DENTISTS BILL

Order for Second Reading read.

The Minister for Health (Mr Lim Hng Kiang): 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 dentists and for matters connected therewith, and to repeal the Dentists Act (Chapter 76 of the 1985 Revised Edition). It will enhance the role of the Dental Council so that it can perform its functions more effectively and raise the standards of professional conduct and practice.

Singapore enjoys a high standard of dental care. Today there are almost 1,000 graduate dentists and 67 Division II dentists. And amongst our graduate dentists, more than a quarter have postgraduate qualifications, providing a wide range of specialist dental care.

To maintain this high standard of dental care, we need to ensure that dental students are trained effectively and registered practitioners are kept abreast of advances in dental sciences to meet the needs and expectations of Singaporeans.

Let me now highlight the major new provisions that are being introduced in this Bill.

The Dental Council

The current Act provides for a Dental Board of eight appointed members and two ex-officio members. There is no provision for the election of members to the Dental Board. To bring it in line with the corporate governance of the medical and other professions, the Bill proposes a Council of six appointed and five elected members. The appointed members will represent the cross-section of dentists, with one member from the academia, one member from the non-graduate dentists and the rest from the public and private sectors. The election of five council members will provide the mechanism for representatives to be elected by their peers.

In the current Act, the Director of Dental Service is designated as the President of the Dental Board. In future, members of the Council shall themselves elect one of its members to be the President. This will give the Council greater autonomy and self-regulation.

To ensure that Council members take their appointments seriously, clause 8 provides for the removal from office of any member of the Council who is absent without leave for three consecutive ordinary meetings of the Council or its Committees.

The Bill will make it compulsory to vote for the elected members to the Council. This is similar to the provisions in the Medical Registration Act and the Legal Profession Act, which also provide for compulsory voting of members to the Medical Council and the Law Society respectively.

Functions of the Dental Council

In addition to the current functions of registering dentists, issuing practising licences, and regulating the professional conduct of dentists, the Bill seeks to broaden the functions of the Dental Council. Clause 4 enables the Dental Council to make recommendations to the appropriate authorities on:

(i) the content and nature of courses of instruction and examinations leading to the dental degree at NUS; and

(ii) the training and continuing education of registered dentists.

This is to ensure that our dental students and practising dentists continue to receive appropriate training, and to keep abreast of advances and developments in order to maintain high professional standards.

Register of Dental Specialists

With the increasing number of graduate dentists and the trend towards specialisation, there is a need for us to establish a dental specialist register. Clause 31 provides for the establishment of a Dental Specialists Register through the publication of Regulations to be made under this Act as and when necessary.

Disciplinary Procedures

Sir, let me now move on to disciplinary procedures. To expedite the handling of complaints, and to allow for wider representation from dentists in general and from the lay public, the Bill allows for the setting up of Complaints Committees to include Dental Council Members, other dentists and lay persons. Presently, there are no provisions for lay persons in the disciplinary process. The concept of lay persons being involved in disciplinary procedures is in the Medical Registration Act, the Legal Profession Act and Accountants Act. It makes the disciplinary process more transparent and open.

Today, dentists are disciplined only if they are convicted of any heinous offence, or are guilty of infamous conduct in a professional respect. The proposed amendments will allow the Council to discipline dentists who have been guilty of any improper act or conduct which brings disrepute to his profession, or who have been guilty of professional misconduct. This is also in line with provisions in the Medical Registration Act.

If a dentist is guilty of infamous conduct in a professional respect, the existing Act prescribes only one penalty, that of striking his name off the register. This does not allow for a graded penalty according to the severity of the offence. The Bill addresses these shortcomings by enhancing the penalty options available to the Dental Council. It empowers the Council to:

(i) remove the name of the dentist from the Dentists Register;

(ii) suspend the dentist from practice for a maximum period of three years;

(iii) impose a fine of not more than $5,000; or

(iv) censure the dentist.

The Council shall also be empowered to 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 dental practitioner concerned.

Restoration to the Register

If a dentist has his name removed from the Register pursuant to a disciplinary inquiry, it does not mean that he cannot practise his profession anymore. There is provision for the dentist to apply for his name to be restored after a minimum period of three years.

