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Medical Malpractice Insurance: End of the Road for SMC Fines

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The last few years have been quite a rollercoaster ride for the Singapore Medical Council's (SMC) disciplinary processes.

In 2019, orthopaedic surgeon Dr Lim Lian Arn was brought before the SMC's disciplinary tribunal, accused of failing to inform a patient of the possible side effects of a common H&L steroid injection. Dr Lim pleaded guilty and was subjected to the maximum possible fine of S$100,000.

Many will recall the backlash that this penalty sparked amongst Singapore’s medical fraternity. The SMC was criticized on medical chat sites and in news reports. A petition was launched and gathered 6,000 signatures before it was presented to Singapore’s Health Minister. The matter was even raised in Singapore’s Parliament.

It was around this time that doctors began to ask whether their malpractice insurance could be expanded to include SMC fines and penalties. At that time there was no solution available. As a starting point, we need to recognise that most fines and penalties cannot be insured, due to public policy implications.

Imagine that Howden started offering insurance against parking fines. Customers with “Howden Parking Fine Insurance” would park wherever they liked, secure in the knowledge that they would not have to pay any resulting fines. I doubt it would be long before I was called in for a friendly chat with Singapore’s Land Transit Authority.

The point is that fines and penalties are intended to deter behaviour that is considered undesirable by society. Protection against the financial impact therefore acts contrary to public policy objectives.

Medical Malpractice Insurance policies routinely exclude fines and penalties for this reason.The public policy argument against insuring fines. All perfectly correct, all entirely unhelpful.

The heat came out of the issue a little with the announcement of an inquiry. The Ministry of Health announced the formation of a workgroup (chaired by Quek BoonTheng from The Legal Clinic – one of Howden’s panel solicitors). The workgroup’s recommendations were eventually implemented via the Medical Registration (Amendment) Act 2020, and included these provisions:

  • Disciplinary Tribunals must include one legal professional
  • Disciplinary Tribunals may appoint independent experts
  • The minimum suspension term of three months was removed.

These and the numerous other amendments all seemed to be steps in the right direction.

However, there was one glaring omission as the changes did not extend to the fines that can be imposed by the SMC. While the processes are now more robust, Singapore’s doctors are still exposed to the prospect of S$100,000 SMC fines.

The process of reviewing the SMC’s processes and introducing changes to the Medical Registration Act took a little over two years. During that time, we noticed a trend in other insurance classes; more and more specialist insurance policies were beginning to offer cover for fines and penalties. In Cyber Insurance, for example, it has become commonplace for insurers to cover fines levied under the PDPA. MedTech Insurance that covers companies developing medical devices and technology also offers cover for fines imposed by Singapore regulatory bodies.

Clearly the time to act had arrived, and so we did: With effect from 1 August, 2022, doctors insured with Howden are covered for SMC fines that relate to malpractice events.

Now, if our previous reason for not offering this cover was that it was contrary to public policy, it is reasonable to ask what has changed?

Whenever a Howden client doctor notifies a claim or potential claim, our first response is always to arrange a meeting to talk through the process and agree a response plan. There are many factors to consider, but one of the most important is protecting the doctor’s reputation.

It is very damaging to a practice than to have negative reviews posted on Google. Even more damaging is to have a public record of an adverse finding by an SMC disciplinary tribunal. Let’s face it, a prospective patient who searches a doctor’s name and discovers an SMC history of any kind is likely to go elsewhere. Taking this into account, we see no prospect that a doctor will be careless in dealing with patients simply because he is insured for any fine the SMC may impose.

Of course, the cover only applies to SMC fines relating to malpractice. Should a doctor be fined for non-malpractice failures, such as failing to store medications correctly, then no cover will be available. In other respects, we are delighted to advise that for SMC fines, this is the end of the road.

Authored by:

Mike Griffith

Mike Griffiths
Regional Director, Healthcare
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