Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18 Jun

[Mdm Tang]

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Brothers Where Are The Links To Dr Susan Lim's Old Threads

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http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_681222.html


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Jun 18, 2011
Dr Susan Lim's charges reasonable, says expert
Amount is in line with the surgeon's past earnings, according to his report
By Salma Khalik, Health Correspondent



The report by forensic accounting expert Owain Stone concluded that Dr Susan Lim's actual charges amounted to $6,484 an hour. This was well below the rate of $12,800 if he were to use the 2006 revenue earned by her company. He also concluded that if Dr Lim had not looked after her Bruneian patient, her group could have expected a daily revenue of $46,000. -- PHOTO: THE BUSINESS TIMES



DR SUSAN Lim's $12 million bill for treating her Brunei patient over a six-month period was reasonable based on her past earnings, said a forensic accounting expert in a report last year.

In his analysis, the accountant also benchmarked Dr Lim's fees against that earned by a top British surgeon who also saw the same patient; the salary of Singapore's Defence Minister, Dr Ng Eng Hen, before he joined the Government; and the amount made by top local earners in other professions.

These findings were submitted by Mr Owain Stone of KordaMenthaNeo in a 31-page expert report for the Singapore Medical Council hearing against Dr Lim.

The report was commissioned by Dr Lim, but Mr Stone states that he is aware that his 'primary duty is to the disciplinary tribunal' and not to the person who pays him.

The report, dated Jan 20, 2010, concluded that Dr Lim's actual charges amounted to $6,484 an hour.

This was well below the rate of $12,800 if he were to use the 2006 revenue earned by her company, he concluded.

Read the full story in Saturday's edition of The Straits Times.




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In her own words


•On the media attention over her case:'It's like I'm in some prolonged Halloween party and I've been masqueraded in a cloak of scandal.'


•On the true wishes of her patient:'This is the problem when the patient is not alive. If she were alive, she would say this is exactly what I wanted. It's because people now looking at the bills were not privy to what happened in those years.'


•On the impact of the case on her business: 'From being the most successful private practice in two locations, with a staff of 33, research labs, overseas collaborations, business ventures, we are now technically bankrupt.'


•On how she reacted to the allegation of overcharging:'So okay, don't pay me then. And that was what was (my attitude). If you have any issue, don't pay me because I have my pride, but I can't say anything about the third-party costs, I'm not responsible for them.'


•On going to Brunei to treat her patient:'It's an experience to be in a palace; we are common citizens, after all. It's such an experience, it was overwhelming.'

On how she risked damage to her vision to treat the patient while still recovering from a detached retina:'My staff met me at the Hyatt, they guided me up the lift, I was supported on both sides, I was wearing my eye patch, and I was walking like this (with head down). Honestly, the Hyatt people know me as the doctor with the one eye patch and the oxygen tanks.

'There I was, with that 20 minutes' allowance time when I could lift my head up to speak. Me, with my whole surgical career on a knife's edge because - would I ever see again? And there she was, breathless.'


•On how she is coping emotionally:'This is not an emotional exercise. Let me tell you what's emotional. When you've been in my business for the last 30 years, 'emotional' is when you wake up one morning and you're faced with a diagnosis of cancer, and your world crumbles.

'And then it's so emotional because, at the end of the day, you realise you don't have a handle on your destiny.'



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Timeline of the case


•August 2007: The patient, Pengiran Anak Hajah Damit, dies.


•July 2007: Brunei seeks Singapore's help after receiving the $24.8 million bill sent by Dr Susan Lim's office.


•August 2007: Dr Lim gives a discount which brings the bill down to $12.1 million.


•January 2010: The Singapore Medical Council (SMC) starts disciplinary hearings.


•July 2010: The disciplinary committee (DC) steps down after being accused of pre-judging the case.


•September 2010: SMC convenes a new DC to hear the case.


•February 2011: Start of the judicial review by the High Court, sought by Dr Lim

•May 31: Court finds in favour of the SMC.


•June 30: Dr Lim has to decide by this date if she wants to appeal against the verdict.



