susan lim
Ex-lover
Surgeon tried to halt hearing with 'threat' to MFA: Counsel
By Salma Khalik, Health Correspondent
SURGEON Susan Lim tried to stop a disciplinary hearing against her by writing to the Foreign Minister to alert him that it might expose information that could cause 'unnecessary embarrassment' to Brunei and affect bilateral ties, the High Court heard yesterday.
Revealing the existence of the letter, Senior Counsel Alvin Yeo, for the Singapore Medical Council (SMC), said the letter amounted to Dr Lim 'threatening' Foreign Minister George Yeo and was another attempt by her to 'subvert the legal process'.
'This is nothing more than a pressure tactic,' he said. 'The ministry rightfully responded that it could not intervene in the ongoing legal process.'
The High Court yesterday resumed a hearing on Dr Lim's call for a judicial review of the SMC's case against her.
The question before High Court judge Philip Pillai is whether the SMC can set up a second disciplinary hearing against her concerning fees she had charged a patient, the sister of Brunei's Queen.
Dr Lim had been Pengiran Anak Hajah Damit's main doctor between 2004 and her death in August 2007.
She charged $24.8 million (before GST) for care rendered in 2007. After giving a discount, the bill came up to $12.1 million, including costs for third-party doctors amounting to more than $3 million.
Following inquiries by Brunei's Health Ministry on the size of the bill, the Singapore Health Ministry filed a complaint to the SMC, which set up a disciplinary committee to hear the matter last year.
The hearing stopped after Dr Lim's lawyers accused the committee of pre-judging the case. The SMC then set up a second committee to hear the case, and this is the one that Dr Lim wants the High Court to quash.
Her lawyers argue that the SMC is biased against her and that she would not get a fair hearing. In any case, they say she and the patient had an agreement that charges would amount to $100,000 to $200,000 a day.
Wrapping up the SMC's case yesterday, Senior Counsel Yeo revealed the letter sent to Foreign Minister Yeo, which was submitted to the court. In the three-page letter dated March 1 last year, Dr Lim said her fees were 'a matter for private negotiation'.
'I remain unclear why the issue is being pursued against me as a disciplinary matter, but in any event, I am deeply concerned that information will eventually come to public light, which will cause unnecessary embarrassment to Brunei. This in turn may affect ties between Brunei and Singapore.'
She said the information included:
the medical condition of the patient;
the 'extraordinary and often unreasonable demands' placed on her by the patient and the royal family, including significant out-of-pocket expenses she had to bear;
how she has 'not been paid for the work done for almost three years' even though she had paid $3.256 million in third-party costs;
the 'apparent inconsistent relationship' between Brunei's Ministry of Health, the royal family and the patient's family.
She said she looked forward to a 'practical resolution of the matter, which I believe to be in the interests of Brunei and Singapore'.
Senior Counsel Yeo described her application to the High Court as 'desperate' and 'bankrupt', as there was nothing to support even the allegation of actual bias. He added: 'It is Alice in Wonderland logic.'
He asked Justice Pillai to 'look at this with more than a jaundiced eye', and reiterated the point he had made several times before: that a disciplinary hearing was the proper place to decide if there was any impropriety on Dr Lim's part.
In his rebuttal to Mr Yeo's points, Senior Counsel Lee Eng Beng, acting for Dr Lim, accused the SMC of being 'false, mischievous and scandalous' in the way it presented invoices purporting to represent 'fantastic' mark-ups by Dr Lim.
He said the invoices were not detailed and that there were doctors who were paid for their work whose names did not appear in any invoice.
Also, the total billed for third-party work came to $4.87 million - of which $3.1 million or 64 per cent went to other doctors. Dr Lim's companies charged $1.76 million for their services.
He argued that, had the Brunei palace been unhappy with her charges, based on the same rates prior to 2007, it would not have returned to her again and again.
The SMC's charges also included the pre-discounted amount of $24.8 million. The 50 per cent discount she had voluntarily given was done on Aug 1, 2007, before she had any inkling that there might be a case against her, he said.
He also said that the SMC should put its house in order before convening a second hearing. For a disciplinary committee to step down because it had pre-judged the case 'is one of the most terrible things that could happen', said Mr Lee.
None of the lawyers from either side had found any precedence in disciplinary hearings in either the legal or medical professions where this has happened.
The judge reserved judgment yesterday.
[email protected]
Mar 29, 2011
Surgeon: Admirer I rejected is heading SMC's second panel
By Melissa Kok
SURGEON Susan Lim has claimed that the man heading a disciplinary panel to investigate her for overcharging was once keen on her romantically.
Going back 30 years, she said SingHealth Group chief executive Tan Ser Kiat wooed her with flowers, danced with her late into the night and asked her to 'go steady' with him.
But she rejected him and that ended their friendship abruptly, according to Dr Lim, who was a junior doctor at the time.
This is one of the reasons why she is unhappy that he was picked to chair a disciplinary committee to investigate allegations against her.
Dr Lim was brought before a Singapore Medical Council disciplinary committee last year, but it stood down after her lawyers claimed it had prejudged the case. A second panel was then set up, chaired by Prof Tan.
Her objections to his appointment were revealed in a sworn document she submitted to the courts on Feb 14, claiming it would lead to conflicts of interest that may 'taint, or will appear to taint, the disciplinary proceedings'.
Her lawyers also wrote to Prof Tan on the same day, saying that some time between 1980 and 1982, he had been 'an admirer' of Dr Lim and expressed interest in her while she was a junior doctor at Singapore General Hospital (SGH).
Prof Tan allegedly met Dr Lim and her parents at their family home and sent a large bouquet of flowers in advance of his visit. There, he danced with Dr Lim 'late into the night' in the presence of her mother.