Health Committee

At present, a dentist who is unfit to practise because of psychiatric condition, drug or alcohol dependency or any other physical or mental condition, cannot be removed from the Register. Clauses 48 and 49 provide for the setting up of a Health Committee to review any dentist whose fitness to practise is impaired by reason of his physical or mental condition. It will be empowered to restrict or suspend the dentist's practice, or recommend that his name be removed from the Register. The Medical Registration Act and the Dentists Act of the United Kingdom also provide for the establishment of a Health Committee with similar functions.

Proposed increase in penalty for unauthorised persons acting as dentists

Another problem, which we face from time to time, is the illegal conduct of dental procedures by unqualified persons, eg, the making of dentures. Often these are done improperly or under non-hygienic conditions. Clause 28 increases the maximum penalty for a first offender from the present $2,000 to $25,000. For subsequent offences, the penalties will be increased to $50,000 or imprisonment of up to six months or both. These enhanced penalties very clearly signal that the Government is determined to stamp out such cases of illegal practice.

Consequential and other minor amendments

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

Mr Speaker, Sir, we have come a long way in the provision of dental care. The general state of dental health in Singapore is good. It is that way because we have well trained and highly competent dentists.

The challenges facing the dental profession and the entire healthcare sector will be greater in the years ahead. We will continue to see the development of new materials to treat dental decay, new techniques and new methods to replace missing teeth. The dental profession must ensure that its members are properly qualified before they are allowed to use the new materials and technology. At the same time, we must deter dentists from advising their patients to undergo unnecessary high-tech procedures for financial or other reasons.

This Bill will help to achieve these objectives. It will enhance the role of the Dental Council, and empower it to safeguard the high professional and ethical standards of dental practice, and to uphold the integrity of the profession.

Sir, I beg to move.

Question proposed.

Dr Lily Neo (Kreta Ayer-Tanglin): Mr Speaker, Sir, I rise to speak in support of the Dentists Bill. As it repeals and re-enacts, with amendments, the Dentists Act of 1985 that has become outdated and inadequate in many areas, its introduction is necessary and timely.

Although there are several details that merit concern and comment, I feel that the setting up of a Dental Council to replace the Dental Board is significant and very welcome. Unlike previously, the registered dentists will now have their own representatives as spelt out in the amendments in clause 3, in this important "watchdog body" of the profession. Furthermore, the role of the Dental Board is not replaced by a 6-function regulatory role of the Dental Council, as defined in clause 4. All this should place the "watchdog body" of the dental profession in good stead in the eyes of both the dental practitioners as well as the general public.

Sir, I would like to comment on other aspects of the Dentists Bill as follows:

Clause 4. This clause defines the functions of the Dental Council and the function to determine and regulate the conduct and ethics of registered dentists is welcome indeed. This will provide the avenue for patients to bring complaints against their dentists. Furthermore, this will establish a means to protect patients from unscrupulous or unethical dentists as well as to ensure the high standards of the dental profession here. Many are concerned about the Dental Council having full control over the dentists in Singapore because the application for a Practising Certificate shall be made in such form and manner as the Dental Council may require. Sir, this can become one control too many for the dentists and be an extra "bitter pill to swallow" for all the dentists, especially if the "such form and manner" becomes too restrictive and expensive to comply with. I would like to urge the Council to practise restraint and not to use the issuing of the Practising Certificate as a tool to pressurise and to cause extra demands on the dental profession.

Clause 15(5)(b). In this clause, the words "is not of good reputation and character" are undesirably vague and wide. This criterion, Sir, is also very subjective. Perhaps, it should be qualified by adding the words "such as to render the person unfit, in the interest of the public, to practise his or her profession."

Clause 17(6) and (7). There are no guidelines as to what premises or conditions are deemed unsuitable for practising dentistry. There is also no avenue of appeal. This makes it draconian and unsatisfactory.

Clause 21(1)(e). This appears to be targeted at "bond breakers". There is inevitably a penalty imposed where there is a breach of undertaking. It seems inequitable and unduly harsh to deregister a dentist merely on this ground.

Clause 34(1). This clause requires the Dental Council to appoint not less than five and not more than 10 lay persons together with not less than 10 and not more than 20 registered dentists as part of its Complaints Panel. This means a ratio of two registered dentists to one lay person is possible in the Committee of Complaints. Some people may argue that this will result in a bias in the assessment of a patient's complaint since there is an easy majority of dentists. The public would probably prefer a more balanced representation in the committee for assessments to be open and fair. An unbalanced representation may cause the Committee of Complaints to be perceived as a "peer review or internal audit panel".

