The Hippocratic oath demands that doctors do no harm. Thankfully, most doctors follow this in the exercise of their skills. Sadly, some fall short of the mark in discharging their duties to the patient, whether intentionally or otherwise, while others deliberately engage in unethical practices. In one case, Dr Wong of Raffles Hospital gave a construction worker two days medical leave and a month’s worth of light duties despite the fact that he had fractured his hand and required surgery. Fortunately, given the high standards upheld by the medical profession here, such cases are few and far between.
Over the past decade, the Singapore Medical Council (“SMC”) has received less than 400 complaints per year. But what happens if you do run into a ‘rogue’ doctor? What can you do if you truly believe that you or your family members have encountered some form of medical negligence or malpractice? From the outset, it is important to first note that there are a spectrum of grievances which patients and their families may have against a doctor. As a patient, it is critical to first consider the nature of the complaint which you have against the doctor so as to determine the appropriate steps to take. In some cases, where the complaint pertains to something less serious (such as the doctor being rude or disrespectful), feedback to the Hospital or the relevant healthcare institution might be a more appropriate forum to air your unhappiness.
However, if the allegation is more serious (for instance, inappropriate sexual conduct, a mis-diagnosis, or unethical behaviour), there are generally two options available. The first, would be to file a formal complaint with the SMC, while the second would be to commence legal proceedings against the errant doctor. While the two options are not mutually exclusive, a patient may in most cases consider adopting one approach first, before deciding what further steps to take. This article deals with each option in turn, highlighting the different considerations (i.e. advantages and disadvantages) of each one.
Filing a formal complaint with the Singapore Medical Council
A typical response from an aggrieved patient would be to raise a complaint with the Hospital (i.e. the relevant healthcare institution). If the parties are unable to arrive at a satisfactory conclusion or resolution after discussions with the relevant healthcare institution however, one may then consider lodging a formal complaint with the SMC. One may still choose to lodge the complaint even while discussions/negotiations on the matter are ongoing.
The SMC is a statutory body under the Ministry of Health. Amongst other things, the SMC regulates the professional conduct and ethics of registered medical practitioners. It does not, however, entertain complaints against Traditional Chinese Medicine (“TCM”) practitioners, nurses, hospitals or other allied health professionals. In addition, the SMC will not look into issues which relate to the healthcare institution itself, for instance, administrative problems or difficulties encountered in the processes relating to billing or appointments, etc. As stated on the SMC website, it is empowered to investigate the following:
- Cases involving serious misconduct on the part of the doctor or serious mistakes pertaining to a patient’s medical care, for example, serious cases involving a mis-diagnosis or mis-prescription by the doctor concerned. This could include a failure to refer a patient for further treatment to allow their medical issues to be managed in a timely manner. To give an example, Dr Victor Chew was charged for failing to refer a patient to a psychiatrist despite being aware that the patient had become dependent on the medication and suffered from mental illnesses such as anxiety.
- Improper conduct by a doctor (e.g. an inappropriate or sexual relationship between a doctor and his patient);
- Breach of confidentiality by a doctor.
- Unethical behaviour by a doctor against his/her patient. This could be in the form of an over-prescription of medication while having no clear medical grounds for doing so and being aware of the fact that the patient was potentially abusing his medication. Alternatively, failure to obtain informed consent from the patient could constitute grounds for a complaint of unethical behaviour (i.e failing to warn the patient of the inherent risks of the procedure).
- Criminal offences committed by doctors that reflect on their professional standing and the standing of the medical profession. Recently, Dr Winston Liew was struck off the medical register after he was convicted of molesting a female patient.
It should be noted that any complaint made to the SMC has to be filed within six years of the alleged incident. The complaint should be type-written in English and contain the names of the doctors whom the complaint is directed towards. Sufficient details regarding the alleged incident(s) should also be furnished along with any documentary evidence supporting your allegation. Crucially, the complaint has to be supported by a Statutory Declaration, which is essentially a sworn statement about the alleged incident. The SMC has the option of referring any complaint received to the Singapore Mediation Center under the Singapore Mediation Center – Singapore Medical Council Mediation Scheme.
After the SMC complaint is lodged, the doctor/doctors involved will be informed and SMC is likely to call upon them to provide a written response to your complaint. If the SMC is of the view that the matter should proceed after reviewing the doctor(s)’ written explanation, further investigations may be conducted. Depending on the nature of the allegations and the complexity of the matter, the entire process could take at least a few months, if not more. You will in due course be notified of the outcome of the complaint (i.e. whether the complaint was dismissed, or if the doctor would receive warning, etc.). If you are unsatisfied with the outcome, an appeal may be lodged with the Minister but the Minister’s decision is final.
