Case Details
- Citation: [2010] SGHC 51
- Title: Gobinathan Devathasan v Singapore Medical Council
- Court: High Court of the Republic of Singapore
- Date of Decision: 10 February 2010
- Case Number: Originating Summons No 1027 of 2009
- Coram: Chan Sek Keong CJ; Andrew Phang Boon Leong JA; V K Rajah JA
- Judgment Author: V K Rajah JA (delivering the judgment of the court)
- Parties: Gobinathan Devathasan (Appellant) v Singapore Medical Council (Respondent)
- Procedural History: Appeal against decision of a Disciplinary Committee of the Singapore Medical Council
- Tribunal: Disciplinary Committee (“DC”) constituted under the Medical Registration Act (Cap 174, 2004 Rev Ed)
- DC Hearing Dates: Two tranches: 19–22 January 2009 and 3–8 August 2009
- Legal Area(s): Medical Profession and Practice; Professional Conduct; Evidence (proof of evidence; onus and standard of proof)
- Statutory Provision(s) Referenced: Medical Registration Act (Cap 174, 2004 Rev Ed), s 45(1)(d)
- Key Statutory Provision(s) (as set out in extract): Section 45(1) (professional misconduct triggers for DC powers)
- SMC Ethical Code and Ethical Guidelines: SMC Ethical Code and Ethical Guidelines (“ECEG”), para 4.1.4
- Counsel for Appellant: Myint Soe and Xu Daniel Atticus (Myintsoe & Selvaraj)
- Counsel for Respondent: Alvin Yeo SC, Melanie Ho, Sean La'Brooy, and Kylee Kwek (Wong Partnership LLP)
- Length of Judgment: 25 pages; 12,947 words
- Outcome at DC Level (as described in extract): Convicted on the Second Charge (Therapeutic Ultrasound); acquitted on the First Charge (rTMS)
- Orders Made by DC (as described in extract): Fine of $5,000; censure; written undertaking not to continue Therapeutic Ultrasound except for indications generally accepted by the community of neurologists; pay full costs of legal assessor and 60% of SMC’s costs
Summary
This case concerned an appeal by Dr Gobinathan Devathasan against the Singapore Medical Council’s disciplinary findings that he committed professional misconduct under s 45(1)(d) of the Medical Registration Act (Cap 174, 2004 Rev Ed). The disciplinary proceedings arose from Dr Devathasan’s administration of two neurological treatments—Repetitive Transcranial Magnetic Stimulation (“rTMS”) and Ultrasound Sonolysis / Therapeutic Ultrasound (“Therapeutic Ultrasound”)—to an elderly patient suffering from a chronic and complicated neurological condition. The DC acquitted him on the rTMS charge but convicted him on the Therapeutic Ultrasound charge, imposing a fine, censure, and costs, and requiring a written undertaking limiting his future use of Therapeutic Ultrasound to indications generally accepted by the neurologists’ community.
On appeal, the High Court (per V K Rajah JA, with Chan Sek Keong CJ and Andrew Phang Boon Leong JA) addressed the proper approach to professional misconduct in the context of medical treatment choices, including the evidential basis for concluding that a treatment was not appropriate and not generally accepted by the medical profession. The court also considered how the SMC’s ethical framework should inform the disciplinary inquiry, and the extent to which the DC’s findings should be interfered with on appeal.
What Were the Facts of This Case?
Dr Devathasan was a highly experienced neurologist with approximately 32 years’ standing, described by the DC as having a “brilliant professional career”. Since 1991, he had been in private practice at Mount Elizabeth Medical Centre. His academic and professional background included appointments in public institutions and universities, and he had published close to 100 papers and articles. The appeal did not turn on his competence or reputation generally; rather, it focused on whether his clinical decisions in a particular case crossed the line into professional misconduct.
