Ang Yong Guan v Singapore Medical Council: Professional Misconduct in Prescribing Medication

Dr. Ang Yong Guan, a psychiatrist, appealed against his conviction by the Disciplinary Tribunal for failing to provide professional services of reasonable quality under s 53(1)(e) of the Medical Registration Act (MRA). The Singapore Medical Council (SMC) cross-appealed against Dr. Ang's acquittal on charges of professional misconduct under s 53(1)(d) of the MRA and against the sentence imposed. The charges related to Dr. Ang's prescriptions to a patient, the late Mr. Quek Kiat Siong, which deviated from Ministry of Health (MOH) guidelines. The Court of 3 Judges of the General Division of the High Court found Dr. Ang guilty of professional misconduct under s 53(1)(d) of the MRA for some charges and dismissed the appeal in part and allowed in part.

1. Case Overview

1.1 Court

Court of 3 Judges of the General Division of the High Court

1.2 Outcome

Appeal dismissed in part and allowed in part. Dr. Ang was found guilty of professional misconduct under section 53(1)(d) of the Medical Registration Act for some charges.

1.3 Case Type

Regulatory

1.4 Judgment Type

Judgment

1.5 Jurisdiction

Singapore

1.6 Description

Psychiatrist Dr. Ang Yong Guan appeals conviction for inappropriate prescriptions. The court examines standards for medical professionals and departures from guidelines.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilRespondent, AppellantStatutory BoardAppeal dismissed in part and allowed in partPartial
Ang Yong GuanAppellant, RespondentIndividualAppeal dismissed in part and allowed in partPartial

3. Judges

Judge NameTitleDelivered Judgment
Sundaresh MenonChief JusticeYes
Tay Yong KwangJustice of the Court of AppealNo
Belinda Ang Saw EanJustice of the Court of AppealNo

4. Counsels

Counsel NameOrganization
Kronenburg Edmund JeromeBraddell Brothers LLP
Colin Wu GuolinBraddell Brothers LLP
Chan Yu JieBraddell Brothers LLP
Nicole Lee Man RuoBraddell Brothers LLP
Christopher Chong Fook ChoyDentons Rodyk & Davidson LLP
Chandra Mohan K NairTan Rajah & Cheah LLP
Sia Tian Wa Jeremy MarcDentons Rodyk & Davidson LLP
Sim Mei Jun AndreyDentons Rodyk & Davidson LLP

4. Facts

  1. Dr. Ang prescribed medications to Mr. Quek, who later died.
  2. The prescriptions deviated from MOH guidelines.
  3. A complaint was lodged against Dr. Ang with the SMC.
  4. The Disciplinary Tribunal acquitted Dr. Ang of some charges but convicted him of others.
  5. Both Dr. Ang and the SMC appealed the DT's decision.
  6. The patient was also taking opioid analgesics prescribed by another doctor for chronic back pain.

5. Formal Citations

  1. Ang Yong Guan v Singapore Medical Council and another matter, , [2024] SGHC 126
  2. Ang Yong Guan, , C3J/OA 8/2023
  3. Singapore Medical Council, , C3J/OA 9/2023

6. Timeline

DateEvent
Patient first consulted Dr. Ang.
Dr. Ang issued final prescription to the Patient.
Patient passed away.
Court of Appeal issued decision in civil proceedings.
Complaint filed against Dr. Ang with the SMC.
Originating Application No 8 of 2023 filed.
Originating Application No 9 of 2023 filed.
Hearing held.
Judgment reserved.

7. Legal Issues

  1. Professional Misconduct
    • Outcome: The court found Dr. Ang guilty of professional misconduct under s 53(1)(d) of the MRA for some charges.
    • Category: Substantive
    • Sub-Issues:
      • Intentional departure from medical standards
      • Failure to provide professional services of reasonable quality
  2. Standard of Care
    • Outcome: The court determined the relevant standard of care for medical practitioners, considering MOH guidelines and product inserts.
    • Category: Substantive
    • Sub-Issues:
      • Deviation from MOH guidelines
      • Appropriateness of prescriptions
      • Risk-benefit analysis
  3. Burden of Proof
    • Outcome: The court clarified that the evidential burden falls on the medical practitioner to demonstrate that deviations from codified standards are justified.
    • Category: Procedural
    • Sub-Issues:
      • Evidential burden to justify departures from standards
      • Objective justifiability of treatment

