Lim Mey Lee Susan v Singapore Medical Council: Professional Misconduct and Ethical Obligations of Medical Practitioners

Lim Mey Lee Susan appealed to the High Court of Singapore against her conviction by a Disciplinary Committee (DC) appointed by the Singapore Medical Council (SMC) for 94 charges of professional misconduct under the Medical Registration Act. The charges related to excessive fees invoiced to a patient. The High Court, consisting of Andrew Phang Boon Leong JA, V K Rajah JA, and Tan Lee Meng J, dismissed the appeal, upholding the DC's decision and emphasizing the ethical obligations of medical practitioners to charge fair and reasonable fees.

1. Case Overview

1.1 Court

High Court

1.2 Outcome

Appeal Dismissed

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Appeal against conviction for professional misconduct involving excessive fees. The court examined ethical obligations of doctors and upheld the conviction.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilRespondentStatutory BoardDecision UpheldWon
LIM MEY LEE SUSANAppellantIndividualAppeal DismissedLost

3. Judges

Judge NameTitleDelivered Judgment
Andrew Phang Boon LeongJustice of the Court of AppealYes
V K RajahJustice of the Court of AppealNo
Tan Lee MengJudgeNo

4. Counsels

Counsel NameOrganization
Ho Pei Shien MelanieWongPartnership LLP
Lim Wei LeeWongPartnership LLP
Alvin YeoWongPartnership LLP
Sim Mei LingWongPartnership LLP
Jolyn Francisca de RozaWongPartnership LLP
Liu Xueyuan AlvisWongPartnership LLP
Lee Eng BengRajah & Tann LLP
Amy SeowRajah & Tann LLP
Paul TanRajah & Tann LLP
Jonathan CheongRajah & Tann LLP
Elizabeth WuRajah & Tann LLP

4. Facts

  1. Appellant, a registered medical practitioner, was charged with 94 counts of professional misconduct.
  2. The charges related to fees invoiced for services provided to a member of the Brunei royal family.
  3. The invoiced fees totaled approximately $24 million for services rendered over 110 treatment days.
  4. The services primarily involved palliative care and coordination of treatment for advanced breast cancer.
  5. The Appellant offered to reduce the fees to about $12.6 million after concerns were raised.
  6. The Ministry of Health of Singapore received a complaint from the Ministry of Health of Brunei regarding the high charges.
  7. The Disciplinary Committee found the Appellant guilty of all 94 charges.

5. Formal Citations

  1. Lim Mey Lee Susan v Singapore Medical Council, Originating Summons No 780 of 2012, [2013] SGHC 122

6. Timeline

DateEvent
Appellant began treating the Patient for cancer of the left breast.
Susan Lim Surgery Pte Ltd issued invoices amounting to $671,827.80 for services rendered to the Patient.
Appellant resumed treatment of the Patient.
Appellant's clinics issued invoices amounting to $2,708,895 for services rendered to the Patient.
Appellant provided medical services to the Patient.
Appellant's clinics issued invoices amounting to $3,790,237.50 for services rendered to the Patient.
Appellant provided medical services to the Patient.
Appellant's clinics issued invoices amounting to $7,501,357.50 for services rendered to the Patient.
Appellant provided medical services to the Patient.
Patient was admitted to Gleneagles Hospital.
End of the 110-day period for which the Appellant's invoices were issued.
Appellant provided medical services to the Patient in Brunei.
Appellant's clinics issued invoices amounting to $26,042,112.50 inclusive of Goods and Services Tax for services rendered to the Patient.
High Commission of Brunei alerted MOHB to the magnitude of the Appellant’s bills.
MOHB’s Director-General of Medical Services met with the Director of Medical Services of the Ministry of Health of Singapore to review the bills issued by the Appellant.
Officials of MOHB met with the chief executive officer of the Parkway Group and informed him that MOHB found the Appellant’s bills excessive.
Appellant informed the Permanent Secretary of MOHB that 43 invoices should be disregarded and offered to reduce the amount set out in the remaining invoices by 25% and to withdraw another two invoices.
The Patient passed away.
Appellant apologised to the Minister of Health of Brunei for what she described as “inadvertent mistakes” made by her office in respect of the invoices.
MOHB responded to the Appellant restating its position that the charges were extremely high.
MOHB wrote to MOHS expressing its view that the Appellant’s charges were unacceptable and extremely high.
Appellant wrote to the Permanent Secretary of MOHB offering to travel to Brunei at her own expense for a meeting to resolve the matter amicably.
Appellant met with the Permanent Secretary of MOHB.
Appellant sent a letter to the Permanent Secretary of MOHB setting out the offer that she had made at the meeting.
MOHS sent a letter of complaint to the chairman of the Respondent’s Complaints Panel.
Appellant provided her written explanation on the Complaint.
Appellant provided her written explanation on the Complaint.
The CC ordered that a formal inquiry be held by a Disciplinary Committee.
Appellant met with the Minister of Health of Brunei.
Respondent issued to the Appellant a notice of inquiry containing 94 charges of professional misconduct.
Hearing before the First DC took place.
Hearing before the First DC took place.
Parties attended before the First DC to present their oral arguments on the Appellant’s “no case to answer” submission.
A fresh Disciplinary Committee was appointed.
Appellant filed Originating Summons No 1252 of 2010 in the High Court.
The High Court dismissed the Appellant’s application in OS 1252.
The Court of Appeal dismissed the appeal.
Pre-inquiry conference.
Pre-inquiry conference.
Appellant confirmed that she had decided to proceed on the basis of the transcripts of the evidence adduced before the First DC.
Appellant’s counsel informed the DC that the Appellant was of the view that the evidence adduced by the Prosecution had not established any of the charges against her.
Parties tendered their written closing submissions and appeared before the DC to present their oral closing submissions.
Parties tendered their written closing submissions and appeared before the DC to present their oral closing submissions.
DC ordered that the Appellant be suspended from practice for a period of three years, pay a financial penalty of $10,000 and be censured in writing.
High Court dismissed the appeal.

