MOH may impose stricter timelines for review of disciplinary cases by SMC
Mr Edwin Tong, Senior Minister of State for Health, said that doctors had raised concerns over the Singapore Medical Council's disciplinary processes during engagement sessions.
New regulations may soon be in place to shorten the time taken for the disciplinary tribunal of the Singapore Medical Council (SMC) to review cases.
Mr Edwin Tong, Senior Minister of State for Health, made the remarks during a doorstop with the media on Tuesday (May 21) at Mount Elizabeth Novena Hospital. He was there to take part in an engagement session conducted by a workgroup set up by the Ministry of Health (MOH).
The 12-member workgroup, which was convened in March, is conducting a review of the medical concept of “informed consent” and the SMC’s disciplinary processes.
The big picture: Questions over informed consent, and the way the SMC goes about meting out penalties to doctors found to have engaged in misconduct, have been hot topics in recent months because of two high-profile cases.
The workgroup was set up after judgements against orthopaedic surgeon Lim Lian Arn and psychiatrist Soo Shuenn Chiang triggered heated debate within the medical fraternity here, with thousands petitioning against the harshness of the hefty fines imposed.
Both cases broadly involved questions of informed consent — the sometimes complex set of rules relating to what doctors have to do to get permission to treat patients.
More than 1,000 doctors already had their say: Mr Tong said that the workgroup has so far held 12 engagement sessions with more than 1,000 doctors — and that was even before Tuesday’s session. It had given MOH a “very good sense of what the issues are and what needs to be done”.
“I think chief among that is... we need to redress the fairness in the process, give a lot more clarity to doctors on what it means to take informed consent,” Mr Tong said. This included what exactly the process involved, he added.
Clearer guidelines are on the way: Mr Tong said that MOH is considering clearer guidelines on informed consent, although they would not be “overly prescriptive” and should be flexible enough to account for dynamics in a doctor-patient relationship.
Mr Tong also said that doctors had raised concerns over the SMC’s disciplinary processes during engagement sessions. Recent judgements by the disciplinary tribunal had made doctors concerned that the SMC would “pounce” on them the moment they made lapses, or that patients would make claims against doctors.
Mr Tong added that there needs to be greater clarity in the disciplinary process, as well as quicker outcomes.
PROPOSALS CONSIDERED BY WORKGROUP
The MOH gave an interim update on the workgroup’s recommendations on Tuesday.
To address “serious delays” in the disciplinary process, the workgroup is considering imposing stricter timelines, as well as stricter criteria for the extensions of time for each stage in the proceedings.
At the moment, the complaint committee has a timeline of three months although this is frequently extended. The committee evaluates complaints reported to the SMC. If it finds the complaint valid, it will refer the case to the SMC’s disciplinary tribunal, which will summon the doctor to a hearing. The workgroup said that it aimed to complete the process of inquiry — from the point the complaint is received to the point the tribunal issues its decision — within one to one-and-a-half years, much shorter than cases now which can take up to two years or longer to conclude.
The workgroup also highlighted the lack of consistency and fairness in sentences imposed by the disciplinary tribunal. While some are too lenient, others, such as in the cases of Dr Lim and Dr Soo, were seen as too draconian.
To enhance consistency of decisions, more training and legal resources could be provided to members of the SMC’s complaint committee and disciplinary tribunal. Before a matter is referred to the tribunal, the committee may also formulate the charge, identify guidelines or provisions that a doctor is alleged to have breached and explain why there is a case to answer. This will also help the committee formulate a more standardised way to review cases and provide it with a reference point for future decisions. The workgroup added that for the tribunal, full-time employees such as senior doctors and retired lawyers could be considered. This will allow members presiding over cases to have a sense of how each case was relative or proportionate to another.
To professionalise the disciplinary tribunal, the workgroup is considering, among other things, a full-time independent body to oversee the tribunal. It is also considering High Court judges for the tribunal.
To filter frivolous or vexatious complaints that consume the SMC’s resources, the council could consider accepting complaints only when mediation has first been considered. The council could also have the discretion to impose costs to discourage people from submitting baseless complaints. In his remarks to the media, Mr Tong added that SMC could work with the Singapore Mediation Centre to ensure that the right kind of cases are resolved through mediation.
To overcome the difficulty in obtaining expert evidence, or receiving conflicting expert evidence, the workgroup is considering the appointment of a panel of experts, made up of those from each specialty. Right now, any party who is charged may bring in their own experts to the tribunal. However, this may create for an adversarial process if experts give conflicting views. The workgroup suggested that the tribunal could instead have a single expert provide evidence if parties agree. This will help to reduce any acrimony in the proceedings that may arise due to conflicting expert evidence.
PROGRESS IN WORKGROUP’S CONSULTATIONS
From now till the end of June, the workgroup will conduct another eight to 10 more engagement sessions with junior doctors, professional indemnity groups and legal professionals.
It will then conduct consultations on its interim proposals and present its final recommendations at the end of the year.
Mr Tong said that while the workgroup was “moving as quickly as it can”, the proposed measures had to be calibrated to put the safety of patients first.
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