MaNaDr Clinic to be stripped of licence after probe into short teleconsultations; 41 doctors under scrutiny

SINGAPORE: MaNaDr Clinic is set to get its licence revoked after a Ministry of Health (MOH) probe into its short teleconsultations, with some lasting less than a minute.
The ministry on Thursday (Oct 24) issued a notice to MaNaDr Clinic saying that it intends to revoke its licence to provide all outpatient medical services, including physical, temporary and remote consultations.
“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 MOH.
If its licence is revoked, the clinic will no longer be able to provide outpatient services at its clinic at 371 Beach Road City Gate, at temporary premises such as patients’ residences, and remotely via teleconsultations.
MOH will also refer 41 doctors who conducted teleconsultations for MaNaDr Clinic to the Singapore Medical Council (SMC) for possible professional misconduct as they had potentially breached one or more of the ethical guidelines set out by the council.
“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.
Following an MOH investigation that uncovered possible wrongdoing, the ministry on Aug 16 issued a direction to MaNaDr Clinic to stop providing outpatient teleconsultations until further notice.
MOH then conducted further investigations into the clinic’s operations and the professional practices of its doctors. These investigations have been completed.
The ministry 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,” said MOH.
Following these short teleconsultations, some patients were also issued with multiple MCs over a few different teleconsultations within a short period of time, for example, over 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 satisfied that MaNaDr Clinic is unable to continue providing outpatient medical services in a manner that is “clinically and ethically appropriate” and intends to revoke its licence.
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.
CNA has contacted the SMC and MaNaDr Clinic for more information.
“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.”
The health ministry said it will take such misconduct into consideration in assessing professional standing and suitability for any licensing matters, or applications that may be submitted for accreditation under healthcare financing schemes.
MOH will also continue to monitor and audit other licensed providers of outpatient medical services who provide teleconsultation services, either through the MaNaDr platform or other telemedicine platforms, to ensure that such consultations comply with regulatory requirements.
“MOH will take regulatory actions against the licensees and/or key appointment holders, should non-compliances be found.”
MOH on Oct 14 implemented a new regulation requiring all licensed healthcare services to ensure that every MC issued includes the name and registration number of the issuing medical or dental practitioner.
In its circular earlier this month, it said that this information would be required “for the purposes of accountability and transparency of the issuing practitioner”. 
“This will complement the Ethical Code and Ethical Guidelines of the (SMC) and Singapore Dental Council that all MCs carry a professional and legal responsibility and that it must be filled and signed by the medical or dental practitioner personally,” MOH said.
If the MCs are generated electronically where signatures are not required, they must still include the name and the issuing practitioners’ registration number.
Earlier this year, MOH sought feedback on this new regulation and did not receive any objections.
The health ministry said it may conduct “random audits” of MC issuances.
“Non-compliance to this new regulation may result in enforcement actions being taken,” MOH said.
These include but are not limited to written censure, financial penalty, modification of licence conditions, shortening of the licence term, or suspension of licence.