Ang Peng Tiam v Singapore Medical Council: Professional Misconduct in Medical Practice

Dr. Ang Peng Tiam, a medical oncologist, was convicted by a Disciplinary Tribunal for professional misconduct related to representations made to a patient, MT, regarding her cancer treatment. Dr. Ang appealed the conviction, and the Singapore Medical Council appealed the sentence. The High Court dismissed Dr. Ang's appeal against the conviction but allowed the SMC's appeal, increasing the sentence to a suspension of eight months.

1. Case Overview

1.1 Court

High Court

1.2 Outcome

Appeal dismissed in part and allowed in part.

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Dr. Ang Peng Tiam appeals conviction for professional misconduct. The Singapore Medical Council appeals the sentence as inadequate. The court allows the appeal in part.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilRespondent, AppellantStatutory BoardAppeal dismissed in partLost
ANG PENG TIAMAppellant, RespondentIndividualAppeal dismissed in partLost

3. Judges

Judge NameTitleDelivered Judgment
Sundaresh MenonChief JusticeYes
Andrew Phang Boon LeongJustice of the Court of AppealNo
Judith PrakashJudge of the Court of AppealNo

4. Counsels

Counsel NameOrganization
Chang Man Phing JennyWongPartnership LLP
Ho Pei Shien MelanieWongPartnership LLP
Lim Ying MinWongPartnership LLP
Lim Xian Yong, AlvinWongPartnership LLP
Lim Wan Yu CheronneWongPartnership LLP
Mak Wei MunnAllen & Gledhill LLP
Tan Ruyan KristyAllen & Gledhill LLP
Ong Hui Fen RachelAllen & Gledhill LLP
Edwin TongAllen & Gledhill LLP

4. Facts

  1. Dr. Ang told MT she had a 70% chance of responding to treatment based on her race, gender, smoking history, and cancer type.
  2. Dr. Ang did not order an EGFR mutation test for MT.
  3. Surgery was a viable treatment option for MT's stage IIB lung cancer.
  4. Dr. Ang did not offer surgery as a treatment option to MT.
  5. MT's cancer did not respond well to the prescribed treatment, and she passed away six months later.
  6. The SMC brought charges against Dr. Ang for professional misconduct.
  7. There was a delay of four and a half years between the complaint and the Notice of Inquiry.

5. Formal Citations

  1. Ang Peng Tiam v Singapore Medical Council and another matter, , [2017] SGHC 143

6. Timeline

DateEvent
MT first consulted Dr. Ang at Parkway Cancer Centre.
MT attended a consultation with Dr. Ang to review test results.
Dr. Ang informed MT that the biopsy confirmed cancer and recommended chemotherapy and targeted therapy.
MT passed away.
MT’s daughters lodged a complaint to the SMC.
SMC’s Complaints Committee wrote to Dr. Ang notifying him of the Complaint.
Dr. Ang provided his explanation.
Dr. Ang received a letter from the CC notifying him of its decision to refer the matter to a formal inquiry.
SMC constituted a DT in late 2013.
A second DT was eventually constituted.
A Notice of Inquiry specifying the charges of professional misconduct was served on Dr Ang.
Inquiry before the DT took place in two tranches between November 2015 and February 2016.
Inquiry before the DT took place in two tranches between November 2015 and February 2016.
The DT delivered its verdict on conviction and sentence.
Hearing date.
Judgment reserved.

7. Legal Issues

  1. Professional Misconduct
    • Outcome: The court upheld the conviction of Dr. Ang for professional misconduct.
    • Category: Substantive
    • Sub-Issues:
      • False representation to patient
      • Failure to offer viable treatment option
  2. Sentencing
    • Outcome: The court increased the sentence from a fine to a suspension of eight months.
    • Category: Procedural
    • Sub-Issues:
      • Mitigating factors
      • Aggravating factors
      • Delay in proceedings

