EXEMPTED BUSINESS (MOTION)

Resolved,

That the proceedings on the item of business under discussion and the remaining items on the Order Paper for today be exempted at this day's sitting from the provisions of Standing Order No. 1. - [Dr Lee Boon Yang].

Mr Bernard Chen (West Coast): Mr Speaker, Sir, unlike the previous three speakers, I am not a doctor. So I hope I can give a non-medical practitioner's view.

I just want to make two comments on the Medical Registration Bill. The first refers to clause 4 where the composition of the Medical Council is spelt out. The Council has quite wide functions in terms of the fact that they are deciding on the issue of practising certificates for medical practitioners, including foreign doctors. It also regulates the conduct and ethics of registered medical practitioners. I notice that all the Council members are medical practitioners. There is no lay person in the Council at all. There is always a temptation for a professional group, whether it be doctors or lawyers, to resort to a certain degree of closed-shop practice, and the registration of medical practitioners can be construed to be a closed-shop practice in the sense that they may want to shut out certain people whose qualifications may not meet with the approval of the practitioners. If there is no lay person in the Council, there is no so-called check and balance.

It would also appear from the Bill that the Council is the final authority. There is no recourse for appeal. I wonder whether the Minister will consider, in the event that a medical practitioner who is barred by the Council from being registered to be a practitioner, whether he has recourse at least to the Ministry to have a second opinion. Otherwise there is a tendency for the professionals to shut them out. I am not saying that it is happening now but there is a possible danger in that.

The second comment I would like to make is on the disciplinary proceedings and Complaints Committees. Again, although there is a lay person in these committees, the lay person is an observer. By definition, an observer is not supposed to say anything. He only observes. How will his views be taken into account in the Committee? Or will his comments, in fact, be accepted or will he have a deciding factor in matters that require a decision? Dr Tan has mentioned quite eloquently that the number of cases of complaints on doctors is increasing and the Minister has also confirmed that. As the expectations of our population increase, the need to make sure that disciplinary cases are fairly conducted and be seen to be conducted is very important. We have seen in the newspapers in the past years that there have been a lot of disputes but there is always a perception by the public that whenever a case is being referred to a professional body to judge one of their peers, there always seems to be an element of cover-up. To be fair to the doctors concerned, when they judge their peers, it could be difficult. So could the lay person be given at least a bit more say in these committees and could the Ministry provide an avenue for appeals to be heard in the sense that the final decision may not rest with the Medical Council where one of their own members has been judged? This will go a long way to convince our population that in cases of malpractice or neglect, the cases are fairly conducted and at least publicly seen to be so.

Dr Toh See Kiat: Sir, thank you for allowing me to catch your eye. First, let me declare that I am not a medical doctor so that I would not be charged for falsely pretending to be one.

My only interest in this debate is that of President of the Consumers' Association and I would like to address two concerns of consumers. First, under clause 17, any unauthorised person who practises medicine is guilty of an offence. "Practising medicine", I notice, is not defined and perhaps it is important to allow the judges to develop the meaning as the cases come along. But I would like to point out that there is a particular situation which clearly cries for attention, and this is the beautician who perhaps applies astringent to the skin or prescribes herbs or beverage type food-based laxatives and using non-controlled drugs in a practice that would allow him or her to prescribe slimming treatment (they even use the word "treatment"). This person may or may not be practising medicine. I believe that there should be some provisions to cover this sort of situation, because such so-called treatments can cause severe skin problems - I have actually encountered cases like that - and sometimes even health problems like bulimia and anorexia.

Clause 17(b) talks about an unauthorised person who wilfully and falsely pretends to be a duly qualified medical practitioner. The people who are doing this kind of business are experts in skirting the grey areas of the law and they will look at this and say, "Well, if I do not do something that clearly is labelled as practising medicine, then I will be okay. And yet what I really want to do is to convince the consumer that I am highly qualified to prescribe this item." So we have actually - this is not hypothetical, Mr Speaker, Sir - cases of people who have Ph.Ds in unrelated sciences or even arts, promoting products like herbs, royal jelly, mushrooms, evening primrose oil - name it, you have it. And they are very much in the eyes of the consumers pretenders - wilful, false, all the elements, except that perhaps they have not been practising a branch of medicine. It is like, for example, with respect to Dr John Chen, instead of worrying about clogged arterial highways, he decides now to sell some kind of oil to unclog cholesterol in human arteries, because he is a "doctor". I think people will say, "Ah ha! Okay, I will buy it." Perhaps there are others who would call themselves something else. Instead of cosmeticians, they call themselves cosmetologists. Instead of beauticians, they call themselves acnetologists. And these people are clearly falsely pretending to the gullible and unaware consumer. Again, I would suggest that there is provision needed for such situations.

