The Singapore Medical Council (SMC) has issued a three-month suspension of a doctor on the basis of “serious negligence”. The doctor was found to have inadequately treated a private shuttle bus driver who had an eye ailment.

Speaking at a press conference on 28 July, SMC said Dr Sanjay Srinivasan diagnosed the patient with a mild cataract and posterior vitreous detachment in his right eye on 16 October 2013. He then allowed him to continue his usual routine including driving a bus and issued the driver one day of medical leave for the consultation.

Sanjay, a senior resident physician at the Department of Ophthalmology and Visual Sciences at Khoo Teck Puat Hospital, told the patient to return for a follow-up visit in six weeks or to return earlier if the patient developed new symptoms.

On top of that, the 45-year old clinician gave the bus driver the option of making spectacles. He said the follow-up visit would address any issues if the patient’s vision failed to improve with the spectacles.

Doctor convicted of two charges – inadequate evaluation and care

Between 17 to 21 October 2016, a Disciplinary Tribunal (DT) inquiry was held for Sanjay. The inquiry was held again this year on 17 February in response to the complaint made by the bus driver on 28 Jan 2014. The doctor contested two charges but was convicted.

The first charge was related to his failure to provide adequate clinical evaluation when he assumed the patient would meet the visual standards based on a pinhole test. The DT found that the clinician’s diagnosis did not take all of the driver’s signs and symptoms into consideration and he should have explored other diagnoses and evaluated further.

Besides that, upon realising that the patient required a Mandarin interpreter to comprehend the diagnosis and management plan, Sanjay ought to have re-taken the patient’s history.

SMC stated, “The DT noted that it was for the doctor to properly integrate, assimilate and assess the information obtained from the patient and through a thorough examination before arriving at a diagnosis and Dr Sanjay clearly fell below the standards expected of him.”

The other charge he was convicted of was that he failed to provide “competent and appropriate care” for the patient when he allowed him to drive. Instead he should have placed him on medical leave from the time of the initial consultation until six weeks later when he was scheduled for a follow-up visit.

Sanjay was well aware of the nature of his patient’s job and the medical guidelines in place on the need for a visual acuity of at least 6/12 in each eye for bus drivers’ fitness to drive. The patient’s right eye had a visual acuity of only 6/24.

The doctor also expected the patient to obtain a pair of prescription glasses just half a day after the consultation as opposed to mandating that he make one before driving, found the DT. Additionally, he did not evaluate if the patient could meet the required standards with the glasses and failed to provide instructions regarding making spectacles.

Disciplinary Tribunal says Sanjay’s sentencing should send a message

This was Sanjay’s first offence and he was “remorseful”, stated the DT. However, the tribunal said it was important to convey a message that proper and careful clinical evaluation of a patient is important for adequate standard of care and should be taken seriously.

The DT also said the clinician put lives at risk – namely the patient, passengers and other road users – when he allowed the patient to resume driving.

“The DT was of the unanimous view that this was simply unacceptable and given the public safety implications, the professional misconduct was sufficiently serious to warrant a suspension,” said SMC. MIMS

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