8. Remedies Sought

  1. Appeal against conviction
  2. Appeal against acquittal
  3. Appeal against sentence

9. Cause of Actions

  • Professional Misconduct
  • Failure to Provide Professional Services

10. Practice Areas

  • Professional Misconduct
  • Medical Malpractice
  • Health Law

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Singapore Medical Council v Dr Ang Yong GuanDisciplinary TribunalYes[2023] SMCDT 2SingaporeRefers to the Disciplinary Tribunal's decision which acquitted Dr. Ang of professional misconduct charges but convicted him of professional services charges.
Low Cze Hong v Singapore Medical CouncilHigh CourtYes[2008] 3 SLR(R) 612SingaporeCited for the two-limb test for professional misconduct: intentional departure from standards or serious negligence.
Quek Kwee Kee Victoria (executrix of the estate of Quek Kiat Siong, deceased) and another v American International Assurance Co Ltd and anotherHigh CourtYes[2016] 3 SLR 93SingaporeCited to provide background on the civil suit commenced by the Patient's sister against the Patient's insurers.
Quek Kwee Kee Victoria (executor of the estate of Quek Kiat Siong, deceased) and another v American International Assurance Co Ltd and anotherCourt of AppealYes[2017] 1 SLR 461SingaporeCited to provide background on the civil suit commenced by the Patient's sister against the Patient's insurers.
In the Matter of Dr Foo Chee Boon EdwardDisciplinary TribunalYes[2018] SMCDT 14SingaporeCited for the principle that doctors may depart from product inserts if it is in the patient's interest, but the burden is on the doctor to justify the departure.
Singapore Medical Council v Lim Lian ArnHigh CourtYes[2019] 5 SLR 739SingaporeCited for the principle that not every departure from acceptable standards of conduct amounts to professional misconduct.
Yong Thiam Look Peter v Singapore Medical CouncilHigh CourtYes[2017] 4 SLR 66SingaporeCited for the operative standard under s 53(1)(e) of the MRA.
In the Matter of Dr Eric Chong Yu and Dr Kong Kok LeongSingapore Medical Council Disciplinary CommitteeYes[2012] SMCDC 10SingaporeCited for the principle that Relevant Guidelines represented codifications of the standards observed or adopted by the medical profession.
Gobinathan Devathasan v Singapore Medical CouncilHigh CourtYes[2010] 2 SLR 926SingaporeCited for the principle that once it has been established that a doctor's treatment is not generally accepted by the profession, the evidential burden shifts to the doctor to justify his departures therefrom.
Huang Danmin v Traditional Chinese Medicine Practitioners BoardHigh CourtYes[2010] 3 SLR 1108SingaporeCited for the principle that once it has been established that a doctor's treatment is not generally accepted by the profession, the evidential burden shifts to the doctor to justify his departures therefrom.
Jen Shek Wei v Singapore Medical CouncilHigh CourtYes[2018] 3 SLR 943SingaporeCited for the principle that an intentional and deliberate departure will be found so long as a doctor knows what the applicable standard of conduct is and chooses nonetheless not to comply with it.
Singapore Medical Council v Looi Kok Poh and another matterHigh CourtYes[2019] 5 SLR 456SingaporeCited for the principle that all that is required to be shown is that the doctor was conscious of that standard and decided to depart from it without due cause.
Ho Tze Woon v Singapore Medical CouncilHigh CourtYes[2023] SGHC 254SingaporeCited for the test for liability under s 53(1)(e) of the MRA.
Ang Pek San Lawrence v Singapore Medical CouncilHigh CourtYes[2015] 1 SLR 436SingaporeCited for the elements of a charge of professional misconduct under s 53(1)(d) of the MRA.
Wee Teong Boo v Singapore Medical Council (Attorney-General, intervener)High CourtYes[2023] 3 SLR 705SingaporeCited for the principle that a disciplinary proceeding is quasi-criminal in nature, it is for the SMC to establish these elements beyond a reasonable doubt.
In the Matter of Dr Tan Yang KhaiSingapore Medical Council Disciplinary CommitteeYes[2012] SMCDC 11SingaporeCited for the principle that departures from MOH guidelines may be permissible in individual cases if they are justified or supported by good reasons.
In the Matter of Dr ABJSingapore Medical Council Disciplinary CommitteeYes[2010] SMCDC 7SingaporeCited for the principle that departures from MOH guidelines may be permissible in individual cases if they are justified or supported by good reasons.
Bolam v Friern Hospital Management CommitteeHigh Court of JusticeYes[1957] 1 WLR 582England and WalesCited for the test for medical negligence.
Bolitho v City and Hackney Health AuthorityHouse of LordsYes[1998] AC 232England and WalesCited for the test for medical negligence.
Khoo James and another v Gunapathy d/o Muniandy and another appealCourt of AppealYes[2002] 1 SLR(R) 1024SingaporeCited for the test for medical negligence.
Singapore Medical Council v Wong Him ChoonHigh CourtYes[2016] 4 SLR 1086SingaporeCited regarding the threshold for appellate intervention.
Hii Chii Kok v Ooi Peng Jin London Lucien and anotherCourt of AppealYes[2017] 2 SLR 492SingaporeCited for the standard of care owed by a doctor to his patient requires that he advise the patient in question of all matters to which the patient was reasonably likely to have attached significance in arriving at his decision as to whether to consent to a particular course of treatment

13. Applicable Rules

Rule Name
Singapore Medical Council Ethical Code and Ethical Guidelines (2002 Edition)

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
  • Medical Registration Act
  • Ministry of Health guidelines
  • Standard of care
  • Disciplinary Tribunal
  • Prescription
  • Benzodiazepines
  • Opioid analgesics
  • Mirtazapine
  • Zolpidem
  • Risk-benefit analysis
  • Informed consent
  • Drug interactions

15.2 Keywords

  • Medical malpractice
  • Professional misconduct
  • Singapore Medical Council
  • Prescription drugs
  • Psychiatrist
  • MOH guidelines
  • Medical negligence

17. Areas of Law

Area NameRelevance Score
Professional conduct75
Prescription Regulations65
Medical Malpractice60
Psychiatry55
Healthcare Law50
Medical Negligence45
Breach of Duty of Care40
Patient Confidentiality30

16. Subjects

  • Medical Law
  • Health Law
  • Regulatory Law
  • Professional Responsibility