GP fined $30,000 for failing to immediately refer patient to specialist

(PHOTO: Getty Images)
(PHOTO: Getty Images)

A general practitioner (GP) has been fined $30,000 for failing to immediately refer a patient with a corneal ulcer to an eye specialist.

As a result, the patient ended up having to undergo a corneal transplant and cataract operation. She also lost most of her sight in her left eye.

Following a complaint filed by the patient with the Singapore Medical Council (SMC), a disciplinary tribunal was held for Dr Sim Kwang Soon, a GP at Alliance Clinic and Surgery, between March 2016 and August this year.

The 53-year-old doctor was found to be in breach of the SMC’s Ethical Code and Ethical Guidelines. This information was shared with the media via an SMC press release and its grounds of decision on Tuesday (26 September). The patient’s name was not revealed in either document.

Dr Sim had pleaded guilty to one charge of failing to refer the patient to a specialist for her eye condition in a “timely manner”. Another charge for “failing to exercise due care in the management of the patient by failing to carry out an adequate history taking of the patient” was taken into consideration for Dr Sim’s sentencing.

“Dr Sim’s failure to refer the Patient to a specialist in a timely manner caused a further aggravation of the ulcer, and ultimately, after a therapeutic corneal transplant, the Patient suffered permanent disability in her left eye with a decreased rate of functionality of only 20 per cent post-surgery,” said the SMC.

Patient first seen in 2010

On 16 June 2010, Dr Sim diagnosed the patient to be suffering from a corneal ulcer in her left eye but did not immediately refer her to an eye specialist. Instead, he told her that the corneal ulcer was small and would not affect her vision.

Dr Sim advised the patient to see him again if her condition did not improve, and would refer her to a specialist then. A day later, the patient visited another GP and was referred to the Singapore General Hospital.

She underwent a corneal transplant about a month later after her condition was found to be worsening despite medical treatment. The patient subsequently filed a complaint with the SMC against Dr Sim on 28 May 2013.

Practice not suspended

While Dr Sim was fined for his actions, the tribunal did not suspend him from practice as it found that his breach was not serious and direct enough to warrant a suspension.

The tribunal also found that Dr Sim had not withheld the referral for personal gains, out of malice, or out of a total disregard for the patient’s wellbeing.

There was also insufficient evidence to show that the harm caused to the patient was due to Dr Sim’s failure to refer her to a specialist immediately, said the SMC.

The tribunal took into consideration Dr Sim’s “long good standing in the medical profession”, the good testimonials tendered on his behalf and the fact that the GP had pleaded guilty at an early stage.

It was also satisfied that Dr Sim did not appear to have a “propensity to re-offend”, as there was no evidence of dishonesty in his case, and that he had no other complaints of possible misconduct since the date of his offence.

Apart from the fine, Dr Sim was ordered by the tribunal to be censured and for the doctor to give a written undertaking to the SMC that he will not repeat his conduct. He was also ordered to pay for any expenses related to the proceedings, including the costs of the solicitors, to the SMC.

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