PRIVATE HOSPITALS AND MEDICAL CLINICS BILL

Order for Second Reading read. 3.30 p.m.

The Minister for Health (Dr Toh Chin Chye): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Singapore is now a free market place and it lends itself open to adventurists and entrepreneurs who will invest in the gullibility of a segment of our population. For example, in the past years, we had the Gemini Chit Fund, pyramid selling and sanatronic clinics. Members of the House will recollect that in May 1977 I brought their attention to the existence of sanatronic clinics which were mushrooming in Singapore and which claimed to be able to cure a wide variety of ailments, ranging from rheumatism, migraine, insomnia, mental fatigue, asthma, indigestion and skin diseases.

There is, at present, the Nursing Homes and Maternity Homes Registration Act which was passed in 1959 but this Act is inadequate for today's situation. It is because of this that today I am moving the Second Reading of the Private Hospitals and Medical Clinics Bill. The purpose of this Bill is to license the place of practice of physicians and dentists whether they are or are not registered under the Medical Registration Act and the Dentists Registration Act. This Bill therefore covers premises used by physicians practising traditional medicine and acupuncturists. The Kwong Wai Shiu Hospital is a charitable institution performing an admirable service to the community as a nursing home. There is no intention to curb the activities of this hospital.

However, it is necessary that minimum standards must be provided for in private hospitals, nursing homes, maternity homes and in clinics where physicians perform curative services to patients. Some of these standards are already spelt out in the existing Nursing Homes and Maternity Homes Registration Act and also under regulations relating to the Dentists Registration Act. Likewise, under the Abortion Act, regulations also exist on certain standards required in premises where abortions are performed. All these clauses relating to minimum standards will be transferred to the existing Private Hospitals and Medical Clinics Bill.

There will be two separate registers for these premises as is already the practice for dental premises under the existing system. Dentists who come under Division I have their premises registered separately from the premises of dentists who are registered in Division 11. Likewise, we intend, under this Bill, to keep two separate registers for medical clinics, one for physicians who are registered under the Singapore Medical Registration Act and the other for physicians who are not registered at all.

Clause 4 (1) of the Bill does not apply, and is not intended to apply, to houses of patients which are visited by physicians for the treatment of their patients. Clause 5 of the Bill relates to the minimum standards which I have already spelt out. They are already contained in the Nursing Homes and Maternity Homes Registration Act, regulations under the Abortion Act and regulations under the Dentists Registration Act.

In clause 9, an amendment will be made to allow appeals against revoking of licences to be heard by sub-committees of the Singapore Medical Council and the Dental Registration Board, insofar as these appeals relate to premises which are used by practitioners who are registered respectively under the Medical Registration Act and the Dental Registration Board. However, the Minister's decision will be final after he has considered recommendations by these subcommittees.

Clause 10 of the Bill permits inspection of premises - (a) in order to ensure that the premises comply with the conditions of the licence which has been given to the practitioner, and (b) for action to be taken against unregistered premises.

Clause 12 of the Bill requests data from private hospitals and clinics. This is not an intention to invade the patient's privacy or to be curious about the patient's record. The purpose is to obtain statistical compilation of morbidity data. At present, whatever morbidity statistics we have are available only from the public sector but a large segment of morbidity data available in the private sector is not being collated because of the absence of a machinery for such purpose. Amendment will be made in this clause so that the patient's consent will be required, if it is at all necessary, for any clinic to furnish the particular patient's record.

Section II of the Nursing Homes and Maternity Homes Registration Act relates to unauthorised communication made by officers in the execution of the Act. This provision will be transferred to the Private Hospitals and Medical Clinics Act.

Clause 14 provides for advisory committees. This will be established to help the drafting of regulations relating to the Act and for such purposes as may be required in its implementation.

Sir, I beg to move.

Question proposed.

Mr Sia Khoon Seong (Moulmein): Mr Speaker, Sir, let me first congratulate the Minister for the timely move in bringing this Bill before this House. No doubt, in our system of free enterprise, people in any trade or business or profession, including that of medicine and medical care, should be accorded the fullest freedom as is compatible with public interest to conduct their business with the least hindrance from the Government.

As in this case where the practice of the profession or conduct of the business may literally mean the difference between the life and death of people receiving medical consultation, treatment, or care, the Government has certain moral obligations to ensure that certain safety standards are maintained, whether in relation to the services provided by or to certain medical paraphernalia used in the private clinics and private hospitals. This is not to suggest that doctors in private practice, by and large, have not been careful with maintaining standards. Private medical practitioners not only have a moral obligation towards their patients' well-being but also their own reputation to protect. There is no doubt that the vast majority of them should find no objection at least to the raison d'etre of the Bill which is to ensure that certain standards of medical consultation, treatment or care of their patients are maintained.

Some doctors in private practice may view the Bill as a measure to impose unnecessary hardship on them in their practice. Some unkind souls may even deliberately misconstrue this Bill as a desperate measure of the Government to prevent further brain-drain of doctors from the Government service to the private sector. I have no doubt that the Minister has no such "macabre" intention.

