SINGAPORE — A surgeon who was previously fined $100,000 for failing to advise a patient on the possible side effects of a steroid injection had his conviction set aside by the High Court on Wednesday (24 July).
In the judgement delivered by Chief Justice Sundaresh Menon, the High Court said that the charge against Dr Lim Lian Arn was not made out.
Dr Lim was fined by a disciplinary tribunal of Singapore Medical Council (SMC) in January after it ruled that he had failed to advise the patient of the potential risks and complications from the injection and as such did not get her informed consent before he administered the injection.
The patient consulted Dr Lim, an orthopaedic surgeon with Gleneagles Medical Centre, in October 2014 for her pain on her left wrist. Following a scan, she was given two options by Dr Lim: a bracing and oral medication or a steroid injection with bracing and oral medication. The patient chose the latter option and later experienced swelling and pain in the injected area about two hours after the injection.
After the conviction, the SMC appealed to have the fine reduced to $20,000 while maintaining that the conviction was sound.
The court noted that there were “serious inadequacies” in the expert report submitted to support the charge.
“The report merely presented conclusions without setting out the reasons for the conclusions. Such an opinion was valueless to the court,” said the High Court.
On the issue of “informed consent”, the court said a doctor was not under a duty to state to the patient “every conceivable risk”. “Ultimately, what had to be disclosed was largely a matter of common sense.”
The court stated that it had “serious doubts” as to whether Dr Lim had failed to advise the patient of the risks and possible complications of the injection.
On the options presented to the patient, the court said it was “very doubtful” that the patient would have chosen the injection without any discussion about its possible side effects.
Based on the facts found by the tribunal, the court said the circumstances of the case did not meet the disciplinary threshold.
Dr Lim had offered an alternative option of conservative treatment. He had not offered the injection as the only treatment, nor had he actively recommended it to the patient, said the court.
In view of the patient’s symptoms and investigations done by Dr Lim, the injection was an appropriate treatment and that it was a minimally invasive procedure often performed in a clinic.
The court said, “While the patient did suffer some side effects from the injection, there was nothing to suggest that the complications which she experienced were in any way permanent or debilitating. Those complications were also not caused by any act or omission on Dr Lim’s part, but were instead simply a consequence of the injection.”
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