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Psychiatrist Ang Yong Guan found guilty of misconduct over prescriptions that deviated from guidelines
Selina Lum
SINGAPORE â Psychiatrist Ang Yong Guan has been found guilty of three counts of professional misconduct for departing from guidelines in prescribing various medications to a patient.
Dr Ang is also assistant secretary-general of the Progress Singapore Party, and contested the Marymount seat in the 2020 General Election.
The current case concerned a series of prescriptions Dr Ang had given a former patient, Mr Quek Kiat Siong, which did not conform with guidelines issued by the Ministry of Health (MOH).
Mr Quek died of multiple organ failure four days after the last of these prescriptions was issued in 2012. He was 50 years old.
The final prescription included a daily dosage of 60mg of antidepressant medication mirtazapine, which Dr Ang acknowledged went to the âedge of the killing rangeâ.
The patientâs sister lodged a complaint with the Singapore Medical Council (SMC), which brought three disciplinary charges against Dr Ang.
But a disciplinary tribunal acquitted Dr Ang of professional misconduct and instead found him guilty of failing to provide professional services of the quality that is reasonably expected of him.
On May 13, the Court of Three Judges overturned the tribunalâs decision, and found him guilty of professional misconduct. Dr Ang had appealed against his conviction on the alternate charges, while the SMC appealed against the acquittal and argued for a three-year suspension.
In its written judgment, the court ruled that Dr Angâs departures from the guidelines in relation to various prescriptions amounted to misconduct because he was unable to justify those decisions.
The patient had concurrent prescriptions of multiple benzodiazepines, concurrent prescriptions of benzodiazepines with opioid painkillers, and excessive dosages of mirtazapine and a controlled-release form of zolpidem. Benzodiazepines are depressants, while zolpidem is used to treat insomnia.
The court, which comprised Chief Justice Sundaresh Menon, Justice Belinda Ang and Justice Tay Yong Kwang, will hear arguments at a later date on the appropriate sanctions to be meted out.
Under the Medical Registration Act, doctors found guilty of professional misconduct can be struck off the register, suspended or ordered to pay a penalty, among other things.
Dr Ang, who runs his own practice, Ang Yong Guan Psychiatry, began treating Mr Quek on Feb 8, 2010, for various conditions, including insomnia, depression, post-traumatic stress disorder, obsessional ruminations and anxiety.
His final prescription was issued on July 31, 2012, four days before Mr Quek died on Aug 4 that year.
The cause of death was certified as âmulti-organ failure with pulmonary haemorrhage, due to mixed drug intoxicationâ.
The concentration of drugs in the patientâs blood was found to be âelevated beyond the therapeutic concentrations found in living subjectsâ.
After Mr Quekâs death, his sister sued his insurers, which had denied liability under two personal accident policies. She argued that he died as a result of accidental drug interactions, but the insurer denied that the death was accidental.
In 2017, the Court of Appeal ruled in favour of Ms Quek and ordered the insurers to pay out the sums under the policies. The court found that the most likely scenario was that Mr Quek had taken his medication as prescribed.
Ms Quek then filed a complaint with the SMC against Dr Ang in April 2017.
The first charge brought against Dr Ang pertained to prescriptions issued between Feb 8, 2010, and Dec 31, 2011, while the second charge concerned prescriptions issued between Jan 1, 2012, and July 31, 2012.
The third charge concerned the final prescription issued on July 31, 2012.
It was for a daily dosage of 60mg of mirtazapine, which exceeded the permitted maximum daily dosage of 45mg, and for a daily dosage of 25mg of controlled-release zolpidem, in excess of the permitted maximum daily dosage of 12.5mg.
It was not disputed that Dr Ang had made such prescriptions, and that these prescriptions were inconsistent with both the guidelines issued by MOH and the package inserts in the medication.
The SMCâs disciplinary tribunal had concluded that Dr Angâs conduct did not amount to an intentional and deliberate departure from the standards of treatment, as he had shown âcare and concernâ for the patient and had âattempted to meet the standardâ expected of him.
In its judgment, the court said that while doctors may depart from codified standards adopted by the medical profession, the burden falls on them to demonstrate that the departure is objectively justified in terms of the risks and benefits.
The court added that in cases where there is significant risk from the patientâs perspective, the doctor would have to show that the patient had been informed of the risks, even if they were objectively outweighed by the benefits.
The court found that on the first two charges, Dr Ang had shown that some of his decisions to depart from the guidelines were objectively justifiable, while others were not.
As for the third charge, the court said Dr Ang was unable to demonstrate that his prescription of mirtazapine and zolpidem in excess of the stated maximum dosages was objectively justifiable.
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