Wong Meng Hang v Singapore Medical Council: Medical Misconduct, Negligence, and Professional Standards
In Wong Meng Hang v Singapore Medical Council, the Court of Three Judges heard appeals concerning Dr. Wong Meng Hang and Dr. Zhu Xiu Chun, who were found guilty of professional misconduct under the Medical Registration Act for negligence that led to a patient's death during a liposuction procedure at Reves Clinic. Dr. Wong, who performed the procedure, was initially sentenced to 18 months' suspension, while Dr. Zhu, the assisting doctor, received a six-month suspension. The Singapore Medical Council appealed both sentences, and Dr. Wong cross-appealed his sentence. The court dismissed Dr. Wong's appeal, allowed the Singapore Medical Council's appeals, ordered Dr. Wong to be struck off the register, and increased Dr. Zhu's suspension to 18 months.
1. Case Overview
1.1 Court
Court of Three Judges of the Republic of Singapore1.2 Outcome
Appeal of Dr. Wong dismissed; Singapore Medical Council's appeals against Dr. Wong and Dr. Zhu allowed. Dr. Wong ordered to be struck off the register of approved medical practitioners; Dr. Zhu's suspension increased to 18 months.
1.3 Case Type
Regulatory
1.4 Judgment Type
Judgment
1.5 Jurisdiction
Singapore
1.6 Description
Two doctors were found guilty of professional misconduct for negligence leading to a patient's death during a liposuction. The court addressed sentencing principles.
1.7 Decision Date
2. Parties and Outcomes
| Party Name | Role | Type | Outcome | Outcome Type | Counsels |
|---|---|---|---|---|---|
| WONG MENG HANG | Appellant, Respondent | Individual | Appeal Dismissed, Order to be struck off the register of approved medical practitioners | Lost, Lost | Christopher Chong Fook Choy, Melvin See Hsien Huei |
| SINGAPORE MEDICAL COUNCIL | Respondent, Appellant | Statutory Board | Appeals Allowed | Won | Philip Fong Yeng Fatt, Sui Yi Siong, Kevin Koh |
| ZHU XIU CHUN @ MYINT MYINT KYI | Respondent | Individual | Suspension Increased | Lost | S Selvaraj, Leong Hoy Fok Edward |
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 | Justice of the Court of Appeal | No |
4. Counsels
| Counsel Name | Organization |
|---|---|
| Christopher Chong Fook Choy | Dentons Rodyk & Davidson LLP |
| Melvin See Hsien Huei | Dentons Rodyk & Davidson LLP |
| S Selvaraj | MyintSoe & Selvaraj |
| Leong Hoy Fok Edward | MyintSoe & Selvaraj |
| Philip Fong Yeng Fatt | Eversheds Harry Elias LLP |
| Sui Yi Siong | Eversheds Harry Elias LLP |
| Kevin Koh | Eversheds Harry Elias LLP |
4. Facts
- Dr. Wong and Dr. Zhu administered Propofol to a patient for a liposuction procedure without proper training.
- The doctors used a complex technique of continuous intravenous infusion by titration, which they were not qualified to perform.
- The patient was given an excessive dosage of Propofol, leading to a state of deep sedation and general anaesthesia.
- Dr. Wong inadvertently caused multiple puncture wounds to the patient’s intestines during the liposuction.
- The patient was left unattended for at least five minutes after the procedure, leading to airway obstruction and cardiac arrest.
- Dr. Wong falsely told A&E doctors that the patient had not been sedated with Propofol.
- The patient died due to the effects of asphyxia secondary to intravenous Propofol.
