berthahenson

Why are doctors so special?

In News Reports on December 6, 2014 at 3:18 am

Why does it look like the Singapore Medical Council is a law unto itself? I refer to a commentary in ST today which says that the SMC has “refused to divulge if its income comes entirely from its 11,000 members, or whether it has separate government funding’’. I wish the newspaper told its readers if its refusal was to questions from the media, or whether it is a general blanket “no comment’’. It’s probably the latter.

Unlike the Singapore Dental Council, the SMC doesn’t list its income or disbursements in its annual reports. No financial information at all. The Dental council gets G funding (not much: about $180,000 for 2013) and puts down its registration fees in total. So what is happening in SMC? All we know now is that doctors who want to renew their practising licence pay $400. So that’s $4,400,000 every year. What about G funding? If the G gives to the dentists, surely it disburses to doctors as well. The SMC is, after all, a statutory board set up under the Medical Registration Act. Aren’t doctors concerned about how their money is being used? What’s the oversight authority doing then? Surely, the Health ministry can compel the SMC to do what it should in the interest of accountability?

I have to say I am pretty surprised, even outraged, at how the SMC shrouds itself in silence despite several controversies that it has been associated with. In fact, I wonder how it can get away with such shoddy annual reports for so many years. The G keeps emphasising the prudent use of taxpayers’ money (I am assuming it gets a grant) and proper procurement and payment procedures but it seems the SMC is exempt. Can the Auditor-General, Accountant-General and the Public Accounts Committee go take a look please?

I read the article with much interest because I have been following medical disciplinary cases. It’s not widely known that doctors pay their own legal fees, whether they win or lose a case at the disciplinary inquiry level or in the courts. But late last month, the courts decided to break precedent when it ordered SMC to pay the legal costs of gynaecologist Lawrence Ang.

Reading the back story to Dr Ang’s case was illuminating. So a baby’s mother complained to SMC that Dr Ang didn’t act in her best interest. Her new-born had to resuscitated and ended up with an infection and congenital pneumonia that required five months in hospital. Now, get this, the SMC actually dismissed her complaint. So she went to the Health minister who told SMC to hold the inquiry. It found him guilty of not having a neonatologist present and suspended him for three months. This is despite five of seven doctors who said there was no need for a neonatologist to be present all the time. It seems the SMC took the minority view – and didn’t explain why. Dr Ang (good on him!) fought the verdict in court and the SMC was blasted by no less a personage than Chief Justice Sundaresh Menon who said there was nothing in the disciplinary hearing that supported a guilty verdict and “the question of sentence does not arise at all”.

Sigh. It does make you wonder if Dr Ang was presumed guilty as charged because the Health Minister wants an inquiry and therefore wants results. Ooops! Cannot be lah.

Back however to the question of money. Who pays in the end?

The ST article was useful in giving the court’s (old) point of view that the SMC should be exempt from paying legal costs. In 2010, the highest court of the land said in overturning another SMC guilty verdict said it was prepared to give SMC “the benefit of the doubt that it had acted in good faith and in the public interest in trying to stop what it believed to be an inappropriate treatment for a particular medical condition’’.

Now, doctors are insured by the Medical Protection Society, an international body, so they don’t really have to pay out of their own pocket. It’s just that their premiums get higher and higher the more complaints made against them. And I guess patients pay more and more…According to ST, the premium for gynaes like Dr Ang is now $36,000 a year, up from $25,695 just three years ago.

As for the SMC, it really doesn’t matter whether it wins or lose a case, since somebody else will be paying the cost. I wonder if this why SMC’s lawyers seem to think that they can charge SMC the earth, and the SMC is willing to foot the bill – it would have come from somebody’s pocket anyway. In the case of Dr Ang, the SMC would have to pay its own way. (It’s not known how much). Frankly, I am still wondering how it intends to pay Wong Partnership the fees it had charged SMC for handling the Dr Susan Lim case. Her husband went to court to get it taxed down. In total, the original bills amounted to $2.33million, and was brought down to $687,000. Since it can’t turn to the Medical Protection Society, the money to pay the lawyers must come from somewhere, unless the lawyers give a big discount…

The ST article made much of how doctors should stick to medicine and leave the disciplinary stuff to trained lawyers. In 2009, attempts to place a lawyer on its disciplinary tribunal were “derailed’’, said ST. I had a look at the Medical Registration Act and it actually “allows’’ – not mandate – legal eagles to sit on the tribunal. Here’s the legal gobblededook from Section 50:

  1. (1)  The Medical Council may from time to time appoint one or more Disciplinary Tribunals, each comprising —

(a) a chairman, from a panel appointed by the Minister, who shall be —

(i) a registered medical practitioner of not less than 20 years’ standing;

(ii) a person who has at any time held office as a Judge or Judicial Commissioner of the Supreme Court;

(iii) an advocate and solicitor of not less than 15 years’ standing as an advocate and solicitor; or

(iv) an officer in the Singapore Legal Service who has in the aggregate not less than 15 years of full-time employment in the Singapore Legal Service;

(b) subject to paragraph (c)(ii), not less than 2 registered medical practitioners of not less than 10 years’ standing from among members of the Complaints Panel; and

(c) where the chairman is a registered medical practitioner —

(i) one observer from among members of the Complaints Panel who is a lay person; or

(ii) a member who is a person referred to in paragraph (a)(ii), (iii) or (iv), in lieu of one of the registered medical practitioners referred to in paragraph (b),

Now, I can’t recall a time when the chairman is NOT a doctor (I will be glad to be proven otherwise). But if the chairman IS a doctor, then there must be either a layman or legal person on board. In Dr Ang’s case, there was one un-named layman. Frankly, I don’t need to be a lawyer to see that it’s simply NOT common sense to pick a minority view to pronounce a guilty verdict and not explain why.  Perhaps, it’s time for another review of the MRA.

More importantly, it’s time someone told the SMC that it cannot operate like some private entity and keep the books to itself. Doesn’t it have any corporate governance procedures? Its finances are a total blur/blank. Even worse than that of the Workers’ Party-run town council. (Sorry. Couldn’t resist that.)

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  1. Reblogged this on Hey you, yes you!.

  2. “In fact, I wonder how it can get away with such shoddy annual reports for so many years.”

    Maybe because of the fact that many doctors are either in Parliament or have political connections?

    I heard from my NUS medical student friend about one speciality “mafia”, which was supposedly under the control of a specialist who passed away recently, only admitting selectively – usually by connections, looks (for girls only), then only by meritocracy – to preserve the low number of specialists in that specialty so that each specialist will have higher demand.

    When asked why the G doesn’t step in to remedy this, he outlined two reasons: 1) This person controls everything in that specialty. G steps in, he/she migrates, say goodbye to this specialty in Singapore and 2) His/her friends/ex-students are very well-connected politically. They’re in the G, what to do?

    Now that he/she is gone, I suggest the G step in to remedy this. It would be fairer for the medical students to enter the specialty of their choice via meritocracy instead of connections anyway.

  3. How come the Minister has to direct the SMC to conduct an inquiry from time to time without thinking that a more serious action must be taken to shake up the SMC?

    Minister, why?

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