Clause 17(c) talks about practising medicine or any branch of medicine, under any name, title, addition or description implying the practice of any branch of medicine. It is easy for a medical professional to say, "I see this name "cosmetologist", I know it is not a medical profession." But the man-in-the-street sees a big long word like this and he says, "I give it the benefit of the doubt." And so he or she gets conned, you might say, and I think we need ways of preventing the consumer from becoming a "conned-sumer".

You have situations, for example, where this particular business might register a name in the Registry of Companies and Businesses as the "London Institute of Trichologists". I have confirmed with my colleagues in the House, the medical professionals, that trichology is not a medical speciality, but the man-in-the-street does not know. And up to this moment, I did not know until I asked them. So you have people who do things that seem to be practising medicine and the Act does not cover them. So I would like to suggest, Mr Speaker, Sir, that the Minister consider provisions that would cover these situations.

That flows on to what I want to say about clause 22, which is the registration of specialists. Under this Bill that will be passed, there will be registration of specialists and there will be a highly qualified panel to decide who is one and who is not. But it is very easy for a person to advertise in circumstances that make him look like he is a medical practitioner. I have in mind, for example, lots of what we call "infomercials" that are screened past 12 midnight. I am an owl, so I watch them. And they have got this guy who is "Dr So-and-So", MD (maybe he is a real MD, but he is not a recognised medical professional in Singapore). He is a MD, he wears a white frock, he carries a stethoscope, perhaps even an injection needle, syringe, and then he says that, "Well, I recommend this particular thing." or "I recommend this exercise machine." And people would then gladly think that he is a specialist in this area and buy that product. I think these people deserve to be penalised. If not these people, because they are overseas, then their local promoters should be penalised.

I would therefore urge the Minister to consider a provision that penalises a person who pretends to be a specialist either by conduct or perhaps by allusion to certain things. He could, for example, set up his business looking like a medical clinic with people walking around with white masks and white frocks. And I would say that there have been instances even of businesses that call themselves "The specialists from Harley Street". And, of course, you and I know that Harley Street is the famous London street of doctors.

Other than that, Mr Speaker, Sir, I support the Bill.

Mr Jeyaretnam: Mr Speaker, Sir, as I indicated earlier, I had not intended to speak on this Bill, but having listened to the speakers in this House, I feel I should put in what they call here two-cents worth of my views on this Bill.

There are some provisions in this Bill, Mr Speaker, Sir, that again alarm me. One, of course, is this deregistration of practitioners who do not perform their bonds. If I may say so, Sir, it is a dangerous thing to do. It is to bring about a compliant society which we are almost becoming, and one sees it in other spheres as well. When somebody wants to renew their business licence registration, they are told, "Oh, you haven't paid up your CPF Medisave account. Unless you go and do that, we are not going to renew your business registration.", and it goes on. This is trying to produce a compliant society. I would ask the Ministry to reconsider this. There is sufficient punishment provided by the bond itself - the requirement that the doctor repays whatever has been spent in training him if he decides to leave the service.

Secondly, and what is worse, Mr Speaker, Sir, is that there would appear to be no appeal provided. I have said earlier about the danger of giving Ministers too much power. There is also the provision, as I now heard, that if the Council refuses to register a doctor who seeks registration, there is no appeal again. It is a man's livelihood. Should he not have some redress? Should the Council not be asked to state publicly its reasons for refusing registration? And should that not be challenged in a court of law? Such a system, Mr Speaker, Sir, will point to a government and an administration which is accountable, which is prepared to submit its decisions to an independent body and particularly the Judiciary.

