Doctors ‘bound by ethics to charge fair fees’

Source: Todayonline  24 Nov 2012

Doctors here are ethically bound not to charge unfair and unreasonable fees for their services.

The Singapore Medical Council’s (SMC) lawyers made this point, among other things, in a 190-page response to prominent surgeon Susan Lim’s appeal against her three-year suspension and S$10,000 fine for professional misconduct.

The council had found Dr Lim guilty of 94 charges, the bulk of which involved overcharging the late sister of Brunei’s Queen, whose bills amounted to S$24.8 million for care rendered in 2007.

In her appeal, Dr Lim, 57, argued, among other things, that Singapore does not have any guidelines or a cap on what a doctor can charge a patient.

According to documents submitted to the court – dated Thursday – SMC’s lawyers from WongPartnership pointed out that “there is an intrinsic ethical limit prohibiting doctors from charging unfair and unreasonable fees”.

“Excessive charging undermines the foundation of any profession based on honour, trust and integrity,” they said.

Drawing reference from the legal fraternity, the SMC’s lawyers argued that the principles of honour and integrity apply to the medical profession with or without written rules in their ethical guidelines.

Pointing out that Dr Lim’s fees are in “an extraordinary class of exorbitance on its own”, they also said that the assessment of a practitioner’s fee is determined objectively by her peers.

“It is settled law that in assessing whether fees rendered are grossly excessive such as to amount to professional misconduct, the benchmark is an objective assessment of the fairness and reasonableness of the fees charged, having regard to all relevant factors, such as the complexity of the services rendered, and the seniority and skill of the practitioner involved,” the lawyers said.

While Dr Lim has insisted that the fees were agreed between her and her patient, the SMC’s disciplinary committee ruled otherwise.

Even if there was a fee agreement, “that does not mean that it is ethical … for a doctor to charge excessive fees”, the lawyers said.

“As a concomitant, whilst a fee agreement can be valid under general contract law, that does not mean that the agreement is ethical under the rules of professional conduct,” they added.

In the legal profession, for example, the courts have also previously ruled that solicitors might be found guilty of overcharging despite having a fee agreement, the lawyers noted.

They reiterated that the case is not one of inadvertence or negligence – Dr Lim knew what she was doing was wrong. Not showing remorse, she continued to assert that there was nothing wrong with her conduct, the lawyers said. They reiterated that “it is not the SMC’s intention to make a public example of Dr Lim”.

The SMC is charged with the statutory duty to regulate the conduct and ethics of registered medical practitioners, and to uphold the standards and reputation of the medical profession, the lawyers said.

“And it is a matter of fundamental importance in the definition and conception of the medical profession as an honourable profession that practitioners refrain from levying grossly excessive, unfair and unreasonable fees that bring the entire profession into disrepute,” said the lawyers.

It is “equally important that medical practitioners maintain the highest standards of integrity in their billing practices”, they said.

“That, however, is precisely what Dr Lim has not done.”

The court is scheduled to hear Dr Lim’s appeal in January.