Doctor who failed to refer patient for TB treatment suspended 15 months

A doctor who certified a domestic worker from Myanmar as fit, when she actually was suffering from multi-drug-resistant tuberculosis (TB), has been suspended for 15 months.

Dr Teo Sze Yang, a general practitioner at Providence Clinic, also did not refer her for treatment, as required by law, after her X-ray showed possible infection in her lungs.

She was later diagnosed with TB by another doctor.

The Singapore Medical Council (SMC) disciplinary tribunal said in a release on Monday (June 13) that it was possible the more than a month's delay in the domestic worker's treatment caused the brother of the woman's employer, who was living in the same household, to contract TB.

TB is an air-borne disease transmitted through close and prolonged exposure to someone who is infected but untreated.

The patient had seen Dr Teoat his clinic in Redhill on March 17, 2018, for the regular six monthly medical examination as required by the Ministry of Manpower (MOM).

Her X-ray results showed possible infection in both lungs, and it came with the recommendation for further management and follow-up.

Dr Teo saw her again on March 29 and she had a fever, cough and sore throat.

He prescribed antibiotics and a cough mixture, and he said he planned to refer her to the TB Control Unit ("TBCU") within a week if needed.

But he did not follow-up on this.

On May 5, she was diagnosed to have TB by another doctor, who referred her to the TBCU.

In November 2018, the then director of the TBCU lodged a complaint against Dr Teo with the SMC, the professional watchdog.

The SMC filed two charges against Dr Teo: failure to provide appropriate care to his patient, and certifying in a form that she did not have TB "when there was in fact no basis for him to do so".

A disciplinary tribunal found him guilty of both charges and suspended him for 15 months.

The SMC told the tribunal that the symptoms "would have greatly increased the suspicion that the patient had TB and the need to refer her to TBCU promptly."

That Dr Teo did not do so was either "an intentional, deliberate departure from standards of the medical profession or such serious negligence that it objectively portrayed an abuse of the privileges accorded to a medical practitioner".

In his defence, Dr Teo said the Ministry of Health (MOH) guidelines did not stipulate that a patient must be referred to the TBCU immediately if his X-ray screening was abnormal.

But Dr Teo admitted that he did not have the expertise to say she did not have TB.

On the second charge, Dr Teo said he had pre-signed the certification form, which he claimed was submitted by his clinic assistant without his instructions due to an "administrative error".

In finding the doctor guilty, the tribunal said it was apparent that he "was simply indifferent to the patient's welfare or to his own professional duties".

His notes on the case were very brief and did not support his claim that he had mentioned the possibility of TB.

An aggravating factor, it said, was Dr Teo repeatedly providing false and/or misleading information on why he did not refer the patient to TBCU, and how the wrong certification was submitted to MOM.

There were no mitigating factors.

The tribunal said doctors are required to refer suspected TB patients to the TBCU "to reduce the risk of transmission and to ensure that suspected TB cases can be expeditiously managed", as it could be fatal if not treated properly.

Last year, more than 1,300 people were diagnosed with TB here.

The tribunal agreed with the SMC that a deterrent sentence was merited as medical certification forms are often "the first (and only) line of defence against a public health threat", and doctors should take their responsibility seriously.