The other point that concerns me is this compulsory voting. I know we have had it in the Legal Profession Act for some years and the Minister says they have decided to follow what is in the Legal Profession Act. I did not know whether the Minister has consulted lawyers as to whether this compulsory voting has done any good to the legal profession. As I heard the Minister say, it is to encourage doctors to take a greater interest in the affairs of their Council and their profession. I am not sure that this compulsory voting that was introduced in the Legal Profession Act has had this effect. I know several lawyers who are not really interested in what is going on because they have a feeling that there is very little they can do about changing anything. So I do not know why we have to have compulsory voting for the doctors as well now. And the principle is you do not compel persons to do something. You got to treat our doctors, our lawyers, and our people as adults who would be able to make their own judgement. We do not have to spoonfeed them and say, "You got to do this. You got to do that. You got to do this, otherwise you're out." That does not make for a mature responsible society. So I would ask the Ministry to reconsider this compulsory voting as well.

Finally, Mr Speaker, Sir, this provision for nominated members exceeding those elected members, as pointed out by Dr Tan, would be a great incentive for doctors not to vote or to spoil their votes. What good is it going to do if there is going to be an excess of nominated members on the Council, nominated by the Government, without consulting them? Will the Ministry see that all nominations are first submitted to the doctors to ask whether they agree with the nominations? Let us have some form of democracy in this place.

Mr Yeo Cheow Tong: Mr Speaker, Sir, first, let me thank the five elected MPs who have spoken in strong support of the Bill and, of course, the NCMP for his remarks which I will respond to in an appropriate manner afterwards.

Sir, Dr Tan Cheng Bock spoke very strongly in support of the Bill. He has raised quite a few questions which I shall endeavour to answer one by one.

Sir, he has talked quite a fair bit about compulsory voting which Dr Michael Lim and Mr Jeyaretnam have also spoken about. I will take them altogether. He has asked why should the majority of the members of the Council be nominated members rather than the reverse. Let me explain that the compositions of the governing bodies of the different professions vary. For example, for the Professional Engineers Board, the Board of Architects and the Public Accountants Board, in fact, all members are nominated members. For the Law Society, 15 out of 19 are elected. For the Singapore Medical Council, it has always been that half of the Council are elected members, half are nominated, and one is ex-officio, which is the Director of Medical Services.

The system has worked well mainly because whilst the Government is responsible for nominating half the Council, we have always made sure that those nominated members are professionals of the highest standing and of the highest reputation as well.

Mr Jeyaretnam: You don't trust the doctors.

Mr Yeo Cheow Tong: Sir, this has always been the case and if any of the Members have information to the contrary, I will be very happy to hear about that. In terms of the election, Dr Tan Cheng Bock has said that actually it is because many doctors found the election process very cumbersome, that they have to get two names to countersign. Sir, I think he has got it mixed up. The need to have two names only applies to the nomination process. If you are nominating somebody, you need a proposer and a seconder. But if you are voting, the vote is supposed to be secret, so therefore you submit your vote without the need to have another peer checking whom you have voted for, and this will still apply under the compulsory voting. If Dr Michael Lim is worried about the standing of doctors who are members of the Council, then I think it is even more important that for the half who are elected, they are people who have withstood the scrutiny of the entire membership of the medical profession. I think to have only 15% vote in half the membership of the Council is definitely unsatisfactory. If you want to have people of good standing, then they must be people who have withstood the scrutiny of all the members.

Dr Michael Lim Chun Leng: May I clarify?

Mr Speaker: Yes.

Dr Michael Lim Chun Leng: Mr Speaker, Sir, the point I wanted to make was that, in making these changes in this Bill which I personally welcome, if you want to compel members of the profession to vote, it really does not make sense if having undergone such a big exercise by compelling everybody to vote and penalising them if they do not want to vote, then at the end of the day, the members who are elected are the minority, not the majority. As it stands now, voting is optional under the present system and so those who want to vote for the members can vote on who will get in. But if we know that the majority of the members are nominated members and if you want to compel people to vote, it really does not make sense. As I said in the analogy which I gave, if you want to make voting of Members of Parliament compulsory in the elections, then it is really a mockery of the system if there are more Nominated Members than Elected Members. The same analogy will follow too.

