Pang Ah San v Singapore Medical Council: Professional Misconduct & Innovative Medical Treatment
Dr. Pang Ah San appealed a decision by the Disciplinary Committee (DC) of the Singapore Medical Council (SMC), which found him guilty of professional misconduct for performing a loop Percutaneous Endoscopic Gastrostomy (loop-PEG) procedure on a patient, Mdm Goh Lee Kheng. The DC held that the treatment was not generally accepted by the profession outside the context of a formal and approved clinical trial, breaching Clause 4.1.4 of the Singapore Medical Council’s Ethical Code and Ethical Guidelines (ECEG). The High Court, comprising Sundaresh Menon CJ, Chao Hick Tin JA, and V K Rajah JA, dismissed the appeal, affirming the DC's decision.
1. Case Overview
1.1 Court
High Court1.2 Outcome
Appeal Dismissed
1.3 Case Type
Regulatory
1.4 Judgment Type
Grounds of Decision
1.5 Jurisdiction
Singapore
1.6 Description
Appeal over professional misconduct for loop-PEG procedure. The court examined innovative treatment, regulatory balance, and ethical obligations.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Pang Ah San | Appellant | Individual | Appeal Dismissed | Lost | Gregory Vijayendran, Lester Chua, Jason Gabriel Chiang |
| Singapore Medical Council | Respondent | Statutory Board | Appeal Dismissed | Won | Melanie Ho, Chang Man Phing, Sim Mei Ling, Chang Qi-Yang |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Sundaresh Menon | Chief Justice | Yes |
| Chao Hick Tin | Justice of the Court of Appeal | Yes |
| V K Rajah | Justice of the Court of Appeal | Yes |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Gregory Vijayendran | Rajah & Tann LLP |
| Lester Chua | Rajah & Tann LLP |
| Jason Gabriel Chiang | Rajah & Tann LLP |
| Melanie Ho | WongPartnership LLP |
| Chang Man Phing | WongPartnership LLP |
| Sim Mei Ling | WongPartnership LLP |
| Chang Qi-Yang | WongPartnership LLP |
4. Facts
- Dr. Pang performed a loop-PEG procedure on Mdm Goh, an 84-year-old stroke patient.
- The loop-PEG procedure was a novel device not generally accepted outside clinical trials.
- Mdm Goh's children filed a complaint after her condition deteriorated and she passed away.
- Dr. Pang did not seek approval from any ethics committee or IRB for a clinical trial.
- The Disciplinary Committee found Dr. Pang guilty of professional misconduct.
- The loop-PEG procedure lacked a bumper-bolster mechanism, increasing leakage risk.
- Dr. Pang had a patent application for the loop-PEG device.
5. Formal Citations
- Pang Ah San v Singapore Medical Council, Originating Summons No 799 of 2012, [2013] SGHC 266
6. Timeline
| Date | Event |
|---|---|
| Appellant performed loop-PEG procedure on the Patient. | |
| Patient was discharged. | |
| Patient passed away. | |
| Patient’s children made a complaint to the Respondent. | |
| High Court affirmed the DC's decision. |
7. Legal Issues
- Professional Misconduct
- Outcome: The court found that the Appellant's actions constituted professional misconduct.
- Category: Substantive
- Sub-Issues:
- Breach of ethical guidelines
- Administration of non-accepted medical treatment
- Innovative Medical Treatment
- Outcome: The court held that the loop-PEG procedure was not generally accepted and required clinical trial approval.
- Category: Substantive
- Sub-Issues:
- Permissibility of innovative treatment without regulatory approval
- Balance between patient safety and medical innovation
8. Remedies Sought
- Appeal against the Disciplinary Committee's decision
9. Cause of Actions
- Professional Misconduct
10. Practice Areas
- Healthcare Law
- Professional Discipline
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Gobinathan Devathasan v Singapore Medical Council | High Court | Yes | [2010] 2 SLR 926 | Singapore | Cited for setting a standard of good medical practice, requiring time-tested methods with well-researched benefits and risks to ensure patient safety. |
| Khoo James v Gunapathy d/o Muniandy and another appeal | Court of Appeal | Yes | [2002] 1 SLR(R) 1024 | Singapore | Cited by the appellant for the test of determining whether a doctor has breached the tortious duty of care owed to his patient, which the court rejected as the test for 'not generally accepted by the profession'. |
| Low Chai Ling v Singapore Medical Council | High Court | Yes | [2013] 1 SLR 83 | Singapore | Cited for the principle that the assessment of whether a particular medical treatment is generally accepted must be scientific rather than empirical. |
| Low Cze Hong v Singapore Medical Council | High Court | Yes | [2008] 3 SLR(R) 612 | Singapore | Cited for the principle that professional misconduct can be made out where there is an intentional, deliberate departure from standards observed or approved by members of the profession. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Medical Registration Act (Cap 174, 2004 Rev Ed) | Singapore |
| Medicines Act (Cap 176, 1985 Rev Ed) | Singapore |
| Health Products Act (Cap 122D, 2008 Rev Ed) | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Loop-PEG
- Percutaneous Endoscopic Gastrostomy
- Singapore Medical Council
- Ethical Code and Ethical Guidelines
- Clinical Trial
- Professional Misconduct
- Medical Innovation
- Institutional Review Board
- Generally Accepted Treatment
- Gastropexy
15.2 Keywords
- Medical Law
- Singapore
- Professional Misconduct
- Innovative Treatment
- Regulatory Law
- Healthcare
16. Subjects
- Medical Law
- Ethics
- Regulatory Compliance
17. Areas of Law
- Medical Ethics
- Regulatory Law
- Administrative Law