Though the Minister's intention is honourable, the danger is that some over-zealous Ministry officials may implement the provisions of the Bill, after it has been passed, in such a manner as to make it more difficult than necessary for the doctors in private practice to conduct their business. I understand that this Bill will be committed to a Select Committee. The Minister is certainly wise in committing this Bill to a Select Committee to enable interested parties to voice their fears and/or views on the Bill. Knowing the Minister, who is still very much a democrat at heart, I have no doubt he will give whatever views that will be presented to the Select Committee his utmost consideration before this Bill is read a Third time.

In any case, the act of licensing private clinics and private hospitals is no more or no less than the act of licensing the private schools which the Education Ministry has been doing all along. The Bill, when seen in this light, should be considered as a logical step for the Minister to introduce in this House, particularly at a time when we see more private clinics and hospitals springing up.

The Bill also seeks to prohibit the trading in human blood. All right-thinking Singaporeans must surely give the Hon. Minister their wholehearted support in this particular provision. Much has been said and written about the abuses and undesirable consequences of trading in human blood elsewhere. Singapore today can pride itself on its public-spirited citizens who have unfailingly responded to every call for blood donation. This has not only ensured that healthy blood is available for those who need blood transfusion, irrespective of whether they are rich or poor, but it has also served to prevent people donating blood for money even when their health does not permit it.

The Bill, however, does not deal with the growing problem that the Government faces arising out of the proliferation of private clinics and private hospitals, i.e. the brain-drain of good Government doctors to the more lucrative pasture of the private sector. I do not know whether the Minister for Trade and Industry, in his recent announcement in this House on 11th December 1979 (Hansard, Vol. 39, col. 521) regarding the Consultation Fees Scheme for doctors in the Government Service, honestly believed that the scheme was going to help at all in slowing down the brain-drain. To me, and more so to the doctors in the Government Service, what the scheme contained was nothing more than peanuts. It was a case of too little being done too late. And to make matters worse, those in the lower rungs of the medical service are not even going to get the peanuts. How is the Health Ministry going to prevent a further brain-drain? Whether the Minister for Trade and Industry or the Professional Services Review Committee likes it or not, the doctors have a greater market value than the administrators.

Mr Speaker, Sir, on this point, I am sure I can get you to agree with me. But I am not so sure whether I can get the Minister of Defence, who was once the Head of the Civil Service, to agree with me. If the scheme of service for doctors in the Public Service does not even come anywhere near what an average doctor in private practice gets, then the brain-drain of doctors from the Government service to the private sector is going to be further aggravated. We do not want a situation to arise in future where first-rate medical service is only to be found in private hospitals and clinics, and second-rate medical service in the Government hospitals, and only the rich can seek swift and effective remedies for their sicknesses while the poor, as well as the not-so-poor, have to be content with second-rate treatment or, worse still, depend on prayers to heaven to help them get well.

Two cases that happened sometime ago in the Government hospitals must surely cause some disquiet among members of the public over the lapses of the Government health services, especially when they have grown accustomed to the high standards of medical services provided by the Government hospitals. One was the case of a patient who died after an appendicitis operation because the doctor removed a lump of fat instead of the affected appendix. The other was the death of a girl patient suffering from concussion after a fall, as she was not given the prompt medical attention she deserved. I believe the reason given in this case was that the equipment in the neuro-surgery department was overworked and the department understaffed. I know it is not fair singling out just these two cases to give the impression that something is amiss in the Government medical services. Two swallows certainly do not make a summer. The numerous successful cases in the Government hospitals that have gone unnoticed certainly more than make up for the few failures.

My point is that under existing circumstances when the standard of Government medical services is high, such lapses have occurred. I shudder to think what will happen in future when there is a deterioration in the standard of Government medical services as a result of a massive "desertion" of Government doctors to take up private practice. Hon. Members must surely agree that with the springing up of more private clinics and hospitals and the dissatisfaction of the Government doctors over their terms and conditions of work, the flow of Government doctors to private practice is likely to quicken. Retaining the services of first-rate doctors in adequate numbers in the Government service is certainly going to be more challenging for the Minister for Health in future. The task of the Hon. Minister is made more difficult sometimes by the niggardly attitude and "the ostrich with its head in the sand" kind of outlook adopted, particularly by the Finance Ministry officials, that often frustrate any positive move to remedy the situation.

I quite sympathise with the Minister for Health and his other fellow Ministers in not being able to get what they want for their Ministries from the Finance Ministry. Only the Prime Minister and the Deputy Prime Minister, I am told, get what they want.

