Doctor fined $2500? (Only?)

Read this in the papers today.

A doctor's delinquency

Mismanagement of Subutex prescriptions results in $2,500 fine

A DOCTOR in Woodlands has been found guilty of failing to properly administer Subutex — the first such case since the medicine was listed as a controlled drug in August.

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It is believed that several other doctors are under investigation for the same reason by the Singapore Medical Council (SMC).

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Dr John Heng Kuo Leng was fined $2,500 by the SMC and given a stern warning for mismanaging 19 of his patients.

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Incidentally, this is not the first time the 47-year-old general practitioner from First Medical Clinic and Surgery has been censured.

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In 2004, he was suspended by the SMC for 18 months for dispensing addictive cough mixtures and sleeping pills too freely at his clinic in Woodlands Street 11.

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This time round, one of the charges levelled at the doctor is that he did not record and provide sufficient patient details and results of the diagnosis.

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A council disciplinary inquiry last week found him guilty of mismanaging the 19 patients between December 2002 and February 2004.

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"The (council) unanimously found that the medical record of each of the patients concerned was very scanty and did not contain sufficient details of the patient's diagnosis, symptoms and conditions or any management plan such as to enable Dr Heng to assess properly the medical condition of the patient," said the SMC.

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The council, however, was not in total agreement that he did not formulate a proper treatment plan for each of his 19 patients. But as a majority thought so, it was enough to censure him, a break from the past where convictions would be based on unanimous decisions.

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Dr Heng, who has been practising since 1984, was also ordered to pledge in writing that he would not commit the same offence again. He now has to be supervised by a mentor.

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Under Health Ministry guidelines, doctors must ensure proper care and supervision of their patients undergoing drug addiction treatment. They must also record all prescriptions of the drug to prevent a patient from doctor-hopping to get multiple dosages.

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Dr Heng's case could be just the tip of the iceberg. In August, the SMC's executive secretary, Dr Lau Hong Choon, said the council was investigating "a number of doctors for wrongdoing in the prescription of addictive drugs like Subutex" so that errant doctors would not "tarnish the medical profession".

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If found guilty, these doctors can be struck off the medical register and fined up to $10,000.

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Subutex abuse came under the spotlight after heroin addicts — who were prescribed Subutex to wean them off their habit — sought highs by mixing the drug with sleeping tablet Dormicum and water, and injecting the mixture into the body.

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After Subutex became a controlled drug on Aug 14, it was declared that anyone caught importing, distributing, possessing or consuming the drug faces jail and fines, unless he is a doctor or patient registered with the Government's Subutex Voluntary Rehabilitation Programme.

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Doctors are no longer allowed to prescribe or dispense the drug as take-home medication.

Dr John Heng's name sounded familiar. And some checking showed that he had been interviewed as being a good doctor who prescribed Subutex well. This was in a story the New Paper ran.

It goes to show that the problem was really bad. No doubt about it but those doctors were doing very bad things. And it is no surprise that this doctor was not a 1st time offender. Same pool of patients, same nice market.

What surprises me though is the punishment meted out.

$2500 fine and a few stern words?

I think SMC is sending a signal out to young doctors like myself. Make your millions selling all kinds of sleeping pills, addictive medicines etc then get slapped with a bit of a pocket change fine +/- a short suspension for you to go on holiday and sabbatical then come back with the latest addictive drug and make a few million after 1-2 years and then go on holiday again.

Looks like a wonderful plan to me!

This topic was discussed before.

1 tablet of Subutex earned profit of $20. This doctor had 19 patients taking 1 tablet a day. 19 X $20 = $380. $380 profit a day. $380 x 365 = $138,700 $138,700 x 2 = $277,400. So that's how much he earned over 2 years with just 19 patients. And this is if he had totally been doing everything all well and proper. Who's to say he wasn't prescribing more than 19 tablets a day?

There were an estimated 8,000 Subutex abusers according to MOH. Let's say each of them take 1 tablet a day. That means 8,000 tablets are sold a day. Each tablet gives a profit of $20.

Subutex has been around for 4 years?

So in total the profits over the past 6 years = 8000 x $20 x 365 x 4 = $233,600,000!

$233.6 million over the past 4 years! And if you divide it by the 35 GPs registered to sell Subutex, each GP made $6.67 million over the past 4 years!

That's an incredible amount of money! Maybe I've been doing the wrong sort of work all these years!