Ho Paul v Singapore Medical Council

JurisdictionSingapore
JudgeChan Sek Keong CJ
Judgment Date16 January 2008
Neutral Citation[2008] SGHC 9
Date16 January 2008
Subject MatterWhether Disciplinary Committee directing itself to right inquiry,Doctor not represented by counsel,Relevant precedent not brought to attention of tribunal,Standard of natural justice,Whether Disciplinary Committee was expected to ensure doctor appreciated importance of mitigation plea,Whether sentence manifestly excessive,Administrative Law,Whether Disciplinary Committee was expected to warn doctor of legal implications of not cross-examining witnesses,Disciplinary tribunals
Docket NumberOriginating Summons No 615 of 2007
Published date17 January 2008
Defendant CounselHo Pei Shien Melanie, Agnes Chan and Kylee Kwek (Harry Elias Partnership)
CourtHigh Court (Singapore)
Plaintiff CounselRebecca Chew, Mark Cheng and Loke Pei-Shan (Rajah & Tann)

16 January 2008

V K Rajah JA (delivering the grounds of decision of the court):

1 This was an appeal against the decision of the respondent, the Singapore Medical Council (“the SMC”), which found the appellant, Dr Paul Ho (“Dr Ho”), guilty of 19 charges of professional misconduct, and ordered that he be, inter alia, suspended from practice for a period of three months with effect from 21 April 2007 as well as fined $1,000. We allowed the appeal in part, in that while affirming the SMC’s finding of culpability, we set aside the three-month suspension and increased the fine to $2,500. We now give the reasons for our decision.

The facts

2 Dr Ho is a medical practitioner who has been in practice for more than 20 years. Between 2002 and 2005, the prescription of Subutex – often used in the management of opioid dependence – formed part of his practice. In August 2006, Subutex was made a controlled drug after the authorities learnt that drug addicts were misusing Subutex.

3 In December 2003, Dr Ho’s patient records were reviewed by the Ministry of Health (“MOH”). Concerns were raised by MOH regarding Dr Ho’s practice of prescribing Subutex, and MOH later referred the matter to the SMC. Subsequently, 19 charges of professional misconduct under s 45(1)(d) of the Medical Registration Act (Cap 174, 2004 Rev Ed) were presented against Dr Ho. Each charge was identical, the essence of which asserted:

a. Your management of the said patient was inappropriate in that you did not formulate and/or adhere to any management plan for the treatment of the said patient’s medical condition by the prescription of Subutex; and

b. You did not record or document in the said patient’s Patient Medical Records details or sufficient details of the patient’s diagnosis, symptoms and/or condition and/or any management plan such as to enable you to properly assess the medical condition of the patient over the period of treatment …

4 During the inquiry before the disciplinary committee of the SMC (“the DC”), Dr Ho chose not to have legal representation and conducted his own defence. The hearing took place over two days. The DC found Dr Ho guilty of all 19 charges and ordered, inter alia, that he be fined $1,000 as well as suspended from practice for three months with effect from 21 April 2007.

5 In justifying its decision, the DC referred extensively to a report prepared by the SMC’s expert witness, Dr Tan Yew Seng (“Dr Tan”), dated July 2006. The report, a copy of which was given to Dr Ho prior to the inquiry, concluded that Dr Ho had neither put in place any management plans for the 19 patients concerned nor recorded sufficient details of their symptoms and conditions or information as to how their treatment could be properly administered.

6 The DC agreed with Dr Tan’s observations that Dr Ho had failed to follow the prescription guidelines supplied by Subutex manufacturers. Further, it doubted if Dr Ho’s purported management plan – namely, imposing pecuniary penalties on patients who exceeded the recommended dosage – had any positive effect on the patients’ addiction. Dr Ho had also argued that, as a sole proprietor, it was more difficult for him to keep fully documented records of his patients, but this was not accepted by the DC as a legitimate excuse. Nevertheless, for the purposes of sentencing, the DC took into consideration Dr Ho’s unblemished record of 26 years of practice as well as the apparently genuine interest which he had demonstrated in the treatment of drug addiction over the years.

