MEDICAL REGISTRATION BILL

Order for Second Reading read.

The Minister for Health (Mr Yeo Cheow Tong): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

This Bill seeks to provide for the registration of medical practitioners and for matters connected therewith, and to repeal the Medical Registration Act (Chapter 174 of the 1985 Revised Edition).

The current Medical Registration Act (MRA) derived its origin from the Medical Registration Ordinance 1953. The title of the legislation was changed to Medical Registration Act in 1971. Other than some minor amendments in 1979, the MRA has remained essentially unchanged.

We need to update the MRA as the medical profession and the practice of medicine in Singapore have undergone tremendous changes over the past 30 years. We need to enhance the role and structure of the Singapore Medical Council to enable it to perform its functions more effectively and raise standards of professional conduct and practice.

Let me briefly explain some of the major changes in our medical sector over the past 30 years. Firstly, the number of doctors in Singapore has increased almost five-fold, from less than 1,000 in the mid-sixties to 4,800 today. Today, nearly 50% of the doctors are in private practice, unlike in the past where most of the doctors worked in the public health care sector.

Secondly, about 40% of the doctors now have post-graduate qualifications today, compared to only a small number 30 years ago. The range of specialisation and sub-specialisation has also increased tremendously. For example, we only had general surgeons previously, we now have surgeons specialising in heart surgery, with further sub-specialisation in surgery for children with congenital heart diseases.

Medical science and technology have also changed tremendously over the past 30 years. As a result, doctors now have a variety of effective treatment options for many medical conditions. For example, numerous operations can now be performed either as conventional open surgery or as minimally invasive surgery. Doctors are also able to offer drug therapy instead of subjecting the patient to surgical procedures for an increasing number of medical conditions.

These changes have benefited Singaporeans. We now enjoy a standard of medical care that is comparable to the best in the developed countries. Singaporeans now have a much wider choice of doctors and treatment modalities. But because medical science has made so much progress, and the number of specialties expanded so rapidly, there is an urgent need to provide for an accreditation system for specialists that will ensure that they have undergone the necessary training and are continuing to upgrade their knowledge and skills.

Another change is that, as Singaporeans become more affluent and better educated, their expectations of the quality and outcome of medical care also increase. Patients are now more ready to seek redress when they are dissatisfied with the performance of their doctors.

Although the level of medical litigation in Singapore is much lower than that of the developed countries, there is, nonetheless, an up-trend in the number of complaints filed with the Singapore Medical Council (SMC) against doctors for alleged professional negligence, misconduct, unethical practice and so on and so forth.

In 1996, the SMC received 66 formal complaints against doctors compared to only 18 in 1986. In terms of number of complaints per 1,000 doctors, these figures represent an increase from 6 complaints per 1,000 doctors in 1986, to 14 in 1996. In the sixties, formal complaints against doctors were rare.

We therefore need to strengthen the Medical Council's structure to enable it to better handle the increasing number of complaints. We will need to increase the membership of the Council and improve the inquiry process so that complaints can be processed expeditiously.

Another problem that we face from time to time is the illegal conduct of procedures and treatments which are to be performed only by qualified and registered medical practitioners. Often, these illegal procedures are done improperly, and patients need to go to qualified specialist doctors for corrective treatment. Some less fortunate patients may have to suffer for life because the damage to their tissues or organs was permanent and could not be corrected completely. Many of these illegal procedures are conducted by beauticians or other lay persons who unscrupulously mislead their clients into believing that they are qualified to undertake such procedures. One example is the recent case where a lay person provided colonic washout treatment to a member of the public resulting in permanent damage to her rectum and anus.

The present MRA provides for a penalty of only a maximum fine of $500 for unauthorised persons providing treatments which only registered doctors are allowed to do. The current penalty is a grossly inadequate deterrent in view of the potentially large financial gains possible.

I shall now highlight the major new provisions that are being introduced in this Bill.

Larger Medical Council

To widen the representation in the Singapore Medical Council and to expedite the processing of complaints, clause 4 increases the number of members in the Council from the current 13 to 17.

