New Year, Old Grumblings

Greetings from Middle Earth.

Yet another new year beckons. Another year of laughter, tears and long letters from SMC, going by the trend set in December of 2014.  We received two long letters in the space of 2 weeks from SMC. The first, dated 16 December 2014, was titled “Clarifications on the SMC Disciplinary Process” and the second, “SMC – Consultation Exercise on the Draft SMC Ethical Code and SMC Professional Standards in Practice” was sent out on 29 December 2014.

The two letters seem as long as The Hobbit Trilogy but not half as much fun unfortunately.

Let’s deal with the earlier letter first. Para. 2 states “We cannot discuss the specifics of the case involving Dr Lawrence Ang as the matter is still pending before the Courts”. When a stupid lay-halfling (read: this hobbit) like me reads this sentence – the first reaction was “you mean after the Court of Three Judges decided he is innocent, Dr Lawrence Ang is still NOT off the hook???”

But fear not.  Some snooping around by this hobbit and his friends in the dark pits of Don Guldor reveal that Dr Lawrence Ang is truly, really, completely, verily, off the hook. The only issue pending before the courts is that the parties are debating as to who pays how much of the costs.

Obviously, there is either a cunning linguist running around drafting letters for SMC or this hobbit is very bad at English comprehension, for which I unreservedly apologise.

That brings us to the issue of costs. And the Lawrence Ang appeal will go down in the annals of SMC and legal history as the first time the Courts have ordered costs incurred by the doctor to be paid by SMC. This is no small deal. It’s a big deal. Hitherto, SMC has NEVER paid a doctor’s costs incurred in a disciplinary hearing. At most, it pays it own costs when the doctor is innocent, and when the doctor is found guilty, the doctor has to pay both his and SMC’s costs as well.

The next issue that was brought up in the letter dated 16 December 2014 is that “The SMC process, while not perfect, has worked well in an overwhelming majority of cases. The numbers bear this out. Over the past six years, i.e. since 2008, SMC has processed over 1000 cases lodged against doctors and, as to date, about 110 formal inquiries have been conducted before Disciplinary Committees or Disciplinary Tribunals. Out of these, four outcomes were reversed by the Courts”.

This is one perspective of things. Let this hobbit give you another perspective with this hypothetical scenario – “The Middle Earth Justice System, while not perfect, has worked well in an overwhelming of cases. The numbers bear this out. Over the past six years, Middle Earth Police has processed over 1000 cases of alleged assault and/or battery. To date, 110 cases were tried before the Courts and of these, four poor fellas were found to have been wrongly convicted by the Appeals Courts”. These four fellas would have gone to jail for about 6 months had not the Appeals Courts decided otherwise”.

Yup. It’s all a matter of perspective. To some, it’s 4 out of 110. To others, it’s 4 out of more than 1000. To the guy at the centre of the case, it’s the end of the world, or at least the end of his career. It is not a percentage or probability to the doctor being tried. It is either 0 or 100%.  One is one case too many.

In any case, no matter how we wing it or swing it, euphemise it or defend it, when a statutory body like SMC has to pay costs, to borrow a Chinese phrase, it can be described as SMC 死得好难看。(Bad Singlish Translation: SMC die until look very ugly”)

SMC is funded by doctors’ subscriptions and government funding (i.e. taxpayers money). Acting in such a way as to be ordered by the Courts to pay the doctor’s costs in addition to its own is not exactly the best (or even decent) way to spend the medical profession and taxpayer’s monies, even as the same letter claims that SMC is (and indeed, should be) acting in the interest of the public.

We now go on to the second letter dated 29 December. The first thing to note is that the layout is very different from the first letter. It is in very small font, single spaced. It is meant for elves or anyone that graduated in this century and not the last. And the sentences are kind of long. Obviously the aforesaid cunning linguist was not around when this second letter was drafted.

For a start, can SMC standardize its letters’ layout? Otherwise, the content of the letter is pretty encouraging, especially when it is stated that the original intention was not to make “the guidelines seem like a long check-list that is to be followed religiously”. Well, calling this “guidelines” and not “professional standards” is a good start. Whenever I see the words “professional standards”, I feel like I am being strangled by a boa constrictor. “Guidelines” is far less suffocating. Also please shorten this document. My humble GP clinic table-top deskjet printer CANNOT print out the document at one go. Seriously. Or should I make use of the Productivity Fund to upgrade my printer to one of those massive ones that can print, fax, scan, photostat, speak English and make skinny lattes?

The last bit we want to look at this month comes from the lawyers. I consider our judges and lawyers to be very smart people. A lot smarter that some folks in MOH or the Competition Commission of Singapore. At the opening of the 2015 Legal Year the Honorable Chief Justice mentioned that a major concern in the area of Civil Justice is the management of litigation costs. And one of the three key steps undertaken to address this is “the imminent publication of costs guidelines in the Supreme Court Practice Directions and on the Supreme Court website. Although the issue of costs remains fully at the discretion of the court, these guidelines will serve as a signpost to the parties of the level of costs that they can expect at various stages of litigation”.

I guess the Chief Justice is a believer in cost guidelines, like this Hobbit, like SMA, and like most doctors; although we called ours guidelines of fees (GOF).  But the idea is quite similar, because for professional services like legal or medical professional services, cost guidelines are not too much different from fee guidelines.  Unlike what the CCS proposes, the Courts are not going to publish actual bill sizes etc and hope the consumer/client does his research before engaging a lawyer.

The only difference is that the Courts is an organ of state and the SMA is an association. Fine, if some wise guys think an association cannot publish fees or costs guidelines, then get someone who can.

Like the SMC.

Oops. Did I really just say that?

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