An incident that has been simmering in the background for some time has finally gained prime time in the local newspapers.
Four years ago, local surgeon Susan Lim treated a woman linked to the Bruneian royal household for a period of 7 months and issued a bill of $24.8 million. The Bruneians sought a discount (it does not appear that they had pressed charges from the local press reports) and our MOH lodged a complaint with the Singapore Medical Council. Things have deteriorated to the point where the surgeon has dragged SMC to court, and it appears that she has assembled quite a powerful team of lawyers to press her suit.
Whatever the result, the local medical profession will not come out smelling like roses. On the one hand, there is no escaping the perception that the SMC (especially its disciplinary committee) will appear incompetent. Even the judge had suggested as much. It's very well to slap warnings and penalties on small-time GP's overprescribing sedatives; it's another matter to take on someone with the resources and capability to hit back hard. On the other hand, although we understand that the Bruneian royal family is fabulously rich, and that Dr Susan Lim is not the sole recipient of the 24.8 million dollars (some of it will go towards paying off expenses, as well as other specialists who were undoubtedly called in to assist), it is hard not to believe that she was greedy. Charging as much as the market will bear is an accepted practice in business, but there are limits beyond which virtually all views of such transactions become negative, particularly in healthcare.
And the question that inevitably arises - does she really need that much money? Dr Susan Lim was the first person in Singapore to successfully perform a liver transplant, she is featured on the Monash University website as one of its prominent alumni, and has a wax replica of her hands in Madam Tussaud's. She also has more awards than most and has doubtlessly inspired whole generations of doctors and surgeons. One is left pondering the question: why did it go so wrong?
20 comments:
I don't think it's possible to say whether or not she was greedy unless we know the breakdown of the bill.
To me what this media circus has shown us is the problem we have in our disciplinary process, where the line between MOH and SMC is unclear and where the MOH-SMC can be seen to be complainant, judge and jury all at the same time.
Furthermore, I tend to agree with the defence counsel that this being a matter of contractual agreement, unless there was an issue with fraud, misrepresentation or malpractice, SMC should not have acted on the complaint.
2nd para - was it 7 months or 7 years?
from http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_638329.html:
The patient, the younger sister of Brunei's Queen and a cousin of the Sultan, had breast cancer and died in August 2007. Dr Lim treated the woman from 2001 until she died.
Blame it on the 2nd digit before the decimal place. But it’s still a private contract. Doctor is paid to be at beck and call of wealthy and not un-influential patient. There is a quid pro quo - $ for service. If the price is a rip-off, the courts can equitably and should deal with it. Why should MOH involve itself? There seems to be more behind the scenes manoeuvring than meets the eye.
MOH should explain why it believes this case might singularly “tarnish the reputation of Singapore.” How about bankers given free rein to sell fraudulent financial products to unsuspecting ignorant oldies during the last boom? Both over-pricing but one is over-pricing for medical care to try and save a life, the other to cheat a life (actually, many lives).
From the press reports, Brunei official called on MOH “to ask for a discount”. MOH responds with a cudgel and a search warrant. When a foreign diplomat rams and kills innocent pedestrians, we are told to let justice in the foreign land run its course. Is our public policy un-levelling the playing field between Spore and international “best practices”?
Back to the big digit “2”. Didn’t the good doc sell her practice some years back? Privatisation of hospitals has its consequences, likewise privatisation of private practices. Topline, bottomline, and the dreaded KPIs. Case of pot calling the kettle black?
Can angry doc explain how on earth can charging a bill of $25mil, in all decency, for whatever treatment be "not greedy"? This is at best hypocrisy and at worst, a blatant rip off. Criticism has to come with certain level of wisdom
Greed aside, does MOH/SMC have the legal right to go after someone for his/her charges? Especially if there was no complaint from the other party?
"Can angry doc explain how on earth can charging a bill of $25mil, in all decency, for whatever treatment be "not greedy"?"
Can you, without knowing what exactly were the services rendered, the equipment required, the expendable items consumed, the drugs prescribed and dispensed, the facilities set up and maintained, the number of other specialists involved in the care of this patient and their services utilised, explain how the bill constituted a "rip off"?
Or is the size of the price tag your only basis for your accusations?
aliendoc,
I looked through the SMC Code of Ethics - there is nothing that says they have a right to come after us for the pricing of our services.
In fact, SMA had to withdraw their guideline of fees to make sure we are "competitive", remember? :)
"Both over-pricing but one is over-pricing for medical care to try and save a life, the other to cheat a life (actually, many lives)."
People will procliam loudly how precious life is... until presented with their bill.
http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_638327.html
Tough fight when the rules can be changed half-way by one party...........
Especially so when you are fighting a case against those who can amend the rules unilaterally.
You ask the question. Why did it go so wrong?
The Straits Times article states that the Bruneians had no problem paying the bills till March 2007. But after that they had "issues".
Interestingly if you go digging up the history books you will find that in April 2007, the SMA withdrew its Guidelines on Fees (GOF) because it contravened the "Competition Act".
Coincidence? Up to March 2007 no problems. April 2007 GOF is withdrawn and perhaps the bills jumped exponentially?
So where did it all go so wrong? When someone decided that the GOF should not be there and doctors should be allowed to be "competitive".
That's where it all went wrong.
http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_638327.html
http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_638329.html
There. Finally some figures.
As a layperson, I think there needs to be what lawyers would call "due process" whenever there is a disciplinary hearing of any sort. Justice must not just be done, it must be seen to be done. Perhaps its time for medical students/doctors to take undertake some law training to better prepare themselves for such cases.
Aliendoc, the MOH does have loci standi of some sorts, it possibly being protecting patients interests from predatory billing.
-bonafidelawyer
The ST article was certainly an entertaining read, filled with salacious details about how a VVVIP patient made huge demands on her surgeon, even dragging her out of a hospital bed, post-surgery for retinal detachment.
And I found Dr. Lim's remark about the marked up bills being a 'mistake' made by her office staff very amusing indeed.
It may still be too early to pass judgment on her actions, however reprehensible they seem based on the ST report.
If I were forced to jeopardize my own recovery to pacify a patient's unreasonable demands, I might be tempted to mark up my bills too.
Prima facie, it appears to involve gross overcharging - but as long as the doctor has communicated to the patient the potential charges (gross as it may seem) and patient has accepted it and (not complaining!) - we have a willing buyer and willing seller, who else is to judge what is reasonable/unreasonable? There are some private doctors who charge X times higher than their counterparts and they are not shy to let the patient know. It's then up to the patient to decide who they choose as their doctor and the level of care. Isn't this the reason given by the government to have low subsidy of medical services so that patients have almost full autonomy with regards to their medical care based on their preferences and affordability (with some disclosure of fees by MOH for patients to compare prices)?
Yes, I don't quite get the concept of "overcharging" when it comes to professional fees.
Misrepresenting a charge, or levying a 20X mark-up for playing the middle-man (Middle-woman? Middle-surgeon) is... not so classy, is it?
What constitutes overcharging?
When I go to a Chinese restaurant, I may be charged $1 dollar for a bowl of white rice.
Is that overcharging when the price of a KG of rice to the restaurant may not be that far off?
How about paying $1 for a cup of coffee at a local coffeeshop when the cost to the operator may be only 10ct or 20ct?
Some people will argue on the operating costs, manpower costs etc. which the operators have to pay.
All these reasons are certainly valid and certainly apply to any business operators, clinic owners included.
I still believe in the reasons behind willing buyer and willing seller. If both parties agree to the fees, why should an external third party step in?
The most obvious case of overcharging in Singapore should be the COE!
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