Additional functions for the Singapore Medical Council (SMC)

The Bill will broaden the functions of the Singapore Medical Council. Clause 5 empowers the SMC, in addition to its current functions, to also make recommendations to the appropriate authorities on:

(a) the content and nature of courses of instruction and examinations leading to the Singapore Medical degree; and

(b) the training and continuing education of registered medical practitioners.

This is to ensure that our medical students and practising doctors are continuing to receive appropriate medical training, and are keeping abreast of medical advances and developments in order to maintain high professional standards.

Compulsory Voting by Medical Practitioners

Currently only about 15% of registered medical practitioners participate in the election of representatives to the Council. This is clearly not satisfactory. To ensure that those elected are truly representative of the medical profession, the Bill will make voting compulsory. Those failing to vote shall not be entitled to apply for practising certificates unless they have good reasons or unless they pay a fine. This is similar to the Legal Profession Act, which provides for compulsory voting of members to the Law Council.

Vacating Office

To ensure that Council members take their appointments seriously, clause 9 provides for the removal from office any member of the Council who is absent without leave for 3 consecutive ordinary meetings of the Council or its Committees.

Conditional Registration of Foreign Medical Graduates

The SMC currently grants conditional registration to foreign-trained graduates from Universities listed in the Schedule to the Act. The usual conditions are that they have to work for a minimum of two years under the supervision of a registered medical practitioner, and be assessed by the SMC before being granted full registration. This is to ensure that they have adequate knowledge, skill and competence before full registration is granted. Conditional registration is also practised in countries like the United Kingdom, Australia and New Zealand. Clause 21 formalises this practice.

Full registration can, however, be granted immediately to a foreign-trained doctor if the SMC decides that he holds recognised qualifications, or has the knowledge and skills which we need.

Specialists Accreditation Board

Another new provision in the Bill is the creation of a Specialists Accreditation Board, consisting of not less than eight doctors. The Specialists Accreditation Board will:

(a) determine the qualifications, experience and standards required for specialists registration;

(b) define the specialties in medicine for the Register of Specialists;

(c) determine and accredit the training programmes for speciality training;

(d) grant certificates to persons who fulfil the qualifications for specialists registration; and

(e) recommend to the Medical Council programmes for the continuing medical education of registered specialists.

These provisions are in line with current practices in the United Kingdom and the United States. The provisions are not intended to restrict the doctors' practice to specialist practice only, as they are already qualified as registered medical practitioners for general practice. The Specialists Register will, however, ensure that only qualified specialists are allowed to practise in the field of specialisation in which they have been registered.

Health Committee

At present, a doctor who is unfit to practise because of psychiatric condition, drug/alcohol dependency or any other physical or mental condition, cannot be removed from the Register. Clauses 47 to 49 provide for the setting up of a Health Committee to review any doctor whose fitness to practise is impaired by reason of his physical or mental condition. It will be empowered to restrict or suspend the doctor's practice, or recommend that his name be removed from the Register. The Medical Act of the United Kingdom also provides for the establishment of a Health Committee with similar functions.

Disciplinary Procedures

Sir, let me move on now to disciplinary procedures. Presently, complaints are dealt with by the Preliminary Proceedings Committee (PPC) of the SMC, before being referred to the Council for an inquiry if so determined by the Committee. As the PPC is made up only of Medical Council members, their limited numbers inevitably slow down the processing of complaints. The PPC's authority is limited to either dismissing the complaint or referring it for formal inquiry by the SMC.

To overcome the present limitations and to allow for wider representation, clause 39 provides for the establishment of a Complaints Panel, consisting of:

(a) not less than 3 members of the Medical Council; (b) not less than 10 and not more than 40 doctors of at least 10 years' standing who are not members of the Medical Council; and

(c) not less than six and not more than 40 lay persons.

Clause 40 provides for the appointment of Complaints Committees, with the members appointed from the Complaints Panel. Each Committee will comprise two members of the Complaints Panel who are members of the Medical Council, a member of the Panel who is a doctor but not a member of the Medical Council, and a member of the Panel who is a lay person.

The large membership of the Complaints Panel will enable several Complaints Committees to be formed should the need arise, and help expedite the processing of complaints. The concept of lay persons being involved in disciplinary procedures is also present in the Legal Profession Act and Accountants Act, and will make the disciplinary process more transparent and open.

