MANADR CLINIC INSTRUCTED TO STOP PROVISION OF OUTPATIENT MEDICAL SERVICES VIA TELECONSULTATION

Arising from several complaints, the Ministry of Health (MOH) is investigating MaNaDr Clinic for its provision of outpatient medical services via its website (https://manadr.com/) and mobile device application. Our preliminary findings have revealed that the teleconsultation services provided by MaNaDr Clinic are likely to have involved clinically and ethically inappropriate practices, as there was a large number of patients who had undergone very short teleconsultations, and cases of multiple medical certificates (MCs) issued over a short period to the same patients. To safeguard the health, safety and welfare of patients, MaNaDr Clinic has been directed to stop the provision of outpatient medical services via teleconsultation from 16 August 2024, until further notice.

2. MaNaDr Clinic, located at 371 Beach Road City Gate #02-52, is currently licensed under the Healthcare Services Act 2020 (HCSA) to provide outpatient medical services via three modes – at its permanent premises, any temporary premises as well as remotely. MOH has received complaints against MaNaDr Clinic relating to remote provision of outpatient medical services i.e. via teleconsultation in the past few months.

3. MOH has investigated and assessed that MaNaDr Clinic is likely to have routinely engaged in clinically and ethically inappropriate practices for its outpatient medical services, without due concern for the safety and quality of care of their patients. The preliminary investigations have revealed the following:

a) Short teleconsultation duration. A very large number of cases seen by MaNaDr Clinic involved very short teleconsultations. For example, in a sampled month, more than 100,000 teleconsultations involved video calls with patients of one minute or less in duration, with the shortest being one second. Such short consultations raise concerns about the safety and quality of clinical care provided to patients.

b) Multiple issuances of MCs. Following these very short teleconsultations, some patients were issued with multiple MCs over a short period of time, typically within a month. For example, in a sampled month, more than 1,500 patients were issued with MCs on five or more occasions, with the highest number of MCs issued to a single patient in a month being 19.

c) Questionable and poor documentation. While the duration of these teleconsultations was short, some of the corresponding case notes contained detailed information that did not appear to be commensurate with the duration of teleconsultation. At the same time, in other instances, the case notes were extremely sparse or brief, potentially compromising the continuity of patient care.

4. MOH will be continuing with its investigations against MaNaDr Clinic, and will not hesitate to take any further enforcement actions against the clinic and its key appointment holders.

5. MOH is also reviewing the clinical consultations of the medical practitioners engaged by MaNaDr Clinic, to assess if there is any potential breach of the Singapore Medical Council’s (SMC) Ethical Code and Ethical Guidelines (ECEG). The ECEG sets out guidelines for medical practitioners pertaining to their duty of care, the clinical evaluation of patients, provision of telemedicine, proper recording of medical records, issuance of MCs and prescription of medicine. MOH will refer any medical practitioners with potential breaches of the ECEG to the SMC for disciplinary actions.

6. In addition, MOH will be auditing and monitoring other licensed providers of outpatient medical services via teleconsultation, particularly those doing so via platforms such as the MaNaDr platform, to ensure that teleconsultations are properly conducted in compliance with relevant regulatory requirements.

7. All healthcare providers approved under the HCSA to provide outpatient medical services remotely via teleconsultations are reminded to comply with their statutory obligations under HCSA as well as the applicable regulations and relevant licensing conditions issued thereunder (including the Licence Conditions for Remote Provision of Outpatient Medical Service). Medical practitioners who practise telemedicine are reminded that they are at all times to abide by the SMC’s ECEG when doing so.

8. MOH will take decisive enforcement action against errant practices by healthcare service providers, to protect patients and also uphold the reputation of and trust for healthcare professions.