When a person is registered in the Register of Provisionally Registered Medical Practitioners (RPRMP) but his provisional registration has expired, is he still bound by the Medical Registration Act (MRA)?
Whether a doctor subject to disciplinary proceedings must be a registered medical practitioner at the time of the inquiry
In Singapore Medical Council v Chua Shunjie (Chua Shunjie), the High Court held that disciplinary proceedings under the MRA lie only against persons who are registered medical practitioners (RMPs). Although the statutory objectives of the MRA are to uphold standards of practice within the medical profession and maintain public confidence in it, the purposive interpretation cannot rewrite the plain words of the statute.
Whether a person with an expired provisional registration is an RMP
A person’s registration on the RPRMP does not terminate immediately upon the expiry of his provisional registration. This is because the expiration of a provisional registration does not result in automatic deregistration of the person, whose name remains on the RPRMP until one of only a limited number of events takes place:
- Such as when the doctor has successfully obtained registration on another register;
- Specific circumstances pursuant to s 31 of the MRA which allow the Registrar to remove the name of a provisional RMP; or
- Specific circumstances pursuant to s 32 of the MRA which allows the SMC to order the removal of the name of a provisional RMP.
Although the expiration of a medical practitioner’s provisional registration would prevent him from carrying out or performing any regulated activities as a provisional RMP, his name would still remain on the register. Thus, a person with an expired provisional registration is still subject to disciplinary proceedings under the MRA.
Just because the offender bears a provisional registration does not render the striking off of their name from the RPRMP useless. This is because the striking off of a medical practitioner’s name would trigger several important professional consequences, and be prevented, by s 56 of the MRA, from seeking restoration to the register for a period of three years from the date of removal. After the three years, the restoration process is particularly stringent, and must satisfy many additional requirements.
When is a striking off from the register warranted?
The SGHC in Wong Meng Hang laid out the following non-exhaustive factors to determine whether striking off is warranted:
- the real nature of the wrong and the interest that has been implicated;
- the extent and nature of the deception;
- the motivations and reasons behind the dishonesty and whether it indicates a fundamental lack of integrity on the one hand or a case of misjudgement on the other;
- whether the errant doctor benefitted from the dishonesty; and
- whether the dishonesty caused actual harm or had the potential to cause harm that the errant doctor ought to have or in fact recognised.
In Chua Shunjie, the offending RMP’s conduct was so serious that it would render him unfit to remain a member of the medical profession. His conduct had demonstrated a persistent pattern of dishonesty, which manifested itself in a number of different ways during a relatively short period of time. Just because the offending RMPs misconduct pertained to research integrity not within the realm of medical conduct does not entail less severe consequences. Furthermore, the offending RMP’s conduct was clearly motivated by personal benefit, and there was clear potential harm in depriving the opportunities of other, possibly more deserving, candidates from entering the same programme the offending RMP had applied to.
Possible mitigating factors when a striking off is warranted
Nonetheless, a striking off might be tempered by mitigating factors present in the case.
- Personal and financial hardships hardly have any mitigating weight
- Expression of remorse
Although an early plea of guilt may be regarded as a sign of remorse and warrant a reduction in sentence, this plea must demonstrate the offender’s genuine contrition. If the plea is disingenuous, this a guilty plea will not be considered a mitigating factor.
- The SMC’s delay in prosecuting matters
The Court opined that the underlying rationale for imposing sentencing discounts in cases involving an inordinate delay in prosecution is the undue suffering which the doctor has likely suffered in the form of anxiety, suspense and uncertainty.
However, in Chua Shunjie, this was not a relevant mitigating factor as the SMC took just over two years and three months, which although significant, was substantially shorter than in other cases in which there had been delays. Furthermore, the the offending RMP himself appeared to have partially contributed to the delay.
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