Chia Foong Lin v Singapore Medical Council: Appeal Against Disciplinary Tribunal's Decision on Doctor's Misdiagnosis of Kawasaki Disease
Dr. Chia Foong Lin, a pediatrician, appealed to the High Court of Singapore against the decision of a Disciplinary Tribunal (DT) appointed by the Singapore Medical Council (SMC), which found her guilty of professional misconduct under s 53(1)(d) of the Medical Registration Act for failing to diagnose Kawasaki Disease (KD) in a one-year-old patient. The DT imposed a three-month suspension from practice. The High Court, comprising Chao Hick Tin JA, Andrew Phang Boon Leong JA, and Judith Prakash JA, heard the appeal on 27 February 2017 and dismissed it on 27 June 2017, upholding the DT's decision.
1. Case Overview
1.1 Court
High Court of the Republic of Singapore1.2 Outcome
Appeal Dismissed
1.3 Case Type
Regulatory
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
Appeal by Dr. Chia Foong Lin against a Disciplinary Tribunal's decision finding her guilty of professional misconduct for misdiagnosing Kawasaki Disease. Appeal dismissed.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| Chia Foong Lin | Appellant | Individual | Appeal Dismissed | Lost | Edwin Tong SC, Kristy Tan, Leong Yi-Ming |
| Singapore Medical Council | Respondent | Government Agency | Decision Upheld | Won | Philip Fong, Shazana Anuar, Sui Yi Siong |
3. Judges
| Judge Name | Title | Delivered Judgment |
|---|---|---|
| Chao Hick Tin | Judge of Appeal | Yes |
| Andrew Phang Boon Leong | Judge of Appeal | No |
| Judith Prakash | Judge of Appeal | No |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Edwin Tong SC | Allen & Gledhill LLP |
| Kristy Tan | Allen & Gledhill LLP |
| Leong Yi-Ming | Allen & Gledhill LLP |
| Philip Fong | Harry Elias Partnership LLP |
| Shazana Anuar | Harry Elias Partnership LLP |
| Sui Yi Siong | Harry Elias Partnership LLP |
4. Facts
- The Patient, a one-year-old, was admitted to Gleneagles Hospital with a three-day fever.
- Dr. Chia diagnosed the Patient with a viral infection.
- The Patient exhibited symptoms including conjunctivitis, rash, and red lips.
- Dr. Chia did not order supportive tests for Kawasaki Disease.
- The Patient was later diagnosed with Kawasaki Disease by another pediatrician, Dr. Lee.
- The Disciplinary Tribunal found Dr. Chia guilty of professional misconduct.
- Dr. Chia was suspended from medical practice for three months.
5. Formal Citations
- Chia Foong Lin v Singapore Medical Council, Originating Summons No 10 of 2016, [2017] SGHC 139
6. Timeline
| Date | Event |
|---|---|
| Patient admitted to Gleneagles Hospital with high fever. | |
| Patient discharged from Gleneagles Hospital. | |
| Dr. Chia reviewed the Patient at her clinic. | |
| Patient taken to Dr. Lee at Mount Elizabeth Hospital for a second opinion. | |
| Patient admitted into Mount Elizabeth Hospital. | |
| Patient discharged from Mount Elizabeth Hospital. | |
| SMC sent Dr. Chia a Notice of Complaint. | |
| SMC informed Dr. Chia that a formal inquiry would be held by a DT. | |
| SMC sent Dr. Chia a Notice of Inquiry. | |
| Decision of the Disciplinary Tribunal of the Singapore Medical Council made against Dr Chia Foong Lin. | |
| Originating Summons No 10 of 2016 filed. | |
| Oral submissions heard by the court. | |
| Judgment reserved. |
7. Legal Issues
- Breach of Standard of Care
- Outcome: The court found that Dr. Chia breached the standard of care by failing to diagnose Incomplete Kawasaki Disease and order supportive tests.
