Surgeon loses appeal against censure, fine

SINGAPORE - A three-judge court yesterday dismissed an appeal by a general surgeon who was fined $10,000 and censured by the Singapore Medical Council (SMC) for using a non-standard feeding tube on a patient.

The court upheld the findings of an SMC disciplinary committee that Dr Pang Ah San, 55, was guilty of professional misconduct by breaching ethical guidelines.

The SMC's code of ethics states that doctors shall not offer to patients remedies that are not generally accepted by the profession, except in approved clinical trials.

An issue that concerned the court - which is likely to be addressed in its written judgment to be issued later - is the question of when a doctor should seek approval from an ethics panel before providing innovative treatment.

In the current case, the device in contention, known as a loop percutaneous endoscopic gastrostomy (PEG) tube, was designed by Dr Pang, who runs his practice at Mount Alvernia Medical Centre.

In October 2007, he applied for a patent, which was granted two years later.

In July 2008, he inserted the loop PEG tube into Madam Goh Lee Kheng, 84, who required permanent tube-feeding after she suffered a stroke.

He had recommended the procedure to the patient's caregiver as a better alternative to the standard PEG tube.

After she was discharged, Madam Goh developed fever, pain and a high pulse rate. She was hospitalised but died three weeks later of pneumonia.

Her family complained to the SMC, saying that Dr Pang had not told them Madam Goh was only the third patient in the world on whom the loop PEG tube had ever been used.

Last July, an SMC disciplinary committee found that the loop PEG tube was a novel device and its use was not generally accepted by the profession.

Dr Pang was fined $10,000, censured and had to give an undertaking not to use the device unless he obtains approval from the authorities.

Appealing to overturn the decision, Dr Pang's lawyer, Mr Gregory Vijayendran, argued that the procedure did not fall within "remedies" in the code of ethics. He argued that surgical innovation was part and parcel of medical practice.

The SMC's lawyer, Ms Melanie Ho, argued that the need to promote innovation has to be balanced with the need to ensure patient safety.

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