MaNaDr Clinic set to get its licence revoked after MOH probe into short teleconsultations

SINGAPORE: MaNaDr Clinic is set to get its licence revoked after a Ministry of Health (MOH) probe into its short teleconsultations.
MOH on Thursday (Oct 24) issued a notice of intended revocation of licence to MaNaDr Clinic for the provision of outpatient medical services across all its modes of service deliveries, including physical, temporary and remote.
“This is in view of MOH’s assessment that MaNaDr Clinic is unable to continue providing outpatient medical services in a clinically and ethically appropriate manner,” said the ministry.
If its licence is revoked, the clinic cannot provide outpatient services at its clinic at 371 Beach Road City Gate, at temporary premises such as treating patients at their residences, and remotely via teleconsultations.
MOH will also refer 41 doctors who provided teleconsultations at MaNaDr Clinic to the Singapore Medical Council (SMC) for inquiries into possible professional misconduct as “they have potentially breached one or more of the ethical guidelines in SMC’s Ethical Code and Ethical Guidelines”.
“These guidelines pertain to a doctor’s duty of care, clinical evaluation of patients, provision of telemedicine, medical records, issuance of medical certificates (MCs), and prescription of medicines,” said MOH in its press release.
On Aug 16, MOH issued a direction to MaNaDr Clinic to stop providing outpatient teleconsultations until further notice.
It conducted further investigations into the clinic’s operations and the professional practices of its doctors. These investigations have been completed.
It found that a “very large number of cases” seen by MaNaDr Clinic doctors involved very short teleconsultations with video calls that lasted one minute or less, but 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.”
Following these short teleconsultations, some patients were also issued with multiple MCs over a few different teleconsultations within a short period of time, such as 30 days.
“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 compromise the continuity of patient care,” said the health ministry.
MOH said that 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”.
The director-general of health is also satisfied that MaNaDr Clinic is unable to continue providing outpatient medical services in a manner that is “clinically and ethically appropriate”.
MaNaDr Clinic has 14 days to make representations to MOH.
“In addition, MOH is currently reviewing whether Dr Siaw Tung Yeng, the principal officer and clinical governance officer of MaNaDr Clinic, has discharged his duties in these capacities satisfactorily, in assessing his suitability to continue acting in these capacities,” said the ministry.
Last year, CNA reported concerns about certain telemedicine apps issuing MCs after extremely brief consultations. In one instance, a CNA reporter obtained an MC from MaNaDr after a remote consultation that lasted 43 seconds.
A total of 41 doctors will also be referred to the SMC for inquiries into alleged professional misconduct.
These arose from potential breaches – short teleconsultations, repeated issuance of MCs to the same patient over a short period of time and questionable and poor documentation.
Of the 41 doctors, 13 worked as locum practitioners providing teleconsultations at MaNaDr Clinic while being employed by public healthcare institutions or MOH Holdings.
“These doctors had breached their employment terms by undertaking external employment and conducting secondary clinical activities without the approval of their employers,” MOH said.
“Furthermore, most of these doctors provided teleconsultations while on active duty in the public healthcare institutions.”
Five have since left the public healthcare sector. Of the remaining eight, seven have been dismissed.
The remaining doctor, due to the lesser severity of his actions, has been subjected to disciplinary action.
“Doctors who practise telemedicine are reminded to abide by the SMC’s Ethical Code and Ethical Guidelines at all times,” MOH said.
“MOH views these inappropriate practices and their potential impact on patient safety very seriously and will not hesitate to take further action against doctors, including referral to SMC, for any found to have engaged in professional misconduct.”