7. Legal Issues

  1. Professional Misconduct
    • Outcome: The court found the appellant guilty of professional misconduct due to overcharging and false representation.
    • Category: Substantive
    • Sub-Issues:
      • Overcharging
      • Breach of ethical obligations
      • False representation
  2. Ethical Obligations of Medical Practitioners
    • Outcome: The court held that medical practitioners have an ethical obligation to charge fair and reasonable fees, which supersedes commercial interests.
    • Category: Substantive
    • Sub-Issues:
      • Duty to charge fair and reasonable fees
      • Conflict between ethical and commercial obligations
      • Abuse of trust and confidence

8. Remedies Sought

  1. Appeal against Disciplinary Committee's decision

9. Cause of Actions

  • Professional Misconduct
  • Breach of Ethical Obligations

10. Practice Areas

  • Healthcare Regulation
  • Medical Malpractice
  • Professional Discipline

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Narindar Singh Kang v Law Society of SingaporeCourt of Three JudgesYes[2007] 4 SLR(R) 641SingaporeCited for the solemn declaration made by lawyers upon admission and the duties it signifies.
Law Society of Singapore v Rasif DavidCourt of Three JudgesYes[2008] 2 SLR(R) 955SingaporeCited for the importance of values in the legal profession and the public's confidence in lawyers' ethical standards.
Wong Keng Leong Rayney v Law Society of SingaporeHigh CourtYes[2006] 4 SLR(R) 934SingaporeCited for the embodiment of moral compass and aspirations of the legal profession.
Wong Keng Leong Rayney v Law Society of SingaporeCourt of AppealYes[2007] 4 SLR(R) 377SingaporeCited for the embodiment of moral compass and aspirations of the legal profession.
Associated Provincial Picture Houses, Limited v Wednesbury CorporationEnglish Court of AppealNo[1948] 1 KB 223England and WalesCited for principles related to the unreasonableness of a decision.
Lim Mey Lee Susan v Singapore Medical CouncilHigh CourtNo[2011] 4 SLR 156SingaporeCited regarding the quashing order against the Respondent’s decision to appoint a fresh Disciplinary Committee.
Lim Mey Lee Susan v Singapore Medical CouncilCourt of AppealNo[2012] 1 SLR 701SingaporeCited regarding the quashing order against the Respondent’s decision to appoint a fresh Disciplinary Committee.
Low Cze Hong v Singapore Medical CouncilHigh CourtYes[2008] 3 SLR(R) 612SingaporeCited for the importance of maintaining the highest level of professionalism and ethical conduct in the medical profession.
Law Society of Singapore v Andre Ravindran Saravanapavan ArulHigh CourtYes[2011] 4 SLR 1184SingaporeCited for the obligation of advocates and solicitors to charge fairly for work done and the consequences of gross overcharging.
Re Han Ngiap JuanHigh CourtYes[1993] 1 SLR(R) 135SingaporeCited for the principle that lawyers who grossly overcharge their clients can be found guilty of professional misconduct.
Re Lau Liat MengHigh CourtYes[1992] 2 SLR(R) 186SingaporeCited for the principle that lawyers who grossly overcharge their clients can be found guilty of professional misconduct.
Thomas Bruce Hart v Joseph O’Connor and OthersJudicial Committee of the Privy CouncilNo[1985] AC 1000New ZealandCited in relation to the doctrine of unconscionability in contract law.
Sandar Aung v Parkway Hospitals Singapore Pte Ltd (trading as Mount Elizabeth Hospital) and anotherSingapore Court of AppealNo[2007] 2 SLR(R) 891SingaporeCited in relation to the doctrine of unconscionability in contract law.