Advantages:
- Markedly cheaper than litigation (i.e suing the doctor). The only costs likely to be incurred would be engaging a Commissioner for Oaths in making the Statutory Declaration, unless you engage a lawyer to prepare the SMC Complaint for you. If SMC refers the case for mediation, all fees payable to the Singapore Mediation Centre will be borne by the SMC. All other costs will be borne by the parties themselves.
- While it is not as time consuming because SMC handles the entire investigation once your formal complaint is lodged, the SMC takes on average, about 9 months to conclude its investigations. As stated above, more complex cases could even take more than a year.
Disadvantages:
- It should be noted that this option results only in the possibility of seeing the errant doctor being disciplined. The SMC is empowered only to take disciplinary action against the errant doctor and you will not be able to obtain monetary compensation for harm caused as a result of the doctor’s misconduct/negligence through this SMC complaint process, nor refund or reduction in bills incurred.
Commencing Legal Proceedings
In the alternative, one may commence legal proceedings in either the State Court (if the amount claimed is up to $250,000) or the High Court (if the amount is above $250,000).
There are certain legal requirements to be established before negligence can be found. These pertain to issues/concepts such as duty of care, standard of care and breach of duty. In gist, one has to first show that a duty of care is owed (to the patient) before moving on to determine the standard of care that is owed. A duty of care is likely to be established if the alleged negligent act took place in the context of a doctor-patient relationship. Thereafter, it must be shown that the doctor has breached the standard of care reasonably expected of a competent doctor and that the loss suffered by the patient can be attributed to the negligence of the doctor. Some examples of medical negligence established in previous cases include those set out in the table below:
| Examples | |
|---|---|
| Mis-diagnosis | In the case of Armstrong, Carol Ann v Quest Laboratories Pte Ltd and another [2018] SGHC 66, the doctor was sent a specimen of tissue taken from the patient. He concluded that the specimen was non-malignant but it turned out to contain cancerous tissue. |
| Providing the wrong medical advice | The relevant test for determining if a doctor has fallen below the standard of care required when providing medical advice was discussed in Hii Chii Kok v Ooi Peng Jin London Lucien [2017] 2 SLR 492: Firstly, the patient must identify the exact nature of the information that he alleges was not given to him and establish why it would be regarded as relevant and material (at [132]). Secondly, the doctor must have been in possession of that information (at [133]). Thirdly, the doctor’s decision to withhold this information from the patient must be justified (i.e because it would cause psychiatric harm to the patient) (at [134]). |
| Error in treatment | While people tend to forget where they have left their things, this would be a major issue in the case of a surgery/surgeon and is nothing short of gross negligence. This was the Court’s view in Three Rivers Medical Centre v Sophia Savage where a surgical sponge was left in a patient’s body after the surgery. |
Advantages:
- Damages (i.e. monetary compensation) will most likely be awarded in a successful case. The matter may also come to a settlement/resolution before the matter goes to trial.
- For many patients and their families, the experience of negligent treatment (whether established/real or perceived), can be deeply scarring and leave people aggrieved. Having the matter adjudicated and determined by a Court of law can therefore bring healing and resolution for some, particularly where a settlement itself does not meet this need.
Disadvantages:
- Litigation will more often than not be very costly, as there is much preparation to be done by your solicitors (such as drafting court documents, corresponding with relevant parties, interviewing and engaging expert medical witnesses, etc.).
2. Litigation is definitely time consuming and emotionally draining. While our legal system is efficient, a typical matter may take a substantial period of time to conclude, especially if it goes on appeal. Generally, actions commenced in the High Court take about 15 to 18 months to be disposed of, and possibly even longer if the matter is complex.
Conclusion
We have discussed 2 main avenues of redress for those who believe that they have encountered or suffered medical negligence/malpractice, although the two options are not mutually exclusive. Both also have their respective advantages and disadvantages. In deciding which option is most appropriate in the circumstances, one should always be minded to ask: “What exactly is it that I want to achieve?”
Where one hopes to seek some kind of monetary compensation/damages, litigation will generally be the more suitable option. However, if one is motivated by wanting to ensure that the relevant medical practitioner is singled out and sanctioned accordingly, a formal complaint to the SMC would be more appropriate.
Any questions?
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This article is written by Jonathan Cho from Covenant Chambers LLC and Soh Kian Peng from the Asian Law Students’ Association
This article does not constitute legal advice or a legal opinion on any matter discussed and, accordingly, it should not be relied upon. It should not be regarded as a comprehensive statement of the law and practice in this area. If you require any advice or information, please speak to practicing lawyer in your jurisdiction. No individual who is a member, partner, shareholder or consultant of, in or to any constituent part of Interstellar Group Pte. Ltd. accepts or assumes responsibility, or has any liability, to any person in respect of this article.