Fewer cases of errant doctors

This is good news. Either that or doctors are more careful on what drugs are being prescribed to whom. An analogy would be speeding offences in a year. Lower offences recorded does not mean actual lower cases of speeding cases because it could also suggest that there was lax enforcement or drivers know when to slow down and when to speed up so as to avoid getting a ticket.

Fewer cases of errant doctors
Stricter measures implemented by MOH and enforcement by the SMC have reaped positive results. -myp
Wed, Oct 20, 2010
my paper

BY JOY FANG

STRICTER measures implemented by the Ministry of Health (MOH) and enforcement by the Singapore Medical Council (SMC) have reaped positive results, with a drastic drop in complaints from patients.

The measures implemented in 2008 by MOH made it a requirement for doctors to be more meticulous in the exercise of their profession.

For instance, doctors were made to document details of their patients' condition and treatments given and keep records to justify why they prescribed certain drugs. They must also inform MOH if they suspect a patient of being addicted to drugs.

So far this year, nine doctors have been subjected to disciplinary action by the SMC, said an SMC spokesman, with the latest case involving a general practitioner found to be lax in prescribing sleeping pills and cough mixture to his patients.

Last year, 96 complaints were lodged against medical practitioners, compared to 138 the year before.

Most cases involved general practitioners, while some involved specialists such as neurologists and surgeons.

Of the complaints lodged with the SMC in 2008, 22 were for the excessive or inappropriate prescription of drugs. There were only seven such complaints last year.

Another 28 complaints received last year were for professional negligence and incompetence while 10 were for unnecessary or inappropriate treatment.

In the latest case, Dr Chua Boon Ling, 43, from the Simon Road Family Clinic in Serangoon faced 14 charges of professional misconduct for dispensing a range of benzodiazepines - or sleeping pills - and medicines which contain codeine without due care.

MOH tightened its guidelines on benzodiazepines in October 2008, following a surge of cases involving doctors prescribing sleeping pills and other drugs too readily. Benzodiazepines are a class of hypnotic drugs which can be addictive.

The disciplinary committee (DC) also found that Dr Chua failed to properly document sufficient details of his diagnoses, patients' symptoms and conditions, and advice given in patient medical records, and failed to refer his patients for specialist treatment.

The DC said that given the extent of the patients' dependence on and addiction to the medications prescribed, they "did not accept that Dr Chua was in a position to continue with his management of the patients".

They added that "such a failure was inappropriate and unprofessional" as the dependency of patients was left unchecked.

A spokesman for SMC said they took action after receiving a complaint against Dr Chua from MOH.

Under the Medical Registration Act, SMC can take action or commence investigations against a doctor only after receiving an official complaint supported by law, said the SMC spokesman.

Dr Chua contested all 14 charges, but was convicted on nine of them. He was suspended for four months, from Oct 12, and fined $5,000. He also had to give a written pledge not to repeat the offences, and bear the costs of the disciplinary hearing.

The SMC has been cracking down on errant doctors, conducting 39 disciplinary inquiries over the past three years.

joyfang@sph.com.sg

Doctor fined, suspended for four months

This time, it is benzodiazepines and not subutex, but these two are the drugs most commonly liberally prescribed. Four months suspension and $5,000 fine, there were different earlier cases of six months suspension and $7,000 fine so this Dr Chua did not break the record for this year.

Doctor fined, suspended for four months

05:55 AM Oct 20, 2010

by Saifulbahri Ismail

SINGAPORE - The Singapore Medical Council has suspended Dr Chua Boon Ling of Simon Road Family Clinic for four months when it found him guilty of professional misconduct.

Dr Chua was convicted of nine charges by the council's disciplinary committee.

The committee found that Dr Chua, 43, had inappropriately prescribed benzodiazepines on an indefinite basis to his patients.

It noted that the medication was highly addictive and that the prescribing physician had the responsibility to exercise great care and control to ensure that his patients did not develop an addiction. In addition, Dr Chua failed to properly maintain the relevant patients' records for the management of his patients' treatment.

The committee said such a failure was inappropriate and unprofessional in that the dependency of the patients was left unchecked.

In addition to being suspended, Dr Chua was also fined $5,000. He had filed an appeal to the High Court but subsequently withdrew it.

Bad Doctor...

An old experienced doctor who probably knew he knew best, and if the patient had a drug dependency and always went to him for prescription and consultation, all the better. Doctors and the healthcare industry are businesses and repeat customers are good as the sales mindset goes.

Aug 11, 2010
Doctor fined for sleeping pills

THE Singapore Medical Council (SMC) has censured and fined a doctor after he admitted to seven charges of professional misconduct over the treatment of his patients with hypnotics.

