Low Cze Hong v Singapore Medical Council: Professional Misconduct in Ophthalmology

Dr. Low Cze Hong appealed to the High Court of Singapore against the Singapore Medical Council's decision finding him guilty of professional misconduct. The charges stemmed from a complaint by Toh Seng, a patient, regarding a surgical procedure performed on his blind right eye. The High Court, comprising Chan Sek Keong CJ, Andrew Phang Boon Leong JA, and V K Rajah JA, dismissed the appeal, upholding the SMC's decision that Dr. Low administered inappropriate treatment and failed to obtain informed consent. The court provided its grounds for the decision, emphasizing the scope of 'professional misconduct' and the role of the court in appeals from disciplinary tribunals.

1. Case Overview

1.1 Court

High Court of Singapore

1.2 Outcome

Appeal Dismissed

1.3 Case Type

Regulatory

1.4 Judgment Type

Grounds of Decision

1.5 Jurisdiction

Singapore

1.6 Description

Appeal of Dr. Low Cze Hong's conviction for professional misconduct for inappropriate glaucoma treatment and lack of informed consent. Appeal dismissed.

1.7 Decision Date

2. Parties and Outcomes

Party NameRoleTypeOutcomeOutcome TypeCounsels
Singapore Medical CouncilRespondentStatutory BoardDecision UpheldWon
Low Cze HongAppellantIndividualAppeal DismissedLost

3. Judges

Judge NameTitleDelivered Judgment
Chan Sek KeongChief JusticeNo
Andrew Phang Boon LeongJustice of the Court of AppealNo
V K RajahJustice of the Court of AppealYes

4. Counsels

Counsel NameOrganization
Agnes ChanHarry Elias Partnership
Chang Man PhingHarry Elias Partnership
Melanie HoHarry Elias Partnership
Christopher ChongRodyk & Davidson LLP
Vanessa LimRodyk & Davidson LLP

4. Facts

  1. Dr. Low performed trabeculectomy with Molteno tube implant on Toh Seng's blind right eye.
  2. Toh Seng had been treated for glaucoma by Dr. Tseng for ten years prior to consulting Dr. Low.
  3. Dr. Low diagnosed Toh Seng with neovascular glaucoma during the first consultation.
  4. Dr. Low did not consult with Dr. Tseng before performing the surgery.
  5. Toh Seng suffered an extrusion of the Molteno tube after the surgery.
  6. Dr. Low charged Toh Seng $9,292.66 for the procedure on both eyes, with $3,800.00 for the right eye.
  7. The Disciplinary Committee found Dr. Low guilty of professional misconduct on two charges.

5. Formal Citations

  1. Low Cze Hong v Singapore Medical Council, OS 203/2008, [2008] SGHC 78

6. Timeline

DateEvent
Toh Seng treated for glaucoma by Dr. Peter Tseng
Toh Seng treated for glaucoma by Dr. Peter Tseng
Toh Seng treated for glaucoma by Dr. Peter Tseng
Toh Seng consulted Dr. Low Cze Hong
Dr. Low performed cataract surgery and trabeculectomy on Toh Seng
Toh Seng suffered an extrusion of the Molteno tube
Toh Seng underwent surgery to remove the Molteno tube
Toh Seng filed a complaint against Dr. Low with the SMC
Dr. Low filed his reply to the Complaints Committee
SMC sent a letter to Toh Seng and Dr. Low for clarification
Toh Seng responded to SMC's letter
Dr. Low responded to SMC's letter
Complaints Committee notified Dr. Low that some aspects of the complaint would be referred to a disciplinary committee
Dr. Low received a notice of inquiry from the SMC
Inquiry held by the disciplinary committee
Inquiry held by the disciplinary committee
Inquiry held by the disciplinary committee
Disciplinary committee came to conclusions on the first charge
High Court dismissed the appeal

7. Legal Issues

  1. Professional Misconduct
    • Outcome: The court upheld the SMC's finding that Dr. Low was guilty of professional misconduct.
    • Category: Substantive
    • Sub-Issues:
      • Inappropriate treatment
      • Failure to obtain informed consent
  2. Informed Consent
    • Outcome: The court agreed with the DC that there was no balanced discussion of risk versus benefit in this case to allow the patient to make an informed consent.
    • Category: Substantive
    • Sub-Issues:
      • Failure to inform patient of treatment options
      • Failure to explain risks and side effects
  3. Appropriateness of Treatment
    • Outcome: The court found that Dr. Low's treatment was inappropriate given the patient's condition and history.
    • Category: Substantive
    • Sub-Issues:
      • Failure to consider alternative treatments
      • Failure to consult patient's primary doctor