Mr Yeo Cheow Tong: It is very easy for someone to use an analogy which has got no comparison at all. This is a Parliament that is responsible for the entire affairs of the country. As I said, for professional bodies, there is a whole variety of options. Of course, if Dr Michael Lim feels that it is not worthwhile to have half the members, people whom he has chosen, I would be quite happy in future amendments to convert the SMC into something more akin to the engineers, accountants and architects and I think it would be to the great disadvantage of the profession. The key thing now is the profession has the advantage of being able to elect half of the members of the Council, make sure that those half are people of high standing and integrity who would be prepared to listen to the complaints and conduct the inquiry in a fair and unbiased manner. It is not the people whom he is afraid of, people with biases, people with axes to grind, who would inevitably get in if only a few members of the profession vote because they will then get their best friends to vote for them. If that is what Dr Michael Lim is worried about, then he should welcome this. Because under this system, it is less likely that those people whom he fears very much, and apparently, he has got many people whom he fears, these are the ones who will not be able to get in.

Dr Michael Lim Chun Leng rose ---

Mr Yeo Cheow Tong: Sir, let me move on. If he has any other points, he can bring them up later.

Dr Michael Lim Chun Leng resumed his seat.

Mr Yeo Cheow Tong: On the point about the Law Society having different bands, the key thing to appreciate is that what we are looking for is to have a Medical Council that comprises people of not just integrity, but people who have enough expertise, knowledge and skills who can then sit in judgment of their peers. Where should that dividing line be? Should it be 10 years? Should it be 15 years? Should it be 5 years? I think there will always be contention. The key thing to note is that for the medical profession, even for specialists, it takes at least seven years to train a specialist. So based on past experience, 10 years appear to be a workable and satisfactory dividing line. It has worked very well so far. Let us keep to it. It makes the system a lot simpler for everybody.

Dr Tan has asked whether we could require doctors who have conducted tests like ultrasound tests, and so on, to give their reports in writing. Sir, it is a proposal which I would be happy to ask my officials and the SMC to look into.

Several Members have spoken on clause 33(1)(g) about the removal from the register for having failed to serve the Government or any such body as may be specified in any undertaking given by him to the Government. Sir, the key operative word there is "undertaking". When a medical student enters into a contract which allows him to go through medical school, he also signs a bond that requires him to serve the Government or any other organisation, as stipulated by the Government, in lieu of which he has to pay liquidated damages. That is the total undertaking. He either serves or pays liquidated damages. This clause applies to those who break the undertaking, ie, they refuse to serve the bond and they do not pay up the liquidated damages. Because of this clause, we have not had to apply it. But it is a useful deterrent. So in answer to Dr Lim's point, if he pays up his liquidated damages, he is allowed to practise. That is why we have so many medical officers who have broken the bond, left to join the private sector and they are practising quite happily.

Dr Tan Cheng Bock: Mr Speaker, Sir, can I seek a clarification?

Mr Speaker: Mr Yeo, are you giving way?

Mr Yeo Cheow Tong: Yes.

Dr Tan Cheng Bock: First, I thank the Minister for his clarification. But I am still not clear because I am not a lawyer. However, if we were to read this clause very carefully it does give people the impression. For the benefit of all in the House, I will read it:

"Power of Medical Council to remove names from registers

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:

(g) 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."

As I said earlier, when you register somebody, you register him based on his professional competence. That is the criterion and that is the key for registration of doctors. He must be competently qualified. He must come from the National University of Singapore or any of the medical schools recognised by the Government. In this case, the medical student has broken his bond. That is a breach of contract. It has nothing to do with the very reason he was registered. And the Minister said that if he can pay his liquidated damages, he would not be deregistered. I still think that it is wrong. That means you are actually removing him from the register for a different reason, and not for the original reason. I am not a lawyer. I am sure this needs clarification because this was carried over from the previous Act and we cannot perpetuate a wrong if it is a wrong.

Mr Yeo Cheow Tong: Sir, Dr Tan Cheng Bock has unduly limited the scope of the current Act and this Bill. He has limited the definition of the grounds for which to remove registered practitioners from the register only on professional grounds.

