Ang Pek San Lawrence v Singapore Medical Council: Professional Misconduct & Standard of Care in VBAC Delivery
Dr. Ang Pek San Lawrence appealed to the High Court against the Singapore Medical Council's Disciplinary Committee's decision, which found him guilty of professional misconduct for failing to ensure a neonatologist was present or on standby during a patient's VBAC delivery on 23 September 2009. The High Court, comprising Sundaresh Menon CJ, Andrew Phang Boon Leong JA, and Judith Prakash J, allowed the appeal, setting aside the conviction and associated orders. The court found the conviction unsafe, unreasonable, and contrary to the evidence, citing failures in determining the requisite standard of conduct, explaining preferences for medical opinions, considering facts beyond the charge's scope, and factual errors.
1. Case Overview
1.1 Court
High Court1.2 Outcome
Appeal Allowed
1.3 Case Type
Regulatory
1.4 Judgment Type
Written Judgment
1.5 Jurisdiction
Singapore
1.6 Description
Appeal against conviction for professional misconduct. The High Court allowed the appeal, finding the conviction unsafe and unreasonable due to failures in determining the standard of conduct.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Ang Pek San Lawrence | Appellant | Individual | Appeal Allowed | Won | Lek Siang Pheng, Mar Seow Hwei, Lim Yew Kuan Calvin, Aw Jansen |
| Singapore Medical Council | Respondent | Statutory Board | Orders set aside | Lost | Ho Pei Shien Melanie, Chang Man Phing Jenny, Ng Shu Ping |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Sundaresh Menon | Chief Justice | Yes |
| Andrew Phang Boon Leong | Justice of the Court of Appeal | No |
| Judith Prakash | Judge | No |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Lek Siang Pheng | Rodyk & Davidson LLP |
| Mar Seow Hwei | Rodyk & Davidson LLP |
| Lim Yew Kuan Calvin | Rodyk & Davidson LLP |
| Aw Jansen | Rodyk & Davidson LLP |
| Ho Pei Shien Melanie | WongPartnership LLP |
| Chang Man Phing Jenny | WongPartnership LLP |
| Ng Shu Ping | WongPartnership LLP |
4. Facts
- The appellant, Dr. Ang Pek San Lawrence, is a registered obstetrician and gynaecologist.
- A patient (the complainant) filed a complaint regarding the appellant's management of her labour and delivery on 23 September 2009.
- The complainant had a previous emergency Caesarean section in her first pregnancy managed by the appellant.
- The complainant requested a vaginal birth after Caesarean (VBAC) for her second delivery.
- Amniotomy revealed moderate meconium-stained liquor.
- The CTG trace showed an increase in the baseline foetal heart rate.
- The baby developed congenital E. coli septicaemia and congenital pneumonia after birth, unrelated to the appellant's actions.
5. Formal Citations
- Ang Pek San Lawrence v Singapore Medical Council, Originating Summons No 1219 of 2013, [2014] SGHC 241
6. Timeline
| Date | Event |
|---|---|
| Appellant managed complainant’s first pregnancy, resulting in an emergency Caesarean section. | |
| Complainant admitted to Thomson Medical Centre at 2.38pm in labour for her second child. | |
| Amniotomy performed at 3.40pm, revealing moderate meconium-stained liquor. | |
| Appellant left Thomson Medical Centre at around 4.00pm. | |
| Ward nurse contacted appellant at 6.30pm, updating him on complainant’s condition. | |
| Appellant returned to Thomson Medical Centre at about 8.15pm. | |
| Appellant attended to the complainant at about 8.30pm. | |
| Appellant delivered another patient's baby at about 8.43pm. | |
| Appellant commenced delivery of complainant’s baby at about 8.50pm. | |
| Complainant’s baby was delivered at 9.03pm with the assistance of forceps. | |
| Disciplinary Committee issued its written decision. | |
| Dr Ang Pek San Lawrence filed an affidavit. | |
| Judgment reserved. |
7. Legal Issues
- Professional Misconduct
- Outcome: The High Court found that the Disciplinary Committee failed to properly determine the standard of conduct required and whether the appellant's actions constituted a departure from that standard amounting to professional misconduct.