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[Mdm Tang]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

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http://sg.news.yahoo.com/blogs/sing...hnically-bankrupt-dr-susan-lim-053252735.html

My practice is technically bankrupt: Dr Susan Lim
By Faris Mokhtar | SingaporeScene – Fri, Jun 17, 2011
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My practice is technically bankrupt: Dr Susan Lim



Dr Susan Lim explains her side of the story about allegations that she overcharged a Bruneian patient. (Photo screengrab …

Susan Lim, the prominent Singaporean doctor facing an inquiry on alleged overcharging of a patient related to the Brunei royal family, has broken her silence on the scandal to give her side of the story.

Earlier this year, the Singapore Medical Council (SMC) alleged in court that Dr Lim had grossly marked up her bills to her wealthy Bruneian patient, the sister to the Brunei Queen.

In a ruling late last month, the High Court dismissed Dr Lim's applications to block the SMC from forming a second disciplinary committee to look into the complaint of overcharging, as the court found no indication of alleged impropriety, illegality or bias on the part of the SMC.

Her practice, which was once deemed the most successful private surgical practices in Singapore, is now technically bankrupt, she told The Business Times in her first ever media interview since news broke out on her story.

For her part, Dr Lim pointed out to a detailed report produced by a firm specialising in forensic accounting which concluded that the daily breakeven cost for her practice, over a six-month period in 2007, during which she worked intensely on the patient, amounts to $46,000.

This compares to the $58,000 daily charges which she billed the patient for, which included overtime pay and work done outside of Singapore not factored into the calculation of the $46,000.

"So I ask you, where are the huge profits? This was a huge loss-making assignment," said Dr Lim who performed the first successful liver transplant in Singapore in 1990.

As her bills for the work done for the Brunei patient are in dispute, she has yet to be paid, with Dr Lim adding that, since then, her practice has reached a "very sad and sorry state".

"From being the most successful private practice in two locations, with a staff of 33, research labs, overseas collaborations, business ventures, we are now technically bankrupt," she said.

And if not for the interest-free loans that both she and her family had loaned to the company, it would have been shut down, she claimed. Dr Lim said they have injected about $4 million into the company, as of today.

"And my 33 staff would have been out of jobs since 2008. And their families would have been in difficult situations," she added.

"So, I'm asking you, if this was such an amazing assignment, gosh, you wouldn't want this kind of conclusion. It doesn't' seem right."

What about the high mark-ups?

In the High Court hearing, it was alleged that on numerous occasions Dr Lim took the invoices sent to her by third-party specialists, inflated them and then billed her patient based on these charges. In one case, she allegedly marked up a $400 bill to $211,000 — almost 500 times.

Dr Lim's lawyer, senior counsel Lee Eng Beng, then described the allegations as "false and mischievous", and that the reading of the bills were taken out of context and should include other services provided at the time.

Giving her account, Dr Lim said that she had arranged the patient to be reviewed by oncologist Dr Whang Whee Yong who prescribed the medication required and then left.

But Dr Lim stayed back — for a total of three days — to see how the patient would respond to the chemotherapy treatment.

Since one of the days happened to be a public holiday — June 2 — Dr Lim said she had to accompany the patient at Hyatt hotel to make sure the treatment went well as the patient did not want to remain in the hospital.

"So, when I render a bill related to this episode of chemotherapy (which amounted to $211,000), it is a bill for my time and my staff's time — looking after her and ensuring there are no complications and the treatment goes well. So where does this alleged mark-up come from?" she argued.

She also dismissed the allegation that she had also offered discounts to her original bill of $24.8 million upon learning that the Brunei health ministry was unhappy with her charges.

"I never ever changed that $12.1 million that I asked for on 1 August 2007," she said.

Issue of trust?

"Doctors are very dispassionate…but you cannot help but feel sad that this engagement had come to an end because this patient's life was coming to an end, after all these years of looking after her."

She added that as a gesture to the patient-doctor relationship, she would reduce the final billing from $24.8 million to $12.1 million, but this was exclusive of the $3.25 million of raw third-party costs.

But when Dr Lim first heard that there were concerns about her charges, she decided to request for only the $3.25 million to be paid.

"So, okay, don't pay me then. And that was what was (my attitude): 'If you have any issue, don't pay me because I have my pride, but I can't say anything about the third-party costs, I'm not responsible for them.'

"The business of medicine is based on trust between the doctor and the patient that once you agree the terms of the relationship, you don't go about collecting progress payments, asking for deposits, because, had I done that in 2007, this issue would never have arisen," said Dr Lim, who also oversaw the treatment of her patient days after she herself had an eye surgery.

