THE Ministry of Health (MOH) issued a notice of intended revocation of MaNaDr Clinic’s licence on Oct 24 for providing outpatient medical services physically, temporarily and remotely. This decision comes after the ministry assessed that the clinic is unable to deliver such services in a “clinically and ethically appropriate manner” after completing further investigations into its operations and the professional practices of its doctors.
MOH had initially issued a direction to MaNaDr Clinic on Aug 16 this year to suspend outpatient medical services via teleconsultation until further notice and its subsequent investigations revealed several concerning findings.
“Based on these findings, there is reason to believe that there is an entrenched culture of disregard for the applicable clinical and ethical standards within MaNaDr Clinic,” it said.
In light of this case, MOH will continue to “monitor and audit” other licensed providers offering teleconsultation services, either through the MaNaDr platform or other telemedicine platforms, to ensure compliance with regulatory requirements.
The ministry warned that it will take regulatory actions against any instances of non-compliance and advised all doctors practising telemedicine to abide by the Singapore Medical Council (SMC)’s Ethical Code and Ethical Guidelines (ECEG) at all times.
The ministry added that it views inappropriate practices and their potential impact on patient safety very seriously and will not hesitate to refer doctors to SMC for any professional misconduct.
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It will also consider such misconduct when assessing professional standing and suitability for any licensing matters under the Healthcare Services Act or applications for accreditation under its healthcare financing schemes, such as the Community Health Assist Scheme, MediSave and MediShield Life.
MOH is currently reviewing whether Dr Siaw Tung Yeng, the principal officer and clinical governance officer of MaNaDr Clinic, has satisfactorily fulfilled his duties in his roles. This assessment will determine his suitability to continue in these positions for three other licensed outpatient medical services.
Ethical violations
MOH has already initiated regulatory actions against 41 doctors providing teleconsultations at MaNaDr Clinic by referring them to the SMC for potential professional misconduct.
The ministry said they have possibly breached one or more of the ethical guidelines in SMC’s ECEG, which covers aspects such as clinical evaluation of patients, provision of telemedicine and issuance of medical certificates (MCs).
MOH’s investigations found that a significant number of cases seen by MaNaDr Clinic doctors involved very short teleconsultations with video calls that lasted one minute or less in duration, but nevertheless concluded with the prescription of medications and issuance of MCs.
“Such short consultations raise concerns about the safety and quality of clinical care provided to patients, including whether the medications and MCs were prescribed and issued on sound medical grounds,” MOH said.
Following these short teleconsultations, some patients were found to be issued with multiple MCs over a few different teleconsultations within a short period of time such as 30 days.
While MOH does not prescribe a minimum consultation duration, it mandates that a teleconsultation must be held to the same standard as any other consultation.
Meanwhile, MOH discovered that in some instances, patient case notes contained detailed information that was not commensurate with the short duration of the teleconsultation.
Conversely, in other instances, patient case notes were extremely sparse or brief, which potentially compromised the continuity of patient care.
