SINGAPORE – The Ministry of Health (MOH) intends to revoke the licence of MaNaDr, which means that the telehealth provider will not be able to offer any medical services.

       “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 in a statement on Oct 24.

       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.

       In addition, 41 public and private sector doctors who provided teleconsultations at MaNaDr Clinic will be referred to the Singapore Medical Council (SMC) for inquiries into possible professional misconduct.

       This is as they have potentially breached one or more of the ethical guidelines in SMC’s Ethical Code and Ethical Guidelines (ECEG), the ministry said.

       The latest move comes two months after MOH issued a direction to the telehealth company to stop the provision of outpatient medical services via teleconsultation until further notice.

       Investigations by MOH had 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 in duration, but nevertheless concluded with the prescription of medications and issuance of medical certificates (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 the MOH spokesman.

       Following such short teleconsultations, MOH found that some patients were issued with multiple MCs over a few different teleconsultations within a short period of time, like within 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.

       “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,” said the MOH spokesman.

       These guidelines pertain to a doctor’s duty of care, clinical evaluation of patients, provision of telemedicine, medical records, issuance of medical certificates, and prescription of medicines.

       Of the 41 doctors referred to SMC, there were 13 who worked as locum practitioners providing teleconsultations at MaNaDr Clinic while being employed by the 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.

       Most of these doctors had also provided teleconsultations while on active duty in the public healthcare institutions. Five have since left the public healthcare sector, the ministry said.

       Of the remaining eight, seven have been dismissed. The remaining doctor, due to lesser severity of his actions, has been subjected to disciplinary action, said the MOH spokesman.

       “Doctors who practise telemedicine are reminded to abide by the SMC’s ECEG at all times. 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,” said the MOH spokesman.

       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.

       MaNaDr Clinic has 14 days to make representations to MOH.