"Had I demanded payment of all my bills before sending her back to Brunie, they would've paid handsomely, and we would not be sitting here today and I would be telling a different story about my research," she said.

 

[Leongsam]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

Have you tried using the search function you twit?

Brothers Where Are The Links To Dr Susan Lim's Old Threads

 

[johnny333]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

Poor thing, it's so hard to make a few million

After all it's only 12 million & everyone knows the high cost of doing bizniss in Spore

 

[scroobal]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

She is really a silly women and digging a deeper hole. With all the billings and yet she is struggling financially. Balji really giving her bad advice.

 

[Avenger]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

Shhhh.. don't tell our ministers about daily charge of 58K by Susan Lim!! They may peg their salary to it soon.. now it is only 10K per day!

 

[Mdm Tang]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

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http://www.businesstimes.com.sg/sub/news/story/0,4574,443754-1308340740,00.html?
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Business Times - 17 Jun 2011


Susan Lim counts the cost, says that her practice is technically bankrupt

By MICHELLE QUAH

(SINGAPORE) These past few months have been utterly surreal for her, says Susan Lim. But the damage has been concrete. It can even be measured in dollars and cents.

Her practice, once among the most successful private surgical practices in Singapore, is now technically bankrupt, she says.

Speaking to The Business Times in her first media interview since the saga involving allegations of 'mark-ups' began, Dr Lim says with a hint of wonder: 'It's like I'm in some prolonged Halloween party and I've been masqueraded in a cloak of scandal.'

The 'scandal' made news with the Singapore Medical Council (SMC) alleging in court earlier this year that Dr Lim had grossly marked up her bills to her wealthy Bruneian patient, in one case by as much as 500 times - a point she has strenuously contested.

'This is the problem when the patient is not alive.' Her patient - the younger sister of the Queen of Brunei - died in August 2007.

'If she were alive, she would say this is exactly what I wanted. It's because people now looking at the bills were not privy to what happened in those years.'

She points to a detailed report produced by KordaMentheNeo's Owain Stone, an expert in forensic accounting, which concludes - among other things - that the daily breakeven cost for Dr Lim's practice, over a six-month period in 2007 during which she worked intensely on the patient, amounts to $46,000.

This compares to the $58,000 a day she billed the patient for, which included overtime pay and work done outside Singapore not factored into the calculation of the $46,000.

'So I ask you, where are the huge profits? This was a huge loss-making assignment,' Dr Lim says.

'When you take on a job like this, whatever the fee - however big, however small - it is a one-time payment. It cannot compensate for the loss to the practice, the loss of new patients, existing patients, putting your other businesses on hold, stopping technology transfer and development. And we are seeing that, we are still trying to catch up. (But) it's not possible.

'And, since the non-payment of the bills, we've reached a very sad and sorry state.'

All of Dr Lim's bills for work done for her Brunei patient in 2007 are in dispute and not paid.

'From being the most successful private practice in two locations, with a staff of 33, research labs, overseas collaborations, business ventures, we are now technically bankrupt. And if not for the interest-free loans that my family and I have loaned to the company, we would be shut down. And my 33 staff would have been out of jobs since 2008. And their families would have been in difficult situations.'

Dr Lim has injected about $4 million into the company, as of today. 'So, I'm asking you, if this was such an amazing assignment, gosh, you wouldn't want this kind of conclusion. It doesn't seem right,' she says.

According to evidence she has submitted to court, a pricing analysis report prepared by KPMG valued Dr Lim's business at between $85.4 million and $103 million, as at the end of 2006. It is her case that, applying the same formula to 2008 figures, her business would be valued at no more than $11.69 million - a $73.7 million destruction of value, at the very least.

And then, there's the matter of clearing her name.

The SMC has alleged that Dr Lim, on numerous occasions, took the invoices sent to her by third-party specialists, inflated them considerably and then sent them on to her patient. In one case, she has been accused of marking up a $400 bill to $211,000 - almost 500 times.

'This one really sticks with me,' she says. By her account, the patient arrived in Singapore on June 1, 2004, with advanced-stage cancer that left her unable to walk. Dr Lim, who had undertaken to be the patient's primary physician attending to all her needs, arranged for oncologist Whang Whee Yong to review the patient. After Dr Whang prescribed the medicine and left, she stayed back to see how the patient would respond to the treatment.