Perhaps for a start, the Ministry of Health can help to change the attitude of the top Finance Ministry officials by ensuring that if any one of them is admitted to hospital for treatment, he is given the poorest medical attention and services possible, just to give the Finance Ministry official a dose of his own medicine. If that official happens to be the one in charge of the allocation of funds for the building of community centres, then the Minister can even count on the services of the hon. Member for Kim Seng who, as we have all learnt from recent press reports, is on the warpath with the Finance Ministry over unfair allocation of funds to his constituency's community centre building project. In his present "belligerent" mood and frustration, he might even be tempted to use his surgical skills to cut him up as mercilessly as the Finance Ministry officials had slashed the financial allocation for his constituency's community centre building.

Of course, Mr Speaker, Sir, the last portion of my speech is made in a lighter vein. I support the Bill before this House.

Mr Ho See Bong: Mr Speaker, Sir, I rise in support of the Private Hospitals and Medical Clinics Bill. However, I surely do not share the sentiments of the Member for Moulmein because he talked about the doctor's remuneration. But I know that the teachers' remuneration is even worse. I hope that when the time comes to the debate on the Ministry of Education's allocation of funds, he will speak louder or as loud as he has at this time.

Dr Toh Chin Chye: Mr Speaker, Sir, I thank the Member for Moulmein and the Member for Khe Bong for their ostentatious support. I must emphasise that the Bill on which we are discussing relates to the licensing of premises and has no relationship with the emoluments of doctors. I am quite sure, nonetheless, that my medical staff will be very pleased if they could have heard the Member for Moulmein speaking on their behalf and acting as their champion.

I must add that it was not quite fair for the Member for Moulmein to bring up before the House what was reported in the newspapers on two cases which appeared before the coroner. In the Government hospitals, the Ministry of Health officials, doctors, physicians, dentists and other staff members are publicly accountable and, therefore, there is great scruple over unusual deaths that may occur in a hospital. It is because the peers exercise judgment over themselves that unusual deaths are promptly reported to the coroner and a public inquiry held to ascertain whether the death has been due to negligence or has been due to misadventure.

For this reason, we can say that patients who are treated in Government hospitals can be thankful that here we have a system which keeps physicians, surgeons and other hospital staff on their toes, so that standards are maintained and mistakes are not covered up. This is essential to good hospital practice, and it is because of this that we have received adverse publicity. But let us assume that all these things have been covered up, then of course, there would not have been coroner's inquiries, there would have been no newspaper reports, and everybody would have believed that the Government medical staff, surgeons and other hospital staff are as capable and as efficient as their counterparts in the private sector. But the Member for Moulmein could probably do an investigation on the quiet to find out what happens in the private sector. I suspect that he will be entering the twilight zone.

For his information, if he is ignorant, I would like to inform him that patients who are high risks are rarely treated by private practitioners. In fact, they are referred to Government hospitals. Patients who have become moribund because of mismanagement by private physicians are also referred to the Government hospitals. So in the end the Government hospitals are the reservoirs or receptacles for very bad risk cases whilst private practitioners take on the low risk cases and gain fame.

There is a degree of unfairness in the mass media and, if this is reflected by the reaction of the Member for Moulmein, it will be a great help indeed if the mass media could do their own probes. I for one could vouch that letters of complaint about the performance in the private sector have been written to the mass media for publication in the newspapers but have been covered up. The letters, copied to me, were written to the Straits Times but they chose to publish only letters of complaint against public hospitals, never against private hospitals. I think the mass media in this sense is doing a disservice to the public, the consumers. Patients are consumers of health services and it is their right to know what they are consuming, how they are being treated. It is the intention, therefore, of this Bill to uphold the patients' right and to protect patients.

As I have pointed out earlier on, there are segments of the population who are fastidious over health care and are easily gullible to all advertisements relating to cures, fantastic cures, which may well be unfounded. It is to protect them that we have to extend the Nursing Homes and Maternity Homes Registration Act to cover clinics run by private physicians. This is a gap which has been in existence over the last 20 years. The situation today warrants that expeditious action be taken because, as Singapore hopes to become a medical centre in this region, we can expect that more and more adventurers will make use of this facility in Singapore to advance their own cause.

Mr Sia Khoon Seong: Mr Speaker, Sir, I notice that I have touched on the favourite subject of the Minister for Health but I do not intend to prolong the discussion any further. I just want to touch on what the Member for Khe Bong has said - asking me to speak louder for the teachers' cause. If he had read and listened to some of my speeches in the past, he would have noticed that that was precisely what I did.

Question put, and agreed to.

Bill accordingly read a Second time.

Resolved,

That the Private Hospitals and Medical Clinics Bill be committed to a Select Committee consisting of Mr Deputy Speaker as Chairman and the following Members: Dr Ang Kok Peng (Buona Vista) Dr Koh Lip Lin (Nee Soon) Mr Lee Yiok Seng (Bukit Panjang), Parliamentary Secretary to the Minister for National Development Mr Sia Khoon Seong (Moulmein) Encik Sidek bin Saniff (Kolam Ayer) Mr Tan Soo Khoon (Alexandra) Dr Toh Chin Chye (Rochore), Minister for Health Mr Eugene Yap Giau Cheng (Mountbatten). - [Dr Toh Chin Chye]