Well-known cancer surgeon gets 8-month suspension for professional misconduct. JUNE 29, 2017
Well-known cancer surgeon gets 8-month suspension for professional misconduct. JUNE 29, 2017
Well-known cancer surgeon gets 8-month suspension for professional misconduct. JUNE 29, 2017

Well-known cancer surgeon gets 8-month suspension for professional misconduct. JUNE 29, 2017


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Dr Ang Peng Tiam. TODAY File Photo SINGAPORE — Prominent cancer surgeon Ang Peng Tiam’s punishment for giving a former patient suffering from Stage 2B lung cancer false hope about her disease has been upped to an eight-month suspension. The suspension for his “aggravated” professional misconduct would have been double that, said the Court of Three Judges which heard his appeal, if not for the 4½-year delay in the disciplinary proceedings by the Singapore Medical Council (SMC). In its grounds of decision released on Wednesday (June 28), the court made clear that the penalty it is imposing had nothing to with whether Dr Ang — a 35-year veteran and medical director of Parkway Cancer Centre — was correct in his treatment plan for the 55-year-old, who died about six months after seeing him. Rather, Dr Ang had no basis to tell the patient there was a 70 per cent chance of her tumour shrinking with the treatment plan he had. He also should not have taken away her right to choose surgery, even if he assessed it to be an unsuitable course of action. “A doctor might believe that a particular treatment option is in his patient’s best interests, but ultimately, it is the patient who must make the decision on her treatment,” said Chief Justice Sundaresh Menon, delivering the judgment on behalf of the court on Tuesday. Dr Ang first saw the patient in late-March 2010. She had a 8cm, fast-growing and aggressive tumour, as well as a few smaller growths, in her right lung. He recommended combining chemotherapy with a drug called gefitinib, telling her, in Mandarin, this treatment would give her “at least a 70 per cent chance that the tumour will shrink”. Dr Ang also explained to the patient, her husband, and their two daughters that his assessment of her chances was based on her being Chinese, female, someone who had never smoked, and a tumour diagnosed with adenocarcinoma. But he had no justification for his claim because this rate of success was only applicable to patients with these characteristics who had also tested positive for epidermal growth factor receptor mutation. Dr Ang did not send the patient for a test to determine her status. He also did not tell her that surgery was an alternative way to treat the cancer. The patient went with his plan but did not respond well to treatment, dying a little over six months later. Her daughters lodged a complaint with the SMC later. After a 13-day hearing, a disciplinary tribunal fined him S$25,000 for two counts of professional misconduct, relating to his unjustified claim about the patient’s chances and his failure to provide surgery as a treatment option. Dr Ang appealed against his convictions. The Court of Three Judges, which included Judges of Appeal Andrew Phang and Judith Prakash, upheld the tribunal’s decisions on both counts. This was not a case where Dr Ang had made a mistake, misjudged or misinterpreted medical papers on the effectiveness of his treatment plan for the patient, it said. Instead, he made the claims intentionally even though he knew or ought to have known there was no basis for him to do so. On not giving the patient the option to go for surgery, which was the preferred option with similar conditions as this patient under the National Comprehensive Cancer Network guidelines, Dr Ang argued that as a doctor, he was obliged to exercise his clinical judgment instead of blindly and rigidly following the guidelines. While they agreed that doctors should not suspend their clinical judgment and slavishly adhere to the guidelines, the judges said doctors were obliged to present the range of viable options and what the pros and cons of each of these were. Patients must get to decide for themselves what treatment they want, the judges added. “It was not Dr Ang’s role to decide, but to inform,” the judges said. In deciding on the sentence, CJ Menon said the priority in this case was in general deterrence, rather than preventing reoffending. Noting Dr Ang’s senior position — he has been president of the Singapore Society of Oncology and Singapore Cancer Society, among others — he is “expected to set an exemplary standard and to serve as a role model for fellow practitioners”, he added. “Seniority and eminence are characteristics that attract a heightened sense of trust and confidence, so that when a senior and eminent member of the profession is convicted of professional misconduct, the negative impact on public confidence in the integrity of the profession is correspondingly amplified,” CJ Menon said. Dr Ang’s unblemished record and past contributions to society were also of little relevance. “The law must also not be misconstrued as providing those with an established good track record a free pass for misconduct on the basis that it is out of character,” said CJ Menon. http://www.todayonline.com/singapore/well-known-cancer-surgeon-gets-8-month-suspension-professional-misconduct


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