SINGAPORE: A judge presiding in the appeal case of surgeon Susan Lim said a profession is more than just a business, and that there must be a concept of ethical charging.
Justice V K Rajah said it is inherent in a profession that there must be a just and fair limit.
He said this at the hearing of an appeal on Tuesday by Dr Lim against the punishment meted out by the Singapore Medical Council (SMC).
This came after Dr Lim’s lawyer, Senior Counsel Lee Eng Beng, argued that the case raises an important issue of whether there is an ethical limit to the quantum of fees a doctor may charge in Singapore.
Assuming there was, he said it would be a "grotesque breach of the principles of fairness and natural justice" to convict her of its breach —— as these ethical limits were not published or made known at the time she was found guilty.
Dr Lim maintained that she could not have overcharged as Singapore has no guideline on fees.
The appeal case has been adjourned for lawyers to make further written submissions and provide the court with more information. The court has indicated it would reserve judgment as no further date has been set.
Dr Lim was not present at Tuesday’s hearing, but her husband Deepak Sharma was spotted in the packed courtroom.
She was found guilty of 94 charges of professional misconduct in August 2012, and the medical watchdog imposed a three—year suspension and fined her S$10,000. She had been accused of overcharging the late sister of the queen of Brunei — with a bill of S$25 million for treating Pengiran Anak Hajah Damit over several months.
The patient died of cancer in 2007.
Singapore’s health ministry later filed charges of professional misconduct with the SMC.
SMC’s lawyer Senior Counsel Alvin Yeo told the court that the health ministry launched an investigation into Dr Lim’s case after receiving a complaint from the government of Brunei about the bill.
He added that even though the patient may have entered freely into a fee agreement with the doctor, a regulatory body could intervene if it felt there was a possibility that the patient was being taken advantage of as this could bring disrepute to the profession.
"In this case, there was concern that this would give rise to public concern about the profession," he said.
Mr Yeo also countered Mr Lee’s suggestion that the conviction was unsafe and unreasonable.
Mr Lee had argued that the disciplinary committee did not identify any evidence or perform required analysis to justify the conclusion that Dr Lim had breached this limit. But Mr Yeo gave examples of how Dr Lim inflated bills and made false representations in her charges for the services of third—party doctors.
For example, she would charge between S$250,000 and S$450,000 per day during the time the patient was in the Intensive Care Unit, even though her role was mostly to coordinate. This was roughly more than 10 times the amount that other doctors deem reasonable.
Dr Lim had also billed the patient between S$35,000 and S$45,000 each time she accompanied the patient with her nurse to radiotherapy treatments. The radiotherapy was actually administered by a third—party oncologist who billed only S$300 per session.
Mr Yeo also highlighted incidents of Dr Lim charging the patient large sums for having to cancel conferences she was scheduled to attend in order to tend to the patient.
Mr Yeo also pointed to a string of inconsistencies in Dr Lim’s side of the story. These include the withdrawal of some invoices and the offer of discounts after she learnt of the Bruneian government’s concern regarding the fees.
She also offered to waive her fees if the Bruneian government gave her a letter of good standing —— indicating that it would not pursue the matter.
"There’s no genuine remorse...the disciplinary committee felt these were deliberate acts on her part and the subsequent discounts showed consciousness of her own guilt," said Mr Yeo.
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