5. Formal Citations
- Wong Meng Hang v Singapore Medical Council, Originating Summons No 1 of 2018, [2018] SGHC 253
- Wong Meng Hang v Singapore Medical Council, Originating Summons No 2 of 2018, [2018] SGHC 253
- Wong Meng Hang v Singapore Medical Council, Originating Summons No 3 of 2018, [2018] SGHC 253
6. Timeline
| Date | Event |
|---|---|
| Dr. Wong scheduled to perform a liposuction procedure on a patient. | |
| Dr. Wong called Dr. Zhu to assist in the liposuction procedure. | |
| Dr. Wong administered Propofol to the patient. | |
| Dr. Zhu left the procedure room with Dr. Wong’s consent. | |
| Patient was discovered to have collapsed and an ambulance was called. | |
| Patient arrived at the hospital without a pulse. | |
| Patient passed away. | |
| Coroner recorded the patient’s death as a medical misadventure. | |
| Coroner's findings were referred to the Singapore Medical Council. | |
| Notices of Complaint were sent to Dr. Wong and Dr. Zhu. | |
| Dr. Wong and Dr. Zhu were notified of the Complaints Committee’s decision to convene a Disciplinary Tribunal. | |
| Dr. Wong and Dr. Zhu were served formal Notices of Inquiry. | |
| Dr. Zhu’s inquiry took place before the Disciplinary Tribunal. | |
| Dr. Wong’s inquiry took place before the Disciplinary Tribunal. | |
| The Disciplinary Tribunal rendered its decisions in respect of both doctors. | |
| Court of Three Judges heard the appeals. | |
| Judgment was delivered. |
7. Legal Issues
- Professional Misconduct
- Outcome: The doctors were found guilty of professional misconduct due to serious negligence.
- Category: Substantive
- Sub-Issues:
- Serious Negligence
- Failure to Ensure Adequate Monitoring
- Abuse of Privileges
- Practicing outside the scope of competency
- Sentencing Principles in Disciplinary Cases
- Outcome: The court outlined a systematic approach to sentencing, emphasizing harm, culpability, and public interest.
- Category: Procedural
- Sub-Issues:
- General Deterrence
- Specific Deterrence
- Public Interest
- Mitigating Circumstances
- Harm-Culpability Matrix
- Dishonesty in Professional Conduct
- Outcome: The court emphasized that misconduct involving dishonesty should almost invariably warrant striking off.
- Category: Substantive
- Sub-Issues:
- False Statements
- Cover-Up Attempts
- Violation of Trust
8. Remedies Sought
- Suspension from Practice
- Striking Off from Register
9. Cause of Actions
- Professional Misconduct
- Negligence
10. Practice Areas
- Medical Malpractice
- Professional Regulation
- Healthcare Law
11. Industries
- Healthcare
12. Cited Cases
| Case Name | Court | Affirmed | Citation | Jurisdiction | Significance |
|---|---|---|---|---|---|
| Low Cze Hong v Singapore Medical Council | Singapore High Court | Yes | [2008] 3 SLR(R) 612 | Singapore | Established the two limbs of professional misconduct: intentional departure from standards and serious negligence. |
| Ang Peng Tiam v Singapore Medical Council and another matter | Singapore High Court | Yes | [2017] 5 SLR 356 | Singapore | Discussed the weight of mitigating circumstances in disciplinary proceedings and the impact of delays. |
| Singapore Medical Council v Kwan Kah Yee | Singapore High Court | Yes | [2015] 5 SLR 201 | Singapore | Emphasized the importance of general deterrence in disciplinary cases. |
| Tan Kay Beng v Public Prosecutor | Singapore High Court | Yes | [2006] 4 SLR(R) 10 | Singapore | Discussed the principle of general deterrence. |
| Lee Kim Kwong v Singapore Medical Council | Singapore High Court | Yes | [2014] 4 SLR 113 | Singapore | Distinguished between intentional and negligent misconduct and their sentencing implications. |
