By Benjamin Cheah
A lawyer with Rajah and Tann asks a very relevant question on the Court’s decision on Dr Susan Lim’s case: What is an objective ethical limit on the fees a doctor can charge?
Rebecca Chew says in the November issue of SMA News: “The judgement does create some uncertainty as to the appropriate fee one should charge for medical and other services provided to patients.
“The I-know-it-when-I-see approach to determining an objective ethical limit on fees is unsatisfactory and compounded by the fact that a breach of the objective limit, no matter how innocent, cannot be brushed away as an outlier.”
Outlier was the word used by Dr Tan Chi Chiu in an earlier article in the September issue of SMU News when he commented on Dr Lim’s case, which became sensational news, especially after it was revealed that she had charged $24 million for treating a patient from Brunei’s royal family for 110 days.
Chew says the Court avoided collision with this fundamental by saying that overcharging was an offence inherent in the description of a professional.
“This leaves open the question as to what other duties or obligations may be implied by the court in the future, even in the absence of clear statutory provision or codificication,” she argues.
“This implies that it is possible to ascribe some kind of intrinsic value to different types of medical care. How this value is to be determined is unclear,” Chew argues.
Chew asks other questions related to this point: What if patients demand their doctors’ undivided attention? And what if giving such attention ends in the loss of other income for medical practitioners?
“Does it mean that very little value can be attributed to this opportunity cost? The judgement did not appear to have clarified this point,” says Chew.
She says the court did not consider two important points made Susan Lim: What the patient had paid in previous years and what she was prepared to pay in 2007, which was the subject of the proceedings against the doctor.
These points were dismissed by the court, which said the ethical limit on fees were in force over and above market and contractual dealings.
“Medical practitioners must be careful to ensure that the terms of their agreement do not breach the objective ethical threshold. But the key question would be what the appropriate threshold is,” says Chew.
She concludes by saying: “The current regime which treats all disputes on fees as a disciplinary matter may not be an ideal solution and does not provide the guidance which the medical profession needs.’
Here’s a copy of SMA’s report on the case by Rebecca Chew.