The Complaints Committee will inquire into the complaint, and upon completion of its inquiry, shall:-

(a) dismiss the complaint;

(b) warn the doctor complained against;

(c) issue him with a letter of advice; or

(d) refer the complaint to either the Disciplinary Committee or the Health Committee for action.

To ensure that complaints are dealt with expeditiously, each Complaints Committee will be given three months to complete its preliminary investigations.

Disciplinary Committees

Clause 42 provides for the Medical Council to appoint Disciplinary Committees, each comprising not less than three doctors of at least 10 year's standing, of whom at least two shall be members of the Medical Council, and one lay observer. The Disciplinary Committee shall formally inquire into any matter referred to it by the Complaints Committee, and is expected to make its finding and order within six months of its appointment.

Today, doctors are disciplined only if they are convicted of any heinous offence, or are guilty of infamous conduct in a professional respect. This is too restrictive a definition of the offences for which disciplinary action can be taken by the Medical Council. The proposed amendments will allow the SMC to discipline doctors who have been guilty of any improper act or conduct which brings disrepute to his profession, or who have been guilty of professional misconduct.

Enhancement of Disciplinary Powers

Under the existing MRA, if a doctor is guilty of infamous conduct in any professional respect, the SMC can either censure him, suspend his registration for a period of not more than 12 months, or strike his name off the register.

The wide difference in severity of the penalties provided in the existing MRA has often resulted in a lower penalty being imposed on the doctor. For example, if a doctor has been found guilty of an offence which warrants more than a censure, but which was not serious enough to merit a suspension, he is likely to end up with only a censure. In such cases, a fine would have been more appropriate.

The Bill addresses these shortcomings by enhancing the penalty options available to the Medical Council. It empowers the Council to:

(a) remove the name of the doctor from the medical registers;

(b) suspend the doctor from practice for a maximum period of three years, instead of the current maximum of one year;

(c) impose restrictions on the practice of the doctor for up to three years; or

(d) impose a penalty of not more than $10,000.

The Council may also order the suspension, or removal of name to take effect immediately, instead of after 30 days, if it is deemed necessary in the public interest or in the best interest of the medical practitioner concerned.

Restoration of Name

Clause 46 provides for a doctor whose name has been removed from the Register by order of the Disciplinary Committee to apply for his name to be restored after a minimum period of three years.

Proposed increase in penalty for unauthorised person acting as medical practitioner

I had mentioned in my opening remarks about unauthorised people carrying out medical procedures and treatments illegally. Clause 17 increases the maximum penalty for a first offender from the present $500 to $100,000 or imprisonment of up to one year, or both. For subsequent offences, the penalties will be increased to $200,000 or imprisonment of up to two years or both.

This provision will enable the Government to act effectively against unauthorised persons who are illegally providing medical treatment and procedures, even though they had not claimed to be registered medical practitioners. These enhanced penalties very clearly signal that the Government is determined to stamp out such abuses.

Consequential and other minor amendments

The Bill also proposes consequential changes as a result of the proposed amendments that I have just described, other minor amendments to delete obsolete terminology and to update the existing provisions.

Conclusion

Mr Speaker, Sir, we have come a long way in the provision of medical care. We have a high standard of care today because we have well trained and highly competent doctors, backed by equally competent supporting personnel and well-equipped hospitals and clinics. Our doctors are not only professionally competent but the vast majority also practise medicine as a calling. Collectively, they help to uphold the professional and ethical standards and integrity of the system.

However, the challenges facing the medical profession and the entire health care sector will be even greater in the years ahead. We will continue to see the development of new medical procedures and treatments, and the introduction of new diagnostic equipment and tests, and so on and so forth. To safeguard our patients, the profession must ensure that its members are properly trained before they are allowed to use the new medical developments and technology. At the same time, we must deter doctors from being tempted into advising their patients to undergo unnecessary tests, procedures or operations for financial or other reasons.

This Bill will help to achieve these objectives. It will enhance the role and structure of the Medical Council, and empower it to safeguard our high standards of medical practice, and promote the further development of the medical profession.

