Man loses leg after S’pore GP fails to refer him to hospital or specialist during 5 visits, GP gets 13-month suspension

A general practitioner in Singapore has been handed a 13-month suspension after he repeatedly failed to refer a patient with a severely infected foot to a hospital or specialist, resulting in the amputation of the patient's right leg and the permanent loss of his ability to walk.

The patient had been suffering from gangrene in his toes, necrosis or dead tissue, as well as cellulitis.

Visited five times

According to the judgment paper, the patient had consulted Lim Geok Leong, who was practising at Central Medical Group in Bukit Merah at the time, five times between Apr. 11 and May 2022.

At the first visit, on Apr. 11, 2022, Lim diagnosed the patient with severe and extensive cellulitis, as well as severe diabetes.

He prescribed oral antibiotics and advised the patient to return for a review in four days.

The patient later returned to Lim four more times in the following weeks.

At each visit, Lim either told him his condition was unchanged or improving, and continued treating him with oral antibiotics and other medication.

He did not refer the patient to a hospital emergency department or a specialist at any point.

Sought second opinion

On May 10, 2022, the day after his fifth and final visit to Lim, the patient consulted a different clinic.

He was found to have extensive "wet gangrene" on his right foot — a severe infection that had spread from his third toe to his second toe and the top of his foot.

He was hospitalised and subsequently underwent a series of "high-risk ascending amputations" to his right leg, leaving him permanently unable to walk.

He also suffered further complications related to the amputations.

Standards not met

Lim, as a registered medical practitioner, was required under ethical guidelines to provide appropriate care and refer patients to other doctors or institutions best placed to treat them.

Medical standards required him to immediately refer any patient with an active diabetic foot condition, showing symptoms such as inflammation, wound discharge, cellulitis or wet gangrene, to the emergency department of a hospital.

However, he failed to do so across all five consultations.

An expert report submitted during proceedings stated that this "significantly contributed to the risk of the patient having to undergo ascending serial amputations on his right leg".

The expert also noted that for patients with diabetes and peripheral artery disease, waiting more than two weeks between a primary care assessment and revascularisation, which is a procedure to restore blood flow, significantly raises the risk of major amputation.

The patient's five consultations with Lim spanned 29 days, which is more than double that threshold.

It was ultimately also the patient's own decision to seek care elsewhere.

Suspension

The Singapore Medical Council had sought a 14-month suspension, while Lim's lawyers argued for a maximum of 10 months.

The tribunal eventually settled on 13 months, finding that Lim did not intentionally cause harm and that his conduct constituted "serious negligence".

In mitigation, Lim's lawyers highlighted his clean disciplinary record across more than four decades in medicine and submitted patient testimonials in the form of Google Review comments, speaking to his reputation in the community.

Beyond the suspension, Lim has also been censured and must submit a written undertaking to the Singapore Medical Council pledging that he will not reoffend.

He is further required to cover the costs and expenses of the proceedings.