'So, I sat with her for three days - 1st, 2nd and 3rd of June - all throughout the treatment.' She was also in attendance in the Hyatt hotel because the patient didn't want to stay in the hospital on one of those days - June 2 - which was a public holiday, to make sure the treatment went well.

'So, when I render a bill related to this episode of chemotherapy (which amounted to $211,000), it is a bill for my time and my staff's time - looking after her and ensuring there are no complications and the treatment goes well. So, where does this alleged mark-up come from?'

SMC also says that Dr Lim had offered a flurry of discounts - from that original $24.8 million - upon learning that Brunei was unhappy with her charges.

Dr Lim counters this by saying: 'I never ever changed that $12.1 million that I asked for on Aug 1, 2007.

'Doctors are very dispassionate...but you cannot help but feel sad that this engagement had come to an end because this patient's life was coming to an end, after all these years of looking after her.

'And so, when I finally totalled up and looked at the bills, I felt that, as a gesture to the relationship, I would reduce the final billing to $12.1 million - and that was inclusive of $3.25 million of raw third-party costs.'

And when she first heard that someone was upset about her bills, she decided to ask only for this $3.25 million, she says.

'So OK, don't pay me then. And that was what was (my attitude). 'If you have any issue, don't pay me because I have my pride, but I can't say anything about the third-party costs, I'm not responsible for them'.'

'The business of medicine is based on trust between the doctor and the patient. That once you agree the terms of the relationship, you don't - and I don't - go about collecting progress payments, asking for deposits, because, had I done that in 2007, this issue would never have arisen. Had I demanded payment of all of my bills before sending her back to Brunei, they would've paid handsomely, and we would not be sitting here today and I would be telling a different story about my research,' she said.




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[Mdm Tang]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

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http://www.businesstimes.com.sg/sub/news/story/0,4574,443753-1308340740,00.html?

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Business Times - 17 Jun 2011


'My whole surgical career was on a knife's edge'

Susan Lim describes the tumultuous years of treating a remarkable patient

By MICHELLE QUAH

(SINGAPORE) Susan Lim says she is known to the Hyatt staff as the doctor who goes up and down the hotel with oxygen tanks, and the one who once wore an eye patch - thanks to the fact that she often had to turn up at the hotel to meet her Bruneian patient's demands, no matter what.

She says that, for the only time in her career, she had to be much more than a surgeon and physician to her patient, ready to manage even her most idiosyncratic of needs.

'She first came to me in October 2001, with advanced breast cancer. Somebody as powerful and able to access any doctor in the world - why would she come (to me) with advanced, stage four breast cancer?

'I think this is important because it underlies the entire crux of the case: she was a very, in a sense, strong woman, with her own strong views.

'She really did not like doctors, and I guess she was in denial. For her to wait this long, tells you a lot about what eventually brought her to see me. She didn't accept what had been offered to her previously, so she came.'

Not that Dr Lim proved to be immediately popular. After she performed the needed surgery and referred the patient to an oncologist for a follow-up, she thought that was the end of it. She later found out her patient had refused follow-up treatment.

On a social visit to Brunei in 2004, Dr Lim was approached by the Queen herself. 'The Queen said to me, 'Professor' - they call me professor - 'can you please look at my sister?' I said, 'How can I help?' And she said, 'My sister cannot walk'.'

Dr Lim said she diagnosed that the cancer had spread to the patient's spine and that, if the patient refused to be treated in Brunei, she had to come to Singapore.

Her patient said: 'Professor, I will come to Singapore, if you promise not to do to me what you did to me in 2001.'

'I was aghast because I thought I had done everything good for her. What was she now accusing me of? She said, 'Professor, you sent me to another doctor. You didn't take responsibility for me. If I come back to you in Singapore, you promise me you will look after me, because I trust you.' '

She adds: 'It's an experience to be in a palace; we are common citizens, after all. It's such an experience, it was overwhelming.'

Her patient's demands continued even when Dr Lim herself became seriously ill, she said.

'In 2006, I was skiing - that's a big pastime of mine - and I fell. I hit the left side of my face. I was wearing a helmet. My goggle dislocated and essentially I had this huge bruise on my face. I skied back with my daughter Christina holding a block of ice to my face.