- Category: Substantive
- Sub-Issues:
- Failure to meet standard of care
- Negligence
- Breach of duty of care
- Standard of Care
- Outcome: The High Court held that the Disciplinary Committee failed to identify the requisite standard of care against which the appellant's conduct was assessed.
- Category: Substantive
- Sub-Issues:
- Appropriate medical management
- Duty to arrange for neonatologist
- Assessment of foetal distress
- Expert Evidence
- Outcome: The High Court found that the Disciplinary Committee failed to explain its reasons for preferring certain medical opinions over others in the face of conflicting medical opinions on key issues.
- Category: Procedural
- Sub-Issues:
- Conflicting medical opinions
- Preference of one view over another
- Interpretation of CTG trace
8. Remedies Sought
- Setting aside conviction
- Setting aside or reducing suspension period
- Setting aside costs order
9. Cause of Actions
- Professional Misconduct
10. Practice Areas
- Disciplinary Proceedings
- Medical Negligence
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Low Cze Hong v Singapore Medical Council | High Court | Yes | [2008] 3 SLR(R) 612 | Singapore | Cited for the criteria for assessing professional misconduct by a medical practitioner, specifically intentional departure from standards and serious negligence. |
| Gobinathan Devathasan v Singapore Medical Council | High Court | Yes | [2010] 2 SLR 926 | Singapore | Cited regarding the deference the High Court should give to the Disciplinary Committee's views as a specialist tribunal. |
| Lee Kim Kwong v Singapore Medical Council | High Court | Yes | [2014] 4 SLR 113 | Singapore | Cited for the importance of distinguishing between the two limbs of professional misconduct delineated in Low Cze Hong. |
| Smith v Southampton University Hospital NHS Trust | England and Wales Court of Appeal (Civil Division) | Yes | [2007] EWCA Civ 387 | England and Wales | Cited for the principle that when there is a conflict in medical opinion, the preference of one body of opinion over another should not only be stated, but also explained. |
| Ho Paul v Singapore Medical Council | High Court | Yes | [2008] 2 SLR(R) 780 | Singapore | Cited for the principle that the framing of a charge and the precise wording used are crucial in assessing the case that must be met by the medical practitioner facing the charge. |
| Lim Teng Ee Joyce v Singapore Medical Council | High Court | Yes | [2005] 3 SLR(R) 709 | Singapore | Cited for the principle that if, in the course of an inquiry, there emerges certain conduct on the part of the medical practitioner which is not mentioned in the charge but which the Disciplinary Committee tasked with the carriage of the inquiry disapproves of, that conduct would generally not be a ground for imposing any punishment on the medical practitioner. |
| Gan Keng Seng Eric v Singapore Medical Council | High Court | Yes | [2011] 1 SLR 745 | Singapore | Cited for the principle that the real question is whether the medical practitioner was prejudiced or misled by the deficiency in the charge and/or by the attempt to rely on material not mentioned in the charge. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Medical Registration Act | Singapore |
| Medical Registration Act (Cap 174, 2004 Rev Ed) s 45 | Singapore |
| Medical Registration Act (Cap 174, 2004 Rev Ed) s 45(1)(d) | Singapore |
| Medical Registration Act s 46(8) | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Professional misconduct
- VBAC
- Meconium-stained liquor
- CTG trace
- Foetal distress
- Neonatologist
- Standard of care
- Disciplinary Committee
- Tachycardia
- Hypoxia
15.2 Keywords
- Medical
- Singapore Medical Council
- Professional Misconduct
- VBAC
- Neonatologist
- Standard of Care
- Appeal
16. Subjects
- Medical Disciplinary Proceedings
- Medical Negligence
- Obstetrics
- Standard of Care
17. Areas of Law
- Medical Law
- Regulatory Law
- Professional Misconduct
- Obstetrics and Gynaecology