My Ministry has actively sought the views and inputs of the Singapore Medical Council, Singapore Medical Association, Academy of Medicine and College of Family Physicians during the preparation of the Bill. These professional bodies have given their general agreement and support to the Bill. They have made some suggestions on the voting procedures and other operational details. My Ministry will take these inputs into consideration when preparing the Regulations.

Sir, I beg to move.

Question proposed.

Dr Tan Cheng Bock (Ayer Rajah): Mr Speaker, Sir, I would like to declare my interest. I am a family medical practitioner.

Mr Speaker, Sir, there are 63 clauses in this Bill, excluding the Schedule. Of these 63 clauses, only 12 are similar to the old Act. The rest are either amendments or new provisions. I have gone through this Bill and I support this Bill. In fact, it is long overdue as medical practice in Singapore has changed tremendously and this Bill will bring it up to date with the many developments in medical practice. However, there are a few clarifications I would like to seek and suggestions which I would like the Minister to consider. As this is a long Act, I will approach this in sections or parts, as laid out in the Bill.

Mr Speaker, Sir, Part II deals with Medical Council. It relates to the Constitution of the Medical Council and it makes voting for election of Medical Council members by registered medical practitioners compulsory. I will take the two clauses (4 and 6) of this Part II.

Mr Speaker, Sir, there are 17 members on the Singapore Medical Council (SMC) Board. Of these, nine are nominated and eight elected. If you introduce compulsory voting, I would have thought that we would follow the example of the Law Society where there are only three nominated members out of a board of 19. Is there any particular reason for a majority of nominated members over the elected ones for the medical profession?

I support the compulsory voting system to be introduced because it would allow the members to send in the representatives of their choice for the wider medical body. But it does appear odd if compulsory voting only permits the elected doctors to have a minority representation on the Board, like I said, eight out of a majority of 17. Is it because the Ministry has less confidence in the medical professional group? Unlike the Law Society, this Bill allows only doctors with at least 10 years' experience in the practice of medicine to stand for election. If you want a better representation of the Council, allowing them to vote their representatives with their own band age of practice would be better. Here we have to take the example of the Law Society where those with less than seven years' practice can have their representation. Similarly, those practising between seven and 12 years will do the same, and those more than 12 years have their own representation. I do not know whether there is any particular reason why voting along the respective band years of practice is not being considered for the medical profession. We could have two bands - one for those with less than 10 years of practice and another band for those with more than 10 years of practice.

On the question of compulsory voting, the Minister just mentioned that only 15% voted in each exercise for election into the Medical Council, in the present format. I think this is because voting is quite cumbersome. Each time a medical doctor wants to vote, he has to get two signatures from two other doctors before he can vote. So I hope we can change this pattern of voting for doctors into the Medical Council.

Mr Speaker, Sir, I would refer to Part III of the Bill which is on pages 8 and 9. I support this upping of fines and imprisonment for those who purport to be medically trained doctors. In the past, as the Minister has mentioned, the fines were too low and therefore many non-medical Singaporeans dared to take a chance. And I am sure many of you must have heard that there are so-called foreign doctors who practise out of homes of Singaporeans or even from hotels. We must therefore discourage these practices. Moreover, practices of medicine like skin peeling and use of sophisticated medical machine, for example, ultrasound, to impress gullible Singaporeans should not be in the hands of non-medical personnel. These practices must be under supervision of the doctors, and I am glad the Minister mentioned that. There are also, if the Minister is not aware, roadside laboratories being set up where they do laboratory tests for your cholesterol, triglycerides, sugar, and these gullible Singaporeans will subject themselves to these tests and the practitioner would then advise them to seek treatment from him or persuade these Singaporeans to go and seek treatment from their own quack doctors. So I am glad this Bill takes into account this factor.

Let me refer to Part IV which deals with registration of medical practitioners. In general, I have no quarrel with this Part. However, can I refer you, Mr Speaker, Sir, to pages 17 and 18, clause 33(1) and 33(1)(g). This refers to the power of the Medical Council to remove names from registers. Clause 33(1) states:

"Notwithstanding the provisions of this Act, the Medical Council may, upon such evidence as it may require, order the removal from the appropriate register the name of a registered medical practitioner under any of the following circumstances:" There are many circumstances listed out. But there is one particular circumstance, clause 33(1)(g), that caught my attention, and that is this:

"if he has failed to serve the Government or such other body or organisation as directed by the Government for such period as may be specified in any undertaking given by him to the Government." This would mean that he can get deregistered.

