6-year time limit for patients to file complaints against doctors among proposed changes to medical disciplinary process
Among other things, the amendments to the law seek to improve the quality and consistency of the processes and outcomes of the system, speed up resolutions and protect patients more effectively.
- Amendments to the law seek to update disciplinary proceedings for doctors
- They come after court cases triggered debate among doctors about unfair and unclear rules
- The changes are focused on taking informed consent from patients and improving disciplinary processes
SINGAPORE — Under changes to the laws regulating medical professionals, doctors who come under disciplinary proceedings will be assessed by a panel of their peers instead of by the courts.
There will also be a six-year time limit for patients to file complaints to the Singapore Medical Council (SMC).
Mr Edwin Tong, former Senior Minister of State for Health, laid out these and other changes to the existing Civil Law Act and the Medical Registration Act for a debate on Tuesday (Oct 6) before they were passed in Paraliament.
Mr Tong, who is now Minister for Culture, Community and Youth after Cabinet changes in July, said that the planned changes would meet the urgent need to address the gaps in the "health ecosystem" so that trust can be restored between doctors and patients, and between doctors and the system.
WHY IT MATTERS
The changes are based on a list of recommendations released by a workgroup that reviewed the applicable standard of care when taking informed consent from patients and the disciplinary process of the SMC.
The review came after orthopaedic surgeon Lim Lian Arn and psychiatrist Soo Shuenn Chiang were penalised by an SMC disciplinary tribunal last year.
Dr Lim was fined the maximum S$100,000 for failing to inform a patient of the risks or complications that could arise from a steroid injection to her wrist.
Dr Soo was fined S$50,000 for not verifying a caller’s identity and then sharing confidential information about a patient’s condition with her brother, who had posed as her husband when he called.
The two cases led to a heated debate within the medical fraternity here, as doctors questioned the complex set of rules surrounding getting patients’ consent and giving patients adequate information before treating them.
The workgroup’s recommendations were made public last December and accepted by the Ministry of Health (MOH).
Some of the recommendations have already been implemented.
Others will be made by way of legislative amendments to the Civil Law Act and Medical Registration Act, which were debated in Parliament on Tuesday.
KEY CHANGES TO CIVIL LAW ACT
The amendments to the Civil Law Act tackle the issue of the taking of informed consent.
Doctors had raised concerns that there is a lack of clarity on how much information they should give when advising patients, based on the current standard of care.
A new statutory test for medical advice will be introduced and will override the existing test.
Mr Tong said that the new test moves away from being either patient- or doctor-centric, and instead takes into account patient empowerment while providing doctors certainty in the medical and legal climate.
With the new test, a healthcare professional would meet the standard of care in providing advice if:
His or her conduct is assessed to be reasonable professional practice by a respectable body of his or her peers — also known as the “peer professional opinion”
The peer professional opinion is logical
Previously, this assessment was made by the court.
The peer professional opinion must also require that:
The patient was given information that another patient in the same circumstances, such as in the same occupation, would reasonably need to make an informed decision
The patient was given information that the doctor knows is material to the patient to make an informed decision
There is reasonable justification if certain information is not provided to the patient
The new test defines information that is material to the patient as:
Information that relates to a specific concern or question that the patient expressly communicates
Information that relates to a specific concern or question that the patient has and did not expressly communicate, but the doctor reasonably ought to have been aware of, through the patient’s medical records
The peer professional opinion must also require that the doctor gives the relevant information to the patient even if he or she considers the question to be idiosyncratic.
KEY CHANGES TO THE MEDICAL REGISTRATION ACT
In terms of the reforms to the SMC’s disciplinary process, these seek to improve the quality and consistency of the processes and outcomes of the system, speed up resolutions and protect patients more effectively.
Some of the key changes are:
1. Creation of legal advisory unit
There was feedback that there is insufficient legal support provided to the SMC’s complaints committee
The amendments support the creation of a legal advisory and prosecution unit to advise the SMC’s committees and conduct prosecutions for the council
This will gradually phase out the reliance on private law firms
Right now, SMC engages about 10 private law firms on its panel
2. Introduce time limit for filing of complaints
For now, there is no time limit for complaints to be made to the SMC
An accused doctor may not be able to defend himself adequately for incidents that happened long ago due to poor memory or lack of documentation
The amendment will introduce a time limit of six years from the date of the incident, or from the earliest date the complainant had knowledge of the incident, for the filing of complaints
Complaints for incidents that happen after the time limit can proceed only if it is deemed of public interest
3. Allow interim orders to be issued more speedily
Before, an interim orders committee must have a hearing before an order can be issued, even in cases where there is danger to a patient’s health and safety
With the amendments to the law, the committee can issue an immediate interim order, without a hearing, if any conduct alleged in a complaint poses imminent danger to the health and safety of any patient or doctor
The doctor will be heard within one month on whether an interim order should be issued. If not, the immediate interim order will lapse
The doctor may appeal to the High Court on the committee’s decision