Dr Tan Cheng Bock: Mr Speaker, Sir, I know that a doctor can be deregistered for many other reasons. I am sure all the medical doctors here will know. What I am saying is that, in this particular case, the reason for his deregistration is a breach of contract. It is not for professional misconduct or negligence. It is because he does not like the working condition, he left. And what happens if he has got no money and cannot pay the liquidated damages? He will be deregistered. So I am saying that this particular section could be in the Act already and maybe the Ministry officials overlooked this and passed it over to this new Bill. The Minister thought it is correct. So everybody says it is correct. But we are perpetuating a wrong.

Mr Yeo Cheow Tong: Sir, far from it. In reviewing the clauses in this new Bill, we went through every clause and made sure that for those clauses which were adopted from the existing Medical Registration Act, we justified why that clause should be retained. In this particular case, we have decided to retain it for a very good reason. Doctors are meant to be people who are responsible and they have to be, because they are responsible for the lives of the people. They should have a sense of dedication. Responsibility also refers to the undertaking that you have made in pursuing a medical course. That is why it is important for them to realise that they have an undertaking. They have to reflect that they are responsible because if they cannot even be responsible for the first five years of their working life, what guarantees do we have of the future? And that is why this clause is there. Also, we have students from abroad who study here and who could easily walk away from us the moment they graduate. The ability to deregister them is a great deterrent and that is why, as I said, so far, based on my enquiries, we have not had to use this provision. So let us keep it, because it is a very effective deterrent.

Dr Tan Cheng Bock: Mr Speaker, Sir, I take it that the Minister agrees that this Bill does allow you to deregister a doctor based on the reasons he has given. Sir, I do not want to go on discussing this. Perhaps we could get the Minister for Law to study this carefully because it is very important. For a young doctor, just imagine he is deregistered because he dislikes the working conditions of the hospital and he cannot pay up. His clarification may be good enough for them not to remove the doctor now. But I hope that for legislation in this House, it is better we get all the things properly done. I hope the Minister for Law (he is not here) could have helped us out.

Mr Speaker: Mr Yeo, could you allow Dr Toh to clarify?

Mr Yeo Cheow Tong: Yes.

Dr Toh See Kiat: Thank you, Mr Speaker. Just a quick point. I do support Dr Tan on this point. It is because of my training that, as a lawyer, justice must not only be done but it must be seen to be done. When we deregister a person from a professional register, it casts a pall of something unsavoury. And it would perhaps be less draconian if we suspend him. Because he has breached his contract, we suspend his practising certificate until such time he pays up, rather than deregister him from the professional register.

Mr Jeyaretnam: Point of clarification. I heard the Minister say that if the doctor pays up, he will not be deregistered. Is that provided in the Bill itself?

Dr Michael Lim Chun Leng rose ---

Mr Speaker: Dr Michael Lim, is it on the same point?

Dr Michael Lim Chun Leng: Sir, I support Dr Tan's point. I think the point that Members must note here is that as a medical student, you have to sign a bond. It is not as if someone gave you an option and say, "Would you like a scholarship? Would you like a bursary? You make a choice." Yes, I take the scholarship. I break the bond. I am penalised. Here, you do not have a choice. You go into medical school. You sign the undertaking and you are subjected to these rules. I think there is a distinction here in that we are not looking just at people who are given an option. They do not have an option, unless you say you do not want to do medicine.

I support Dr Tan's point. I think we need to look at this clause very seriously, because it not only can be applied in this situation but it can also be applied in other situations as well.

Dr Tan Cheng Bock: Sir, maybe we could allow a conditional registration in those cases. Give the young doctor a chance.

Mr Yeo Cheow Tong: Sir, Dr Michael Lim says the student has got no choice. He has a choice, as he pointed out. He can either

decide to do medicine or not to do medicine. Just as he can decide whether to take on a scholarship or not to take on a scholarship. It is the choice he has to take. And once he has made the choice, he sticks to it.

What Dr Tan is concerned about is whether we apply this provision immediately a medical officer resigns from Government. I would like Members to realise and understand that actually my Ministry is made up of many compassionate people. Doctors are compassionate.

Dr Tan Cheng Bock rose ---

Mr Speaker: Order.

