Singapore Medical Council v Chua Shunjie

• Jurisdiction: Singapore
• Judge: Sundaresh Menon CJ
• Judgment Date: 04 November 2020
• Neutral Citation: [2020] SGHC 239
• Plaintiff Counsel: Ho Mingjie Kevin and Tan Qian Ni Roseanne (Braddell Brothers LLP)
• Docket Number: Originating Summons No 3 of 2020
• Date: 04 November 2020
• Hearing Date: 18 August 2020
• Subject Matter: Professional conduct,Professions,Medical professions and practice
• Year: 2020
• Defendant Counsel: Tay Wei Loong Julian and Kee Shu'en Theodora (Lee & Lee)
• Court: High Court (Singapore)
• Citation: [2020] SGHC 239
• Published date: 07 November 2020

Sundaresh Menon CJ (delivering the judgment of the court): Introduction

The present appeal is unusual in that for the first time, as far as we are aware, disciplinary proceedings brought against a provisionally registered medical practitioner have come before the High Court. Before the Disciplinary Tribunal (“the DT”), Dr Chua Shunjie (“Dr Chua”) raised a preliminary objection contending that the DT ceased to have jurisdiction to determine the matter upon the expiration of his provisional registration. The DT rejected that objection, and Dr Chua then elected to plead guilty to a total of 4 charges under s 53(1)(d) of the Medical Registration Act (Cap 174, 2014 Rev Ed) (“the MRA”) on the basis of an agreed statement of facts (“the SOF”). He also consented to two charges being taken into consideration for the purposes of sentencing. The six charges concerned a breach of patient confidentiality and the publication of inaccurate and misleading statements in a variety of media. The DT ordered that Dr Chua be suspended for a period of 18 months.

This is the appeal of the Singapore Medical Council (“the SMC”) against the sentence imposed by the DT.

In this judgment, we consider whether disciplinary proceedings under the MRA can be brought against provisionally registered doctors after the expiration of their provisional registration. Relatedly, in the context of sentencing, we consider the availability of the sanction of striking off the name of a registered medical practitioner from the Register of Provisionally Registered Medical Practitioners (“RPRMP”) and the purpose such a sanction would serve in circumstances where provisional registration has expired. We also consider the application of the analytical framework for sentencing that was set out by this court in Wong Meng Hang v Singapore Medical Council and other matters [2019] 3 SLR 526 (“Wong Meng Hang”) for use in cases such as the present that concern professional misconduct involving dishonesty.

Background

Following his graduation from the Duke-NUS Graduate Medical School (“Duke-NUS”) in 2015, Dr Chua was granted provisional registration by the SMC on 1 July 2015 pursuant to s 24 of the MRA. Under s 13 of the MRA, such registration would, in conjunction with a valid practising certificate, allow him to practise as a house officer and obtain the certificate of experience needed to apply for either full or conditional registration under the MRA. As a result of a complaint made by a patient against Dr Chua, which formed the basis of one of the charges Dr Chua faced before the DT and which we elaborate on below, he was temporarily suspended from clinical duties on 20 May 2016. This meant that Dr Chua was unable to complete his housemanship within the usual period of one year, and it necessitated the extension of his provisional registration on 5 August 2016 by four months. Dr Chua eventually completed his housemanship in December 2016 and obtained a certificate of experience.

Disciplinary proceedings leading to the inquiry by the DT

During the course of Dr Chua’s housemanship, a formal complaint was filed against him with the Chairman of the SMC’s Complaints Panel on 25 May 2016, by the Training and Assessment Standards Committee of the Ministry of Health (“the MOH”), alleging a number of instances of professional misconduct. A Complaints Committee was subsequently appointed to inquire into the complaint. The Complaints Committee directed that an investigation be conducted by the MOH’s Investigation Unit. Dr Chua was invited to furnish a written explanation in response to the complaint, which he did on 5 December 2016. The Complaints Committee eventually determined that a formal inquiry by a DT was warranted and conveyed its decision to Dr Chua by a letter dated 31 August 2017. This was followed more than a year later by a Notice of Inquiry dated 26 February 2019 setting out a total of six charges under s 53(1)(d) of the MRA.

