Lam Kwok Tai Leslie v. Singapore Medical Council: Appeal Against Suspension for Failure to Obtain Informed Consent

Dr. Lam Kwok Tai Leslie, a cardiologist, appealed to the High Court against his conviction by the Disciplinary Tribunal (DT) of the Singapore Medical Council (SMC) for professional misconduct. The charge stemmed from Dr. Lam's failure to obtain informed consent from a patient before performing a Percutaneous Coronary Intervention (PCI) in 2011. The High Court, comprising Sundaresh Menon CJ, Andrew Phang Boon Leong JA, and Steven Chong JA, allowed Dr. Lam's appeal, setting aside the conviction and associated orders.

1. Case Overview

1.1 Court

High Court

1.2 Outcome

Appeal Allowed

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Dr. Lam appeals against his conviction for professional misconduct due to failure to obtain informed consent for a PCI procedure. The High Court allowed the appeal.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilRespondentStatutory BoardAppeal DismissedLost
Lam Kwok Tai LeslieAppellantIndividualAppeal AllowedWon

3. Judges

Judge NameTitleDelivered Judgment
Sundaresh MenonChief JusticeYes
Andrew Phang Boon LeongJudge of AppealNo
Steven ChongJudge of AppealNo

4. Counsels

Counsel NameOrganization
Sui Yi SiongEversheds Harry Elias LLP
Philip FongEversheds Harry Elias LLP
Lek Siang PhengDentons Rodyk & Davidson LLP
Priscilla Wee Jia LingDentons Rodyk & Davidson LLP
Audrey Sim Mei JunDentons Rodyk & Davidson LLP

4. Facts

  1. Dr. Lam, a cardiologist, performed a PCI on a patient in 2011.
  2. The patient lodged a complaint with the SMC, alleging that Dr. Lam performed the PCI unnecessarily and without informed consent.
  3. The Disciplinary Tribunal convicted Dr. Lam of professional misconduct for failing to obtain informed consent.
  4. Dr. Lam appealed against his conviction, arguing that the DT erred in its assessment of the evidence.
  5. The patient had a history of coronary artery disease and had previously undergone a PCI in 2006.
  6. The patient signed a consent form (KIV Form) that stated he understood the risks and alternatives of the procedure.
  7. Dr. Lam's clinical notes did not document the discussion of risks and alternatives with the patient.

5. Formal Citations

  1. Lam Kwok Tai Leslie v Singapore Medical Council, Originating Summons No 11 of 2016, [2017] SGHC 260

6. Timeline

DateEvent
Patient's first consultation with Dr. Lam
Second consultation with Dr. Lam; CT Angiogram results available
Third consultation with Dr. Lam; Patient signed KIV Form
Conventional Angiogram and PCI performed
Dr. Lam apprised the Patient of what had transpired during the PCI
Patient lodged a complaint against Dr Lam with the SMC
SMC sent Dr Lam a Notice of Complaint
Dr Lam tendered his written Explanatory Statement
SMC informed Dr Lam that the Complaints Committee had ordered a formal inquiry to be held by a DT
SMC sent Dr Lam a Notice of Inquiry setting out three charges
DT conducted the inquiry
DT conducted the inquiry
DT conducted the inquiry
DT conducted the inquiry
DT conducted the inquiry
DT convened a further hearing
DT delivered its written decision
Judgment reserved
Judgment date

7. Legal Issues

  1. Failure to Obtain Informed Consent
    • Outcome: The court found that the Disciplinary Tribunal placed undue emphasis on the lack of contemporaneous notes and did not adequately consider other evidence, thus setting aside the conviction.
    • Category: Substantive
    • Sub-Issues:
      • Adequacy of information provided
      • Patient's understanding of risks and alternatives
      • Documentation of consent process
  2. Standard of Proof in Disciplinary Proceedings
    • Outcome: The court reiterated that the SMC must prove professional misconduct beyond a reasonable doubt and that the Disciplinary Tribunal's findings must be safe, reasonable, and supported by the evidence.
    • Category: Procedural
    • Sub-Issues:
      • Burden of proof on the SMC
      • Assessment of evidence
      • Reasonable doubt

