Apex court upholds SMC's conviction of doctor who gave patients unapproved hormones

Straits Times

5 days ago

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The three judges felt that the disciplinary tribunal was correct to impose the sentences on Dr Ian Lee Pheng Lip.
SINGAPORE – A doctor who prescribed various unapproved hormones, including one made from desiccated pig thyroid glands, has failed in his appeal to the highest court to quash his convictions and sentences by the Singapore Medical Council (SMC).
Instead, the conviction against Dr Ian Lee Pheng Lip, a general practitioner from Integrated Medicine Clinic, stands.
His 18-month suspension begins in two weeks, and he had to pay $50,000 – the cost of the appeal – to the SMC.
The decision of the Court of Three Judges, comprising Chief Justice Sundaresh Menon, Justice of the Court of Appeal Tay Yong Kwang and Senior Judge Judith Prakash, to dismiss his appeal in respect of 17 charges of professional misconduct under the Medical Registration Act was delivered on July 8.
The three judges felt that the disciplinary tribunal was correct to impose the sentences on Dr Lee, and that the aggregate sentence imposed 'was not manifestly excessive'.
A complaints committee (CC) began probing Dr Lee on May 8, 2014, following a complaint by the SMC that he was offering non-mainstream services.
This was after the Ministry of Health (MOH) notified the SMC of its concerns regarding Dr Lee's provision of various unapproved hormones to his patients.
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These were the following:
Erfa, a thyroid hormone preparation made from desiccated pig thyroid glands containing both the thyroxine (T4) and triiodothyronine(T3) forms of thyroid hormone, which Dr Lee prescribed on 41 occasions between late 2011 and early 2014 to eight patients.
Biest and Triest, custom compounded formulations containing a mixture of estrogens. Between late 2011 and early 2014, he prescribed Biest on 11 occasions to two patients, and Triest on three occasions to two patients.
Testosterone, a hormone produced by both males and females.
Progesterone, a female sex hormone which plays a crucial part in the menstrual cycle and the maintenance of pregnancy. Dr Lee faced two charges for his prescriptions of progesterone to two women, who had undergone hysterectomy.
When Dr Lee's clinic licence expired on March 16, 2015, MOH did not grant a further renewal as he did not show he had the intention to wean his patients off the hormone replacements.
MOH even found out that he was prescribing testosterone to patients who did not need it, nor did he have proper clinical documentation of the patients' testosterone deficiencies.
As a result, a second letter of complaint was issued by the SMC on April 30, 2015.
When invited to submit written explanations, Dr Lee generally took the position that he was entitled to prescribe the hormones to his patients.
The CC sent a letter on Feb 12, 2018, informing him that it had ordered an inquiry to be held by a disciplinary tribunal.
Dr Lee sought to challenge its decision and filed a motion with the High Court seeking to quash the inquiry.
He argued that he suffered substantial prejudice from the 'inordinate delay' it had taken for his case to be referred to the tribunal, but he
failed in his High Court judicial review bid to stop the probe against him.
He appealed to the Court of Appeal but the court dismissed the appeal and upheld the High Court's decision.
Following the lifting of the stay of proceedings, the SMC issued Dr Lee with 21 charges on April 22, 2021.
SMC's case was that Erfa, Biest and Triest were 'non-evidence-based treatments' that could 'only be administered in the context of a formal and approved clinical trial'; and that Dr Lee offered to his patients a management plan or remedy that was not generally accepted by the medical profession.
Two expert witnesses testified for SMC, and after the inquiry an oral hearing was convened on June 6, 2023, after the parties exchanged their written closing submissions.
The verdict was delivered on Jan 16, 2024. On June 4 of the same year, Dr Lee's registration was suspended for 18 months, and he was ordered to bear 80 per cent of the SMC's costs and 100 per cent of its spending, including the fees of its expert witnesses.
However, in his appeal against this verdict, Dr Lee said the disciplinary tribunal's conclusions on the applicable standards of conduct were not supported by the evidence and that it had overlooked the various concessions given by a witness in his cross-examination.
He also said MOH had not made clear whether the hormone therapy he used was prohibited, and it was therefore unjust to punish him for departing from the applicable standards of conduct when there was uncertainty on what was generally accepted by the medical profession.
He felt that a letter of warning would be the appropriate sentence for him and set the motions for an appeal at the highest court in Singapore.
Dr Lee was represented by Senior Counsel N Sreenivasan and lawyers Charles Lin, Tracia Lim and Daniel Poh from Charles Lin LLC for this appeal, while Senior Counsel Thio Shen Yi and lawyers R Arvindren and Ryan Yap from TSMP Law Corporation acted for the SMC.