Frivolous complaints to Singapore Medical Council should come with costs, workgroup recommends

Frivolous complaints to Singapore Medical Council should come with costs, workgroup recommends

Complaints against doctors will be processed more quickly and effectively under recommendations from a workgroup set up by the Ministry of Health. Clearer legal guidelines will give doctors an objective standard to refer to when dealing with patient consent. Gwyneth Teo reports.

SINGAPORE: Anyone lodging a frivolous or vexatious complaint to the Singapore Medical Council (SMC) may be ordered to pay for costs “reasonably incurred” in the proceedings.

A workgroup proposed this in a report released on Tuesday (Dec 3) detailing recommendations to improve the processes of the taking of informed consent and SMC disciplinary proceedings. 

The deterrent is meant to free up resources to deal with serious complaints, the workgroup said.

This, along with 28 other recommendations made by the workgroup, have been accepted by the Ministry of Health (MOH).

READ: MOH to review the taking of informed consent by doctors, SMC's disciplinary process

The workgroup proposed that an inquiry committee be set up to decide if complaints are frivolous and vexatious. 

The committee, or another one, the complaints committee, would then decide on the costs to be paid if the complaints are found to be without substance.

The complainant will be allowed to apply to a High Court judge for a review of that order within 14 days of being notified, the workgroup said in its 68-page report.

“In making this recommendation, the workgroup stresses that there is no intent to create barriers to the ease of lodgement of complaints. Cost orders against complainants will be reserved for the most frivolous or vexatious cases,” it said in its report. 

“The cost may not be a lot but I think it's important to send a signal that frivolous and vexatious complaints are frowned upon. They shouldn't be used as a weapon to achieve other ends,” said Ms Kuah Boon Theng, co-chairman of the workgroup.

WHAT ARE FRIVOLOUS AND VEXATIOUS COMPLAINTS?

She gave examples of what would be deemed complaints without substance.

“Sometimes, in a divorce proceeding that's acrimonious, one spouse makes a complaint against the doctor for refusing to provide medical information on their spouse, which they want to use for various purposes,” Ms Kuah said.

People have also filed complaints against doctors, claiming they were not consulted on their relatives' treatment, despite having made their own decision, she added.

“Some use the process as a pass or fail test and the SMC is perceived as the cheaper route for redress or recourse as opposed to a civil suit,” the workgroup said in the report. 

The workgroup was formed against a backdrop that threatened to erode the trust in a patient-doctor relationship and undermine the strength and proper function of the health ecosystem, MOH said, adding that there was a pressing need to address these concerns. 

In the past five years, 7 per cent of SMC complaints have been dismissed for being frivolous or vexatious, the workgroup said. Currently, a member of public can submit a complaint without fear of penalty or repercussion. 

“Such cases take up considerable resources, and ought to be dismissed at an earlier stage in the process,” it said in the report. 

Other than taking up resources, such complaints had other negative consequences, the workgroup found out from engaging more than 1,000 doctors.

READ: MOH aims to issue legally binding clinical practice guidance for doctors

Doctors felt that such complaints caused unnecessary stress and take time away from their practice.

NO MORE ANONYMOUS COMPLAINTS

The workgroup also recommended that complainants should not be anonymous. 

“The workgroup is of the view that complainants should not have the right to make anonymous complaints. It would be unfair for the doctor to be subjected to the stress of a complaint, when there is no further avenue to verify the accuracy of the information provided in the complaint, through the complainant,” it said.

It added that such complaints should be channeled to the MOH’s existing channel for whistleblowers, where the complainant can be more appropriately dealt with.

CLEARING THE BACKLOG

The workgroup observed that there is a “very substantial backlog” of cases and this has led to cases pending for five to six years before they are heard. 

The longest outstanding case is a complaint that dates back to 2016.

Since 2010, the SMC has received an average of 165 complaints, with about 15 being referred to the Disciplinary Tribunals (DT) annually. An average of 147 complaints and 10 DT matters are resolved each year. 

Even if there are no new complaints received this year, the backlog will take four and a half years to clear, the workgroup said, adding that the situation is "untenable".

There is an urgent need to resource the SMC appropriately at this time to clear the current cases, it said, estimating that it will take about two and a half years to clear the current caseload even with increased resources. 

READ: Patients’ complaints to SMC against doctors could be resolved within 18 months

“Parallel systems will have to be created if the recommended new SMC disciplinary processes are to be implemented quickly," the workgroup said. 

"One track should deal with complaints that are submitted after the recommendations are effected. 

"The other track should be dedicated to clearing the SMC’s current backlog of cases." 

The aim is for complaints to be resolved within 18 months. 

INFORMED CONSENT, MEDIATION 

In terms of informed consent, the workgroup proposed providing a clear legal standard for medical professionals’ duty to advise. This standard will be based on the opinion of a responsible body of doctors, the workgroup said.

“What we do hope to do is to ensure that the assessment of what is material information is done in a more objective way so that it gives doctors a little bit more certainty, predictability about where they stand,” Ms Kuah said. 

Senior Minister of State for Health Edwin Tong told reporters: “Ultimately, what we want to try and do is to encourage a strong doctor-patient relationship. 

"That's a core part of our healthcare system. Doctors must be able to be freely give advice to patients. Patients must trust the advice.”

He also said that mediation can play a bigger role in dealing with complaints.

“Over time, the more you mediate, the more understanding there will be both on the side of the patients and on the side of the medical community,” he said. 

Currently, about 2 per cent of cases are mediated. 

“What we hope is that these wide-ranging suite of recommendations will help to restore trust in the patient-doctor relationship, enhance patient safety and welfare and also restore confidence and trust of doctors in Singapore,” Ms Kuah said. 

Source: CNA/ja

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