Tuesday, March 29, 2011

Double Bill: The curious case of Dr. Susan Lim

Doctors are usually mild-mannered people. They are service providers. They do their job and mind their business. Controversy is something they want to keep at an arm’s length.

If you follow the Singapore news, you will know of Dr. Susan Lim, one of Singapore’s path-breaking surgeons. Willy nilly, the top surgeon finds herself mired in controversy these days.

The doctor has asked the Singapore High Court to disallow a second disciplinary committee’s constitution by the Singapore Medical Council (SMC) to look into a grave charge on her. According to reports, she allegedly overcharged one of her royal patients (Penigran Anak Haja Damit) and billed the Burunei palace $24.8 million for breast cancer treatment between January and July 2007 just before the patient died. The council wants to investigate if the claims of mark ups and inflated bills made by the relatives of her patient, the deceased sister of the Queen of Brunei, are true.

Yesterday, the high court resumed hearings in her case. Dr. Lim was absent from the day long hearing but her lawyer explained how her invoices added up. The Straits Times reported today: “The SMC’s portrayal of Dr. Susan Lim marking up certain bills is false, mischievous and scandalous, her lawyer told the high court yesterday.”

Days in Paradise

From Europe on a skiing trip with her children, Dr. Lim tweeted: “Lessons in life go against the grain of doin good; never provide services even to a regular client without payment upfront; it can backfire.” (March 20)

If you know the background of her case, you will know what she is possibly alluding to.

Her next tweet is: Life is beautiful.

Is it? For her?

If you look at today’s newspaper’s headlines, you would wonder: What must be going on in her mind? Of course, she is rich. She has hired an expensive Queens Counsel, Ian Winter. Yet, moving between Moutiers to Courchevel, where she wants to enjoy the freshness of spring skiing, don’t the headlines from back home weigh her down?

What intrigues me is this: why did she bother to take on the establishment, the SMC and so on? Why does she want to fight back? Why does she want a judicial review?

Is she fighting for her reputation? If so, what’s wrong with that? A doctor’s reputation is all that she has. It is a delicate thing—takes a lifetime to build. One misstep and it is sullied. In today’s digital age, damage to one’s reputation stays for ever—a lifetime of embarrassment.

Is she fighting to get her millions back? The bills that, even after a fifty per cent discount, remains unpaid?

If that is the case, is it (to attempt to get one’s due back) a commercial dispute (between the doctor and the patient’s family) or is it a breach of medical propriety?

I think this question is at the heart of the matter.

Beyond the surface

The intense media coverage that this case has garnered—coupled with the fact that it affects Singapore’s image as a great destination for medical tourism—puts the onus back on the media. The media needs to get to the bottom of the matter.

Dr. Lim sounds very concerned when she tweets like this: “Let not an honest citizen be trampled upon by public authorities when their injustice and irregularities are exposed.”

What injustice? What irregularities?

If there are irregularities indeed, will the media uncover them? Dr. Lim is again skeptic: “the challenge to the media in reporting, is to delve deeper than merely scratching the surface and to report with substance and intellect.”

What is it that Dr. Lim wants the media to find out and expose? What’s beyond the surface? Is there something we have not seen yet?

Now that it has been revealed that the second SMC panel’s head was a rejected admirer of Dr. Lim and SMC’s rebuttal that its rule was not changed to target the beleaguered doctor, it would be interesting to see how the case moves forward and how does the media go after the proceedings. I think it is a great chance for the Singapore media to show its mettle.

What do you think? Which way will the case go? Will the institutions hold Singapore’s reputation of being a just and fair country? Will the media step up to the plate?


deepak said...
This comment has been removed by the author.
Pushpa said...

This is a fascinating article and even more fascinating are the tweets released by Dr Lim. Surely this is both an invitation and challenge to the media to rise to the high standards of journalism and report accurately. One tweet i did understand was in reference to the letter she wrote to the Minister. The SMC legal counsel claimed that it was "threatening" but Dr Lim alludes to a heavy censorship of the article by tweeting "is there any critic out there who can form a strong view with less than 30% revealed; apparently yes, from what i read in ST !" . Seems like her case is not getting full coverage due to a possible one-sided coverage in local media - lets wait and see. Hope she drops more clues.

Betty said...

hey there, her tweets are getting more direct. She has drawn our attention to the Singapore Medical Council's unlawful amendment of Regulation 42 which came into effect at the same time the second DC was appointed and midway thru her Proceedings, in order to target her - TARGETTED legislation ... hmmmm, a definite No No, as aptly pointed out by the Honourable Justice Pillai in High Court which then saw a swift and abrupt about turn in the AG's stance on amended Regulation 42 ! But what if Dr Lim did not have the guts, conviction or resources to bring this to a judicial review ?

The Medical Student said...

26 million dollars for b c treatment? Common.. that's got "ridiculous mark up" written all over it. I'm not sure what she was expecting.. Someone was going to say something sometime...

Betty said...

The 28 march Hearing before Justice Pillai has provided lots of answers to lingering doubts and queries. First, the sum that the doctor was claiming was $12.1 million and not $24 million. Second, of this $12.1 million, some $3.3 million was to third parties, the cost of aircharter etc. What was left to Dr Lim's practice (of 33 staff) was $8.8 million which divided over 153 days of service (both in Singapore and Brunei) was approx $57,000 for 24x7 work provided by a dedicated team of nurses and doctors from her practice. Considering that one third party anesthetist charged only for his services without the infrastructure and responsibilty as primary physician, a sum of $20,000/day, and a professor from London charged, for a brief consultation 150,000 pounds (exclusive of airfare ) and a singapore oncologist charged another foreign patient $300,000 for an overseas consult, Dr Lim's charges were definitely reasonable for the services she provided, not just medical but also non-medical.
We have to take things in perspective and remember that these were exceptional services that were demanded from the doctor's practice, and of course, the doctor is entitled to name her fees if the patient wanted her practice to move to Brunei and provide further service..

Marie said...

Dr susan lim seems to have stumbled on some unlawful activities in government departments and they are out to get her!

Annie said...

Alvin Yeo kept showing individual bills. From my understanding instead of individual bills dr lim had indicated that the amount is 12.1 mil including all treatment days in Singapore and also the period dr lim and her team are based in Brunei. Could Alvin show to everyone the bill for the treatment days in Brunei? There is NONE! Thus you cannot look each bill individually it does not make any sense! See how Alvin has trick the public??? Show all the bills for the treatment period in BRUNEI ! !

Hiko said...

The patient has to be the complainant according to the provisions of the Medical Registration Act. Singapore's Director of Medical Services who doubles up as the Registrar of the Singapore Medical Council has no role and his direct involvement as the complainant ie definitely a case of conflict of interest.From the grapevine, I have heard that he has a bone to pick with Dr Lim and wants her to be fixed good and proper.