MEDICAL REGISTRATION BILL

[Mr Speaker in the Chair]

Debate resumed.

Dr Michael Lim Chun Leng (Cheng San): Mr Speaker, Sir, thank you for allowing me to join in the debate. I must first declare that I am a practising medical specialist.

I welcome this Bill by the Ministry of Health. I think it has made many important changes which keep up with the changes in medicine. The Bill covers three main areas; firstly, matters pertaining to Medical Council; secondly, matters pertaining to accreditation and registration of doctors; and, lastly, disciplinary action on doctors.

I would like to take this opportunity to touch on a few points regarding this Bill. Firstly, matters pertaining to the Medical Council. Clause 6(2) states that:

`Every registered medical practitioner who is required to vote for the election of members of the Medical Council in accordance with subsection (1) and who fails to do so shall not be entitled to apply for a practising certificate unless he satisfies the Registrar that he had a good and sufficient reason for not voting at the election or unless he pays to the Medical Council a penalty prescribed by the Medical Council.' I think this point was brought up by Dr Tan as well. I support the Ministry in making voting compulsory because it means that the medical fraternity will take a more active interest in the Medical Council which has significant powers over the medical profession.

However, I feel that clause 4 does not do justice to the spirit of clause 6 which makes voting compulsory. As pointed out by Dr Tan, out of the 17 members of the Medical Council, only 8 are elected members. The other 9 members are appointed by the Minister. If we take the Singapore Parliament as an analogy and voting in Singapore during elections is compulsory, I think it would make a mockery of the system if there were more nominated Members of Parliament than elected Members of Parliament. Likewise, if voting is to be made compulsory for Medical Council elections, it stands to reason that elected members should outnumber nominated members. I am not certain why the Ministry wants to appoint so many members chosen by them. I am also not sure that the Minister himself is familiar with the members of the medical profession and the process of appointing members is not clear or transparent to members of the medical profession. Those within the fraternity will know the members very well. It does not mean that if a certain member is a head of department or even holding a very senior position in a hospital that this person is suitable to sit as a member of the Medical Council. I think the Minister should clarify this point as to why there is a need to have more nominated members than elected members.

The second point pertains to another point which Dr Tan has also raised in clause 33(1)(g). Medical students who are entering medical school - I stand to be corrected - if I am not wrong, are bonded for five years or a certain period of time. And if they break this bond, they have to pay certain liquidated damages. If the student, upon finishing his examinations and practises as a doctor, decides to break the bond and pays the damages, I want to seek clarification whether there will be penalties imposed upon him. It stands to reason that if he pays the liquidated damages, there should not be a need to punish him further.

Next, I would like to move on to registration of specialists. Part V, clauses 34 and 35 deal with the establishment of the Specialists Accreditation Board. I welcome this move by the Ministry to establish a Specialists Accreditation Board. Currently, most specialists are accredited with the Academy of Medicine which maintains the Specialists Rolls. With the establishment of this Board, the function of this Board will supersede the establishment of training requirements and the accreditation process for specialists which are currently being carried out by the Academy of Medicine. Again, the Board members are appointed by the Minister. Perhaps, I think the Minister should explain to us what is the process of choosing suitable people to sit on this Specialists Accreditation Board, as these people have significant powers to affect the appointment of people for the specialists register. Is there a pre-appointment period so that members of the medical profession can write to the Ministry to comment about those whom they deem are unsuitable? Furthermore, for those currently accredited by the Academy and those on the roll of specialists, will the list be transferred or will everybody have to be re-registered again?

With increasing advances in medical technology, I think the Ministry has to go beyond just simply accrediting someone, for example, as a general surgeon, a cardiologist, an obstetrician or a gynaecologist. Because medicine has advanced so rapidly, within a certain specialty there may be very high-tech services where only certain specialists are trained and not all specialists within that specialty can perform these procedures. I think it is good that the Ministry should look at this so that appropriate people who are trained should be allowed to do this procedure and those who are not trained should not be allowed to do this procedure.

For example, if you do not do this, in a restructured hospital, if you are a very, very senior doctor in the department, and there is a new procedure which your junior doctor who has gone overseas for training has come back and started performing this new procedure, you can say that you are competent to do this procedure because of your years of training, but you may not actually be competent to perform this procedure. An example of this is what the Minister mentioned just now, laparoscopic surgery. Many of these surgeries are performed mostly by the younger doctors. But what is there to stop a very, very senior doctor who is not trained to do it to perform it. There are no safeguards at this point in time.

I also welcome the move by the Ministry to bring more discipline to the medical fraternity, but I beg to differ from Dr Tan Cheng Bock in some points where he says that doctors in private hospitals have to perform many procedures to make the owners of the hospital happy. I think this is not true because the specialists there do not own the hospital and the hospital does not own the specialists either. There is no pressure to use more facilities so that you can be accredited. In fact, I would say that having practised in both restructured and private hospitals, I was pleasantly surprised when I went out to private practice that they have accreditation processes not only for specialties but down to the type of procedures that you can do. This is something which is not very apparent in our restructured hospitals. Every time you want to attempt to do anything new, you have to clear the Ethics Committee, the Credentials Committee, and the Medical Advisory Board in the hospital before you can even write to the Ministry to ask for approval to do any new procedures. But when I was in the restructured hospital, this was not the usual practice. So I think it is good to instill discipline in all the hospitals, whether they are private or Government hospitals, if we want to become a regional centre of excellence.

My next point refers to the Complaints Panel (clause 40(21)). Again, the members are appointed. Are there any ways for the person who has been complained against to write to the Ministry or to the Medical Council if he feels that the member on the Complaints Committee is biased or prejudiced or there is a conflict of interest? As Members know, even within restructured hospitals, there are rivalries between departments and sometimes the rivalries can be fairly bitter. There might be certain instances where a person feels that he may not get a totally impartial hearing. Again, with regard to the appeal to the Minister, if the person is reviewed by the Complaints Committee, how would the Minister be advised? Will there be an independent panel that would look into the facts of the case and advise the Minister or will the Minister just make a decision solely on the report of the Committee? I think the same applies to the Disciplinary Committee as well in clauses 42 to 45. Again, there must be a way in which a member can express concern if he feels that the members on the Disciplinary Committee have certain biases or prejudices.

Further, I feel that members should be allowed to represent themselves because members may not represent themselves or submit explanations unless the Complaints Committee in its absolute discretion otherwise allows. This is in clause 40 (21). I think this is not fair. For a doctor, the moment he faces any disciplinary action, even though he is totally innocent, the publicity that is generated is sufficient to cost significant harm to his reputation and his practice of medicine.

Lastly, if a doctor is sent to the Disciplinary Committee and eventually the charges are either dismissed by the Disciplinary Committee or they are referred to the High Court and dismissed by the High Court, will the Medical Council pay for the legal costs incurred? I think it is not fair to the medical practitioner if, on top of suffering harm to his reputation and the effect on his practice, he has to incur costs on a case which is found without basis by the Disciplinary Committee or the court eventually. I hope that the Minister will look into these points.