SINGAPORE — In a second such decision in recent months, the High Court has overturned the conviction of a doctor who pleaded guilty before a disciplinary tribunal to committing medical misconduct.

Three appeal judges ruled in a 44-page written judgment released on Friday (Oct 18) that the charge against Dr Soo Shuenn Chiang, a psychiatrist at the National University Hospital (NUH) for failing to maintain his patient’s medical confidentiality was not made out. 

The psychiatrist had been fined S$50,000 earlier this year by the Singapore Medical Council’s (SMC) tribunal for not verifying a caller’s identity and sharing confidential information about a patient’s condition with her brother, who had posed as her husband.

The medical watchdog eventually applied to the courts to quash the conviction. 

Dr Soo — the director of the neuroscience clinic at NUH — had not appealed against the fine, which was higher than what he or the SMC asked for. 

In July, the High Court similarly reversed the conviction of an orthopaedic surgeon and called it a “miscarriage of justice”, noting that departing from acceptable medical standards of conduct does not always amount to professional misconduct.

Dr Lim Lian Arn had been fined the maximum S$100,000 for failing to inform a patient of the risks or complications that could arise from a steroid injection to her wrist. 

DR SOO WAS ‘UNDULY KEEN’ TO MOVE ON

In the court’s judgment on Friday, Chief Justice Sundaresh Menon said that doctors can provide a patient’s confidential medical information to those closest to the patient, such as their family, without their consent when:

• They reasonably regard it as necessary to protect the patient from potentially serious self-harm.
• It is in the patient’s best interests to disclose the information.
• The patient’s consent cannot reasonably be obtained.

Among other points, the Chief Justice pointed out that Dr Soo seemed “unduly keen” to move on and warned doctors that they are responsible for looking after their own interests.

The judges raised this point as Dr Soo’s case had caused an outcry in the medical community.

Online petitions were made to protest against the penalty, which was seen as being overly harsh.

Chief Justice Menon said: “Dr Soo could have contested the case on liability, and subsequently, even after pleading guilty to the charge, he could have appealed against at least the sentence imposed on him, but he chose to do neither. 

“It is not unreasonable in such circumstances to hold that he ought to lie on the bed that he has chosen to make for himself.”

WHAT THE CASE IS ABOUT

Dr Soo’s patient was admitted to NUH in January 2015 after a drug overdose. 

Dr Soo noted that she had a history of depression and was at risk of harming herself.

In March, the patient’s brother — posing as her husband — contacted Dr Soo, telling him that she was suicidal and needed to be taken to the Institute of Mental Health. 

The caller was able to provide the patient’s name, medical history and identification number.

Dr Soo issued a memo to refer the patient to IMH and passed it to his clinic staff to give to the patient’s family. 

The brother later used that memo to successfully get a personal protection order against the patient. He had earlier applied to the Family Court on behalf of the patient’s son for the order.

The patient then filed a complaint with the SMC. It is not known if the patient was eventually referred to IMH. 

On March 14 this year, the SMC applied to the High Court for an extension of time to appeal for a reduction of the fine imposed by the tribunal on Dr Soo.

After that, the patient’s brother wrote on Facebook that while he was the man who had spoken to Dr Soo but he had done so with the patient’s husband’s consent. 

The SMC approached both the brother and husband to take statements from them which were not recorded before the patient’s complaint was referred to the disciplinary tribunal. 

As their accounts differed from the facts that Dr Soo pleaded guilty to, the SMC applied to overturn the conviction and sentence.

ACCEPTED EXPERT’S REPORT

The three judges disregarded the brother’s and husband’s accounts as they were not satisfied that they were reliable.

They also called for a medical expert, Dr Daniel Fung from IMH, to give a supplementary report. Dr Fung had earlier told the SMC’s disciplinary tribunal that Dr Soo did not verify the caller’s identity and thus breached medical confidentiality.

But after reading a letter from Dr Soo containing more details of the circumstances under which he prepared his memo, Dr Fung stated that in actual fact, Dr Soo had not breached confidentiality.

Chief Justice Menon noted that the facts in Dr Soo’s letter would have been revealed earlier if he had “not been so keen to put this matter behind him regardless of the cost to him and, it seems, to the medical profession”.

The judges also accepted Dr Fung’s opinion that when Dr Soo received the call, he had “good reason” to find a real risk of suicide in light of the patient’s past medical and psychiatric history.

It was also appropriate for Dr Soo to give her family members the memo as he wanted the police or ambulance staff to quickly take the patient to IMH, the judges said.

Dr Fung had noted that Dr Soo also gave specific instructions to his staff to hand over the memo to the patient’s husband and the staff should have been responsible for verifying the identity of the person collecting it.

As for verifying the caller’s identity, the judges said that it “would seem contrary to good sense, even common sense” for Dr Soo to directly call the patient to do so. 

This was because the caller was giving information suggesting that the patient would mortally injure herself.

“In our judgment, what Dr Soo did was precisely what was called for in the circumstances,” they added.

WORKGROUP SET UP 

The two controversial disciplinary tribunal rulings on Dr Soo and Dr Lim led the Ministry of Health (MOH) to set up a 12-member workgroup to review two issues. 

The workgroup will look into the issues of the taking of patients’ informed consent by doctors, as well as the disciplinary process of the SMC. 

On the taking of informed consent from patients, the workgroup will provide recommendations on the practical steps and any ethical and/or legal standards expected of medical practitioners doing so.

It will also review and give recommendations on the SMC’s disciplinary process, including how complaints are considered and how disciplinary tribunal proceedings are conducted.

The workgroup, which put out some interim recommendations in September, will continue to consult the medical profession on these preliminary ideas and put forth its final recommendations to the MOH for review at the end of this year.