Let me explain further, Mr Speaker, Sir. Our medical students are bonded to serve the Government. Upon graduation, he gets a provisional registration to practise as a house officer. Once he has completed his housemanship, he gets full registration and can practise as a doctor. This clause, which I have just quoted to you, and unless my interpretation of this clause is wrong, allows the Medical Council to remove his name if he breaks his bond. Can I ask the Minister if this young doctor who for whatever reason decides to leave the Government service and go into private practice, let us say, after serving only three years of his eight-year bond, will he be deregistered? Under this present clause, he can be deregistered. I think this is a very serious matter as a young doctor cannot practise medicine unless he is fully registered. The issue here needs clarification.

I see the conflict because his registration as a doctor was based on his professional competence and the fact that he holds a degree from the National University of Singapore or any of the recognised medical schools, as stipulated in page 10, clause 20(1) and (2). And throughout the Part, the key for registration was professional competence. In this clause, his deregistration was based on a breach of contract for failing to serve his bond. We deregister doctors for professional incompetence, negligence but, I am sure, not for a breach of contract. I want this clarified because it has serious implication for young practising doctors.

Mr Speaker, Sir, Part V deals with Specialists Accreditation Board. I support this establishment. We need a proper list not only for doctors but also for patients. However, there is one question that I want to ask the Minister. Having established this Board and having doctors accredited along the line of specialisation, does it mean that such accredited specialists can see only patients within their area of expertise? In other words, a heart specialist can also see and treat a patient with an abdominal problem, or a breast cancer, or the common cough and cold? Must he only see referred patients by family doctors for his expert opinion and perhaps management? Or can he also see patients off the street like any other general practitioner or family practitioner? I am not sure whether the Ministry is moving towards a proper referral system as practised, for example, in Australia and Britain. If not, what is the other reason for setting up this Accreditation Board?

There are implications should we move into a referral system. It has good and bad points. Good for patients for it means a better maximisation of our health care delivery system. There will be less wastage. Because in such a system, patients wanting to seek specialist care can go through their family doctors who then refer the patients to the proper specialists. But when specialists see patients off the streets, there is a chance the specialist might be seeing a patient not within his field of practice. This is very possible in Singapore because Singapore patients are very gullible. They usually listen to friends. Many good specialists in Singapore normally refer such patients to the GPs for assessment and proper referral. But a few will send the poor patient on a merry-go-round, passing from one specialist to another, and the patient is very much the poorer. It is bad for the specialist's practice because he now depends on the family doctors for referral. But, on balance, a proper referral system is good because medical practice in Singapore will be better organised and will help Singapore develop into an efficient medical regional centre to benefit locals as well as foreigners.

Finally, Mr Speaker, Sir, Part VII deals with disciplinary proceedings and the Health Committee. A great deal of this Act is spent detailing the disciplinary proceedings and as it is fairly well done, I will not dwell into it because it will be just repeating what is in the Bill. However, the inclusion of lay persons into the Committee is a good move. For too long the medical profession has been accused of protecting its own interest. I am sure the lay people in the Committee will provide another dimension into the discussion of disciplinary actions on doctors. It makes it more transparent.

The setting up of a Health Committee is something new. It is again a right step. It provides a check on doctors who may be, as the Minister said, physically and mentally not well enough to practise. It also places on practising doctors to report such doctors to the Health Committee. And as pointed out by the Minister, at present there is no law to disallow such doctors to practise. This present Bill clearly states that the Health Committee can recommend to the Medical Council to deregister a doctor if the Health Committee finds him unfit to practise on medical grounds.

