Singapore Court of Three Judges quashes conviction of psychiatrist for failing to protect patient’s confidential information
19 December 2019
Singapore Medical Council v Soo Shuenn Chiang [2019] SGHC 250
In an unprecedented move, the Singapore Medical Council (“SMC”) in Singapore Medical Council v Soo Shuenn Chiang filed an appeal to the Court of Three Judges (“Court”) to ask that the conviction of Dr Soo Shuenn Chiang (“Dr Soo”) by the Disciplinary Tribunal (“DT”) be set aside. The Court allowed the SMC’s appeal and set aside the conviction and sentence imposed by the DT.
DT proceedings
At the DT proceedings, Dr Soo had pleaded guilty to a charge of failing to:
- maintain the medical confidentiality of a patient (the complainant) in providing a memorandum (which contained the patient’s confidential information) to a caller without verifying the identity of the caller; and
- take steps to ensure the patient’s confidential medical information was not accessible to unauthorised persons.
The charge arose from a call Dr Soo received on 20 March 2015, through the hospital’s telephone line, from a caller who identified himself as the patient’s husband. The caller informed that the patient was suicidal, and that he had tried to send her to the Institute of Mental Health (“IMH”) for a suicide assessment but was not successful.
With the patient’s name and identification number provided by the caller, Dr Soo accessed the patient’s clinical records during the call and was able to verify that the information provided by the caller on the patient’s medical history corresponded with the information on the medical records.
With the intention of facilitating an assessment of the patient’s suicidal ideations, Dr Soo provided a memorandum addressed to “Ambulance staff/Police in charge” to request for the patient’s assessment at the IMH to assess her suicide risk (“Memorandum”). The Memorandum was handed to the hospital’s clinic staff, with instructions that it should be handed over to the husband who called.
The Memorandum was collected from the clinic staff by the patient’s brother. The brother subsequently used the Memorandum in proceedings in the Family Court against the patient. The patient made a complaint to the SMC arising from what she believed to be an unauthorised disclosure of her medical information.
Dr Soo pleaded guilty to the charge. Dr Soo’s counsel had argued that a fine of not more than S$5,000 was appropriate in the circumstances. SMC’s counsel sought a fine of not less than S$20,000. After deliberations, the DT meted out a fine of S$50,000 and ordered that Dr Soo be censured, give a written undertaking to the SMC that he would not engage in the conduct complained of or in any similar conduct, and pay the costs and expenses of and incidental to the proceedings.
Appeal by SMC
Both Dr Soo and the SMC did not appeal against the DT’s orders. However, following the publication of the DT’s Grounds of Decision (“GD”), there was a public outcry over the conviction and fine. Concerns were raised by the medical community on the steps that they were expected to take to verify the identity of next-of-kin who communicate with them to seek urgent medical help in a situation where the patient is believed to be at risk to himself or herself. A petition was started in March 2019, garnering more than 8,000 signatures from members of the medical profession and the public in two days.
On 14 March 2019, the SMC announced it would apply to the Court for a reduction of the fine imposed against Dr Soo. This was followed by an announcement on 21 May 2019 that the SMC had decided to apply for Dr Soo’s conviction to be set aside instead in light of new information obtained from the patient’s brother and husband, which raised doubt on the circumstances surrounding the incident.
Proceedings before the Court
At the hearing of the SMC’s appeal, the Court observed that there were discrepancies in the brother’s account which had not been verified with the patient, who had presented a different version of events, upon which Dr Soo was convicted. In the circumstances, the Court was minded to send the matter back for a re-trial.
However, the Court also observed that Dr Soo’s counsel had, following the appeal to the Court, provided further information, at the Court’s request, on the steps that Dr Soo had taken to verify the identity of the patient. This information had not been set out in Dr Soo’s initial letter of explanation to the SMC Complaints Committee or during the DT inquiry (as Dr Soo pleaded guilty to the charge). The Court directed the SMC to file a supplementary affidavit by their expert clarifying the conclusions set out in his initial report, which had been provided by the SMC in support of their charge against Dr Soo.
The SMC’s expert subsequently confirmed in his supplementary affidavit that having reviewed the further information provided, the steps that Dr Soo took to verify the identity of the caller were reasonable.
Taking into account the SMC’s expert views in his supplementary affidavit as well as an examination of the facts, the Court allowed the appeal and Dr Soo’s conviction and sentence were set aside.
Decision of the Court
The Court held that every doctor who handles patients’ confidential information is under a duty to take reasonable care to ensure such information is not mishandled or released negligently to unauthorised persons. To this end, Dr Soo was obliged to take reasonable steps to verify that the caller was the complainant’s next of kin and this inquiry must take into account the context-specific circumstances of the case including whether it was a medical emergency.
On the facts of this case, the Court found that Dr Soo acted reasonably in agreeing to provide the Memorandum at the request of someone whom he reasonably believed was the patient’s husband and in circumstances where he reasonably believed the patient was in danger of seriously injuring herself. The Court also found that Dr Soo had discharged his duty to maintain the patient’s confidentiality in giving specific instructions to his clinic staff to release the memorandum to the patient’s husband and the responsibility of verifying the identity of the person collecting it then fell on those releasing it, who would have been the clinic staff.
Key takeaways
This case clarifies that a doctor is expected to take “reasonable steps” to ensure a patient’s confidential information is not mishandled or released negligently to unauthorised persons. In assessing what is “reasonable”, the court will take into account all the circumstances of the case, including whether it was a medical emergency and the steps that were in fact taken by the medical practitioner to verify the identity of the person requesting the patient’s confidential information.
To provide more guidance on this issue, the Ministry of Health subsequent to this decision released “Guiding Principles for Communication of Medical Information Over the Phone” on 22 October 2019, which medical practitioners and institutions should take note of in establishing its protocols.
Allen & Gledhill Partner Mak Wei Munn represented Dr Soo Shuenn Chiang whose conviction was quashed.
Reference materials
The judgment of the Court of Three Judges is available from the Supreme Court website www.supremecourt.gov.sg or by clicking here.