THE JURY IS OUT ON THE DISCIPLINARY COMMITTEE

In a recent opinion piece by Salma Khalik entitled “Doctor, heal thyself” (Straits Times 17 Jan 2013), the writer highlighted the need for the Singapore Medical Council’s (SMC’s) disciplinary process to be reviewed. There were suggestions that an independent body made up of legal experts could be the way forward to ensure a fairer disciplinary process for the doctors. This would ensure that doctors are fairly tried and that members of the public will have their concerns addressed in a more open manner.

Singapore Medical Council (SMC) has since October 2012 said that they would set up a review committee to look into this matter. However, there have been no concrete developments implemented to date. Exactly who make up this review committee is not made known either. Health Minister Gan Kim Yong has also been silent on this issue.

In light of the recent (2012) DC trial which had been termed “legally embarrassing” by the Court of Appeal (the verdict was overturned by the Court of Appeal), SMC must learn from their mistakes. They must not pay lip service to appease the growing unhappiness amongst the local medical fraternity and sweep these festering problems under the rug, hoping that it will “boil over”. While it may appear that justice has been served because a handful of doctors have had their verdicts overturned in recent months, one must not forget the lengthy process a doctor has to go through when hauled up to face the disciplinary committee. Sometimes, it may take years before a case is heard, and many months of preparation for the trial is bound to take its emotional and physical turmoil on the defendants. Some defendants may even feel that their lives, reputation and careers had been irreparably devastated by the disciplinary hearings. Therefore the disciplinary committee (DC) wields much power over whom they preside. Their role hence should not be taken lightly and close scrutiny of their processes is well warranted. Furthermore, were there doctors wrongfully convicted by the DC but did not appeal? If so, then the recent case highlighted by the Court of Appeal may only be the tip of the iceberg in a crumbling system.

To have a disciplinary committee made up of medical professionals conduct a judicial hearing is akin to having a team of legal experts attempt to perform a life-saving operation. By the time, you realize ‘he’ is unqualified, it is too late. Therefore, there is much work that needs to be done if we want to prevent this type of injustice from being served again.

For a start, Singapore Medical Council (SMC) should stop trying to undermine what went wrong in the recent trials overturned by the Court of Appeal. They should be more accepting of criticism and try to work with the medical community to find a better system forward. In this respect, SMC had announced a review committee to look into the DC processes. Having said that, it is pertinent that the review committee is wholly independent of the SMC; that is it should not be made up of SMC members. Neither should this committee be biased towards MOH or SMC but fully capable of conducting an autonomous review.

Already, there are concerns raised over several such “committees” in the SMC as some committee members were seen to have so many overlapping roles that it was impossible not to question their objectivity. Starting with the Aesthetic Practice Oversight Committee (APOC), a group of doctors appointed to draft aesthetic guidelines in 2008. Prof Goh Chee Leok, a senior dermatologist was part of this committee that drafted the aesthetic guidelines which categorized aesthetic treatments into List A and B; List B being the more experimental aesthetic treatments found in countries like Korea, Brazil, UK and Thailand such as mesotherapy and carboxytherapy. Professor Goh Chee Leok was also the very same expert witness engaged by SMC to testify against Dr Low Chai Ling and Dr Georgia Lee in their disciplinary hearings. SMC, relying on his sole testimony then proceeded to find the doctors guilty of practicing certain procedures including mesotherapy. Sounds straight forward? Except it isn’t.

Prof Goh Chee Leok, besides being a dermatologist at NSC and a MOH official, was also associated with a private aesthetic clinic called AMPL (Aesthetic Medical Pte Ltd). AMPL not only offered many aesthetic practices such as mesotherapy but also offered teaching courses on them. This conflict of interest however did not prevent Prof Goh from acting as an expert witness for SMC in Dr Low and Dr Lee’s cases where his sole testimony helped SMC convict the two doctors of offering the very same treatments (mesotherapy)! By donning multiple hats, it is no wonder that questions abound with regards to Prof Goh’s multiple roles — expert witness for SMC, committee member involved in setting aesthetic guidelines, associate of private aesthetic clinic AMPL. This perception of bias was further fuelled since unlike Dr Low and Dr Georgia Lee, none of Prof Goh’s doctors in AMPL were charged for offering the same treatments. Why are there different sets of rules for different doctors? Were the doctors associated with Prof Goh’s AMPL clinic given ‘special treatment’ then? Or rather were Dr Low and Dr Lee singled out?

AMPL advertisement in The Sunday Times offering mesotherapy

Dr Goh Chee Leok in advert for mesotherapy (Straits Times, March 16, 2005)

In every profession, it is usual to tolerate some amount of professional rivalry and healthy competition. But in the above case, can Prof Goh really be acting in good faith as an expert witness? Prof Goh’s AMPL clinic would most certainly consider Dr Low and Dr Georgia Lee as competitors. Because of the selective persecution of the two aesthetic doctors, one would be forgiven for questioning if Prof Goh as expert witness acted in ‘good faith’.

Because the current SMC disciplinary committee calls on doctors to judge their peers, many rely on the premise that doctors will judge their peers in “good faith” and with a “clear conscience”. However, one cannot deny the very real conflict of interests that some of these doctors have or will have as they sit in judgment of their peers. If a doctor is not in the same field as the defendant, then perhaps he may not understand the medical implications of the case, and will be no better than a legal expert with no knowledge of medicine. On the other hand, if a doctor is practicing in the same field as the defendant, how can we eliminate doubts of professional jealousy clouding his or her judgment and that as a prosecutor, he can put aside all professional jealousy and act in good faith?

Because of this intricate web of relationships that surrounds many of the committees and their members, many have begun to question SMC’s latest review committee. Who exactly is this review committee made up of? Will this review committee be made up of SMC members? If so, how can we be sure that a fair review is carried out? SMC needs to be transparent in their actions to allay any public perception of cover-ups or lack of objectivity.

Finally, what are the intentions of this review committee? Are their intentions to improve the disciplinary process or brush this entire issue underground?

I guess only time will tell.