| Neo Ah Luan v Public Prosecutor | Singapore High Court | Yes | [2018] SGHC 188 | Singapore | Addressed the consideration of potential harm in sentencing. |
| Logachev Vladislav v Public Prosecutor | Singapore High Court | Yes | [2018] 4 SLR 609 | Singapore | Discussed the harm-culpability matrix in sentencing. |
| Public Prosecutor v Koh Thiam Huat | Singapore High Court | Yes | [2017] 4 SLR 1099 | Singapore | Discussed the harm-culpability matrix in sentencing. |
| Singapore Medical Council v Wong Him Choon | Singapore High Court | Yes | [2016] 4 SLR 1086 | Singapore | Signaled the intention to recalibrate sentencing benchmarks for medical misconduct cases. |
| In the Matter of Dr Amaldass Narayana Dass | Disciplinary Committee | Yes | [2014] SMCDC 2 | Singapore | Discussed a case of inadequate explanation of risks and negligent post-surgical care. |
| In the Matter of Dr Fong Wai Yin | Disciplinary Tribunal | Yes | [2016] SMCDT 7 | Singapore | Discussed a case of failure to provide timely referral to an ophthalmologist. |
| In the Matter of Dr AAN | Disciplinary Committee | Yes | [2009] SMCDC 2 | Singapore | Case where a doctor was struck off for inappropriately prescribing hypnotic medication. |
| In the Matter of Dr Ho Thong Chew | Disciplinary Tribunal | Yes | [2014] SMCDT 12 | Singapore | Case where a doctor was struck off for illegally selling cough syrup containing codeine. |
| In the Matter of Dr Ong Theng Kiat | Disciplinary Tribunal | Yes | [2015] SMCDT 2 | Singapore | Case where a doctor was struck off for sexual penetration of a minor. |
| In the Matter of Dr Lee Siew Boon Winston | Disciplinary Tribunal | Yes | [2018] SMCDT 4 | Singapore | Case where a doctor was struck off for using criminal force on a patient and making a false declaration to the SMC. |
| Bawa-Garba v General Medical Council | England and Wales Court of Appeal (Civil Division) | Yes | [2018] EWCA Civ 1879 | England and Wales | Discussed the factors tribunals should consider when imposing disciplinary sanctions on doctors. |
| Re Dr Parajuli | New South Wales Medical Tribunal | Yes | [2010] NSWMT 3 | New South Wales | Discussed the sentencing objectives in disciplinary cases. |
| College of Physicians and Surgeons of Ontario v Peirovy | Ontario Court of Appeal | Yes | [2018] ONCA 420 | Canada | Discussed the sentencing objectives in disciplinary cases. |
| R (on the application of Balasubramaniam) v General Medical Council | High Court of England and Wales (Administrative Court) | Yes | [2008] EWHC 639 (Admin) | England and Wales | Case involving an anaesthetist's failure to monitor a patient, leading to serious consequences. |
| Medical Board of Australia v Duck | Western Australia State Administrative Tribunal | Yes | [2017] WASAT 28 | Australia | Discussed the threshold standard for cancellation of a doctor's registration. |
| Medical Board of Australia v Alkazali (Review and Regulation) | Victorian Civil and Administrative Tribunal | Yes | [2017] VCAT 286 | Australia | Cited Duck on the issue of cancellation of registration. |
| Hill v College of Physicians and Surgeons of Ontario | Ontario Superior Court of Justice | Yes | [2018] ONSC 5833 | Canada | Case involving a physician who falsified patient charts. |
| Law Society of Singapore v Wong Sin Yee | Singapore High Court | Yes | [2018] SGHC 196 | Singapore | Discussed the striking off of solicitors. |
| Law Society of Singapore v Ismail bin Atan | Singapore High Court | Yes | [2017] 5 SLR 746 | Singapore | Discussed the striking off of solicitors. |
| Law Society of Singapore v Chia Choon Yang | Singapore High Court | Yes | [2018] SGHC 174 | Singapore | Discussed misconduct involving dishonesty and the striking off of solicitors. |
