Prominent cancer doctor Ang Peng Tiam given 8-month suspension by Supreme Court
Dr Ang Peng Tiam of Parkway Cancer Centre has been given an eight month suspension in lieu of a $25,000 fine.
SINGAPORE – Prominent cancer specialist Ang Peng Tiam of Parkway Cancer Centre, who had appealed to the Supreme Court against a Singapore Medical Council (SMC) fine of $25,000, has been given an eight-month suspension instead of the fine.
It would have been a 16-month suspension had the SMC acted on the complaint more expeditiously, said Chief Justice Sundaresh Menon, who delivered the Court of Three Judges’ decision on Tuesday.
Two daughters of a former patient made a complaint against Dr Ang in 2010. The patient died in October that year. But the SMC served the notice of enquiry on Dr Ang in April 2015.
The SMC’s disciplinary tribunal had found Dr Ang, 59, guilty of two of the charges: That he made false representation to the patient who was suffering from lung cancer that there was a “70 per cent” chance of responding to the treatment he suggested and that he failed to offer her surgery as an option.
The disciplinary tribunal found that Dr Ang “had no reasonable basis” for saying there was a 70 per cent chance of response and felt that he had “wrongly held out false hope” to the patient and her family.
It also found him guilty of not offering surgery when that was “the preferred initial treatment option”.
A statement from the SMC on Wednesday (June 28) said the disciplinary tribunal found that there was an “intentional, deliberate departure from standards observed or approved by members of the profession of good repute and competency”.
Dr Ang had claimed that he has seen about 16,000 new patients over the past 16 years, of whom 10 to 15 per cent suffered from lung cancer.
It felt that his actions “merit severe penalty” but given testimonials in favour of Dr Ang as well as his community work, it decided against a suspension.
Instead, it imposed a fine of $25,000, a censure, an undertaking not to repeat the offence and for him to pay 60 per cent of the cost of the proceedings.
Dr Ang appealed against the tribunal’s decision to the Court of Three Judges which on Tuesday (June 27) upped his sentence from a fine to an eight-month suspension.
The SMC had also filed an appeal against what it considered was a light penalty from its disciplinary tribunal and had urged the court to impose a six-month suspension for each of the two offences for which Dr Ang had been found guilty.
Instead of taking his “eminence and seniority” as a mitigating factor, the court saw it as an “aggravating” factor and his “unblemished record” of more than 30 years had limited relevance in mitigation.
However, the court took into account the 41/2 years it took the SMC to serve notice of enquiry on Dr Ang after receiving the complaint. This “inordinate delay” caused suffering to Dr Ang.
Justice Menon said the appropriate sentence in the light of the seriousness of the offence would have been a suspension of 16 months for the two charges. But given the long delay by the SMC, it halved the sentence to an aggregate of eight months.
Well-known cancer surgeon gets 8-month suspension for professional misconduct
PUBLISHED: 5:23 PM, JUNE 28, 2017 UPDATED: 7:05 AM, JUNE 29, 2017
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.