Mr Yeo Cheow Tong: Sit down please, Dr Tan. Usually, when medical officers apply to break their bonds, we do hear them out. And if they request for time to pay the liquidated damages, quite often, we do allow them the time. So there is no need for conditional registration or otherwise. But if after having given their commitment to pay liquidated damages per their undertaking, they just walk away and do not pay up, if when given adequate time then, of course, the final step must be taken. But in getting to the final step, there are a lot of intermediate steps which need not be spelt out in this Bill. And that is why this provision has never had to be applied.

As regards referring it to my colleague, the Minister for Law, the Bill is drawn up by the Attorney-General's Chambers and, therefore, it has been fully vetted. I can also assure him that all Bills which are drawn up by the Government have the consent of the Minister for Law. But we will definitely draw this particular provision to his attention and ask him for his considered advice too.

Dr Tan Cheng Bock: Sir, the Minister has asked his Ministry's boys to be compassionate. At least, he is now a little bit more compassionate!

Mr Yeo Cheow Tong: Sir, I am always very compassionate.

On the Specialists Accreditation Board, Dr Tan was concerned that a specialist would still be allowed to see cases that do not fall within his specialty. I think there are two aspects here. One is cases which fall into other specialties. For example, if he is a heart surgeon and a cancer patient comes to see him, will he be allowed to treat? The answer is no. If he is also not at the same time registered as a cancer specialist, he will not be allowed to take on the job of a cancer specialist. But because he is already a registered medical practitioner, as Dr Lily Neo had pointed out, he will be allowed to take on cases for which his undergraduate training has given him the necessary expertise and skills on managing patients with abdominal pains, headaches, colds. If the patient has those conditions, he is, of course, free to treat the patient.

He has also asked whether we should go to a referral system where specialists only see patients who are referred to them. Sir, this has happened in countries where the main payment is a third party payment. In the UK, US, Australia, it can be enforced. In Singapore, it also happens to some extent. Patients who are being treated and who are paid by an insurance system or who are paid by the companies or by the employers, normally, these bodies, whether they are employers or insurance companies, would require that that patient is first seen by a GP and referred to a specialist, if need be, rather than allowing the patient to go directly to a specialist.

The same thing applies to the Government sector. For the subsidised patients, they go to the polyclinics first and if necessary they are referred to the specialist outpatient clinics.

Dr Tan has also made the point that because of the fact that doctoring is now being turned into a business there is a lot of pressure from hospitals and other employers on their doctors to do more tests, investigations and whatnot and, therefore, whether we have enough safeguards in place. I would like to inform him that in terms of tissue audit, yes, it is now compulsory. We made that compulsory when we passed the Private Hospitals and Medical Clinics Act. The same Act also requires hospitals, both restructured and private, to establish medical audit committees. Of course, in terms of medical audit, it is still in an evolutionary stage and we would definitely be looking to see how those audit committees can be enhanced.

Dr Lily Neo has also strongly supported the Bill. She has asked whether the definition of "specialists" would be fairly broad so that we do not allow a whole range and proliferation of sub-specialties. That is indeed our intention. The Specialists Accreditation Board will define what are the broad specialties that will be accredited.

She has asked that the practising certificates not be used as a tool to create additional loads on the doctors. That indeed is not the intention. It is not meant to be a pressure point. It is just to make sure that doctors are suitably qualified and they have also kept up to date when they are given their practising certificates.

Dr Michael Lim asked whether the Minister is familiar with all members of the medical profession, since the Minister is responsible for appointing half of the members. I think no Minister can expect to be familiar with all members of the profession, just as no single member of the profession can be expected to be familiar with all members of his own profession. But what Dr Michael Lim can be assured about is that most Ministers will be familiar with the leaders of the profession, and with people who are outstanding, people with good reputation, people with the necessary expertise. And because of that, whether it is the Singapore Medical Council, statutory boards or other bodies where Ministers as responsible for making the nominations and appointments, we have always made sure that only people of standing are appointed, and this will continue.

He has asked whether those people who are on the Register of the Academy of Medicine would automatically be recognised as specialists. I think the intention must be that there must be a "grandfather system" where people who are already recognised and practising as specialists and who have sat for the necessary examinations and have undergone the necessary training would be recognised for registration in that specialty.

