Singapore Medical Council v Dr Lim Lian Arn: Professional Misconduct & Informed Consent

The Singapore Medical Council appealed against the Disciplinary Tribunal's decision to fine Dr. Lim Lian Arn $100,000 for professional misconduct, specifically failing to obtain informed consent from a patient before administering a steroid injection. The High Court of Singapore, comprising Sundaresh Menon CJ, Andrew Phang Boon Leong JA, and Judith Prakash JA, allowed the appeal, setting aside Dr. Lim's conviction. The court found that the undisputed facts did not support the charge and that there had been a miscarriage of justice.

1. Case Overview

1.1 Court

High Court of the Republic of Singapore

1.2 Outcome

Conviction set aside

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Appeal regarding Dr. Lim's conviction for professional misconduct due to failure to obtain informed consent. The High Court set aside the conviction, finding a miscarriage of justice.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilAppellantStatutory BoardAppeal DismissedLostChia Voon Jiet, Koh Choon Min, Charlene Wong
Dr Lim Lian ArnRespondentIndividualConviction Set AsideWonEric Tin Keng Seng, Cheryl Tsai

3. Judges

Judge NameTitleDelivered Judgment
Sundaresh MenonChief JusticeYes
Andrew Phang Boon LeongJudge of AppealNo
Judith PrakashJudge of AppealNo

4. Counsels

Counsel NameOrganization
Chia Voon JietDrew & Napier LLC
Eric Tin Keng SengDonaldson & Burkinshaw LLP
Koh Choon MinDrew & Napier LLC
Charlene WongDrew & Napier LLC
Cheryl TsaiDonaldson & Burkinshaw LLP

4. Facts

  1. Dr. Lim administered a steroid injection to a patient's wrist.
  2. Dr. Lim did not advise the patient of all possible complications of the injection.
  3. The patient experienced swelling, pain, and skin discoloration after the injection.
  4. The patient filed a complaint against Dr. Lim.
  5. Dr. Lim pleaded guilty to professional misconduct for failing to obtain informed consent.
  6. The Disciplinary Tribunal fined Dr. Lim $100,000.
  7. The Singapore Medical Council appealed the sentence, seeking a lower fine.

5. Formal Citations

  1. Singapore Medical Council v Lim Lian Arn, Originating Summons No 3 of 2019, [2019] SGHC 172
  2. Singapore Medical Council v Dr Lim Lian Arn, , [2018] SMCDT 9

6. Timeline

DateEvent
Patient consulted Dr. Lim about wrist pain.
Patient underwent Magnetic Resonance Imaging scan.
Dr. Lim informed the patient of the scan results and offered treatment options.
Dr. Lim administered H&L Injection to patient's left wrist.
Patient filed a complaint against Dr. Lim.
Amended notice of inquiry issued.
Disciplinary Tribunal's grounds of decision issued (Singapore Medical Council v Dr Lim Lian Arn [2018] SMCDT 9).
Ministry of Health requested the SMC to review the sentence.
Hearing held.
Judgment reserved.

7. Legal Issues

  1. Professional Misconduct
    • Outcome: The court held that the facts did not support a finding of professional misconduct.
    • Category: Substantive
    • Sub-Issues:
      • Serious negligence
      • Abuse of privileges of medical registration
    • Related Cases:
      • [2008] 3 SLR(R) 612
      • [2015] 1 SLR 436
  2. Informed Consent
    • Outcome: The court found that the doctor's failure to disclose certain risks did not meet the threshold for professional misconduct.
    • Category: Substantive
    • Sub-Issues:
      • Duty to disclose risks
      • Materiality of information
    • Related Cases:
      • [2017] 2 SLR 492