Dr Tham Pak Onn, 72, who was practising at Tham Dispensary at Geylang Road, pleaded guilty to failing to exercise due care in the management of his patients at a disciplinary inquiry held against him on June 28, following a complaint to the SMC.

SMC said in a statement on Tuesday that the charges included inappropriate prescription of hypnotics to the patients, failure to refer the patients to a medical specialist for further assessment and treatment and failure to record or document the patients' medical records.He also failed to formulate any long term management plan for the treatment of the patients' medical conditions. Long term consumption of hypnotics may lead to drug dependence, said the disciplinary committee (DC).

'The DC stated that it was the duty of all doctors to be familiar with and to understand current medical standards and prescribing practices in the interests of their patients, and that it was crucial for doctors to formulate a long term management plan to minimise the possibility of creating dependency on such medication in these patients,' said the SMC statement.

The DC found that Dr Tham 'had acted in disregard of his professional duties since the prolonged prescription of hypnotics without specialist referral or proper medical records was inappropriate and unprofessional.' In making its decision, the DC considered several mitigating factors, including the fact that Dr Tham faced relatively few charges, he had pleaded guilty at the earliest opportunity and had cooperated with the authorities. Dr Tham, who is a senior member of the medical profession and had a long standing good record until the disciplinary proceedings, had also voluntarily ceased practice in February 2008, said the committee.

'The DC also specifically mentioned that the sentence did not include a term of suspension which is the usual sentence for misconduct of improper prescription of hypnotics because of the strong mitigating factors in this case. As such, it should not be viewed that doctors convicted of improper prescription of hypnotics will only incur a fine,' added the SMC. Dr Tham also had to give a written undertaking to the Medical Council that he will not engage in similar conduct and pay the costs and expenses of the inquiry proceedings.

Doc Drugs

This is the third doctor in 3 months. This doctor was fined $7,000. A previous one was fined $5,000 and another was suspended for 6 months. The silver lining in this cloud is that either the SMC is bothering to do some weeding in its garden or the CNB is investigating legitimate sources of Subutex which can be used for abuse, or both are cooperating i.e. if the SMC, which is a stat board, does not tend to its own regarding negligent sale of prescription drugs, CNB and the Court would and the punishments can be significantly harder.

According to the MOH website,

"Subutex (or buprenorphine hydrochloride) was approved for use in 2000 by the Ministry of Health and introduced in 2002 as substitution treatment for opiate-dependent (i.e. heroin) drug abusers. The aim of substitution therapy is to reduce craving for heroin and facilitate improvement in social functioning such as employment and personal relationships."

However, druggies with the help of some doctors closing one eye as these cases hint but don't explicitly state, managed to get their highs not from heroin but from liberal dosage of Subutex coctails instead.

Apr 19, 2010
GP fined for doling out Subutex
By Judith Tan

A GENERAL practitioner was fined $7,000 after he pleaded guilty to 122 charges for failing to exercise due care while prescribing Subutex, a controlled drug used in treating heroin addiction.

But as the offences were ccommited before Subutex was banned in 2006, Dr Chai Chwan escaped harsher punishment.

The Singapore Medical Council (SMC), in a statement on Monday, said the cases against the doctor arose from two complaints received in 2003 and 2004.

Dr Chai, who practices at Little Cross Family Clinic in Tampines, had then been too lax with prescribing Subutex, a drug previously used to wean patients off heroin. He also failed to have a management plan, nor kept detailed records of patients treated with Subutex.

While SMC, the medical watchdog, was disappointed that Dr Chai did not take proper care in 'treating his large number of patients', it considered the mitigating factors while meting out the punishment.

Dr Chai was also censured and had to give written undertaking to SMC that he would not repeat the offence, as well as pay the costs of the disciplinary hearing.

Patient Satisfaction Survey (2008) and the Unsaid Dissatisfaction Survey

The CNA news report was nice and didn't focus on the hospitals and sectors that didn't score that well. Hmmm the survey also didn't pursue why 24% of patients were presumably dissastisfied with the healthcare institutions. For hospital and related services to improve, those sadly missing questions are just as important as to why people are happy about the current healthcare infrastructure. With rising medical costs, I'm surprised that more people were not unhappy, regardless if their grouses over overcharging were valid or not.

In a nutshell, Alexandara Hospital scored the highest satisfaction level but what was not mentioned by the press is that Changi General Hospital had the lowest score with 66%. The overall improvements was 2% points over the 2008 results according toe CNA. I thought it was actually a 1% point improvement according to the MOH website but maybe there was some mistake somewhere. Since 2005, the improvements have not been spectacular which is understood as it gets harder to improve standards in a diminishing marginal returns perspective, and it is impossible to please everyone.