Chua Chian Ya v Music & Movements (S) Pte Ltd (formerly trading as M & M Music Publishing)Singapore Court of AppealNo[2010] 1 SLR 607SingaporeCited in relation to the doctrine of unconscionability in contract law.
Wellmix Organics (International) Pte Ltd v Lau Yu ManSingapore High CourtNo[2006] 2 SLR(R) 117SingaporeCited in relation to the doctrine of unconscionability in contract law.
E C Investment Holding Pte Ltd v Ridout Residence Pte Ltd and another (Orion Oil Ltd and another, interveners)Singapore High CourtNo[2011] 2 SLR 232SingaporeCited in relation to the doctrine of unconscionability in contract law.
Law Society of Singapore v Ang Chin Peng and anotherCourt of Three JudgesYes[2013] 1 SLR 946SingaporeCited for the principle that agreements on fees are not final and are subject to review by the court to ensure fairness and reasonableness.
Law Society v Low Yong SenHigh CourtYes[2009] 1 SLR(R) 802SingaporeCited for the objective test of overcharging, considering the nature of the work done and any prior agreement between the parties.
Low Chai Ling v Singapore Medical CouncilHigh CourtYes[2013] 1 SLR 83SingaporeCited for the principle that no professional should overcharge or be allowed to overcharge.
Allinson v General Council of Medical Education and RegistrationQueen's BenchNo[1894] 1 QB 750England and WalesCited for the definition of 'infamous conduct' which was replaced by 'professional misconduct'.
Pillai v Messiter (No 2)Supreme Court of New South WalesYes(1989) 16 NSWLR 197AustraliaCited for the situations where professional misconduct can be made out.
Re Singapore Medical Association – Guidelines on FeesCompetition Commission of SingaporeNo[2010] SGCCS 6SingaporeCited for the viability of arriving at fair and reasonable fees for medical services through improved pricing transparency.
Gan Keng Seng Eric v Singapore Medical CouncilHigh CourtYes[2011] 1 SLR 745SingaporeCited for the role of the High Court in an appeal against an order of a Disciplinary Committee under the MRA.
Gobinathan Devathasan v Singapore Medical CouncilHigh CourtYes[2010] 2 SLR 926SingaporeCited for the role of the High Court in an appeal against an order of a Disciplinary Committee under the MRA.

13. Applicable Rules

Rule Name
Legal Profession (Professional Conduct) Rules (Cap 161, R 1, 2010 Rev Ed)
Legal Profession (Solicitors’ Remuneration) Order 1974 (GN No S 205/1974)

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2004 Rev Ed)Singapore
Medical Registration (Amendment) Act 2010 (Act 1 of 2010)Singapore
Legal Profession Act (Cap 161, 2001 Rev Ed)Singapore
Legal Profession (Admission) Rules 2011 (GN No S 244/2011)Singapore
Legal Profession Act (Cap 161, 2009 Rev Ed)Singapore
Advocates and Solicitors Ordinance 1934 (SS Ord No 32 of 1934)Singapore
Legal Profession Act (Cap 161, 1990 Rev Ed)Singapore

15. Key Terms and Keywords

15.1 Key Terms

  • Professional misconduct
  • Ethical obligations
  • Overcharging
  • Medical fees
  • Disciplinary proceedings
  • Fair and reasonable fee
  • Palliative care
  • Invoices
  • Medical profession
  • Trust and confidence

15.2 Keywords

  • Medical profession
  • Professional misconduct
  • Ethical obligations
  • Overcharging
  • Singapore Medical Council
  • Medical fees
  • Disciplinary proceedings

17. Areas of Law

Area NameRelevance Score
Medical Ethics98
Disciplinary Proceedings95
Disciplinary Proceedings (Medical)92
Professional conduct90
Professional Ethics88
Medical Negligence85
Medical Malpractice80
Healthcare Law70

16. Subjects

  • Medical Ethics
  • Professional Responsibility
  • Healthcare Law
  • Regulation of Medical Profession