also pointed out that it would be in the council's interest not to lose a case: "If a doctor is acquitted, SMC has to bear its own legal fees."

The council told The Sunday Times the legal costs it recovered following disciplinary hearings over the last two years have ranged from $13,000 to $270,000, with an average of $73,000.

The article noted there was only one acquittal out of 25 cases last year. Two guilty verdicts against two aesthetic doctors were overturned by the court on appeal.

One was in September, when the court overturned the council's guilty verdict on Dr Low Chai Ling for practising non-evidence-based aesthetic medicine. The other was against Dr Georgia Lee.

Prof Thirumoothy, who is a dermatologist in private practice, warned: "When doctors do not have confidence in the system of accountability and a fair trial process, they would resort to defensive medicine."

This would mean doing unnecessary tests that would raise costs and add to patient risk. "The good doctor-patient relationship based on respect, empathy and sincerity would fly out the window," he said, adding that it would lead to a "real lose-lose situation".

Associate Professor Goh Lee Gan, a lecturer in family medicine at the National University of Singapore (NUS), agreed with the sentiments expressed by Prof Thirumoorthy. He said: "The prosecution and judgment body should not be the same party. It should be an independent party."

Dr Tay Eng Hseon, medical director of the Thomson Women Cancer Centre, said: "An independent tribunal service will appeal to medical practitioners in general. But it will work only if it is integrated in some way with the civil law court.

"Otherwise, disgruntled medical practitioners will still refer their grievances to the courts. In which case, we would have created another costly layer of judiciary tribunal without achieving our goal."

However, a specialist in private practice, who asked not to be named, said: "I am not sure if a different body would improve the current situation as I suspect the same people and advisers would be on the independent disciplinary committee."

salma@sph.com.sg

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