8. Remedies Sought

  1. Appeal against conviction
  2. Appeal against sentence of suspension

9. Cause of Actions

  • Professional Misconduct

10. Practice Areas

  • Medical Malpractice
  • Healthcare Regulation
  • Professional Discipline

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Low Cze Hong v Singapore Medical CouncilUnknownYes[2008] 3 SLR(R) 612SingaporeCited for the test for professional misconduct.
Eu Kong Weng v Singapore Medical CouncilHigh CourtYes[2011] 2 SLR 1089SingaporeCited as a relevant precedent for sentencing in cases involving failure to obtain informed consent.
Singapore Medical Council v Wong Him ChoonUnknownYes[2016] 4 SLR 1086SingaporeCited for the principles governing the High Court's review of a Disciplinary Tribunal's decision.
Ang Pek San Lawrence v Singapore Medical CouncilUnknownYes[2015] 1 SLR 436SingaporeCited for the principles governing the High Court's review of a Disciplinary Tribunal's decision.
Gobinathan Devathasan v Singapore Medical CouncilUnknownYes[2010] 2 SLR 926SingaporeCited for the deference given to a Disciplinary Tribunal's expertise.
Hii Chii Kok v Ooi Peng Jin London Lucien and anotherCourt of AppealYes[2017] 2 SLR 492SingaporeCited for the requirement that a patient identify the exact nature of information not given in a medical negligence action.
Viswanathan Ramachandran v Public ProsecutorUnknownYes[2003] 3 SLR(R) 435SingaporeCited for the principle of natural justice that a person must be given notice of allegations against him.
In re Bramblevale LtdEnglish Court of AppealYes[1970] 1 Ch 128EnglandCited for guidance on the standard of proof beyond reasonable doubt.
Law Society of Singapore v Lau See Jin JeffreyCourt of Three JudgesYes[2017] 4 SLR 148SingaporeCited for the importance of keeping accurate and contemporaneous attendance notes.
Ang Peng Tiam v Singapore Medical Council and another matterHigh CourtYes[2017] SGHC 143SingaporeCited for the principle that inordinate delay in disciplinary proceedings can lead to a reduction in sentence.
Keeping Mark John v Public ProsecutorHigh CourtYes[2017] SGHC 170SingaporeCited for the principle that an increase in the maximum sentence does not automatically mean heavier sentences should be imposed.
Law Society of Singapore v Andre Ravindran Saravanapavan ArulUnknownYes[2011] 4 SLR 1184SingaporeCited for the principle that fines should be imposed for disciplinary offences that are too serious for mere censures but not serious enough for suspension.
Yong Thiam Look Peter v Singapore Medical CouncilHigh CourtYes[2017] SGHC 10SingaporeCited for the principle that harm resulting from a failure to explain necessary information is a seriously aggravating factor.

13. Applicable Rules

Rule Name
Rules of Court (Cap 322, Rule 5) Order 55

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2004 Rev Ed) s 53(1)(d)Singapore
Medical Registration Act (Cap 174, 2004 Rev Ed) s 53(1)(e)Singapore
Medical Registration Act (Cap 174, 2004 Rev Ed) s 55(1)Singapore
Medical Registration Act (Cap 174, 2004 Rev Ed) s 55(11)Singapore
Medical Registration Act s 53(2)(e)Singapore
Medical Registration Act ss 53(2)(f)Singapore
Medical Registration Act ss 53(2)(g)Singapore
Medical Registration (Amendment) Act 2010 (Act 1 of 2010)Singapore
Medical Registration (Amendment) Bill 2009 (Bill 22 of 2009)Singapore
Legal Profession Act (Cap 161, 2001 Rev Ed) s 83(1)Singapore
Penal Code (Amendment) Act 2007 (Act 51 of 2007)Singapore
Penal Code (Cap 224, 1985 Rev Ed)Singapore

15. Key Terms and Keywords

15.1 Key Terms

  • Percutaneous Coronary Intervention (PCI)
  • Informed Consent
  • Professional Misconduct
  • Disciplinary Tribunal (DT)
  • Singapore Medical Council (SMC)
  • Medical Registration Act (MRA)
  • Ethical Code and Ethical Guidelines (ECEG)
  • KIV Form
  • Stenosis
  • Conventional Angiogram

15.2 Keywords

  • Medical Negligence
  • Cardiology
  • Singapore Medical Council
  • Disciplinary Tribunal
  • Professional Misconduct
  • Informed Consent
  • PCI
  • Medical Law

17. Areas of Law

Area NameRelevance Score
Informed consent95
Medical Registration Act90
Disciplinary Proceedings (Medical)80
Professional conduct75
Medical Negligence60
Medical Malpractice60
Patient Confidentiality50
Breach of Duty of Care40
Administrative Law20

16. Subjects

  • Medical Ethics
  • Informed Consent
  • Professional Discipline