GP suspended for 19 months after Court of Three Judges rejects SMC’s appeal for a higher sentence

Dr Ling Chia Tien, a general practitioner (GP), has been suspended for a total of 19 months over inappropriate prescriptions of sleeping pills and opiates, poor documentation, and for not referring patients to a specialist.

This comes after the Court of Appeal rejected an appeal by the Singapore Medical Council (SMC) to increase the length of suspension.

The suspension runs from July 4, 2024, till Feb 3, 2026, inclusive of both dates.

The SMC had brought 32 charges of professional misconduct against the doctor, who had been working at the Apex Medical Centre in Jurong West Street 92.

His offences came to light following an audit by the Ministry of Health (MOH) in November 2016.

In December 2023, the disciplinary tribunal found Dr Ling, who has almost 40 years of experience, guilty of 29 charges, but decided to group them into four categories, with the various charges within each category to run concurrently.

They are:

• Inappropriate prescription of benzodiazepine, a controlled drug to treat anxiety that is also often used as a sleeping pill; 
• Not referring patients on benzodiazepine to a specialist to treat their underlying conditions; 
• Inappropriate prescription of codeine, an opiate; and
• Poor documentation.

The SMC had asked for an additional month of suspension because the doctor had contested the charges “when it was unmeritorious to do so, and that showed a lack of remorse”.

This was rejected by the tribunal, which agreed with Dr Ling that he had a right to contest the charges, and doing so should not result in a higher sentence. 

In fact, the tribunal decided that it would be fair to the doctor to give him a one-third “discount” in the sentencing, given the long time it took for the case to be heard.

He was given a notice of complaint dated March 12, 2018. The case was finally concluded in December 2023.

The tribunal said in the published grounds of decision, put out on the SMC website on July 8: “We are not persuaded that broader public interests which demand the imposition of a stiff penalty should take precedence in this case over considerations of fairness to the respondent.”

The tribunal’s final decision was 12 months for inappropriate prescription of benzodiazepine, reduced to eight months; four months for not referring patients to a specialist, reduced to three months; nine months for inappropriate prescription of codeine, reduced to six months; and three months for poor documentation, reduced to two months. The sentences run consecutively.

Not happy with the outcome, the SMC appealed to the Court of Three Judges to increase the period of suspension to 36 months, or alternatively, to a period of 30 months. The appeal was rejected.

In coming to its decision, the tribunal said the harm caused by the doctor was slight as “there was no actual harm. The harm in this case was the potential harm that could have resulted from the respondent’s breach”.

It agreed with Dr Ling that the benzodiazepines, such as alprazolam and diazepam, that he had prescribed to the 15 patients were not “highly addictive” ones like dormicum or erimin. Therefore, the risks of addiction and dependence were lower.

The GP claimed that the SMC had overstated the level of harm suffered by the patients by reason of their age. The patients were aged 33 to 82 years in November 2016.

The tribunal agreed with his argument that “the SMC should refer to the ages of the patients at the material time when the prescriptions were made, rather than the current ages of the patients”. Their ages then would be 23 to 67 years.

According to MOH guidelines, benzodiazepines should be for short-term use, generally between one and four weeks. Patients who need to continue on them for the long term should be referred to a psychiatrist for further treatment.

Dr Ling did not refer his patients to such a specialist but instead, continued to prescribe the drug to them.

He was also found guilty of inappropriate sale of codeine-containing cough mixtures, including by his clinic assistants, to five patients on various occasions. Codeine is a controlled drug here as it can be used by addicts for a feeling of euphoria.

As for his poor documentation, he admitted that his handwriting was “scribbly”.

The tribunal found that his documentation was not only insufficient, but it could not also be deciphered by another doctor, should one need to take over the care of his patient.

The tribunal accepted the doctor’s submission that he did not make inappropriate prescriptions for improper financial gain. There was also no suggestion that he had acted maliciously.

Source: Straits Times © SPH Media Limited. Permission required for reproduction.

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