A general practitioner who injected unapproved gel fillers into a patient’s breasts, has been suspended for six months. The fillers caused the patient prolonged pain and discomfort, upon which, she was also later inappropriately prescribed with antibiotics.

Dr Calvin Chan Heang Kng, an aesthetic doctor practising at Calvin Chan Aesthetic and Laser Clinic at Wheelock Place in Orchard Road, was initially suspended for a year. However, the disciplinary tribunal halved the sentence as there was a delay of more than three years between being told of the complaint and being served with notice of inquiry.

Honest mistake turned ugly

Between August 2008 and July 2009, Dr Chan injected Aqualift Dermal Filler to augment the unnamed patient’s breasts.

Registration of the gel was rejected twice, in 2007 and 2009, respectively, by the Health Sciences Authority (HSA) – and there were no acceptable published clinical studies, or data on the safety of the procedure or the filler. Usage of the filler was only permitted in clinical trials.

However, Dr Chan’s lawyers argued that he made an honest mistake of assuming the gel filler was generally accepted “when he saw that other doctors were also using (it) at the material time”, according to the grounds of decision.

AquaLift hydrophilic gel is marketed as a dermal and breast filler. Photo credit: Sarados Do Brasil
AquaLift hydrophilic gel is marketed as a dermal and breast filler. Photo credit: Sarados Do Brasil

In April 2010, the patient was lactating and her right breast tissue became infected. Dr Chan then inappropriately prescribed her several classes of antibiotics without first performing a bacterial culture to find out the organism causing her infection.

On top of prescribing antibiotics, he performed four incisions to the woman’s breast to drain the infection, but it still persisted.

The patient filed a complaint in August 2012, where she experienced "loss of romance and intimacy in her relationship with her husband as a result of her condition".

Dr Chan was notified of the complaint against him in December 2012, but was only served the notice of inquiry three years and four months later, in April 2016.

Since August 2016, breast filler procedures like the one performed by Dr Chan have been prohibited and Aqualift Dermal Filler is no longer sold in Singapore.

“Haphazard approach” caused unnecessary pain and health risks

Dr Calvin Chan, who was practising at Calvin Chan Aesthetic and Laser Clinic at Wheelock Place in Orchard Road started his suspension on 4 January 2018. Photo credit: Calvin Chan Aesthetic, Laser Clinic/The Straits Times
Dr Calvin Chan, who was practising at Calvin Chan Aesthetic and Laser Clinic at Wheelock Place in Orchard Road started his suspension on 4 January 2018. Photo credit: Calvin Chan Aesthetic, Laser Clinic/The Straits Times

The Singapore Medical Council's (SMC) disciplinary tribunal said Dr Chan’s "haphazard approach" caused the patient unnecessary pain and exposed her to possible multi-resistance of bacteria.

“Being relatively new to aesthetic medical practice at the time, he should have exercised even more caution,” said Professor Sonny Wang Yee Tang, a respiratory and critical care medicine expert and also chairman of the tribunal.

Dr Chan pleaded guilty on three accounts: for failing to treat the patient according to generally accepted methods; failing to exercise due care and competence in managing the patient’s mastitis; and failing to obtain informed consent.

The SMC withdrew two other charges. One for failing to practise within the limits of his competence, as the procedure was invasive and “should only be performed by a plastic surgeon”. Another was for not referring the patient in a timely manner to a medical specialist when the infection occurred. There was no reason for this move.

Learning from mistakes

The counsel for the SMC, the medical professional watchdog, had asked the disciplinary tribunal to fine Dr Chan SGD10,000 and suspend him for a total of 12 months, while his lawyers had sought a fine of SGD30,000 to SGD40,000 instead of a suspension.

"It is by no means an easy decision to make when determining whether an errant physician should be penalised with a term of suspension,” said Professor Wang.

However, suspension was necessary in this case as Dr Chan’s acts “were simply unacceptable and inconsistent with upholding high standards of the medical profession".

Taking into account Dr Chan’s guilty plea which "helped to save time and cost", the tribunal decided on halving his sentence to six months from 4 January, because of the inordinate delay in proceedings by the Singapore Medical Council.

Dr Chan, now has 16 years’ experience, has since improved his consent-taking and documentation of patients’ medical records. He has also now been focusing on non-invasive, evidence-based procedures. His suspension began on 4 January. MIMS

Read more:
Suspended GP found guilty over false death certificates and sentenced to 9 months
General practitioner suspended, censured for liposuction error
Singapore Medical Council suspends doctor for “professional misconduct”

Sources:
http://www.straitstimes.com/uncategorized/gp-suspended-6-months-for-causing-prolonged-pain-with-unapproved-breast-treatment?login=true
http://www.straitstimes.com/singapore/health/gp-gets-suspension-over-breast-treatment
http://www.todayonline.com/singapore/gp-suspended-6-months-misconduct-breast-enhancement-case