Doctor suspended after diabetic patient with infected foot had leg amputated
Dr Lim Geok Leong, who has at least 40 years in medical practice, failed to refer the patient to a hospital or specialist during any of his five visits, despite the presence of conditions such as gangrene.
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SINGAPORE: A doctor has been suspended for 13 months after failing to refer his patient – who had an infected right foot – to the hospital's emergency department or a specialist for treatment.
The patient visited Dr Lim Geok Leong, a general practitioner, five times and later had to undergo amputations on his right leg. He can no longer walk now.
He was having conditions such as gangrene in his toes, necrosis or dead tissue, and cellulitis – a potentially serious bacterial infection.
Dr Lim, whose age was not disclosed in the grounds of the decision published on May 15, was practising at Central Medical Group in Bukit Merah in April 2022 when the patient visited him.
Looking at the foot's condition, Dr Lim assessed him to be suffering from severe and extensive cellulitis and severe diabetes.
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He prescribed the patient, who was not named in the judgment, with oral antibiotics and advised him to return for a review four days later.
The patient returned four more times in April and May 2022.
Each time, Dr Lim assessed that the condition remained unchanged or had improved since the last visit, and continued treating him with oral antibiotics and other medication.
He did not refer the patient to the emergency department of a hospital or a specialist.
PATIENT GETS SECOND OPINION
On May 10, 2022, the day after his fifth visit to Dr Lim, the patient sought treatment at another clinic not named in the judgment.
He was documented as suffering from extensive right foot "wet gangrene" on his third toe, extending to his second toe and the top of his foot, which was a severe infection.
The patient was admitted to the hospital from the clinic and underwent a series of "high-risk ascending amputations" to his right leg, which resulted in an irreversible loss of his ability to walk.
The patient also suffered complications related to limb amputations, but no further details were given in the judgment.
As a registered medical practitioner, Dr Lim was required to adhere to ethical guidelines, which include providing appropriate care and referring the patient to other doctors or institutions that can provide the most appropriate services.
The standards required Dr Lim to refer a patient with an active diabetic foot condition to the emergency department of a hospital immediately when certain symptoms are present.
These include signs of inflammation, pus from the wound or cellulitis, or wet gangrene.
In failing to refer his patient to a hospital on the day of each visit, Dr Lim departed from these standards, the disciplinary tribunal found.
The Singapore Medical Council sought a 14-month suspension for Dr Lim, while his lawyers asked for no more than 10 months' suspension.
An expert report stated that the doctor's failure to refer the patient at any of his five visits "significantly contributed to the risk of the patient having to undergo ascending serial amputations on his right leg".
The expert noted that for patients with diabetes and peripheral artery disease, a delay of more than 14 days from the time of primary care assessment and a medical procedure called revascularisation has been identified as an independent predictor of major amputation.
The patient's five consultations with Dr Lim spanned 29 days, more than double this duration, the tribunal noted. It was the patient himself who decided to consult a different doctor.
The tribunal agreed with the Singapore Medical Council that Dr Lim did not intentionally cause harm to the patient and that his misconduct constitutes "serious negligence".
Dr Lim was represented by Mr Eric Tin and Mr Samuel Lim from law firm Donaldson & Burkinshaw, who pointed out Dr Lim's unblemished record over a medical career spanning more than 40 years.
They submitted testimonials in the form of Google review comments to say that he was well-regarded and valued by his patients.
On top of Dr Lim's 13-month suspension, he will also be censured and have to give a written undertaking to the Singapore Medical Council that he will not reoffend.
He will have to pay the costs and expenses of the proceedings as well.
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