The charges

The charges against Dr Chua set out in the Notice of Inquiry fall into two broad categories. The first, which consists of the 1st charge, concerns a breach of medical confidentiality (“the confidentiality charge”) by violating guideline 4.2.3.1 of SMC’s Ethical Code and Ethical Guidelines (2002 Edition) (“the ECEG”), which states: 4.2.3.1 Responsibility to maintain medical confidentiality

A doctor shall respect the principle of medical confidentiality and not disclose without a patient’s consent, information obtained in confidence or in the course of attending to the patient. However, confidentiality is not absolute. It may be over-ridden by legislation, court orders or when the public interest demands disclosure of such information …

The confidentiality charge stems from the patient complaint we have alluded to at [4] above, and it concerns an incident which occurred on or around 27 April 2016 when Dr Chua was posted to the general surgery team at Ng Teng Fong General Hospital and was one of the doctors who examined and treated a patient, and handled the patient’s discharge. Following his discharge, the patient returned for a number of physiotherapy sessions. The patient approached Dr Chua as he was unhappy with the length of medical leave he had been issued. It appears that after a phone conversation with the patient, Dr Chua issued an extended medical certificate without meeting the patient or conducting any assessment. Dr Chua was subsequently approached by the patient’s employer to clarify the condition of the patient who had refused to resume work and had made a claim for loss of income on the basis of the medical certificate issued by Dr Chua. Without the patient’s consent, Dr Chua prepared and issued to the patient’s employer a letter on the hospital’s letterhead informing the employer of the patient’s medical condition, diagnosis and treatment, as well as other information that had been conveyed by the patient in the course of the consultations.

The second category of charges, which consists of the 2nd to 6th charges (which we refer to collectively as “the false information charges”), concerns the provision of inaccurate or misleading information in breach of guidelines 4.4.2 and 4.4.3.1 of the ECEG, which read as follows: 4.4.2 Standards required of information

In general, doctors may provide information about their qualifications, areas of practice, practice arrangements and contact details. Such information, where permitted, shall have the following standards: a. Factual b. Accurate c. Verifiable d. No extravagant claims e. Not misleading f. Not sensational g. Not persuasive h. Not laudatory i. Not comparative j. Not disparaging …

4.4.3 Information in the public domain 4.4.3.1 Public speaking, broadcasting and writing

All information, whether to fellow doctors or the public must conform to the above standards. This includes information given in the context of education for doctors or the public, in talks, broadcasts and seminars organised by professional bodies or healthcare institutions, or in professional journals.

…

The 2nd charge relates to a breach of guideline 4.4.2 read with guideline 4.4.3.1 of the ECEG in a research letter, which is a form of correspondence used for publishing preliminary research or short summaries of primary research, submitted by Dr Chua on or about 16 August 2015 to the British Journal of Dermatology (“the BJD”). There, he presented himself in the author biography as “Chua Shunjie, BEng, MD, National Skin Centre, Singapore” [emphasis added]. This gave the impression that Dr Chua was affiliated with the National Skin Centre (“NSC”) or that the study was somehow affiliated with the NSC, both of which were inaccurate and misleading. Dr Chua did not hold any official appointment or role in the NSC and the contents of the research letter did not involve either patients or doctors at the NSC.

The 3rd and 4th charges relate to breaches of guideline 4.4.2 read with guideline 4.4.3.1 of the ECEG and concern a pair of letters Dr Chua sent to two academic publications. The 3rd charge concerns a clinical letter, which is a form of correspondence used to describe patient cases of novel and extraordinary significance, submitted in August or September 2015 to the Journal der Deutschen Dermatologischen Gesellschaft (“the JDDG”) and published in March 2016, in which Dr Chua claimed that his co-authors included one “Mark Pitts”. The 4th charge concerns a letter submitted in September 2015 to the Obstetrics & Gynecology Journal (“the OGJ”) and published in January 2016 responding to a previously published article, and in which Dr Chua claimed that his co-authors included “Mark Pitts” and “Peter Lemark”. These were both inaccurate and misleading because there were no such co-authors.

The 5th and 6th charges relate to a breach of guideline 4.4.2 of the ECEG and concern a pair of applications that Dr Chua made to the Centralised Institutional Review Board (“CIRB”) on or about 1 July 2015 and 28 October 2015 respectively, seeking approval to conduct two studies. In these, Dr Chua claimed that he was a member of the Singapore General Hospital’s (“SGH’s”) Dermatology Department. These claims were inaccurate and misleading because at the time of the applications, Dr Chua was not in any way involved with SGH’s Dermatology Department.

The inquiry by the DT

At the inquiry before the DT, which took place over three days in June and November 2019, Dr Chua initially raised a preliminary objection against the DT’s jurisdiction. In summary, Dr Chua argued that under s 53(1) read with s 53(2) of the MRA, a DT’s powers could only be exercised in respect of a registered medical practitioner as defined by the MRA (“RMP”). Dr Chua submitted that he had ceased to be a RMP upon the expiration of his provisional registration in December 2016. As against this, the SMC appears to have originally taken the...