8. Remedies Sought

  1. Appeal against the decision of the Singapore Medical Council

9. Cause of Actions

  • Professional Misconduct

10. Practice Areas

  • Disciplinary Proceedings
  • Medical Negligence

11. Industries

  • Healthcare

12. Cited Cases

Case NameCourtAffirmedCitationJurisdictionSignificance
Dudley Ernest Lyncoln Wager Felix v General Dental CouncilN/AYes[1960] AC 704United KingdomCited to define 'infamous conduct' as involving moral turpitude, fraud, or dishonesty, a definition the court rejects as the standard for 'professional misconduct' in this case.
Allinson v General Council of Medical Education and RegistrationN/AYes[1894] 1 QB 750United KingdomCited for its definition of 'infamous conduct in a professional respect' which does not require moral turpitude, fraud, or dishonesty.
Tan Sek Ho v Singapore Dental BoardN/AYes[1999] 4 SLR 757SingaporeCited to explain the restrictive definition of 'infamous conduct' in Felix due to the harsh penalty of removal from the medical register.
John Roylance v General Medical Council (No 2)N/AYes[2000] 1 AC 311United KingdomCited for its thorough exposition of the term 'serious professional misconduct,' requiring more than mere negligence but not necessarily moral turpitude.
In re A SolicitorN/AYes[1972] 1 WLR 869United KingdomCited to support the proposition that negligence can amount to professional misconduct if it is inexcusable and deplorable.
McKenzie v Medical Practitioners Disciplinary TribunalHigh Court of New ZealandYes[2004] NZAR 47New ZealandCited for endorsing the objective test for professional misconduct: whether the practitioner's conduct would be reasonably regarded by colleagues as constituting professional misconduct.
Campbell v The Dental Board of VictoriaSupreme Court of VictoriaYes[1999] VSC 113AustraliaCited for endorsing the test used in Adamson v Queensland Law Society Incorporated: whether the conduct falls short of the standard of professional conduct observed by members of the profession.
Pillai v Messiter (No 2)New South Wales Court of AppealYes(1989) 16 NSWLR 197AustraliaCited for the proposition that 'misconduct' means more than mere negligence and includes a deliberate departure from accepted standards or serious negligence portraying indifference.
Law Society of Singapore v Ahmad Khalis bin Abdul GhaniN/AYes[2006] 4 SLR 308SingaporeCited to define 'grossly improper conduct' in the context of legal profession and to emphasize the importance of maintaining high standards of professionalism and ethical conduct.
Julius Libman v General Medical CouncilN/AYes[1972] AC 217United KingdomCited for the principle that a court will be slow to interfere with the findings of a disciplinary committee unless there was something clearly wrong in the conduct of the trial, the legal principles applied, or the findings were out of tune with the evidence.
Ghosh v General Medical CouncilN/AYes[2001] 1 WLR 1915United KingdomCited to emphasize that while deference is given to the disciplinary committee, the court's appellate jurisdiction should not be abdicated.
Council for the Regulation of Health Care Professionals v General Medical Council and RuscilloN/AYes[2005] 1 WLR 717United KingdomCited to support the view that weight should be given to the expertise of the disciplinary tribunal in evaluating how best to protect the public and the profession.
Sakthivel Punithavathi v PPN/AYes[2007] 2 SLR 983SingaporeCited for the approach to be adopted by courts in dealing with conflicting expert evidence, including scrutinizing the credentials and relevant experience of the experts.
Law Society of Singapore v Tan Phuay KhiangN/AYes[2007] 3 SLR 477SingaporeCited to emphasize that it is the spirit and intent, rather than just the plain letter, of the professional ethical rules that are relevant in assessing whether a lawyer has discharged his professional obligations.

13. Applicable Rules

Rule Name
No applicable rules

14. Applicable Statutes

Statute NameJurisdiction
Medical Registration Act (Cap 174, 2004 Rev Ed) s 45(1)(d)Singapore
Medical Registration Act (Cap 174, 1985 Rev Ed)Singapore
Medical Act 1969 (c 40)United Kingdom
Medical Act 1983 (c 54)United Kingdom
Legal Profession Act (Cap 161, 2001 Rev Ed) s 83(2)(b)Singapore

15. Key Terms and Keywords

15.1 Key Terms

  • Professional misconduct
  • Informed consent
  • Trabeculectomy
  • Molteno tube implant
  • Neovascular glaucoma
  • Intraocular pressure
  • Ophthalmologist
  • Medical Registration Act
  • Singapore Medical Council
  • Ethical Code
  • Invasive therapy
  • Laser cyclophotocoagulation

15.2 Keywords

  • Medical misconduct
  • Ophthalmology
  • Glaucoma
  • Informed consent
  • Singapore Medical Council
  • Disciplinary proceedings

17. Areas of Law

Area NameRelevance Score
Professional conduct90
Medical Negligence85
Medical Malpractice80
Informed consent75
Healthcare Law70
Ophthalmology60
Administrative Law30
Appellate Practice20

16. Subjects

  • Medical Ethics
  • Professional Responsibility
  • Health Law