8. Remedies Sought

  1. Review of Disciplinary Tribunal's decision
  2. Reduction of fine

9. Cause of Actions

  • Professional Misconduct

10. Practice Areas

  • Healthcare Regulation
  • Medical Malpractice
  • Professional Discipline

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Singapore Medical Council v Dr Lim Lian ArnDisciplinary TribunalYes[2018] SMCDT 9SingaporeThe judgment under appeal; details the Disciplinary Tribunal's decision to fine Dr. Lim.
Low Cze Hong v Singapore Medical CouncilHigh CourtYes[2008] 3 SLR(R) 612SingaporeDefines professional misconduct and sets out the two limbs for establishing it.
Ang Pek San Lawrence v Singapore Medical CouncilHigh CourtYes[2015] 1 SLR 436SingaporeExplains the findings a Disciplinary Tribunal must make to prove a charge of professional misconduct.
Singapore Medical Council v Wong Him ChoonHigh CourtYes[2016] 4 SLR 1086SingaporeStates that professional misconduct extends to grave breaches of ethical obligations.
Lim Mey Lee Susan v Singapore Medical CouncilHigh CourtYes[2013] 3 SLR 900SingaporeStates that professional misconduct extends to grave breaches of ethical obligations.
Martin v Director of ProceedingsHigh CourtYes[2010] NZAR 333New ZealandDiscusses the two-stage approach to determining professional misconduct in New Zealand.
B v Medical CouncilHigh CourtYes[2005] 3 NZLR 810New ZealandDiscusses the two-stage approach to determining professional misconduct in New Zealand.
McKenzie v Medical Practitioners Disciplinary TribunalHigh CourtYes[2004] NZAR 47New ZealandDiscusses the two-stage approach to determining professional misconduct in New Zealand.
F v Medical Practitioners Disciplinary TribunalCourt of AppealYes[2005] 3 NZLR 774New ZealandDiscusses the two-stage approach to determining professional misconduct in New Zealand.
Wong Meng Hang v Singapore Medical Council and other mattersHigh CourtYes[2019] 3 SLR 526SingaporeCited by the SMC as material to the sentencing analysis.
Pillai v Messiter (No 2)New South Wales Court of AppealYes(1989) 16 NSWLR 197AustraliaDefines 'misconduct in a professional respect' and distinguishes it from mere negligence.
Jen Shek Wei v Singapore Medical CouncilHigh CourtYes[2018] 3 SLR 943SingaporeIllustrates a case where the disciplinary threshold was crossed due to indifference to patient welfare.
Chia Foong Lin v Singapore Medical CouncilHigh CourtYes[2017] 5 SLR 334SingaporeReiterates the high threshold for misconduct and illustrates a case where it was crossed due to gross negligence.
Pacific Recreation Pte Ltd v S Y Technology Inc and another appealCourt of AppealYes[2008] 2 SLR(R) 491SingaporeStates that an expert cannot merely present his conclusion without also presenting the underlying evidence and the analytical process by which the conclusion is reached
The H156High CourtYes[1999] 2 SLR(R) 419SingaporeStates that an expert cannot merely present his conclusion without also presenting the underlying evidence and the analytical process by which the conclusion is reached
A v A Professional Conduct CommitteeHigh CourtYes[2018] NZHC 1623New ZealandStates that a specialist tribunal may bring its specialist knowledge and expertise to bear in assessing the evidence before it, it cannot supplement evidential gaps using its own knowledge
Hii Chii Kok v Ooi Peng Jin London Lucien and anotherCourt of AppealYes[2017] 2 SLR 492SingaporeSets out the principles for determining the scope of a doctor's duty to obtain informed consent.
Lam Kwok Tai Leslie v Singapore Medical CouncilHigh CourtYes[2017] 5 SLR 1168SingaporeStates that the existence of supporting clinic notes, while obviously desirable, is not determinative of the issue.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2014 Rev Ed)Singapore

15. Key Terms and Keywords

15.1 Key Terms

  • Professional misconduct
  • Informed consent
  • Steroid injection
  • Disciplinary Tribunal
  • Medical Registration Act
  • Negligence
  • H&L Injection
  • Medical practitioner
  • Ethical Code and Ethical Guidelines
  • Material information

15.2 Keywords

  • medical
  • misconduct
  • informed consent
  • singapore
  • regulation

16. Subjects

  • Medical Law
  • Regulatory Law
  • Professional Discipline

17. Areas of Law

  • Medical Law
  • Regulatory Law
  • Professional Misconduct
  • Informed Consent