Singapore's High Court says healthcare supervisor's neglect 'inexcusable'
Singapore's High Court recently dealt with a case involving a dental supervisor's failure to properly oversee a conditionally registered dentist.
The court examined the supervisor's responsibilities and the consequences of allowing unsupervised practice, delving into the complex interplay between professional duties and personal emergencies in healthcare settings.
This case highlighted the delicate balance between professional obligations and unexpected life events for healthcare professionals. It raised important questions about the extent of a supervisor's duties and the potential risks to patient safety when proper oversight is lacking.
The case centred on a Division 1 dentist who was appointed as a supervisor for a conditionally registered dentist. The supervisor faced five charges of professional misconduct for failing to ensure proper supervision on multiple occasions. The events unfolded over several days in December 2016, beginning when the supervisor's pregnant wife unexpectedly went into labour.
On the first day in question, the supervisor sent urgent messages to the conditionally registered dentist, asking her to "cover" for him. This instruction became a key point of contention in the case. The court had to determine whether this meant the junior dentist should simply reschedule appointments or actually treat patients without supervision.
The supervisor claimed he only intended for appointments to be rescheduled. However, the court found this explanation unconvincing. It pointed out that the term "cover" is well understood in medical professions to mean attending to patients.
The court also noted that the supervisor had thanked the junior dentist for "covering" later that day, further undermining his claim.
Importantly, the court emphasised that the supervisor was aware of his duties as outlined in various circulars from the dental council. These circulars clearly stated that conditionally registered dentists must be supervised at all times while practising. The court found that by instructing the junior dentist to "cover" for him, the supervisor had intentionally departed from these standards.
While the court acknowledged the supervisor's difficult personal circumstances, it ultimately ruled that this did not excuse his failure to ensure proper supervision. The court stated: "Having already instructed [the junior dentist] to attend to his patients unsupervised, it was all the more incumbent on [the supervisor] to then clearly instruct her not to attend to her own patients without due supervision (if that was what he truly intended)."
The case also examined the supervisor's actions on subsequent days when he returned to work intermittently. Over the course of about ten days, the junior dentist treated 40 patients without supervision.
The court found that the supervisor made no effort to check whether the junior dentist was being properly supervised during this time, even when he was physically present at the clinic on some days.
The supervisor argued that he assumed the clinic had made arrangements for another fully registered dentist to supervise the junior dentist. However, the court rejected this defence, noting that the supervisor had taken no steps to verify this assumption. The continued lack of oversight was deemed an intentional and deliberate departure from professional standards.
"Even assuming that he did not know for certain that [the junior dentist] was unsupervised on the relevant dates... it was woefully insufficient for him to simply rely on an assumption that [she] would only work under due supervision, without taking any steps to verify or ascertain the matter with the Clinic or [her], despite being in the position to do so," the court stated.
This case serves as a reminder of the responsibilities placed on healthcare supervisors. It underscores the need for clear communication and proactive measures to ensure patient safety, even in the face of personal emergencies.
The court's decision emphasised that while personal circumstances may be considered, they do not automatically excuse professional lapses. The court acknowledged that the supervisor's wife experiencing birth complications was an extenuating circumstance for the first day of the incident. However, it found that this could not justify the continued breaches over the following days when the supervisor was able to return to work.
Healthcare organisations may need to review their policies and procedures for handling unexpected absences of supervisors to prevent similar situations in the future.
The court clarified that both individual supervisors and healthcare facilities have concurrent responsibilities to ensure proper supervision of conditionally registered practitioners.
In its conclusion, the court offered several key insights:
"Ultimately, the inquiry remains whether, in acting or failing to act, the supervisor has fallen short of the standard expected of supervisors, and breached his duties and responsibilities."
"The duty on supervisors to ensure that conditional registrants are supervised at all times while at work does not detract from the duty placed on the employer-clinic to ensure that another Division 1 dentist is assigned when the existing supervisor is on leave," the court added.
"[T]he public interest of discouraging supervising dentists from attempting to evade responsibility by opting not to take any adequate steps to ensure that their supervisee works with supervision far outweighs any sort of personal mitigating factor that [the supervisor] could potentially raise."
The court ultimately reduced the supervisor's suspension from 15 to 12 months but upheld the finding of professional misconduct, sending a clear message about the gravity of supervisory responsibilities in healthcare settings.