- Category: Substantive
- Sub-Issues:
- Failure to diagnose Incomplete Kawasaki Disease
- Failure to order supportive tests
- Failure to discuss treatment options with parents
- Related Cases:
- [2008] 3 SLR(R) 612
- Professional Misconduct
- Outcome: The court found that Dr. Chia's conduct amounted to professional misconduct due to gross negligence.
- Category: Substantive
- Sub-Issues:
- Gross negligence
- Indifference to patient welfare
- Related Cases:
- [2008] 3 SLR(R) 612
- Appropriateness of Punishment
- Outcome: The court found that the three-month suspension imposed by the Disciplinary Tribunal was within the acceptable range of sanctions.
- Category: Procedural
8. Remedies Sought
- Appeal against Disciplinary Tribunal's decision
- Reversal of suspension order
9. Cause of Actions
- Professional Negligence
- Breach of Duty of Care
10. Practice Areas
- Healthcare Regulation
- Medical Negligence
- Professional Discipline
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 test of professional misconduct and the standard of gross negligence. |
| Julius Libman v General Medical Council | Privy Council | Yes | [1972] AC 217 | United Kingdom | Cited for the approach to be taken when considering an appeal from a disciplinary tribunal. |
| Tan Sek Ho v Singapore Dental Board | High Court | Yes | [1999] 2 SLR(R) 70 | Singapore | Cited for the approach to be taken when considering an appeal from a disciplinary tribunal. |
| Chia Yang Pong v Singapore Medical Council | High Court | Yes | [2004] 3 SLR(R) 151 | Singapore | Cited for the approach to be taken when considering an appeal from a disciplinary tribunal. |
| Council for the Regulation of Health Care Professionals v General Medical Council and Ruscillo | Court of Appeal (Civil Division) | Yes | [2005] 1 WLR 717 | United Kingdom | Cited for the weight to be given to the expertise of the members of the disciplinary tribunal. |
| Singapore Medical Council v Wong Him Choon | High Court | Yes | [2016] 4 SLR 1086 | Singapore | Cited for the high threshold to cross for gross negligence. |
| Ang Pek San Lawrence v Singapore Medical Council | High Court | No | [2015] 1 SLR 436 | Singapore | Cited regarding the articulation of the applicable standard of care and the need to explain the preference of one expert's views over another's. |
| Gobinathan Devathasan v Singapore Medical Council | High Court | Yes | [2010] 2 SLR 926 | Singapore | Cited for the deference to be given to the findings of the disciplinary tribunal as a specialist tribunal. |
| Singapore Medical Council v Kwan Kah Yee | Court of Three Judges | Yes | [2015] 5 SLR 201 | Singapore | Cited for the determination of whether the punishment imposed by the DT is appropriate. |
| Council for the Regulation of Health Care Professionals v General Medical Council | Court of Appeal | Yes | [2004] 1 WLR 2432 | United Kingdom | Cited for the determination of whether the punishment imposed by the DT is appropriate. |
13. Applicable Rules
| Rule Name |
|---|
| No applicable rules |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Medical Registration Act (Cap 174, 2004 Rev Ed) s 53(1)(d) | Singapore |
| Medical Registration Act s 55(1) | Singapore |
| Medical Registration Act s 55(11) | Singapore |
| Medical Registration Act s 53(2)(b) | Singapore |
| Medical Registration Act s 53(2)(e) | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Kawasaki Disease
- Incomplete Kawasaki Disease
- Professional Misconduct
- Gross Negligence
- Standard of Care
- Disciplinary Tribunal
- Supportive Tests
- Medical Registration Act
15.2 Keywords
- Medical Negligence
- Kawasaki Disease
- Professional Misconduct
- Singapore Medical Council
- Disciplinary Tribunal
- Pediatrician
- Misdiagnosis
16. Subjects
- Medical Law
- Professional Regulation
- Healthcare
- Disciplinary Proceedings
17. Areas of Law
- Medical Law
- Regulatory Law
- Professional Misconduct
- Disciplinary Proceedings