Singapore Medical Council v Kwan Kah Yee: Appeal Against Sentence for Wrongful Death Certification

The Singapore Medical Council appealed to the Court of Three Judges against the sentence imposed by the Disciplinary Tribunal on Dr. Kwan Kah Yee for two charges of wrongfully certifying the cause of death of two patients. The Court of Three Judges, comprising Sundaresh Menon CJ, Chao Hick Tin JA, and Andrew Phang Boon Leong JA, allowed the appeal, finding the original sentence manifestly inadequate. The court increased the suspension period for each charge to 18 months, to be served consecutively, resulting in a total suspension of three years.

1. Case Overview

1.1 Court

High Court of the Republic of Singapore

1.2 Outcome

Appeal Allowed

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

The Singapore Medical Council appealed against the lenient sentence imposed on Dr. Kwan Kah Yee for wrongfully certifying causes of death. The appeal was allowed.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilApplicantStatutory BoardAppeal AllowedWon
Kwan Kah YeeRespondentIndividualSentence IncreasedLost

3. Judges

Judge NameTitleDelivered Judgment
Sundaresh MenonChief JusticeYes
Chao Hick TinJudge of AppealNo
Andrew Phang Boon LeongJudge of AppealNo

4. Counsels

Counsel NameOrganization
Philip Fong Yeng FattHarry Elias Partnership LLP
Shazana bte Mohd AnuarHarry Elias Partnership LLP

4. Facts

  1. Dr. Kwan Kah Yee certified the cause of death for Patient A as bronchiectasis and chronic obstructive airway disease.
  2. There was no evidence of Patient A having had chronic obstructive airway disease or bronchiectasis.
  3. Dr. Kwan claimed to have relied on a chest X-ray from SATA, but no such X-ray existed, and SATA was closed on the date of the alleged X-ray.
  4. Dr. Kwan certified Patient B's cause of death as ischaemic heart disease (IHD).
  5. Patient B's sister complained that Dr. Kwan certified the cause of death without a proper basis.
  6. Dr. Kwan claimed Patient B had been treated for IHD for many years, based on medical records from polyclinics and KK Hospital.
  7. Investigations revealed that Patient B had no records of IHD treatment at Choa Chu Kang Polyclinic or KK Hospital.
  8. Dr. Kwan initially claimed that Patient B was his patient because her husband was his patient.

5. Formal Citations

  1. Singapore Medical Council v Kwan Kah Yee, Originating Summons No 1 of 2015, [2015] SGHC 227

6. Timeline

DateEvent
Acts committed leading to a prior charge against the Respondent.
Patient A passed away.
Ministry of Health wrote to the Applicant regarding the Respondent's certification of Patient A's death.
Patient B passed away.
Disciplinary Committee held its inquiry into the Prior Charge.
Disciplinary Committee held its inquiry into the Prior Charge.
Disciplinary Committee held its inquiry into the Prior Charge.
Disciplinary Committee held its inquiry into the Prior Charge.
Respondent was sentenced in respect of the Prior Charge.
Proceedings relating to the First Charge commenced.
Respondent admitted wrongdoing and pleaded for leniency regarding Patient A's death certification.
Deadline for Respondent to explain his certification of Patient A’s death.
Applicant served the Respondent with a notice of complaint regarding Patient B's death.
Respondent replied to the notice of complaint regarding Patient B's death.
Respondent confirmed that he did not have any medical reports of Patient B.
Decision of the FPP of the Medical Practitioners Tribunal Service in the case of Dr Amit Pramanik.
Choa Chu Kang Polyclinic confirmed that it did not have any medical records of Patient B.
KK Hospital confirmed that Patient B never consulted or sought treatment from them for IHD.
Changi General Hospital said that its records did not show that Patient B had IHD.
Health Sciences Authority reported on the wrongful certification of Patient A and Patient B's deaths.
Respondent was charged with the wrongful certification of Patient A and Patient B’s death.
Respondent pleaded guilty to the Charges.
Court delivered its judgment, allowing the appeal.

7. Legal Issues

  1. Wrongful Certification of Death
    • Outcome: The court found that the Respondent had wrongfully certified the deaths of two patients and increased the suspension period.
    • Category: Substantive
    • Sub-Issues:
      • False certification
      • Dishonesty
      • Falsification of documents
  2. Manifestly Inadequate Sentence
    • Outcome: The court held that the original sentence imposed by the Disciplinary Tribunal was manifestly inadequate and increased the suspension period.
    • Category: Procedural
    • Sub-Issues:
      • Sentencing principles
      • Mitigating factors
      • Aggravating factors

