SINGAPORE: A psychiatrist was found guilty on Monday (May 13) of three counts of professional misconduct for deviating from relevant standards when prescribing various drugs to patients.
These include prescribing the drug in excess of the maximum dose listed on the package insert.
The case involving Dr. An Yong Guan relates to a series of prescriptions for a patient named Kwek Kiat Siong, who died four days after the last prescription was issued in 2012.
The cause of death was “multiple organ failure accompanied by pulmonary hemorrhage due to mixed drug intoxication.”
Court documents state that drug concentrations in his blood were found to be “elevated above therapeutic concentrations seen in living subjects.”
Mr Quek’s sister filed a complaint against Dr Ang with the Singapore Medical Council (SMC) in 2017.
However, the disciplinary tribunal acquitted Dr. Ang of professional misconduct and instead found him guilty of failing to provide a professional service of the quality that could reasonably be expected of him.
This was overturned on Monday by a three-judge tribunal, which found that Dr Ahn had exceeded the applicable dose limit and could not justify his decision to deviate from the standard. said.
The court, comprising Chief Justice Sundaresh Menon, Justice Belinda Ang and Justice Tay Yong Kwan, will hear arguments at a later date on the appropriate sanctions to be met.
what happened
Mr. Quek first saw Dr. Ahn on February 8, 2010, after being referred by another doctor.
Dr Ang, who is also a member of the Progressive Singapore Party, spent nearly two years treating Mr Quek for multiple conditions including insomnia, depression, post-traumatic stress disorder and anxiety.
The patient was prescribed multiple benzodiazepines concurrently, a benzodiazepine and an opioid analgesic, and was taking excessive amounts of mirtazapine and zolpidem extended release.
Benzodiazepines are depressants that relieve anxiety. Mirtazapine is used to treat symptoms of depression, and zolpidem is prescribed for insomnia.
One of the three charges relates to a final prescription issued on July 31, 2012.
It was for a daily dose of 60 mg of mirtazapine, which exceeded the maximum permitted daily dose of 45 mg, and a daily dose of 25 mg of zolpidem extended-release tablets. This exceeded the maximum permissible daily dose of 12.5 mg.
Mr Quek died four days later.
judgement
Dr Ang admitted that the prescription of 60mg of mirtazapine per night was at the “end of the lethal range”, but did not explain why he thought it was worth the risk to the patient.
“The benefits of his prescriptions must outweigh or justify the risks assumed, and Dr. Ahn has not explained why that is the case in this case,” the three-judge court said.
They wrote in their ruling that prescribing mirtazapine or zolpidem extended-release drugs above the prescribed maximum dose poses little risk when taken alone, but patients may also be taking a variety of other drugs at the same time. He added that it is necessary to keep in mind that there are
The other two charges relate to prescriptions issued between February 8, 2010 and December 31, 2011. and from January 1, 2012 to July 31, 2012.
Dr Ang’s decision to switch antidepressants without ensuring each antidepressant was continued for at least four to six weeks is inconsistent with guidelines issued by the Ministry of Health.
He also violated guidelines for long-term chronic use of benzodiazepines by prescribing a six-month supply of benzodiazepines to a patient.
The court found that some of his decisions to deviate from the guidelines were “objectively defensible,” while others were not.
The court stated in its decision that although doctors may deviate from the standards adopted by the medical profession, the onus is on doctors to demonstrate that their decisions are objectively justified in terms of risks and benefits. Stated.
The SMC’s disciplinary tribunal declined to convict Dr Ahn of professional misconduct, concluding that his decision did not amount to a willful and deliberate deviation from the standard of care.
The newspaper said the psychiatrist showed Quek “care and consideration” and “sought to meet the standards” expected of him.
However, the three-judge tribunal ruled that “care and consideration” for patients was irrelevant to an investigation into professional misconduct.
