SINGAPORE – Dr Tan Joong Piang has been suspended for 22 months for not providing six patients with appropriate care, including not referring them to a specialist in a timely manner.

He had prescribed thousands of sleeping pills, or hypnotics, to them for more than a decade.

The general practitioner, who worked at United Medical Practitioners at Block 201B Tampines Street 21, also did not keep sufficient details of their conditions and treatments in his records.

A complaint was made on Dec 21, 2012, against the doctor by the Singapore Medical Council, which had been given information by the Ministry of Health (MOH) on Feb 29 that year, on the doctor’s prescribing patterns for hypnotics, such as Dormicum and diazepam.

The disciplinary tribunal’s published grounds for decision released last week did not state when the doctor was informed of the complaint – just that his written explanation was given on March 26, 2016, and he was told on June 9, 2017, that he would face a disciplinary hearing.

The doctor pleaded guilty to the charges.

MOH had issued administrative guidelines on prescribing hypnotics in October 2008 warning doctors to be careful in prescribing such drugs.

It said, among other things, that “benzodiazepines are rarely helpful in insomnia due to organic disease and may depress respiration in chronic pulmonary disease”.

It also stated that repeat prescriptions for benzodiazepines should not be provided without a clinical review.

The doctor had provided these patients with thousands of hypnotic tablets like Dormicum and diazepam over more than a decade.

– Patient 1 received a total of 3,290 tablets, in 125 prescriptions, over a period of more than 12 years.

– Patient 2 received 4,100 tablets in 142 prescriptions over more than 13 years.

– Patient 3 was given 3,582 tablets in 232 prescriptions over more than 12 years.

– Patient 4 received 1,235 tablets over 59 occasions over more than 10 years.

– Patient 5 was given 1,264 tablets with 50 prescriptions over more than 10 years.

– Patient 6 was prescribed 2,018 tablets on 123 occasions over more than 14 years.

According to the charges against him, Dr Tan, who has been practising for 38 years, also “allowed the patient and/or the patient’s proxies to collect hypnotics without seeing a physician on various occasions”.

In Dr Tan’s defence, his lawyer said none of the patients were drug addicts and none had developed dependence or addiction to the hypnotics, or other ill effects.

The tribunal decided a fair penalty was 33 months suspension, but reduced it by a third because of the long delay in prosecuting the doctor.

This means he will be suspended for a total of 22 months. He also has to pay the cost of the proceedings and give a written undertaking not to re-offend.

The tribunal said its decision was based on several factors, including the patients’ advanced ages, with the youngest aged 57 and the oldest aged 81, at the time of the last prescription.

The tribunal said: “The elderly is an especially vulnerable class of persons for which the potential risks of drug tolerance and dependency would be amplified.”

It noted that “the numerous disciplinary cases involving the prescription of hypnotics underscores the urgent need to send a deterrent message to those who hold in low regard the safeguards imposed on the dispensation of medicine”.

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