8. Remedies Sought

  1. Increased Suspension Period
  2. Full Costs and Expenses

9. Cause of Actions

  • Professional Misconduct
  • Breach of Ethical Duties

10. Practice Areas

  • Professional Misconduct
  • Disciplinary Proceedings
  • Medical Malpractice

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Lee Kim Kwong v Singapore Medical CouncilSingapore Court of AppealYes[2014] 4 SLR 113SingaporeCited for the principle that fidelity to precedent ought not to lead to ossification of the law and that sentencing precedents may not be helpful guides due to materially different prevailing circumstances.
Council for the Regulation of Health Care Professionals v General Medical Council and anotherN/AYes[2004] 1 WLR 2432EnglandCited to highlight the difference between criminal and disciplinary jurisdictions, where criminal sentencing is concerned with punishment and disciplinary sanction with protection of the public.
Jasinarachchi v General Medical CouncilEngland and Wales High Court (Administrative Court)Yes[2014] EWHC 3570 (Admin)England and WalesCited as an English case where a trainee doctor was suspended for falsely declaring that he had seen the patient’s body and conducted an external examination on her.
Martin Sandler v General Medical CouncilEngland and Wales High Court (Administrative Court)Yes[2010] EWHC 1029 (Admin)England and WalesCited as an English case where a doctor received an interim suspension for wilfully signing false certificates on at least 116 occasions.
Cheatle v General Medical CouncilEngland and Wales High Court (Administrative Court)Yes[2009] EWHC 645 (Admin)England and WalesCited for the principle that sanctions in medical disciplinary proceedings serve two functions: to ensure that the offender does not repeat the offence and to uphold the standing of the medical profession.
Bolton v Law SocietyN/AYes[1994] 1 WLR 512England and WalesCited in Cheatle v General Medical Council for the principle that sanctions in medical disciplinary proceedings serve two functions: to ensure that the offender does not repeat the offence and to uphold the standing of the medical profession.
Dr Samuel Nwogbo v General Medical CouncilEngland and Wales High Court (Administrative Court)Yes[2012] EWHC 2666 (Admin)England and WalesCited for the principle that public interest considerations extend further than just the danger which the doctor may pose to his patients.
Council for the Regulation of Health Care Professionals v General Medical Council and RuscilloN/AYes[2005] 1 WLR 717England and WalesCited for the aim to ensure that the public is protected from the potentially severe outcomes arising from the actions of errant doctors.
Tan Kay Beng v Public ProsecutorSingapore High CourtYes[2006] 4 SLR(R) 10SingaporeCited for the considerations of general and specific deterrence in sentencing.
Law Society of Singapore v Tham Yu Xian RickSingapore High CourtYes[1999] 3 SLR(R) 68SingaporeCited for the principle that mitigating circumstances which weigh in favour of an offender in criminal proceedings are viewed in a qualitatively different light where disciplinary proceedings are concerned.
Law Society of Singapore v Kurubalan s/o Manickam RengarajuSingapore High CourtYes[2013] 4 SLR 91SingaporeCited Law Society of Singapore v Tham Yu Xian Rick for the principle that mitigating circumstances which weigh in favour of an offender in criminal proceedings are viewed in a qualitatively different light where disciplinary proceedings are concerned.
Law Society of Singapore v Manjit Singh s/o Kirpal Singh and anotherSingapore High CourtYes[2015] 3 SLR 829SingaporeCited for the approach to dishonest lawyers who are invariably struck off the rolls regardless of the mitigating circumstances.
Wong Kai Chuen Philip v Public ProsecutorSingapore High CourtYes[1990] 2 SLR(R) 361SingaporeCited for the principle that the court will account for a plea of guilt in mitigation as evidence of remorse, its relevance and weight will depend on the facts.
Public Prosecutor v Tan Teck HinSingapore High CourtYes[1992] 1 SLR(R) 672SingaporeCited for the principle that subordinate legislation, unless saved by the repealing enactment, lapses on the repeal of the provisions under which it was made.
Low Cze Hong v Singapore Medical CouncilSingapore Court of AppealYes[2008] 3 SLR(R) 612SingaporeCited for the importance of maintaining the highest level of professionalism and ethical conduct in the medical profession.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2014 Rev Ed)Singapore
Medical Registration Act (Cap 174, 2004 Rev Ed)Singapore
Coroners Act (Cap 63A, 2012 Rev Ed)Singapore
Medical Act 1983 (c 54) (UK)United Kingdom

15. Key Terms and Keywords

15.1 Key Terms

  • Wrongful Death Certification
  • Disciplinary Tribunal
  • Medical Registration Act
  • Singapore Medical Council
  • Ischaemic Heart Disease
  • Bronchiectasis
  • Chronic Obstructive Airway Disease
  • Dishonesty
  • Falsification of Documents
  • Medical Certificate
  • Prior Charge

15.2 Keywords

  • medical
  • wrongful death certification
  • disciplinary
  • Singapore
  • council
  • sentence
  • appeal

17. Areas of Law

Area NameRelevance Score
Disciplinary Proceedings95
Medical Law90
Administrative Law70
Legal Ethics50
Medical Ethics40
Criminal Law30

16. Subjects

  • Medical Law
  • Professional Regulation
  • Administrative Law