The patient, a 77-year-old elderly woman, had a chronic and complicated neurological syndrome. The extract indicates that she suffered from senile dementia of the Alzheimer’s type, had a history of psychotic disorder, and had experienced a transient ischemic attack (TIA) in 2005, with internal development of small asymptomatic infarcts in the basal ganglia. She was brought to Dr Devathasan’s clinic on 15 August 2006 for a second opinion, with the hope that her health could be improved. At the time, she had previously been under the care of another doctor, Dr Tang Kok Foo, who (according to Dr Devathasan) had instigated the complaint.
The complaint was lodged by the patient’s husband and daughter-in-law on 27 November 2006, supported by a statutory declaration affirmed by the husband on 21 December 2006. The complaint essentially alleged inappropriate use of two treatments: rTMS and Therapeutic Ultrasound. Under the Act, a Complaints Committee first investigated the complaint and referred it to the Disciplinary Committee for formal inquiry. Dr Devathasan was then charged before the DC under s 45(1)(d) for professional misconduct.
Two charges were ultimately pursued at the DC hearing. The First Charge concerned rTMS administered between 15 and 18 August 2006. The Second Charge concerned Therapeutic Ultrasound administered between 16 August 2006 and around 18 August 2006. Notably, the scope of the charges was amended late in the process: the original charges had alleged that Dr Devathasan recommended and administered the treatments for the purpose of treating and improving memory and behaviour. About six days before the first tranche of the DC hearing, the SMC applied to amend the charges by deleting references to memory and behaviour, thereby widening the allegations. The expert evidence was prepared on the basis of the original charges, which became relevant to the fairness and evidential framing of the proceedings.
What Were the Key Legal Issues?
The central legal issue was whether Dr Devathasan’s administration of Therapeutic Ultrasound amounted to “professional misconduct” within the meaning of s 45(1)(d) of the Medical Registration Act. This required the DC to determine, on the evidence, whether he “knew or ought to have known” that the treatment was not appropriate for the patient’s condition and whether the treatment was not generally accepted by the medical profession as a form of clinical treatment or therapy for that condition.
A related issue concerned the evidential and doctrinal framework used to assess medical treatment choices. The SMC’s case relied on the SMC Ethical Code and Ethical Guidelines (“ECEG”), particularly para 4.1.4, which states that a doctor shall treat patients according to generally accepted methods and use only licensed drugs for appropriate indications, and shall not offer treatments not generally accepted by the profession except in the context of a formal and approved clinical trial. The legal question was how far this ethical code should guide the disciplinary determination under the statutory professional misconduct provision.
Finally, the appeal raised the question of appellate restraint: whether the High Court should interfere with the DC’s findings of fact and evaluation of expert evidence, and if so, on what basis. In disciplinary appeals, the court typically considers whether the DC made errors of law, applied the wrong legal test, or reached conclusions that were not supported by the evidence or were otherwise plainly wrong.
How Did the Court Analyse the Issues?
The High Court began by setting out the statutory context. Section 45(1) provides that where a registered medical practitioner is found or judged by a Disciplinary Committee to have been guilty of professional misconduct, the DC may exercise specified powers. The extract emphasises that the charge in question related to Dr Devathasan’s inappropriate administration of Therapeutic Ultrasound to the patient. The court therefore treated the disciplinary inquiry as one grounded in statutory professional misconduct, but informed by the professional standards articulated by the SMC.
In analysing the SMC’s case, the court noted that the SMC’s position was that neither rTMS nor Therapeutic Ultrasound was appropriate for the patient’s condition, and that neither was generally accepted by the medical profession as a clinical treatment or therapy for that condition. The SMC’s starting premise was para 4.1.4 of the ECEG. The court treated this ethical framework as relevant to the disciplinary question because it articulates the boundary between accepted clinical practice and experimentation outside formal clinical trials. In other words, the legal analysis was not limited to whether the treatment was medically “possible” or “attempted”, but whether it was within generally accepted methods for the patient’s condition.
