A doctor was fined $20,000 by the Singapore Medical Council disciplinary tribunal for overprescribing codeine-containing cough mixtures (CCCMs) to three patients.<\/p>\n
Dr Chew Ee Hern Kevin, a doctor at Teban Garden Clinic, pleaded guilty to one charge of failing to provide professional services of the standard reasonably expected of a doctor.<\/p>\n
According to the published Grounds of Decision, the tribunal found that he had prescribed CCCMs to these patients despite patterns of repeated use that should have raised suspicions of dependence or addiction.<\/p>\n
Ministry of Health (MOH) guidelines state that patients should not be prescribed more than 240ml of a CCCM at one time, and where possible should not receive a repeat prescription within four days.<\/p>\n
The guidelines were introduced in 1996 to exercise greater control on the sale and supply of these mixtures and prevent potential abuse of codeine.<\/p>\n
Incidents highlighted by tribunal<\/p>\n
On Nov 16, 2020, a patient with cough symptoms saw Dr Chew and was prescribed 90ml of Promedyl, a CCCM. The patient visited the doctor on two other occasions, Nov 27, 2020 and Dec 14, 2020 and was prescribed with 240ml of Promedyl each time.<\/p>\n
The disciplinary tribunal highlighted that the repeated visits and CCCM prescriptions was a pattern of usage that should have raised suspicions of dependence.<\/p>\n
Separately two other patients had similar experiences with Dr Chew.<\/p>\n
One patient visited him on Nov 27, 2020 and was prescribed 240ml of Promedyl before returning on Nov 30, 2020 and being prescribed 120ml of Promedyl.\u00a0<\/p>\n
The patient had been prescribed CCCMs twice within a four-day period, breaching MOH’s guidelines.<\/p>\n
The patient had consulted Dr Chew three other times before Nov 27, 2020. On Oct 29 and Nov 3, 2020, he was prescribed Promedyl, while on Nov 13, 2020, he was prescribed 240ml of Fedac Co Syrup, another CCCM.<\/p>\n
Likewise, another patient saw the doctor three times in December 2020 and was prescribed a total of 510ml of Cophadyl-E Cough Linctus, a pattern of use potentially indicating dependence.<\/p>\n
Patients exposed to risks of codeine misuse<\/p>\n
The tribunal acknowledged that while the patients did not experience serious harm, the prescriptions nonetheless exposed them to risks of codeine addiction, abuse and misuse, which can lead to overdose and death.<\/p>\n
In one of the cases, the tribunal rejected the doctor’s defence that there was no reasonable explanation to doubt one of his patients who claimed to have lost his previous medication.<\/p>\n
It emphasised that the frequency and proximity of prescribing CCCMs on four occasions in the span of 30 days was “a clear red flag” which the doctor had ignored.<\/p>\n
However, the tribunal also noted that Dr Chew had not simply “rubber-stamped” requests for CCCMs and had advised patients on the potential risks of addiction, but found it regrettable that he continued to prescribe the medication.<\/p>\n
As such, the tribunal decided that a fine would be an adequate punishment.<\/p>\n
The doctor had also been previously penalised by the Health Sciences Authority for his conduct and paid an $18,000 fine in 2021, but this was not taken into account as it was separate from the disciplinary proceedings.<\/p>\n
Besides the $20,000 fine, the tribunal ordered that Dr Chew be censured, provide a written undertaking not to repeat similar conduct and pay the full costs of the proceedings.<\/p>\n
[[nid:728544]]<\/p>\n