8. Remedies Sought

  1. Appeal against conviction
  2. Appeal against sentence

9. Cause of Actions

  • Professional Misconduct

10. Practice Areas

  • Disciplinary Proceedings
  • Medical Negligence

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Low Cze Hong v Singapore Medical CouncilSingapore High CourtYes[2008] 3 SLR(R) 612SingaporeCited for the definition of professional misconduct.
Ang Pek San Lawrence v Singapore Medical CouncilSingapore High CourtYes[2015] 1 SLR 436SingaporeCited for the high thresholds that must be crossed before a conviction of professional misconduct can be sustained.
Lim Mey Lee Susan v Singapore Medical CouncilSingapore High CourtYes[2013] 3 SLR 900SingaporeCited to distinguish the present case, where the medical practitioner was found to have falsely represented the fees of third party doctors.
Hii Chii Kok v Ooi Peng Jin London Lucien and anotherSingapore Court of AppealYes[2017] SGCA 38SingaporeCited for the importance of applying the correct time-frame when assessing liability.
Quek Kwee Kee Victoria (executor of the estate of Quek Kiat Siong, deceased) and another v American International Assurance Co Ltd and anotherSingapore Court of AppealYes[2017] 1 SLR 461SingaporeCited for the limits of statistical evidence.
Gregg v ScottHouse of LordsYes[2005] 2 AC 176United KingdomCited for the limits of statistical evidence.
Rosenberg v PercivalHigh Court of AustraliaYes[2001] HCA 18AustraliaCited for the importance of ensuring that the courts, in evaluating whether the doctor has met the requisite standard of care in any aspect of his interaction with the patient, should apply the relevant tests with reference only to the facts that were known at the time that the material event occurred.
Maloney v Commissioner for RailwaysHigh Court of AustraliaYes(1978) 18 ALR 147AustraliaCited for the importance of ensuring that the courts, in evaluating whether the doctor has met the requisite standard of care in any aspect of his interaction with the patient, should apply the relevant tests with reference only to the facts that were known at the time that the material event occurred.
Yong Thiam Look Peter v Singapore Medical CouncilSingapore High CourtYes[2017] SGHC 10SingaporeCited for the principle that it will generally be a matter for the patient to decide on the treatment she will receive.
Singapore Medical Council v Kwan Kah YeeSingapore High CourtYes[2015] 5 SLR 201SingaporeCited for the function of sanctions in medical disciplinary proceedings.
Re Knight Glenn JeyasingamSingapore High CourtYes[1994] 3 SLR(R) 366SingaporeCited for the principle that a senior officer of the Singapore Legal Service who was holding a “position of not inconsiderable significance within the legal profession and one which frequently placed him in the public eye” undermined public confidence in the integrity of the legal profession as a whole by reason of that prominence and seniority when he was convicted on a corruption charge and was subsequently found guilty of conduct implying a defect of character under s 83(2)(a) of the Legal Profession Act (Cap 161, 1990 Rev Ed).
Knight Glenn Jeyasingam v Public ProsecutorSingapore High CourtYes[1992] 1 SLR(R) 523SingaporeCited for the principle that an offender’s seniority and/or eminence and distinguished record of public service has sometimes been regarded as a mitigating factor in criminal sentencing.
Ryan v The QueenHigh Court of AustraliaYes[2001] HCA 21AustraliaCited for the principle that good character may, in some circumstances, suggest that an offender’s actions in committing the offence were out of character and thus likely to be a one-off aberration, with a low likelihood that he would re-offend.
Tan Kiang Kwang v Public ProsecutorSingapore High CourtYes[1995] 3 SLR(R) 746SingaporeCited for the principle that although delay in prosecution might not, in itself, be a mitigating factor, the court could exercise its discretion to discount the sentence if the following cumulative conditions were met.
Chan Kum Hong Randy v Public ProsecutorSingapore High CourtYes[2008] 2 SLR(R) 1019SingaporeCited for the principle that while there is no general proposition that any or all delays in prosecution would merit a discount in sentencing, the court may discount the sentence if the delay was inordinate, and the offender was in no way responsible for the delay.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2004 Rev Ed)Singapore
Medical Registration Act (Cap 174, 2004 Rev Ed) s 53(1)(d)Singapore

15. Key Terms and Keywords

15.1 Key Terms

  • Professional misconduct
  • False representation
  • Viable treatment option
  • EGFR mutation
  • Chemotherapy
  • Targeted therapy
  • Sentence
  • Suspension
  • Medical Registration Act
  • Disease control rate
  • Disease response rate
  • NCCN Guidelines

15.2 Keywords

  • Medical
  • Singapore Medical Council
  • Professional Misconduct
  • Oncology
  • Cancer
  • Disciplinary Tribunal

17. Areas of Law

Area NameRelevance Score
Medical Registration Act90
Disciplinary Proceedings80
Disciplinary Proceedings (Medical)80
Professional conduct75
Medical Negligence60
Health Care50
Medical Malpractice50
Medical Ethics40

16. Subjects

  • Medical Disciplinary Proceedings
  • Professional Ethics
  • Oncology