Breast Cancer: She Died Even After Multi-Million-Dollar-Medical Bill

We spent the last weekend of February 2011 in Singapore. Actually the trip was to attend a church wedding ceremony of a friend’s daughter. At the same time we had the privilege of being “pampered” by the hospitality of Im’s brother, who lives in Singapore. He put us in a hotel in Raffles City. We could see the amazing city of Singapore from our room on the 54th floor.  We took time to window-shop. Through the glass windows we could see watches on display. One showed a price tag of S$150,000 a piece! Wow, such an amazing price! In short it is always wow, wow and wow when it comes to Singapore.

Another wow struck me the next morning. The Sunday Straits Times of 27 February has a banner headline: Doctor’s charges: How much is too much?

BACKGROUND  STORY

There is an ongoing case of medical fraud making the headlines of leading newspapers. A well renowned surgeon of Singapore, Dr. Susan Lim, is accused of over blowing the medical bill of a Bruneian patient.

Read more:  Dr. Lim Embarrassed the Medical Fraternity http://topnews.net.nz/content/212192-dr-lim-embarrassed-medical-fraternity

The total medical bills that Dr. Susan Lim charged this special patient are as follows:

  • In 2004 total of $2.8 million
  • In 2005 total of $3.8 million
  • In 2006 total of $7.5 million
  • In 2007 total of $24.8 million

So what is a fair and reasonable fee a renown doctor can charge his/her patient? These are the figures given by the various medical doctors of Singapore:

  • Dr. Hong Ga Sze  said a reasonable daily fee is $1,000 to $2,000 per day.
  • Dr. Tan Yew Oo, oncologist at Gleneagles Cancer Centre said $10,000 to $20,000 per day.
  • Professor Soo Khee Chee, head of the National Cancer Centre said $100,000 a day is fine and agreed that on a day Dr. Susan Lim could have charged as much as $450,00 per day.

Don’t you think these figures are worth many, many, many wows?

It is further reported that for the period from January 15 to June 16, the total bill charged by Dr. Susan Lim amounted to $26 million. It did not include work done by Dr Lim and her team in Brunei in June and July of that year. In early August, Dr Lim, decided to waive some charges effectively halving the amount owed. In November that year, she decided to waive her fees entirely, charging the patient only the third party payments which amounted to slightly over $3 million.

Read more:  http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_639428.html

MORE OF THE SUSAN LIM SAGA

That Sunday afternoon we flew home to Penang. I was rather curious about this Susan Lim Saga and started to surf the net for more information. These are some of the information I managed to gather.

Who is the surgeon?

A Brunei online newsportal, Brudirect News, had this report: Singapore Doc Probed For Charging Millions Of $$ From Bruneian. Dr Susan Lim is a famous surgeon who carried out Singapore’s first liver transplant about two decades ago. She has two clinics, Susan Lim Surgery, at the Gleneagles and Mount Elizabeth medical centres. Her clinic’s website lists her also as a transplant surgeon and Visiting Professor at Blizard Institute of Cell & Molecular Sciences, Barts & The London School of Medicine and Dentistry, and a Fellow of the Harvard Stem Cell Institute.

Read more: http://www.brudirect.com/index.php/2010020715483/First-Stories/singapore-doe-probed-for-charging-millions-of-from-bruneian.html

Who is the patient?

Reportedly, the victim was the late Pengiran Anak Hajah Damit, the younger sister of the Queen of Brunei and cousin of the Sultan. She had breast cancer and was treated by Dr. Lim from 2001 until she died in August 2007.

Read more: Doctor bumped up $500 bill to $93,500 AsiaOnline  http://health.asiaone.com/Health/News/Story/A1Story20110224-265072.html

How figures were inflated

An article, Straits Times on 24 February 2011, had this headline: Surgeon inflated $400 bill to $211,000. http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_638329.html#

The article said:

  • A specialist who treated surgeon Susan Lim’s patient sent a bill for $400. She marked it up to $211,000 when she billed the Brunei High Commission here.
  • Another doctor charged $500, but Dr Lim bumped that up to $93,500.
  • Yet another bill for $3,000 was raised to $285,100.
  • Shockingly, when the patient got admitted to the intensive care unit, she asked for $450,000 for the first day and $250,000 for the subsequent four days, in the name of “monitoring services”.

