Re the Medical Registration Act (Cap 174)

• Jurisdiction: Singapore
• Judge: Karthigesu JA
• Judgment Date: 29 October 1993
• Neutral Citation: [1993] SGHC 259
• Docket Number: Originating Motion No 16 of 1993
• Date: 29 October 1993
• Published date: 19 September 2003
• Year: 1993
• Plaintiff Counsel: K Shanmugam, Maria Ho and Andrew Ho (Allen & Gledhill)
• Citation: [1993] SGHC 259
• Defendant Counsel: Harry Elias and Doris Chia (Harry Elias & Pnrs)
• Court: High Court (Singapore)
• Subject Matter: Natural justice,Inquiry by Medical Council against applicant,Whether member of Medical Council should have disqualified himself from sitting in the hearing against the applicant,Proper test to be applied where bias or prejudice of a disciplinary tribunal is alleged,Bias,Administrative Law

Cur Adv Vult

Dr Chuang Wei Ping (`Dr Chuang`) after due inquiry by the Medical Council was on 8 February 1993 found `to have been guilty of infamous conduct in a professional respect`. His name was ordered to be removed from the register of medical practitioners and he was ordered to pay the costs of the proceedings, including the costs of the legal assessor and the solicitors for the Council.

There were 14 charges `of infamous conduct in a professional respect` concerning 14 named patients of Dr Chuang, to each of whom he was said to have over-prescribed drugs of the benzodiazepine group or family of drugs `by prescribing excessive quantities`. The particular drugs in question were Nimetazepam (Erimin), Midazolam (Dormicum) and Triazolam (Somese). A schedule was attached to the charges stating in respect of each of the 14 patients the period of the alleged treatment (ie from which date to which date); the dates the drugs were dispensed; the name of the drug dispensed; the dosage prescribed; and the number of the tablets comprising each prescription that was dispensed. (The benzodiazepines dispensed were always in tablet form). The interval, in days, from the previous date on which the benzodiazepines were dispensed were also given in the schedule.

Dr Chuang applied by originating motion to have the orders of the Medical Council set aside and pending the hearing of the originating motion for the orders of the Medical Council to be stayed. No order for stay was made but the hearing of the originating motion was expedited.

Mr Shanmugam for Dr Chuang advanced the appeal under two heads, both of which he argued were equally important. The first was that there was a miscarriage of justice brought about by a serious breach of the rules of natural justice and the second was that the Medical Council`s finding of guilt was wrong both in law as well as in fact. He also questioned the appropriateness of the removal of Dr Chuang`s name from the register of medical practitioners in all the circumstances of this case.

The miscarriage of justice alleged concerns the composition of the Medical Council which heard the complaint against Dr Chuang. The complaint that Dr Chuang was over-prescribing, or prescribing in excessive quantities, drugs of the benzodiazepine group or family was first made on 9 July 1990. It related to five of Dr Chuang`s patients. The notice of inquiry relating to this complaint is dated 16 March 1991. Then about a year later, a further complaint was made that Dr Chuang was over-prescribing, or prescribing in excessive quantities, drugs of the benzodiazepine group or family. This was on 12 July 1991 and related to another nine of Dr Chuang`s patients. The notice of inquiry in respect of this complaint is dated 18 July 1992. Both notices of inquiry were heard by the Medical Council from 20 January 1993 to 5 February 1993 and at the request of the chairman were consolidated into one notice of inquiry dated 20 January 1993, the five patients of the first complaint being charges 1 to 5 and the nine patients of the second complaint being charges 6 to 14.

The first complaint dated 9 July 1990 covered the period November 1989 to April 1990 and the second complaint, the period January 1989 to February 1990. Both complaints were made by a Miss Amy Lim, deputy director, drug administration division of the Ministry of Health and were addressed to the chairman, preliminary proceedings committee, the appropriate body to whom complaints of infamous conduct in a professional respect against medical practitioners are made.

Mr Shanmugam submitted, and it was crucial to his argument, that the complaints were not the complaints of Miss Amy Lim either in her personal capacity or in her capacity as the deputy director of the drug administration division of the Ministry of Health but that it was the complaint of the Ministry of Health itself. He argued that, as a matter of constitutional and administrative law, citing Wade and Bradley (10th Ed) thereon at pp 277-278, a department or a division within a ministry did not enjoy legal autonomy separate from the ministry of which it was a part but could, if there was express provision for it, enjoy a degree of authority delegated to an executive head. The acts of departmental and divisional heads, whether they were exercising delegated authority or not, were the acts of that ministry. If this were not so and each department or division within a ministry had complete autonomy to determine what it will do and what it will not do, this would lead to confusion and chaos within that ministry. In the instant case, the monitoring of the sale and distribution of scheduled and controlled drugs for therapeutic uses by medical practitioners is entrusted to the Ministry of Health and administered by the drug administration division. How the supervision is carried out and what measures are taken to enforce control and regulation, that is to say, the day to day matters, are seen to by the staff of the drug administration division. The inspectors act under the direction of the director and deputy director, but the overall responsibility as to what actions are to be taken rests with the minister. All those civil servants in his ministry, the director of medical services who is also his permanent secretary, the deputy directors of medical services and the heads of the departments and divisions within the ministry are but the officials through whom the minister acts. As was said by Widgery LJ in R v Skinner 1 at p 707:

The minister is not expected personally to take every decision entrusted to him by Parliament. If a decision is made on his behalf by one of his officials, then that constitutionally is the minister`s decision.

So also in this case, in my judgment, the investigation by the inspectors from the Ministry of Health into the excessive prescribing and dispensing of benzodiazepines by Dr Chuang and the complaint against him by the deputy director of the drug administration division of the ministry are constitutionally the investigation and complaint of the Minister of Health.

If the periods of investigation under the two complaints are combined, the period extends from January 1989 to April 1990. Now, it is a fact which has not been disputed that Dr Chew Chin Hin, whilst holding the substitutive appointment of deputy director of medical services (hospitals), acted as the director of medical services and permanent secretary for the following periods: 21 August 1989 to 13 September 1989; 18 September 1989 to 23 September 1989; 22 November 1989 to 5 December 1989; 27 January 1990 to 8 February 1990; 6 August 1990 to 12 August 1990; 27 August 1990 to 9 September 1990; and 17 December 1990 to 22 December 1990.

Dr Chew Chin Hin has been a member of the Medical Council, appointed under s 4(1)(b) of the Medical Registration Act (Cap 174), for a period of at least two decades until his resignation from the Medical Council which was effective from 28 February 1993. For that period, he and the director of medical services were the two public service appointees on the Medical Council.

Mr Shanmugam`s complaint is that Dr Chew Chin Hin, who periodically acted as the director of medical services and permanent secretary in the Ministry of Health for the last eight months of the investigation and for three periods after the close of the investigation, should have disqualified himself from sitting as a member of the Medical Council which heard the complaints emanating from his ministry; but, instead of doing so, and notwithstanding the possible prejudice to Dr Chuang being brought to the notice of Dr Chew Chin Hin and the Medical Council as constituted on the morning of 20 January 1993 at the commencement of the hearing, nevertheless continued to be a member of the Medical Council hearing into the complaints against Dr Chuang from 20 January...