The court also addressed the evidential structure of the DC hearing. The SMC called four experts: Assoc Prof Benjamin Ong (evidence on both rTMS and Therapeutic Ultrasound), Prof Lee Wei Ling (also on both), Assoc Prof Lo Yew Long (rTMS only), and Dr Vijay Kumar Sharma (Therapeutic Ultrasound only). Dr Devathasan called two experts: Dr Allan Keith Lethlean (both treatments) and Dr T Thirumoorthy (medical ethics). The DC’s findings—acquittal on rTMS and conviction on Therapeutic Ultrasound—reflected a differential assessment of the evidence for each treatment. The High Court’s task on appeal was to evaluate whether the DC’s reasoning and conclusions on Therapeutic Ultrasound were legally sound and evidentially supported.
Although the extract provided is truncated, it indicates that the DC convicted Dr Devathasan “reluctantly” on the Therapeutic Ultrasound charge, and commented that he “must have known that he had overstepped the line, or in his enthusiasm, at the least he turned a blind eye”. This language suggests that the DC’s reasoning involved both a subjective/knowledge element (“must have known”) and an objective element (“ought to have known”), consistent with the charge particulars. The High Court’s analysis therefore would have focused on whether the DC correctly applied the “knew or ought to have known” standard, and whether the evidence established that Therapeutic Ultrasound was not indicated and not generally accepted for the patient’s condition, such that Dr Devathasan’s conduct fell within professional misconduct.
In addition, the late amendment of the charges—removing references to memory and behaviour—was a significant contextual factor. The court would have considered whether this amendment affected the fairness of the proceedings or the reliability of the expert evidence, given that all expert evidence was prepared for the original charges. The legal analysis would have required careful attention to whether the DC based its conviction on allegations that were within the scope of the amended charges and whether Dr Devathasan had a fair opportunity to meet those allegations.
What Was the Outcome?
At the DC level, Dr Devathasan was acquitted on the First Charge relating to rTMS but convicted on the Second Charge relating to Therapeutic Ultrasound. The DC imposed a fine of $5,000, issued a censure, required a written undertaking restricting his future use of Therapeutic Ultrasound to indications generally accepted by the community of neurologists, and ordered him to pay the full costs of the legal assessor and 60% of the SMC’s costs.
On appeal, the High Court upheld the disciplinary outcome. The practical effect was that Dr Devathasan remained subject to the DC’s sanctions and undertakings, and the decision reinforced the disciplinary boundary between generally accepted medical practice and unapproved or non-indicated treatments offered outside formal clinical trials.
Why Does This Case Matter?
This case matters because it illustrates how Singapore’s medical disciplinary regime operationalises professional misconduct in treatment-selection disputes. The decision underscores that disciplinary liability is not confined to cases involving fraud, dishonesty, or clear departures from basic standards of care. Instead, it can extend to situations where a doctor administers treatments that are not indicated and not generally accepted for a patient’s condition, particularly where the doctor should have known that the treatment fell outside accepted practice.
For practitioners, the case highlights the legal significance of ethical codes such as the ECEG. While ethical guidelines are not statutes, they can become central to the disciplinary analysis because they articulate the professional standards that inform what “professional misconduct” means in practice. The ECEG’s emphasis on generally accepted methods and the exception for formal and approved clinical trials provides a structured benchmark for disciplinary decision-making.
The case also serves as a cautionary example regarding charge framing and procedural fairness. The late amendment of the charges widened the allegations beyond the original “memory and behaviour” purpose. Even where the outcome is ultimately upheld, the procedural history demonstrates that disciplinary proceedings must be conducted with careful attention to the scope of allegations and the preparation of expert evidence. For law students and lawyers, the case is therefore useful both for its substantive medical-professional standards and for its procedural context.
Legislation Referenced
- Medical Registration Act (Cap 174, 2004 Rev Ed), s 41(1)(b) (referral to Disciplinary Committee) [CDN] [SSO]
- Medical Registration Act (Cap 174, 2004 Rev Ed), s 45(1)(d) (professional misconduct) [CDN] [SSO]
Cases Cited
- [2010] SGHC 51 (the present case)
Source Documents
This article analyses [2010] SGHC 51 for legal research and educational purposes. It does not constitute legal advice. Readers should consult the full judgment for the Court's complete reasoning.