| Law Society of Singapore v Ravi s/o Madasamy | Singapore High Court | Yes | [2016] 5 SLR 1141 | Singapore | Discussed the importance of honesty and integrity in the legal profession. |
| Law Society of Singapore v Ong Cheong Wei | Singapore High Court | Yes | [2018] 3 SLR 937 | Singapore | Case where a solicitor was struck off for wilful tax evasion. |
| Lim Mey Lee Susan v Singapore Medical Council | Singapore High Court | Yes | [2013] 3 SLR 900 | Singapore | Discussed the historical cornerstone of the medical profession. |
| Law Society of Singapore v Rasif David | Singapore High Court | Yes | [2008] 2 SLR(R) 955 | Singapore | Discussed the importance of honour, integrity, and honesty in the legal profession. |
| Jen Shek Wei v Singapore Medical Council | Singapore High Court | Yes | [2018] 3 SLR 943 | Singapore | Discussed the relevance of delay in disciplinary proceedings. |
| Gupta v The Professional Conduct Committee of the General Medical Council | United Kingdom House of Lords | Yes | [2002] 1 WLR 1691 | United Kingdom | Case where a doctor was erased from the register for allowing her husband to hold consultations at her surgery premises. |
| Bolton v Law Society | England and Wales Court of Appeal (Civil Division) | Yes | [1994] 1 WLR 512 | England and Wales | Laid down the dishonesty rule for lawyers in England. |
| Gan Keng Seng Eric v Singapore Medical Council | Singapore High Court | Yes | [2011] 1 SLR 745 | Singapore | Case involving negligent mismanagement of post-operative treatment. |
| Chia Foong Lin v Singapore Medical Council | Singapore High Court | Yes | [2017] 5 SLR 334 | Singapore | Case involving a doctor who negligently failed to make prompt referrals or run diagnostic tests. |
| R v Adomako | United Kingdom House of Lords | Yes | [1994] 3 WLR 288 | United Kingdom | Case involving an anaesthetist's failure to monitor a patient, leading to the patient's death. |
| Medical Board of Australia v Myers | Western Australia State Administrative Tribunal | Yes | [2014] WASAT 137 | Australia | Standard of proof in disciplinary proceedings. |
| Dr Q v College of Physicians and Surgeons of British Columbia | Supreme Court of Canada | Yes | [2003] 1 SCR 226 | Canada | Standard of proof in disciplinary proceedings. |
| Re Bernstein and College of Physicians and Surgeons of Ontario | Ontario High Court of Justice | Yes | (1977) 15 OR (2d) 447 | Canada | Standard of proof in disciplinary proceedings. |
13. Applicable Rules
| Rule Name |
|---|
| Rules of Court (Cap 322, Rule 5, 2014 Rev Ed) Order 55 |
14. Applicable Statutes
| Statute Name | Jurisdiction |
|---|---|
| Medical Registration Act (Cap 174, 2014 Rev Ed) s 53(1)(d) | Singapore |
| Medical Registration Act (Cap 174, 2014 Rev Ed) s 53(2) | Singapore |
| Medical Registration Act s 62(a) | Singapore |
| Penal Code (Cap 224, 2008 Rev Ed) s 376A(1)(a) | Singapore |
| Penal Code s 354(1) | Singapore |
| Penal Code s 304A | Singapore |
15. Key Terms and Keywords
15.1 Key Terms
- Propofol
- Liposuction
- Sedation
- General Anaesthesia
- Professional Misconduct
- Negligence
- Disciplinary Tribunal
- Medical Registration Act
- Harm-Culpability Matrix
- Striking Off
- Suspension
- Medical Malpractice
15.2 Keywords
- Medical Misconduct
- Negligence
- Professional Standards
- Disciplinary Proceedings
- Sentencing
- Propofol
- Liposuction
- Singapore Medical Council
16. Subjects
- Medical Law
- Professional Regulation
- Disciplinary Proceedings
- Sentencing
- Medical Negligence
17. Areas of Law
- Medical Law
- Regulatory Law
- Professional Misconduct
- Disciplinary Proceedings
- Sentencing Principles