76% of patients satisfied with healthcare institutions in 2009 survey
05 April 2010

SINGAPORE : Seventy-six per cent of patients have expressed overall satisfaction with public healthcare institutions.

This is an improvement of two percentage points over findings from 2008.

Seventy-eight per cent of patients also said they would recommend the services to others, compared to 73 per cent in 2008.

The improved showing was reflected in the independent 2009 Patient Satisfaction Survey commissioned by the Ministry of Health.

Nearly 10,000 patients from the public hospitals, national specialty centres and polyclinics were interviewed between September and December last year.

They were also asked to assess their perceptions based on nine quality service attributes, including knowledge and skills of doctors, and care and concern by nurses.

Among the hospitals, Alexandra Hospital continued to achieve the highest overall satisfaction ratings at 85 per cent.

As for national specialty centres, the Institute of Mental Health clinched the top position with a satisfaction rating of 90 per cent, while Marine Parade Polyclinic was ranked top amongst polyclinics for patient satisfaction.

But while patient satisfaction have improved, the waiting time to consult the doctor remains an area of dissatisfaction.

In a statement, the Health Ministry said the healthcare institutions will have to work harder on this area.

It added that it will continue to increase the number of doctors, but said this will have an impact on operating costs.

Mistakes or Malpractice

Doctors do not have it easy.

Any mistake on their part might end up in a malpratice legal action against them. So it becomes a question of survival and why make another career mistake of admitting an earlier medical mistake some practical doctors might ask themselves and their colleagues. It would not be surprising if the medical fraternity said that doctors should stick together and as long as it was a genuine mistake, the toxic matter should be dumped into the radioactive waste bin. However, for patients and their families, genuine mistake could be seen as gross negligence instead. To believe that doctors cannot ever be accountable for their mistakes is unacceptable.

So how can a balance be achieved? Hospitals as employers should be open about addressing mistakes by their doctors and offering compensation to those affected. Another black box is insurance against malpractice suits which I'm sure they already do, but I'm not exactly sure how it works.

March 11, 2010
Learning to Keep Patients Safe in a Culture of Fear
By PAULINE W. CHEN, M.D.

One afternoon during my training, I watched as one of my closest friends, another surgery resident, was led into the office of the department chief. A week earlier she had been on call when a patient developed a rapid and irregular heart rhythm. He became unconscious and would have soon died if my friend had not stepped in and resuscitated him.

Her intervention, I thought, really proved her mettle.

But there had been a misunderstanding that night about the timing of one of the medications administered. Questions turned into a heated discussion between my friend and a nurse, and what should have been cause for celebration quickly turned into a blistering debate. The next morning, my friend found herself the subject of an “incident report,” a form that hospital workers can use to report accidents. The nurse believed my friend had committed malpractice by ordering the medication too quickly, despite her saving the patient’s life.

“It doesn’t matter if I’m right or wrong,” my friend told me after learning of the report. “That incident report will be a permanent mark on my record.”

I could not argue with her; she was expressing what all of us doctors-in-training believed to be true. While we often talked about errors among ourselves, dissecting the events with great precision, we also went out of our way to avoid any formal documentation of mistakes we had seen. For it seemed that once these mishaps were discussed in department meetings or written up, the narratives called out for someone who could be held accountable. Incident reports, described to us on our first day on the job as a tool for decreasing errors and increasing transparency, became a way for others in the hospital “to hang the residents out to dry.”

Even now, my heart skips a beat when I hear the words “incident report.”

But over the last decade, hospitals have increasingly made patient safety a priority. Incorporating the lessons learned in high-risk industries like aviation and nuclear energy, medical centers across the country have begun promoting protocols, procedures and checklists to prevent health care errors.

Chief among these initiatives has been a push for greater disclosure and transparency — and less fear. We should talk about our errors. We should, if necessary, bring up the topic with one another. We should say we’re sorry. And we should write up incident reports. All of this, doctors have been assured, will improve safety while decreasing blame and the risk of malpractice lawsuits.

But a recent study indicates that current doctors-in-training may still be hesitant to document errors. Last month, The Joint Commission Journal on Quality and Patient Safety reported that the majority of residents have never written up an incident report. And according to a paper issued this week from a committee of leading experts in medical education and health care working with the Lucian Leape Institute of the National Patient Safety Foundation, young doctors are still going out into practice with little education or training in patient safety.

Changing a health care culture that undermines some of the most important principles of error reduction — trust, teamwork and communication — has proved to be much more difficult than a safety checklist would lead one to assume.

