In an unexpected move, more than 1,000 doctors have petitioned the Director of Medical Services to revoke the three-month suspension of a paediatrician at Gleneagles Hospital for failing to diagnose a serious childhood disease in a toddler.

Last month, the Supreme Court upheld the decision by the Singapore Medical Council (SMC) that Dr Chia Foong Lin, a paeditrician on call for that case was to be suspended for three months, the minimum suspension possible for gross negligence in not diagnosing and treating the child correctly.

The petition began on 4 July and was sent on 12 July to Associate Professor Benjamin Ong, Director of Medical Services at the Ministry of Health.

The doctors expressed their "grave reservations" in the petition with the decision to suspend Dr Chia, a paediatrician of 23 years. They said: "We respect the judgment but we strongly feel the punishment was too harsh."

Suspension thought to be too severe


Dr Chia was found guilty by the tribunal of failing to diagnose a one-year-old with Kawasaki Disease (KD), an illness that could cause heart problems.

She appealed to the Court of Three Judges, which upheld the tribunal's decision.

This is the first time so many doctors have come out in support of a colleague. The petitioners said they were concerned by the severity of her punishment and argued a censure or warning would have sufficed to raise awareness and vigilance among doctors. This was because the missed diagnosis was due to human error and not negligence.

"The suspension imposed in this case is likely to prompt health practitioners to lean towards defensive practice, resulting in over-diagnosis of KD, and leading to unnecessary use of intravenous immunoglobulin (a costly blood product)," they wrote.

Incomplete KD is harder to diagnose


KD occurs in 0.0325% of children younger than five years old, which translates to about five cases a month. The doctors noted that there is no test to confirm it and the child in question did not portray all the symptoms, therefore an incomplete KD.

“Diagnosis KD in young children can be challenging as the clinical signs may evolve with time,” said the petition. “Incomplete KD is even more difficult to diagnose conclusively. This is an inevitable and inadvertent limitation of clinical practice.”

However during the court hearing, the SMC argued that KD is the most commonly acquired severe cardiac condition, therefore it is reasonable to expect a paediatrician to diagnose and treat it competently.

Its expert witness, Associate Professor Chao Sing Ming, a senior consultant at KK Women's and Children's Hospital, said Dr Chia's treatment of the child amounted to serious negligence and was wholly unacceptable.

The court upheld the tribunal's decision and said "It is crucial for a paediatrician to maintain a high index of suspicion in relation to KD."

The baby's parents sought a second opinion with another paediatrician in private practice and made the complaint later.

The specialist, Dr Lee Bee Wah, said the patient's parents came to her later, with more symptoms. She is also one of 180 paediatricians to sign the petition. The other 840 include other specialists. MIMS

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Sources:
http://www.straitstimes.com/singapore/1000-docs-petition-to-revoke-paediatricians-suspension
http://www.straitstimes.com/singapore/medical-council-defends-tribunals-judgment