SINGAPORE - The doctor who was fined $100,000 for not telling his patient about the possible complications that could be caused by a commonly used injection might see the penalty reviewed.

The Ministry of Health (MOH) has asked the Singapore Medical Council (SMC) to get the case reviewed in court and the SMC has already filed an application, seeking the court’s permission for this.

The fine was imposed on Dr Lim Lian Arn by the SMC’s disciplinary tribunal, which had found him guilty. This is the first time that the MOH has asked for the disciplinary tribunal’s decision to be reviewed.

The tribunal’s decision caused an uproar within the medical profession.

This is because most doctors who give that steroid jab usually do not tell patients of the side effects, which are both rare and transient.

Doctors feared that the tribunal’s judgment would set a precedent over the amount of information that they will need to share with their patients and lead to the practice of defensive medicine.

The Straits Times Forum pages carried several letters from doctors asking if they now need to alert patients to every possible side effect of every medication they give. One doctor pointed out that even the widely used painkiller, paracetamol, has side effects.

More than 5,000 people had signed an appeal, started by another doctor, to share their concerns with Health Minister Gan Kim Yong.

The subject was also raised in Parliament.

Dr Lim Wee Kiak, an MP for Sembawang GRC, said that while the profession is self-regulated, the MOH should nevertheless have oversight of key issues. In this case, the $100,000 fine “is excessive”, he said, asking if the ministry would consider re-opening this case.

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Senior Minister of State for Health Lam Pin Min had replied that, as both parties had accepted the judgment, there was no need to do so.

But on Wednesday (Feb 20), the MOH sent out a statement to say that it has requested the SMC to apply to the Court to review that decision.

The statement said the ministry “has noted and understands the concerns in relation to both the decision of the Disciplinary Tribunal (DT) in Dr Lim Lian Arn’s case, and the imposition of a $100,000 fine against Dr Lim.

“Sentences have to be commensurate with the circumstances of each case.

“Whilst both Dr Lim and the Singapore Medical Council (SMC) may have accepted the sentence, the decision in this case carries with it much wider professional practice implications and also has an impact on future cases.

“MOH is of the view that this decision should be reviewed.”

The ministry added that it was concerned that the case could “lead to the practice of defensive medicine which would have an adverse impact on patient and clinical safety”.

It felt that it would be good for the case to be thoroughly reviewed in court.

The SMC agreed. It has asked for appropriate revisions to be made, even though the time for such an appeal has passed.

The statement added: “MOH will continue to engage with healthcare professionals to have greater clarity and balance in the practice and processes in the medical community, so as to enhance patient safety and, at the same time, also keep overall healthcare costs affordable.”