“Young doctors are being educated in a toxic culture,” said Dr. Lucian L. Leape, a leading patient safety expert at the Harvard School of Public Health who was chairman of the report’s committee. “The current environment is hierarchical, stressful for the individual, driven by the fee-for-service payment system and humiliating, all of which works against improving patient safety.” To ensure safer health care, doctors-in-training need time to reflect on their actions, a sense of community with colleagues and other health care workers, and the support to engage freely in disclosing errors.

Remarkably, medical schools and clinical training programs have long neglected patient safety in their required curriculum, but in the last few years, several institutions have tried to do so, with varying degrees of success. Many have had difficulty finding financial support, supportive leadership and experienced physician-teachers with formal training in patient safety.

And without appropriate expertise and leadership, institutions are at risk of overlooking even the obvious. In the study of residents and incident reports, for example, researchers found that hospital administrators and educators had told most of the trainees about the importance of patient safety. “But the residents were not aware of the procedure for filling out incident reports or even where they could find the forms,” said Rangaraj Ramanujam, an associate professor of management at the Owen Graduate School of Management at Vanderbilt University in Nashville and senior author of the study. “It seems procedural and mundane, but in terms of shaping behavior, this kind of basic information is pretty important.”

The reward for institutions that have managed to make patient safety education a priority has been dramatic for both students and patients. Six years ago, the University of Illinois at Chicago College of Medicine instituted an extensive patient safety education program that involved a series of required workshops and lectures for medical students beginning in their first year. Graduates have since gone on to take leading roles in patient safety at other hospital systems and academic medical centers. More recently, the university has begun incorporating safety education into their residency programs. Residents at the medical center, who once feared incident reports and filed none, now submit over 100 a month.

“We are a much safer hospital now,” said Dr. David Mayer, co-executive director of the medical school’s Institute for Patient Safety Excellence. “We have been fortunate enough to have incredible leadership in the medical center that has allowed us to move forward with this. No one would ask twice about what we are doing.”

I called my friend from residency this week, and she laughed when I brought up her fateful incident report. Despite her worst fears at the time, the division chief did not fire her. Instead, he spent their meeting discussing ways doctors could better collaborate with nurses.

“I’ve filled out incident reports since,” my friend said to me, recalling the event. “Things are starting to change. But I think you have to feel like what you’re saying really matters and that those in charge are really listening.”

“Otherwise,” she added, “it’s like the not-so-good old days.”

Liberal Prescription of Subutex - Earlier Case

Just a few weeks ago, another case of a doctor profiting from liberal prescription! Who were those wanting Subutex and Benzodiazepines, and did such errant doctors encourage abuse of such controlled drugs?

Doctor fined S$5,000, censured

SINGAPORE: A doctor has been fined S$5,000 and censured for failing to exercise due care in prescribing drugs to his patients.

Dr Mah Mun Mo, Malcolm, who was a general practitioner at Pacific Mah Medical located at Blk 452 Ang Mo Kio Ave 10 pleaded guilty to nine charges.

The Singapore Medical Council (SMC) said eight of the charges related to the dispensation of Subutex, which is used to wean drug users off their heroin addiction. It was banned as an over-the-counter drug in 2006 following rampant abuse.

The other charge was over prescription of Benzodiazepines, a hypnotic medication used to treat patients with insomnia- and anxiety-related problems.

The SMC said Dr Mah had voluntarily ceased medical practice since August 2007 and has not been practising as a medical practitioner ever since.

Dr Mah had to give a written undertaking to the SMC that he would not engage in similar conduct, and was ordered to pay the costs and expenses of the disciplinary proceedings.

Doctors helping with your drug problem

Depends on what you mean by "helping" here. Doctors are expected to prescribe drugs to patients. However, are the drugs prescribed supposed to meet the patient's need, or the patient's demand? More drugs sold mean more profit for the clinic and since clinics are businesses, some doctors would be tempted to place profits before patients.

Mar 2, 2010
More docs lax with drugs
By Joan Chew

THE Singapore Medical Council (SMC) has raised the alarm over the growing number of errant doctors.

In the latest case yesterday, the SMC fined, censured and suspended a general practitioner from practice for six months after he had been charged with inappropriately prescribing drugs to patients.

The Disciplinary Committee (DC) of the SMC found Dr Tan Tek Young guilty of failing to exercise due care in the management of his patients at his clinic in Bedok North.

Of the 22 charges against the doctor, 21 related to the inappropriate prescription of benzodiazepines as hypnotic medication and one to the inappropriate prescription of Subutex, a controlled drug used in treating heroin addiction.

Two of the charges related to both prescription of benzodiazepines and Subutex, while five related to the prescription of both benzodiazepines and a cough mixture containing the opiate, codeine.

Commenting on the case in a statement yesterday, the DC said that Dr Tan's lax prescription of Subutex was 'particularly troubling'.