A general practitioner, now 61, has been suspended from medical practice for three years after he repeatedly prescribed sedative medication to seven patients for years, exceeding the recommended prescription time period.

His actions caused them to grow dependent on the drugs.

The GP prescribed benzodiazepines and zopiclone or zolpidem.

Benzodiazepines are a class of sedatives that treat anxiety and insomnia by making the nervous system less active. It can be habit-forming if taken long term. Zopiclone and zolpidem are sleep medications that work differently from benzodiazepines.

The GP, Maninder Singh Shahi, prescribed these medications to his patients for periods ranging from seven years to 13 years and eight months.

However, benzodiazepine should be limited to short-term use of two to four weeks when treating insomnia while zopiclone and zolpidem should be treated with similar caution. Patients who are prescribed these medications for more than eight weeks need to be referred to a specialist.

In its grounds of decision released on Jan. 9, the Singapore Medical Council (SMC) said that Singh's misconduct undoubtedly created or fuelled his patients' dependence and tolerance to said medicines, including sleeping pills to treat insomnia.

However, they also noted Singh was genuinely remorseful and had a long and unblemished record.

Singh pleaded guilty to 14 charges, including inappropriately prescribing drugs, failing to refer patients to a psychiatrist or medical specialist, and giving insufficient details in patients' medical records.

“A very real risk of developing dependency" on prescribed drugs

Singh, who has almost 35 years of experience in the industry, worked at the 81 Family Clinic—now renamed Legacy Clinic—located in Marine Parade Central.

The offences occurred from 2002 to 2016.

When benzodiazepine is repeatedly prescribed to a patient, justification and comprehensive assessment of the patient, the diagnosis and patient's psychosocial history must be clearly documented in the medical records.

Singh had prescribed his patients prolonged usage of drugs. He gave one patient a total of eight weeks' prescription of benzodiazepines instead of limiting it to four weeks for her insomnia.

Singh acknowledged that his patients' prolonged exposure to the drugs could lead “to a very real risk of developing dependency on the prescribed benzodiazepines, which carried the potential for greater harm”.

Sought a suspension of no more than 18 months

Singh had sought a suspension of no more than 18 months, which was rejected by the council.

The defence said that Singh was not motivated by greed nor profit when prescribing the medicine, but by the motivation to help his patients, all of whom he had long-standing relationships with.

As the patients had stress-related issues such as insomnia and/or anxiety that affected their daily life, Singh continued to prescribed such drugs in the erroneous belief he was helping them.

He had also tried to refer three out of six patients to a psychiatrist, but they told him they were not keen due to the cost or their own reservations about seeking help from institutions such as the Institute of Mental Health (IMH).

Singh did not want to alienate his patients and decided it was better for them to remain in his care so he would be able to monitor their condition.

He also made sure to perform a thorough clinical review for each patient before prescribing them the hypnotic drugs.

The defence added that Singh's actions regarding the seven patients should not reflect the overall level of professionalism and compassion he maintained from seeing 60 to 70 patients a day.

Hard disk containing notes on patients crashed in late 2015

Singh also explained that he had insufficient details in his patients' medical records because his practice was to take brief notes during his consultations and add additional notes related to the drug's treatment and prescription into the clinic’s database.

Unfortunately, the hard disk crashed in late 2015, causing an unintentional loss of the digital records.

To Singh's best knowledge, all patients were able to stop their dependency on the hypnotic drugs.

Discplinary tribunal said they had to ensure punishment reflected the gravity of his misconduct

Singh's argument for a shorter sentence due to a nearly five year delay in prosecution was rejected by the council.

He said that the shock and distress of the investigative process took a toll on his mental health, being served a notice of complaint in 2017 and only receiving a notice of inquiry in 2022.

He had since handed the primary care of his clinic to his daughter and only go to see his patients in the evenings.

The disciplinary tribunal acknowledged that Singh was genuinely remorseful, having pleaded guilty at the earliest opportunity and full cooperation with the investigations by authorities.

However, they also said they had to ensure the punishment reflected the gravity of his misconduct.

The tribunal concluded that Singh is to be censured, as well as provide a written undertaking to the SMC not to repeat his conduct and pay costs of the proceedings.

Top image via Haley Lawrence / Unsplash