Mr Speaker, Sir, as I said in one of my speeches, most of our primary healthcare is in the care of the private clinics. And some of these clinics are now banding together and forming companies to get listed in the Stock Exchange. The implication is very simple. Doctoring is now a business and the bottom line is very important for such companies. As I said before, I dislike calling the medical profession a business. As such, medical practice, medical culture, doctor's behaviour will all change with all this listing of clinics. Various kinds of treatment and equipment, not available in the past, are now available. Doctors, for example, have to turn to skin peeling. It is a treatment for skin problems. GPs are using ultrasounds, X-ray machines, ECG, doing colonic washouts and sigmoidoscopy procedures. There must be more control on the use of these equipment. While we should not discourage doctors from offering more choices of treatments, there must be some degree of caution.

The use of ultrasound, for example, should always be accompanied by a report. Not only ultrasound, but the use of any other medical equipment. This report is very important because it reveals the competency of the doctor when he makes such a report. He must be competent enough to put it down in writing that this is what he sees on an ultrasound picture, or this is what he sees on an X-ray picture. But many a time, as a practising doctor, I come across patients presenting me with an ultrasound picture or an X-ray. I tell them honestly that I am not competent enough to read because I am not well-trained in that field. So Mr Speaker, Sir, may I ask the Minister to consider my request to make it compulsory for anyone who wants to make use of these sophisticated machines to at least give us a report. You can put this as a condition for the renewal of his certificate.

Mr Speaker, Sir, many of our private hospitals are now in the hands of a foreign-owned public listed company. They are now run by non-medical personnel who are not interested or aware of the ethics of medical practice. Their main concern, of course, again is bottom line. Doctors in such establishment would be under severe pressure to perform to meet the bottom line, or probably they would be removed. Doctors not in their payroll would have to meet certain requirements or lose out on the use of the facilities that these hospitals are providing. Therefore, there are going to be more cases of professional misconduct and unethical practices.

Thus, at this point, I would suggest there must be in place, and I hope that they are already in place, medical audits, tissue audits and hospital audits. I think we need to have all these in place because we need to audit how the hospital is functioning. We need tissue audits. Maybe this House is not aware what is tissue audit. Tissue audit is very simple. Every time a surgeon removes a tissue from the body, you must subject this tissue to an audit. In other words, the tissue must be examined by a pathologist to ensure that normal tissues are not being removed. We can remove things from the body. But to the non-medical people, they all think opening up an abdomen is such a great thing. But to the surgeons, it is the easiest. So when you remove something from the abdomen, we must make sure the tissues removed are not normal. This is a good check for unnecessary surgery. So this tissue audit is only one aspect.

Medical audits are important. I do not want to go through the details. For hospital audits, you have got to make sure that the hospitals are being audited very carefully because there are so many procedures. You will see that there are many things happening and I am sure the Minister may be aware too.

Mr Speaker, Sir, as I said, the Bill, on the whole, is a very good Bill and I support this Bill.

Dr Lily Neo (Kreta Ayer-Tanglin): Mr Speaker, Sir, I rise to speak in support of the Medical Registration Bill. As I am a medical practitioner, I would like to declare that I do not have and do not anticipate to have any pecuniary interest through this Bill. On the whole, this Bill is comprehensive and is suitably up-to-date for the immensely changed scene in the medical profession. I must say that the introduction of this Bill to modify the Medical Registration Act is very necessary and is very timely.

It is to be noted that a number of amendments and additions are broad-based. This is appropriate in view of the present state of rapid change. I reckon that room for modification is necessary so as to have adequate and better control of the whole profession when newer developments take root. However, I would like to seek assurance from the Minister that, when they are being finalised, the details of these amended and new clauses will not unnecessarily prejudice or penalise any particular practitioner or group of practitioners.

Sir, I would like to highlight and comment on a few of the new clauses in the Bill.

Firstly, Sir, I note that clause 17(1) in the Bill has been amended from the previous Act to deal with the offence of acting as a medical practitioner by any person who is not authorised to practise medicine. I welcome this long overdue amendment. This clause would now enable the authorities to more effectively address a few unfortunate situations which happened recently and which many felt were not adequately dealt with.

