Patient suffers permanent disability after doctor fails to refer her to a specialist in time

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General practitioner (GP) Dr Sim Kwang Soon has been fined $30,000 by the Singapore Medical Council (SMC) after he failed to refer a patient to a specialist in time, causing the patient to suffer a permanent disability that could have been avoided had he acted in a timely manner.

The 53-year-old doctor was employed at Alliance Clinic & Surgery in 2010 when he diagnosed the patient with a corneal ulcer in her left eye. Instead of referring the patient to an eye specialist at once, Dr Sim told her that the ulcer was small and would not affect her vision.

He advised her to visit him again if her condition did not improve and assured her that he would give her a referral if she returned.

Dissatisfied, the patient sought a second opinion from another GP one day after her appointment with Dr Sim. Upon checking her eye, the second GP immediately referred her to the Accident & Emergency department of a local hospital.

 

The patient was hospitalised for over two weeks and underwent a corneal transplant and cataract surgery. Despite the operations, the patient permanently lost most of her eyesight in her left eye.

The patient filed a complaint against Dr Sim in 2013, at which point the SMC conducted a disciplinary tribunal inquiry to investigate the claims against the GP. Dr Sim pleaded guilty at the inquiry that convened four times over the past two years – on 24 March 2016, 9 September 2016, 13 January 2017 and 18 August 2017.

Finding the GP guilty, the tribunal decided against suspension and instead fined him to the tune of $30,000 and ordered him to pay the SMC for the cost of solicitors and other expenses incurred as part of the proceedings. The SMC said:

 

“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.”

The Council added that the disciplinary tribunal was satisfied that Dr Sim did not show a propensity to re-offend and noted that no further complaints of misconduct were filed against him since the date of the offence. On its decision to fine the GP instead of suspending him, the SMC said:

“There was insufficient evidence to show that the harm caused to the patient was due to Dr Sim’s failure to refer her to a specialist (in a timely manner)… The (tribunal) also considered and gave full credit to Dr Sim for pleading guilty at an early stage, for his long good standing in the medical profession, and the good testimonials tendered on his behalf.”

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