SINGAPORE - There is no verdict yet on Dr Susan Lim's appeal against her guilty conviction from the Singapore Medical Council (SMC), but one question seems to have been answered: there is an ethical limit to what doctors can charge.

"Every profession must have ethical limits. That's what differentiates them from commerce. That is our overarching philosophy," said Judge of Appeal V. K. Rajah, one of three judges hearing the appeal on Tuesday.

But exactly where the ethical limit for a doctor lies, and whether Dr Susan Lim had breached it, are questions which the appeals court has yet to decide on.


These were among the issues discussed on Tuesday at a hearing that was scheduled to last 11/2 hours but instead lasted for five.

Explaining why he was giving both sides more time to argue the case, Justice Rajah said: "We're aware that this case is of considerable importance to both parties and the wider public."

The closely watched case involves Dr Lim having charged a royal patient from Brunei about $25 million for half a year's care, before cutting the bill to $12.1 million.


The doctor was eventually found guilty last year of professional misconduct by the SMC's disciplinary committee, which ruled that she had grossly overcharged her patient.

The committee said notwithstanding any patient-doctor agreement, no doctor should charge more than an "ethical limit". However, it did not state what that limit should be.

In appealing the decision, Dr Lim's lawyers argued on Tuesday that such an "ethical limit" has never been mentioned previously.

Therefore, it would not be fair or legal to find a doctor guilty of doing something in breach of an unknown rule, said Mr Lee Eng Beng of Rajah & Tann.

Having settled that doctors here should be subject to an ethical limit, the Court of Appeal also suggested on Tuesday that a regulator like the Ministry of Health has the right to intervene if it felt that the limit had been breached.

This is even if there was an agreement between the doctor and a patient who is "perfectly happy to pay 100 times the normal rate", said Justice Rajah.

The appeals court, however, questioned some aspects of the disciplinary committee's decision, as well as its sentencing.

Justice Rajah wanted to know what yardstick had been used by the committee in imposing the relatively heavy sentence of a three-year suspension on Dr Lim.

He asked Mr Alvin Yeo of Wong- Partnership, who acted for the SMC, for information on other doctors who had been given the maximum penalty, short of being struck off the register.

Mr Yeo took pains to explain that for six months, the patient had received palliative care and Dr Lim was not required to do any surgery. Some of the time was spent in intensive care, and she merely acted as a coordinator.

He asked the court "what sort of disapproval" they would give a lawyer who was only coordinating and had not appeared in a trial, but presented a huge bill.

However, Justice Rajah said it would be easy to fix an appropriate fee for such a lawyer. He then asked if Dr Lim reported regularly to the palace and suggested her role might have been that of a "court physician".

The judge also asked for examples of double billing on the part of Dr Lim to prove the charge of misrepresentation.

He said the court "has to be painstaking" as this would be a "criminal offence". He also asked if the committee had given credit to Dr Lim for halving the bill to $12.1 million with a discount.

Mr Yeo said no credit was due because the higher bill was "deliberate and intentional" and the discount "showed a consciousness of her own guilt".

Mr Yeo has a week to provide additional information and Mr Lee has three weeks to rebut. The court reserved judgment.