A doctor who was medically negligent had his suspension increased 10 times after his patient who suffered from Fournier’s Gangrene had to have part of his scrotum removed.
Chief Justice Sundaresh Menon chaired a Court of Appeal sitting for an appeal by the Singapore Medical Council (SMC) to lengthen the original three-month suspension imposed by the council’s disciplinary tribunal.
Together with Judges of Appeal Judith Prakash and Tay Yong Kwang, the trio raised the term by 10 times to two-and-a-half years. The court maintained the original fine of S$40,000 against Dr Mohd Syamsul Alam Ismail.
He had been found guilty by the disciplinary tribunal for failing to undertake an adequate clinical evaluation of his patient as well as failing to keep clear and accurate records that would facilitate another doctor taking over.
“This was serious negligence,” said Menon. “Dr Syamsul had failed to perform basic and elementary things that any competent doctor ought to have done.”
The court heard that Dr Syamsul worked at the medical centre of a marine and shipping company in Singapore. On May 14, 2013, the patient, who was not named in court documents, saw Dr Syamsul, complaining of a lump at his buttock and a fever that he had suffered for five days.
NO PHYSICAL EXAMINATION
He also told the doctor that he was diabetic but had stopped taking medication for some time.
The patient alleged that Dr Syamsul failed to conduct a physical examination of his lump, and did not ask him to remove his clothes or lie down on the clinic bed to be examined. Instead, Dr Syamsul prescribed him antibiotics and other medication and ordered a period of medical leave.
The patient’s condition worsened and he was admitted to the Accident & Emergency Department of Alexandra Hospital in great pain the next day. He was diagnosed with Fournier’s Gangrene, and needed surgery which included the partial removal of his scrotum.
He underwent surgery and was warded in hospital for about a month, after which he made a complaint to the SMC.
COURT OF APPEAL
The Court of Appeal noted that Dr Syamsul had a high level of culpability as he had failed to conduct a physical examination at all.
“If he had made a physical examination of the patient and properly assessed the patient’s diabetic condition, as any competent doctor ought to have done, that would have resulted in the patient being sent to hospital immediately and in all likelihood would have prevented the onset or the further spread of gangrene,” said the Chief Justice.
He also noted that Dr Syamsul did not record sufficiently the symptoms that the patient had, which was “a grievous breach of (his) obligation to keep adequate medical records”.
They also cast doubt on Dr Syamsul’s explanation – which came 20 months after he had seen the patient – claiming that he had performed a physical examination of the patient.
“We found it remarkable that he was able to offer such a vivid recollection of the material events given the complete absence of any of these points in his contemporaneous consultation notes,” said the judges.
The judges added that Dr Syamsul “has displayed absolutely no remorse”, refusing to participate in the inquiry and in the Court of Appeal’s proceedings.
“So far as we can tell, he is no longer practising in Singapore. He has only been contactable by email, but he has replied only intermittently to the SMC and SMC’s counsel whenever they attempted to contact him for the purposes of informing him of the disciplinary proceedings,” said Chief Justice Menon.
“Even when he deigned to reply, it was evident that he was fixated more on when he would be able to return to Singapore to work rather than to express remorse or in any way to attempt to justify his conduct. This blatant lack of remorse is seriously aggravating.”
The court also directed the SMC to inform their Malaysian counterparts of the orders it made, as Dr Syamsul is registered to practise in Malaysia. He is believed to be working in Johor.
The judges ordered the doctor to bear the costs of the SMC, which were fixed at S$25,000 including disbursements.
The Chief Justice said the court maintained the fine to send a signal to errant doctors who are able to practise overseas that they cannot simply avoid punishment by waiting out the period of suspension.