Singapore— Dr Lim Lian Arn, who had been fined S$100,000 by his peers at a disciplinary tribunal of the Singapore Medical Council (SMC), had his conviction overturned on July 24, Wednesday.
An important factor in the overturning of Dr Lim’s conviction is that 4,000 physicians had signed a petition to ask the health minister to step in regarding the case.
The SMC disciplinary tribunal gave the orthopedic surgeon the maximum fine possible, as it found that in 2014 he had failed to get informed consent from one patient before administering a steroid injection to her.
Dr Lim pleaded guilty to one charge of professional misconduct. He was given a fine and was subject to several other common disciplinary measures from the tribunal.
However, over 4,000 doctors disagreed with the SMC’s ruling. In January, they signed a petition to request that the Health Minister look into the decision made by the SMC, as well as to clarify its position on the necessity for physicians to get informed consent for minor procedures such as routine injections.
By the next month, the Ministry of Health (MOH) requested that the SMC apply to the court to have its decision reviewed, citing concern that its decision on Dr Lim’s case could lead to defensive medicine.
On July 24, Chief Justice Sundaresh Menon said, “Having heard the parties, we are satisfied that there has been a miscarriage of justice and that Dr Lim’s conviction must be set aside.
Simply put, the undisputed facts do not support the charge,” when he delivered his judgment.
The facts of Dr Lim’s Case
The orthopedic surgeon had been consulted by a woman on October 27, 2014. She had been experiencing pain in her left wrist. Dr Lim had her have an MRI, and then gave her two choices for her treatment. She could either take oral medicines and wear a brace, or receive a steroid injection, which the woman ended up choosing.
Dr Lim later admitted that he failed to inform her of certain after effects of the injection, such as thinning of the skin, a change in skin colour, and the possibility of a local infection, etc.
Two hours after the injection was administered, the woman felt swelling and pain in the injected area, and also experienced “paper-thin skin with discolouration, loss of fat and muscle tissues”.
In January 2016, the woman filed a complaint against the orthopedic surgeon, claiming that he failed to tell her about the potential complications of the injection.
At the tribunal, Dr Lim pleaded guilty to the charge of failing to obtain informed consent and later admitted to the agreed statement of facts without any qualification.
While the SMC sought a five-month suspension, the doctor asked for the maximum fine instead, S$100,000.
The doctors who signed the petition complained that Dr Lim’s sentence was “unreasonably high.”
Chief Justice Menon said at the judgment, “Those protesting appeared to be concerned that the decision would set an unacceptable benchmark for other cases, notwithstanding the fact that the disciplinary tribunal had, in fact, imposed the lesser of the sanctions that Dr Lim himself had sought.”
In its appeal, SMC sought to reduce the sentence to a fine not greater than S$20,000, which Dr Lim agreed to.
However, the court decided to overturn the conviction completely.
According to Chief Justice Menon, “a doctor is not under a duty to convey to his patient every conceivable risk.
The only difference between the two treatment options lay in whether the (steroid) injection would be administered. Just on those facts, we very much doubt that the patient would have proceeded with the (steroid) injection without any question or discussion at all as to its possible benefits and side effects.
The result has been an ill-judged prosecution, an unwise decision to plead guilty and an unfounded conviction. In short, there has been a miscarriage of justice, with dire consequences for the medical practitioner concerned.
Doctors are human after all, and, like the rest of us, are susceptible to lapses, errors of judgment, poor record-keeping and failures of memory.
It would pose an intolerable burden for each medical practitioner, and, indeed, for society, which invests in and depends on the establishment of a vibrant medical profession, if each and every one of these failures were visited with sanctions.”/ TISG