7 Pursuant to s 46(7) of the Medical Registration Act, Dr Ho appealed against the DC’s decision. He argued that the DC had: (a) misdirected itself on the charges which he had to answer in the inquiry; and (b) made an error of law in imposing a sentence which was manifestly excessive.

Whether the DC misdirected itself during the inquiry

8 Before us, it was argued that the DC had operated under a misdirection because, instead of inquiring as to whether Dr Ho had put in place any management plan, the DC had focused on whether there was an adequate or a proper management plan. According to counsel, the charges brought against Dr Ho had clearly contemplated only the issue of whether a management plan existed and nothing else.

9 While a court is generally precluded from reviewing the merits of a lower tribunal’s decision, an exception exists where the tribunal has failed to direct itself to the right inquiry: see Leong Kum Fatt v AG [1984-1985] SLR 367 at 372, [13]. It...

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7 cases
  • Huang Danmin v Traditional Chinese Medicine Practitioners Board
    • Singapore
    • High Court (Singapore)
    • 18 May 2010
    ...that are of equivalent severity: Tan Sek Ho v Singapore Dental Board [1999] 2 SLR(R) 70; Ho Paul v Singapore Medical Council [2008] 2 SLR(R) 780. In the present case, IC 2005/1’s recommendation to cancel the Appellant’s registration as a TCM practitioner was based on the three complaints ag......
  • Dr Eric Gan Keng Seng v Singapore Medical Council
    • Singapore
    • High Court (Singapore)
    • 1 November 2010
    ...nothing more (see Lim Teng Ee Joyce v Singapore Medical Council [2005] 3 SLR(R) 709 at [26] and Ho Paul v Singapore Medical Council [2008] 2 SLR(R) 780 at [9] (“Ho Paul”)). Part IV of the Medical Registration Regulations on Professional Conduct and Discipline (Cap 174, Rg 1, 2000 Rev Ed) (“......
  • Chai Chwan v Singapore Medical Council
    • Singapore
    • High Court (Singapore)
    • 13 May 2009
    ...the charges and was not afforded an opportunity to be heard on those charges. 51 More recently, in Ho Paul v Singapore Medical Council [2008] 2 SLR 780, the appellant prescribed Subutex to his patients from 2002 to 2005. His patient records were reviewed and he was eventually brought before......
  • Ang Peng Tiam v Singapore Medical Council and another matter
    • Singapore
    • High Court (Singapore)
    • 27 June 2017
    ...crucial in assessing the case that must be met by the medical practitioner facing the charge (see Ho Paul v Singapore Medical Council [2008] 2 SLR(R) 780 at [9]). The charge should be set out with sufficient clarity and precision, and the facts that the respondent intends to rely on should ......
  • Request a trial to view additional results
3 books & journal articles
  • Administrative and Constitutional Law
    • Singapore
    • Singapore Academy of Law Annual Review No. 2008, December 2008
    • 1 December 2008
    ...in recognition of the autonomy of quasi-judicial bodies. Nonetheless, as the High Court recognised in Ho Paul v Singapore Medical Council[2008] 2 SLR 780, an exception existed where a tribunal has failed to direct itself to the right inquiry, following Leong Kum Fatt v AG[1984—1985] SLR 367......
  • Biomedical Law and Ethics
    • Singapore
    • Singapore Academy of Law Annual Review No. 2015, December 2015
    • 1 December 2015
    ...court (Kwan Kah Yee at [23]–[24]). In a similar vein, the term ‘manifestly excessive’ was used in Ho Paul v Singapore Medical Council[2008] 2 SLR(R) 780 (at [7] and [14]–[16]) and Lee Kim Kwong v Singapore Medical Council[2014] 4 SLR 113 (at [40]). 6.55 That a sentence being ‘manifestly exc......
  • Case Note: NATURAL JUSTICE: A CASE FOR UNIFORM RIGOUR
    • Singapore
    • Singapore Academy of Law Journal No. 2008, December 2008
    • 1 December 2008
    ...Paul v Singapore Medical Council [2008] 2 SLR 780 Kay Swee Pin v Singapore Island Country Club [2008] 2 SLR 802 This note considers if there is a discernible framework in which courts resolve alleged claims of breaches of natural justice. On the one hand, once it has been ascertained that t......

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