On the process of defining what is a "specialty", we will leave that to the profession. As the Bill provides, the Specialists Accreditation Board would be setting up different committees which are made up of people who are specialists and people from each specialty to help them carry out their work. So it will be done by the profession itself and the leaders of the profession will be the ones who will be chosen to make the decisions.

He has talked about the need to accredit doctors for procedures. I agree with him. In fact, when I was in the United States in the late 80s looking at some of the hospitals, there was a system of accreditation that impressed me very much. And we have asked for that to be instituted here. But I think more can be done and we should strengthen that process and make sure that it is enforced.

He has asked about the composition of the Complaints Panel; firstly, whether a doctor can object to the membership of the committee because he may be afraid that someone on the committee is biased against him, which is why we have three doctors and one lay person. So even if one person is biased, the other three members will make sure that this bias is counteracted. In any case, I think the fundamental approach must be to make sure that only people of standing and integrity are members of the Medical Council and members of the Complaints Panel, which is why the full participation of the medical profession is important, in terms of choosing those eight members who are going to be on the Council.

He asked how the Minister would review appeals to him. Just as the Minister reviews appeals on other matters, the Minister will take advice from a group of senior people who may comprise officials of the Ministry as well as members of the profession. It will change from case to case, but this is how the whole system works. We do not just sit down and do a very arbitrary job. It is a proper review and a considered decision is made in the process.

The Member said that members should be allowed to represent himself and be heard. He is referring to clause 40(21). That subclause has to be read in conjunction with the rest of the clause, because there is another subclause (16) which says, "a Complaints Committee may [amongst other things] require the registered medical practitioner concerned to give all information in relation to such book, document, paper or other record .". The key thing to bear in mind is that in reviewing a complaint, the Complaints Panel, just as the current preliminary proceedings committee, will make sure that they get to hear both sides of the story, because that is the only way to investigate the complaint. It cannot be a one-sided investigation. Inevitably, the doctor complained against would either be asked to submit in writing his response to the complaint or, if there are still some other issues or matters which are not clear, he would be asked to appear. What this means is that the doctor cannot demand to appear because sometimes the written submission may be adequate. In any case, if the Committee finds that the complaint is warranted, the complaint is then referred to the Disciplinary Committee where formal inquiries are conducted. In this case, the doctor automatically is heard.

Mr Bernard Chen talked about the lay member and he asked what is his role in the Disciplinary Committee. His role there is that of an observer but he is free to participate in the hearing. It is just that he cannot vote. So his views will still be heard, but he cannot participate in the vote. Whereas in the Complaints Committee, the lay member participates as a full member and he can vote.

He also talked about the registration of doctors. Sir, I think he has missed out the clause that states that doctors who are aggrieved by the decision of the SMC not to register them may appeal to the Minister within 30 days. So there is always an appeal process and the Minister is the appeal process.

Dr Toh See Kiat talked about clause 17 and said that "medicine" is not defined in this Bill and that it would be left to the judges to decide. Sir, the practice of medicine is so broad that it is very difficult to define precisely what is medicine and what is not medicine. But what can be taken for granted is that any invasive procedure and any prescription of controlled drugs is the practice of medicine. So if a person is practising traditional Chinese medicine, that is provided for in this Bill. He is not infringing on this clause. If a person is selling herbal medicine, that is allowed. But, of course, it would be very difficult for us to come out and say, "People who are advertising cannot wear white frocks and white masks." If we do that, I think there will be a lot of professions, not just the medical profession, who will be affected. People in the catering business, many of them do wear gowns and masks as well. I think there are lots of complications. The key thing is to understand the whole spirit behind this Bill and to ensure that the message is clearly given to those who are inclined to stretch their business into fraudulent areas, including the carrying out of medical procedures just for financial gain.