Read more: Dr. Lim Embarrassed the Medical Fraternity http://topnews.net.nz/content/212192-dr-lim-embarrassed-medical-fraternity

Online USA News:  Susan Lim Singapore Medical Council http://www.onlineusanews.com/susan-lim-singapore-medical-council-11491.php

WHAT BLOGGERS SAY

1. The Great Singapore Rip off – Medical Tourism and the Dr Susan Lim Saga

With specialists like Dr Susan Lim and some members of her fraternity saying doctors can, when warranted, charge up to S$300,000 a day in fees, Singapore can well forget about emerging as the healthcare destination for those in need of medical attention. Dr Lim has become a symbol of extreme greed. The amount was not just astronomical by any stretch of imagination but was loaded with fraud. For instance, when she brought in a specialist outside of her domain, he charged less than S$1,000. But she produced a bill of more than S$300,000 for the Brunei royal family. I think this involves a combination of greed, criminality and stupidity.

Read more: Joslin Vethakumar http://joslinv.wordpress.com/2011/02/27/medical-tourism-with-specialists-like-dr-susan-lim-singapore-can-forget-about-it/

2. I was also shocked …

I was also shocked to read the testimony by Dr. Soo Khee Chee, head of the National Cancer Center, that a fee of $100,000 a day was fine and, in Susan Lim’s case, it was all right for the fee to be $300,000, without the extras, for a particular day’s consultation. How does the head of a publicly funded speciality center get the impression that this is an acceptable level of fee? No wonder, Singaporeans are “frightened” about their medical bills. They must have heard stories of these astronomical fees. There is an important lesson from this case. After the patient spend $26 million, the patient still died. No amount of money can reverse the inevitable.

For a wealthy family who can afford the high cost, it is all right to spend the money. However, for the vast majority of ordinary families who are not extremely wealthy, they should not be spending $100,000 or more for treatment that have a low chance of success. It is better to let nature takes its course.

Read more: Angry Patient  http://easyapps.sg/sgep/admin/file.aspx?id=58

3. Most doctors doesn’t see anything wrong with Dr Susan Lim’s fees

The problem with Singapore doctors is that they are in the profession for the money. Many medical professionals in other countries are doctors because of a desire to help their fellow human beings. The money, although nice, was a secondary consideration. Many sinkie doctors are also from privileged families, and were told to become doctors so as to be rich and prestigious for their families. Ever seen sinkie doctors do this? They are too busy charging outrageous fees to Indons, Malaysians, etc.

When you go and see a doctor in Singapore next time, ask yourself whether they are in it for the money or really in it for your welfare.

Read more: http://www.singsupplies.com/showthread.php?p=686418

4. Dr Susan Lim: The High Cost of Living … Unwell

  • The infamous doctor in this outrageous case (yes, the news has reached as far as New Zealand–and not just Brunei & Singapore) is a surgeon, Dr Susan Lim. According to her website, she is the first Singaporean & also the youngest Fellow of Trinity College. Oh, and she has a Wikipedia article about her too! I guess all these may lead to the ridiculously high bill?!?!
  • And the sad irony is despite all these fantastic amount of money involved, the patient still died of her breast cancer.
  • Surgeon Susan Lim treated a patient linked to the Brunei palace for seven months in 2007. Her bill: $24.8 million.
  • Dr Lim also charged the patient for cancelling two conferences, on top of treatment fees, with one bill costing $78,000 and the other up to $180,000.
  • She also charged between $35,000 and $45,000 a day when her employees accompanied the patient for radiotherapy sessions at the hospital, the newspaper reported.
  • When the patient was in intensive care for five days in May 2007, she was attended to by the doctors and nurses and for that, Dr Lim charged $450,000 for the first day and $250,000 for the other four days for “monitoring services”, according to Straits Times.

Read more: http://anonymousxwrites.blogspot.com/2011/02/dr-susan-lim-high-cost-of-living-unwell.html

Comments

I was baffled when I saw the $150,000 watch at the poshy shop – who on earth is going to buy such an expensive item? But I am sure there are buyers, otherwise the shop would not have displayed so many of them. Space cost a lot of money in Singapore!  Then I looked at what I wore. I only have a less-than- $50 watch! And I am proud of it. I had it for many years now and I have not missed any of my plane   flights yet – meaning my $50-watch has not failed me at all. I wonder what is the difference between my cheap watch and that expensive one?

Besides the watch, today, I have also learned that medical treatments can be extraordinarily expensive in Singapore. It can amount to millions of dollars. I have heard of many expensive charges before but not as expensive as this one. Some years ago, someone sent his wife for leukemia treatment in Singapore. He spent about RM 1.8Million on her treatments. But, at the end his wife also died. The royal patient incurred millions on her medical bills and she also died.  Not much difference from my $50-watch.