For instance, as mentioned by the Minister for Health earlier on, a 57-year old man was charged in court this month for practising medicine without registration. He was accused of performing colon-cleansing amongst other health treatments on patients between 14th and 18th January this year. This colon-cleansing procedure can be dangerous and did result with perforation of the colon in one person. It is possible that unqualified practitioners will do any procedure and some of these could even be life-threatening. The case of a bogus doctor who worked in the General Hospital last year for more than six months is another example of note. Sir, perhaps it would be prudent for us to delineate clearly the sort of treatment which practitioners in traditional medicine or beauty-care should not be administering so that they do not unwittingly violate the law.

The maximum penalty that can be meted out to any unqualified practitioner in medicine or surgery was a fine of up to $500 and a further fine of $50 for every day during which the offence continues. This indeed is absurd and, especially, when even cruelty to animals is punishable with both a fine and also a jail sentence. The potential mental trauma and danger to life should not be punishable by a mere pittance of a fine. This Bill now provides that an unauthorised person acting as a medical practitioner shall be guilty of an offence and shall be liable on conviction to a fine not exceeding $100,000 or to imprisonment for a term not exceeding one year or to both and, in the case of a second or subsequent conviction, to a fine not exceeding $200,000 or to imprisonment for a term not exceeding two years or to both.

I return now to clause 39(1)(c) of the Bill which requires the Medical Council to appoint not less than six and not more than 40 lay persons as part of its Complaints Panel.

Many of you will be glad to know that this means that there will be lay people in the Committee of Complaints. Besides the three or more members of the Medical Council and the 10 to 40 registered medical practitioners over 10 years' standing, there will be six to 40 members from the public in the Panel. Some people have argued previously that there may be bias in the assessment of complaints from patients because the Panel is derived from medical practitioners only. This new addition in the Bill will address peoples' desire to know that open and representative assessments are carried out for all the complaints of any improper acts or conduct by doctors. It will also resolve the perception that doctors who bring disrepute to the medical profession are only subjected to "internal audits" by medical practitioners themselves. The clause provides for up to 83 members to be in the Panel. This is a large number. Perhaps this will help eliminate the element of bias and prejudice.

Clause 22 of the Bill is totally new. The registration of specialists is now necessary to cater for the changing times. There was no necessity to have this clause in the past as, even just 10 years ago, the number of specialists was limited. The need for a Register of Specialists becomes obvious when we note that a whopping 40% of our doctors now are specialists.

The registration of specialists will allow for the public to be better informed on the availability of the specialities and the specialists. Also, this will enhance the reputation of Singapore as a centre of medical excellence with a large number of specialists in wide ranging medical specialities. This will certainly boost the promotion of Singapore as a major medical centre in this region.

I would like to suggest that specialists can register themselves into broad categories. Registration under sub-specialities should be carefully chosen and limited. I would also like to suggest that whilst it may be unwise for a specialist to perform cross-speciality work, their practice of medicine should not become so restrictive that their basic tenet as a doctor is lost and forgotten. In other words, they should still be able and be entitled to treat simple ailments, such as flu, diarrhoea, headache, and so on, in their patients without having to refer them elsewhere. Excessive and unnecessary referrals will only increase healthcare costs.

Clauses 36, 37 and 38 in the Bill are new and concern the introduction of a Practising Certificate which will be granted to every registered medical practitioner.

The validity of this certificate is for a period not exceeding two years from the date of issue. In future, the Medical Council will have full control over the practising doctors in Singapore because the application for a Practising Certificate shall be made in such form and manner as the Medical Council may require. This can become one control too many for the doctors.

Sir, the point I want to make is that this is definitely an extra "bitter pill to swallow" for all the doctors. I would like to urge our Government to practise restraint and not to use this Practising Certificate as a tool to pressurise and to cause extra demands on the medical profession.

I would also like to suggest that the Government practise prior consultation and feedback with all the parties involved before implementing new ideas as laws. This is especially for rules that can affect the livelihood of some of the doctors. Yes, we want medical excellence but we must still retain some respect and compassion for human expectations and limitations. Please do not subject doctors to go back to "school" and do examinations every two years! Well, I am sure the authorities will not have such unfair and authoritative demands.

Sir, I support the Bill.

Mr Speaker: Order. I suspend the Sitting and will take the Chair again at 3.25 pm.

Sitting accordingly suspended at 3.00 pm until 3.25 pm. Sitting resumed at 3.25 pm