'But suddenly, coming down the elevator, I started to see stars. And it was like a curtain falling on one of my visual fields - my left. So, being a doctor, I diagnosed, 'Oh God, this is that giant retinal detachment I've read about!' '

Dr Lim said she had to go for surgery immediately - a procedure which saw the removal of the lens from her left eye. A gas bubble was put in her eye to close the retina, but she was told to lie face down for at least six weeks so that it wouldn't float forward and destroy the cornea.

But, on the third day, Dr Lim got a call from the palace to tend to her patient. 'My staff met me at the Hyatt, they guided me up the lift, I was supported on both sides, I was wearing my eye patch, and I was walking like this (with head down). Honestly, the Hyatt people know me as the doctor with the one eye patch and the oxygen tanks.

'There I was, with that 20 minutes allowance time when I could lift my head up to speak. Me, with my whole surgical career on a knife's edge because - would I ever see again? And there she was, breathless.'

For 14 days, while the patient was in hospital, Dr Lim made daily trips from Singapore General Hospital, where she herself was warded, to oversee the treatment.

'And, finally, when (my patient) left for Brunei, listen to what she said to me: 'Professor, I recovered before you.' I didn't know what to say.'

The result of all that was a close relationship with the palace: 'I was a part of that family, I had been a part of that family for six years.'

'And I think that, in that last year of her life, we gave her what she wanted. She wanted time to be with her family, she wanted respect, and she wanted dignity.'

In August 2007, the patient died but Dr Lim's own troubles were just beginning.

She had sent her final discounted bill of $12.1 million to Brunei's Ministry of Health (MOHB), which expressed some concern over it and wrote to Singapore's Ministry of Health.

At one point, she says her pride came to the fore and she asked for just third-party bills of $3.25 million to be paid.

Meetings in 2009 failed to resolve the issue and in January 2010 she was asked to appear before the Singapore Medical Council's (SMC) disciplinary committee (DC).

The DC recused itself in July, but in September a second DC was convened. She decided to apply for a judicial review.

'People read the papers and think, 'That Susan Lim - so arrogant. She doesn't even want to go before the disciplinary committee. Who the hell does she think she is?' '

'But how wrong,' Dr Lim says. 'I, as a law-abiding Singaporean, I submitted myself. When the disciplinary committee wrote to me, I said okay, I have nothing to hide, I will go through the disciplinary process.'

For the first DC's hearing, she says her team was allocated three days, from July 29 that year, to present their side.

'Man, we worked hard for it. I remember staying up until 2am, putting the facts together. We blocked the clinic on July 29, which means we cancelled all our appointments. And we were all set to go. And then the tribunal comes in and says they've made their decision and unless you have anything more to add, we will deliver our decision. What do you say to that?' said Dr Lim.

The first DC had received Dr Lim's written submissions some days earlier. According to transcripts from the hearing, after the tribunal announced that it had come to a decision, Dr Lim's lawyers asked the DC to recuse itself - which, after some consideration, it agreed to. And the SMC then proceeded to set up a second DC to look into the allegations that Dr Lim had overcharged her patient.

The High Court, in a ruling late last month, dismissed Dr Lim's applications to prevent the SMC from trying her case, saying it found no indication of the alleged impropriety, illegality or bias on the part of the SMC.

The patient is dead, the saga rages on. Meanwhile, friends ask Dr Lim how she is, emotionally. 'This is not an emotional exercise,' she says. 'Let me tell you what's emotional. When you've been in my business, for the last 30 years, 'emotional' is when you wake up one morning and you're faced with a diagnosis of cancer, and your world crumbles. You're on an emotional roller-coaster ride - from denial ('it's not me') to surgery ('can you get it all out, doc?') to chemotherapy; to 'will it come back again?', and then to 'how much longer do I have, how many more days, how many more weeks?'

'And then it's so emotional because, at the end of the day, you realise you don't have a handle on your destiny.'



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[myo539]

Re: Old Threads Missing ??? Dr Susan Lim's Charges Reasonable, Says Expert - S T 18

$12 million dollars (after discount) for the life of a princess. Is it worthwhile?

Now we understand why doctors demand payment first. Once they go home, or the patient dies, it's difficulty to get them to pay. Doctors are here to save lives, but they are not here to run charity.