He then allegedly invited Dr Lim out on a dinner date and asked if they could 'go steady', but Dr Lim said she was not interested as she felt they were incompatible.
The letter to Prof Tan says: 'This rejection abruptly ended the friendship between you and our client, making interaction between both of you awkward ever since.'
It also alleged that in 1997, Prof Tan competed directly with Dr Lim for the same prime space at Gleneagles Medical Centre.
Her lawyers claimed the unit was initially promised to Prof Tan in anticipation of his move to private practice. But Dr Lim persuaded the hospital to lease the unit to her and bought it in 2000.
Dr Lim's lawyers also argued that Prof Tan's job as chief executive of the SingHealth Group raises a possible conflict of interest. This is because the job means he has links to the Ministry of Health (MOH), which brought the complaint against her.
The letter said that the group's holding company, Singapore Health Services, is a wholly owned subsidiary of Ministry Of Health Holdings, for which Prof Tan is a director.
'You therefore answer to the Ministry of Health, Singapore, which was responsible for sending a letter of complaint regarding our client's fees to the chairman of the Complaints Panel of the Singapore Medical Council,' the lawyers said.
They then turned their attention to Prof Tan's alleged dealings with the director-general of medical services in Brunei. He is said to have signed an agreement with the Bruneian, a 'Dr Affendy', over a feasibility study which was to be carried out by SGH.
Dr Affendy was the one who met the Singapore authorities in July 2007 to discuss the size of Dr Lim's bills. This led to the events culminating in the disciplinary proceedings against her.
Dr Lim's lawyers also noted that Prof Tan was invited to participate in the decision to revoke the appointment of the first disciplinary committee and appoint a second one to continue the proceedings against Dr Lim.
Surgeon's lawyer: SMC took bills out of context
It was to divert attention from 'grave failings' of disciplinary process
By Selina Lum
THE Singapore Medical Council's (SMC) portrayal of Dr Susan Lim marking up certain bills is false, mischievous and scandalous, her lawyer told the High Court yesterday.
Senior Counsel Lee Eng Beng contended that SMC had taken the bills out of context to make sensational allegations and divert attention from the grave failings of its disciplinary process.
Last month, SMC's lawyer, Senior Counsel Alvin Yeo, had produced a table with allegedly inflated bills to show there was a case for a disciplinary committee to launch an inquiry against the surgeon.
Mr Yeo said third-party doctors who treated Dr Lim's patient, a woman member of the Brunei royal family, would send her their bills, but she inflated them when she billed the palace.
In one example, cancer specialist Dr Whang Hwee Young's bill for $400 was purportedly bumped up to $211,000 - a 'mark-up' of $210,600 or 526.5 times.
Yesterday, Mr Lee decried the 'waving of invoices' and allegations of 'fantastic mark-ups' which have created a media sensation, suggesting that Dr Lim must have been fleecing her patient and must therefore answer the charges.
Mr Lee said SMC treated the bills as though she was operating a one-woman clinic, when the truth was that they were bills for services provided by a substantial medical business.
He said the bills simply could not be read as relating to third-party doctors' fees alone and there was no evidence that anyone was misled by the bills.
Mr Lee noted that in three of the 14 bills highlighted by SMC in court as examples of mark-ups, the charges faced by Dr Lim were for overcharging, not for mark-ups.
The three were bills from Professor Lee Chuen Neng, a cardiothoracic surgeon; Dr Wong Sin Yew, an infectious diseases specialist; and Dr Whang.
As for the other five doctors, Mr Lee argued that SMC's contention that Dr Lim had marked up their bills and presented them in her own invoices as the amounts billed to her was 'false and misleading'.
The bills for these doctors were rendered by Dr Lim's companies, Group Surgical Practice (GSP) and Centre for Cancer Surgery (CCS), which were like main contractors, providing services to patients, including selecting and coordinating a team of third-party doctors.
The companies were not mere conduits but provided a complete package of third-party doctors' services to their clients.
Mr Lee said GSP and CCS, whose invoices for 2007 came up to $4.9 million, did not earn a huge margin from the bills.
Of the total amount, 64 per cent comprised the third-party doctors' fees and the remaining 36 per cent, or $1.8 million, were the gross fees for GSP and CCS.
He said it was absurd for SMC to take the words stated on the bills, for example, 'professional fees for Dr Chin Kin Wuu', to mean that the amounts in the invoice were to be paid to Dr Chin alone.
It would be clear, he said, that the figures stated were the fees charged by the corporate health-care provider, including the services of the third-party doctor.
Mr Lee argued that Dr Lim's bills were not exhaustive. For instance, she did not issue an invoice for a medical evacuation from Singapore to Brunei.
Mr Lee also countered Mr Yeo's portrayal of Dr Lim's giving of discounts to the patient, and eventually waiving her bills, as acting out of fear of disciplinary reprisals.
Mr Lee noted that Dr Lim's first discount on Aug 1, which reduced the total bill from $24.8 million to $12.1 million, was purely a commercial decision.
This was a case for the civil courts to decide a dispute over fees, not a disciplinary case, he said.
Mr Lee gave an example of another fee dispute between the Parkway Health Group and the United Arab Emirates Ministry of Health where the bill was settled for $17.2 million, half the amount originally charged.
In that case, both sides treated it as a purely commercial matter and no question of professional misconduct was raised.
Mr Lee also disputed Mr Yeo's assertions that in January 2009, Dr Lim had offered to waive all her fees if the Brunei Ministry of Health (MOHB) gave her a letter of good standing to say it took no issue with her bills.
Mr Lee said his client never offered to waive her fees and that Dr Lim was just hoping to get a letter from MOHB expressing its satisfaction with her professional standards.
Mr Lee criticised SMC for not trying to find out from MOHB what work was done by Dr Lim and the value of her work.