Let me repeat what Angry blogger wrote:  “After the patient spend $26 million, the patient still died. No amount of money can reverse the inevitable. For a wealthy family who can afford the high cost, it is all right to spend the money. However, for the vast majority of ordinary families who are not extremely wealthy, they should not be spending $100,000 or more for treatment that have a low chance of success. It is better to let nature takes its course.”

Perhaps he is right. When we have no money to throw around, it is better to let nature takes its course.

It is not for me to comment on the ethics, morality or the right or wrong of the above saga. I believe each of us lives our life guided by our own moral compass. Fairness, morality, etc. are but perceptions and they reflect our upbringing. I came from a poor family. My mother taught me to be thrifty since I was small. So please excuse me for wearing a $50-watch.

When cancer patients come to see me, I too want to try to save as much money for them – just the way my mother taught me to be thrifty with what I have. I fully understand that patients want the best – but the best may not necessarily be the most expensive. I wonder how much better is a $150,000 watch   compared to my $50-watch? There is a good lesson which cancer patients can learn from this story. When consulting infamous experts ask them these questions:

  1. Can you cure my cancer?
  2. What would be the total cost?
  3. Are there side effects associated with the treatments?

Then make your decision wisely after critically evaluating the answers given.

When we started CA Care in 1995, I was mindful of the “get-rich” temptation that we may encounter as we become more effective and well-known.  After all I am also as educated as those experts. I am a Ph.D. and was a full Professor in the University. I was awarded  a research fellowship by the prestigious Alexander von Humboldt Foundation of Germany and also the Matsumae International Foundation of Japan. So, I am not short of valid credentials.  For the past fourteen years, I have counseled thousands of cancer patients. Sometime I would spend many hours with a patient to help him/her through his/her problem.  I would fly to Kuala Lumpur and stay for two days there helping patients. For all these, I accept NO consultation fees – it is all for free.

To ensure that I would not stray and remain true to our mission, I adopted this prayer for CA Care.

Make us Lord,
An instrument of Your love and a light in the path of darkness.
To those who are lost, help us show a way
To those in despair, let there be Hope
To those in sadness, let there be Joy.

Grant us Lord,
Wisdom to do things rightly,
Strength to humbly help others, and
Courage to resist greed and self-glorification.

Throughout all these years, when I wake up each morning, I would say this short prayer: Today, show me Lord Your way. So help me Lord. And let Your will be done.

P/S  A medical doctor who read this post wrote me this message:

Dr Susan Lim saga – all the riches in the world can’t buy happiness. Her greed will eat her up someday.

Update:

Susan Lim issued bills in ‘arbitrary, opportunistic’ manner

SINGAPORE – The Court of Three Judges, after analysing the bills issued by Dr Susan Lim, said the invoices were issued in an “unsystematic, arbitrary and, ultimately, opportunistic manner”. Dr Lim has lost her battle to overturn her conviction for overcharging a royal patient from Brunei. Dr Lim faced a total of 94 charges of professional misconduct …. found her guilty of professional misconduct over the $24 million bill.

http://yourhealth.asiaone.com/content/susan-lim-issued-bills-arbitrary-opportunistic-manner

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3 thoughts on “Breast Cancer: She Died Even After Multi-Million-Dollar-Medical Bill

  1. Dear Dr Chris Teo

    May God continue to bless you and your family for the abuandant help and
    blessings you bring to the Cancer sufferers. Your richness lies in his glory
    and not in the riches of money. I am very touched by your determination
    to stay untempted. You have come a long way to stay faithful to explore
    and expand His gifts and talents in you. You have exemplify Abundance.

    Katherine

  2. The SMC has chosen to put in the forefront of its submissions at the Judicial Review in the High Court of Singapore invoices issued by Dr. Susan Lim. Their, “tidak apa” attitude in auditing the invoices has resulted in gross miscalculations and misinterpretations which leads the public to beleive that there are incredulous mark-ups in her charges to the Pangit Damiran, a member of the Brunei Royal Family. This is totally irresponsible and demonstrative of bias.

  3. There are doctors and there are doctors. Dr. Lim is a very well-known surgeon and her fees would have been known to the royal patient. Also, what Renga is saying here, holds water. The claims of mark ups in fees were exaggerated. Dr. Lim’s lawyer has said the mark up claims are outrageous; and said the position taken by the council on the bills was irresponsible, if not vindictive. Many doctors were involved in medical procedures and hence the monies were divided between them.

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