Dr Toh See Kiat: I just want to clarify that when I talked about people with white masks and white frocks, yes, they could be in a lot of professions, including science, research and development. But when you are trying to sell a product that is meant to do some good for the body, which is referred to as a treatment for something, and you wear white frocks and white masks, and sometimes hanging a stethoscope around the neck, you clearly are alluding to the fact that this guy who is recommending the product or giving a testimonial for the product is giving it in his capacity as an expert. I was particularly referring to a situation where this person is also identified, on top of that, as so-and-so, MD, and that is really a situation where we must clamp down.

Mr Yeo Cheow Tong: Sir, the particular example he gave just now was an advertisement for an exercise bicycle. There are recognised health benefits from exercising. Should we prevent a doctor from saying, "Look, you should exercise and this machine can help you to use up so many calories." I would rather not get into such peripheral areas. The objective of this Bill is to make sure that unauthorised people who carry out medical procedures, and therefore threaten the health of the person they are treating, would be facing very heavy penalties. At the end of the day, we must educate Singaporeans to rely on their family doctor and that when they have a problem, they should consult their doctor. Do not self-refer. Do not self-prescribe and self-medicate. See your family practitioner. That is the message that we are trying to educate Singaporeans on, and what they are talking about herbal cures and so on similarly applies. If there is any interest in all those products, when they next see their doctor, they should ask him. It is not possible for the Health Ministry to be responsible for all the wide range of products that are available in this world.

Dr Toh See Kiat: Sir, I just wanted to refer also to that example that I gave of a person who is a Ph.D in something and not a doctor, but of course we call him a doctor too. "Doctor so-and-so promotes this product that does good to your skin." Actually this happens. He is not a medical doctor at all. But the context of that advertisement makes people think, "Oh, he is a medical doctor and he is recommending this. Therefore, I must buy this." There is also the situation where a doctor who is not a registered medical practitioner in Singapore promotes something like an exercise machine. We do not allow our own doctors to promote things that are not related to medicine. Why should we allow a foreign doctor to do this?

Mr Yeo Cheow Tong: Perhaps CASE might want to look into it.

Mr Jeyaretnam waxed eloquence about many things without even studying what the Bill is all about. He talked about the unfairness of not registering applicants without any recourse to appeal. Sir, if he had read the Bill, he would have found that that is provided for. As for compulsory voting ---

Mr Jeyaretnam rose ---

Mr Speaker: Order.

Mr Jeyaretnam: Is there any appeal to a Judge of the High Court? That is what I want to know.

Mr Yeo Cheow Tong: Sir, it is the Medical Council that is responsible for registering or not registering applicants who are medical practitioners. If the Medical Council refuses to register, there is an appeal process. The appeal process is the Minister. What Mr Jeyaretnam was talking very emotionally on just now was that there is no appeal process, that it is unfair, undemocratic and so on.

Mr Jeyaretnam: An independent body.

Mr Yeo Cheow Tong: The point is that there is a body that is responsible and there is a process and the process is the Minister who shall thoroughly review that appeal.

He also talked about compulsory voting that if it is only for half of the Council, therefore there should be no great interest. I have already answered that in great detail and I shall not prolong except to tell him that it is precisely because of the fact that although it is important for them to vote, only 15% are voting shows that we are not there yet. We have to make it compulsory so that people will value their vote and make sure that they choose people of standing, reputation and integrity and vote them into the Council.

Sir, I think I have answered all the points raised.

Dr Lily Neo: Can I clarify? Can the Minister tell me how does the Ministry monitor unauthorised people practising medicine, for example, using lasers, injections and other instruments on the patient?

Mr Yeo Cheow Tong: Sir, it is not possible for the Ministry to conduct spot checks on all premises in Singapore. For those who are using equipment that requires licensing, they of course have to obtain a licence. The question is: what about those people who obtain those equipment illegally, bring them into Singapore quietly and therefore use them without a licence? The only way for us to know about that is if the members of the public lodge a complaint, or if they have to go and see a medical practitioner for corrective work to be carried out. We would appeal to such patients to let us know so that we can do the proper investigations and take the necessary enforcement actions on such people.

Dr Lily Neo: Can we do improvement in that area because by the time they complained, scarring and abnormality are permanent by that time?

Mr Yeo Cheow Tong: If the Member has got any suggestion, I would be very happy to listen to her.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Yeo Cheow Tong].

Bill considered in Committee; reported without amendment, read a Third time and passed.