Clause 36(7) and (10). These subclauses state that the dentist concerned shall not have the right to be heard by the Complaints Committee and shall not have access to all information used by the Complaints Committee. Sir, this is a denial of natural justice since it is only fair and logical for the dentist to be allowed an opportunity to defend himself. This is especially when the findings on each case of the Complaints Committee has such important repercussions as stated in clause 38. Furthermore, I am concerned whether the findings and recommendations of the Complaints Committee are admissible as evidence in any legal proceedings.

Clause 39(2) and (3). There is no obligation on the part of the Committee to give its grounds of decision. How then is it possible for the aggrieved dentist to appeal with any substance?

Clause 44(1). The appointment of a Disciplinary Committee as in this Dental Act has been long overdue and is urgently required to deal with the area of misconduct and the appropriate disciplinary actions to be meted out. Clause 44(1) has rightly categorised offences into either professional misconduct or improper act or conduct and five different ways to deal with an offence. This is superior to that in the old Act where a dentist could be deregistered for heinous offence or guilty of infamous or disgraceful conduct in a professional sense. There was only one penalty in the old Act, regardless of the severity of the misconduct - the wrongdoer had to be struck off the register of dentists. Clause 44(1)(i) to (v) of the new Act provides for different types of disciplinary actions from fine alone to temporary deregistration before removal of name from the register.

Sir, to conclude, I would like to say that with this Dentists Bill, we could have avoided the awkward situation, where the judgement of the Dental Board last year, in the case of a dentist who was implicated in breach of the Advertising Guidelines, was reversed by the High Court. While I agree with the judgement of the High Court in this case, I am concerned about conflicting judgements that may arise in the future. Would that case set a precedent for future cases of disciplinary actions by the Dental Council to be freely brought to the Courts of Appeal? Would that lead to undermining of the authority and judgement of the Dental Council? If so, is there a question mark over the legitimacy of the Dental Council and since the Dental Council follows the guidelines of the Dentists Act, would this Act be redundant?

Sir, I support the Bill.

Mr Shriniwas Rai: Sir, I rise to support the Bill. My interest in this Bill arose after a judgement by Judicial Commissioner Amarjeet Singh which was referred to by my colleague earlier. In that case, he mentioned, in his judgement, that it is time the Dental Act be reviewed. I am glad that the Government has done that. In fact, I have never expected it to be done in such a fast speed and I congratulate the Ministry for doing it so quickly.

Sir, it is important for this Parliament to review from time to time legislation which are out of time and to repeal and re-enact them in keeping with the needs of the society.

Sir, Dr Lily Neo has mentioned some of the provisions but I would like to mention some other provisions. In particular, I am gratified that now, the Dental Council will be made up of both elected and appointed members. My regret is that the appointed members would be in the majority. I hope that, in keeping with the other professional bodies like the Law Society, where only two representatives from the Ministry sit in the Council, we should have more elected persons.

Sir, the other point that I would also like to commend and applaud is the compulsory voting. It is very important for professionals to take an interest in their professional body, just like every Singaporean is required to vote in a parliamentary election. I think this is a healthy trend. We should require that if every professional wants to practise, he must vote unless he has got exceptional reasons.

Sir, the functions of the Council have been well laid down and it will help in the growth of the dental profession. My only concern is on clause 7 "disqualifications for membership of the Council". Why should a person who is an undischarged bankrupt not be allowed to sit on the Council? I can understand the position of an accountant or a lawyer who is handling money. But a dentist who is bankrupt can practise but could not serve on the Council. I find that this is a very contradictory position. I hope that this provision could be reviewed.

Sir, the other clause that I am a little concerned is this. Clause 15(5)(b) refuses to register any applicant who is not of good reputation and character. These are very subjective tests. What happens if the dentist has a girlfriend? Does it mean that he is not of good conduct? I think we must have a definition, Sir. But I am just stating the worst scenario as an example. I am asking this House that when we have a legislation of this nature, which is going to be interpreted by the Dental Council, possibly by the court if it goes before the court, a definition ought to be put in. In fact, I do not think this clause should be in the Bill at all. But if we insist on it, then we should provide for it.

The other worrying trend is that, with due respect to the Minister, the Minister's decision is going to be final in clause 15. This would affect the livelihood of a professional colleague. It would be very important for us to provide an avenue.

If there is a refusal, he should have right of audience to the Court. I may be the only lone voice in this Chamber where I think it is very important for us to have a safeguard. I am quite sure that there would be no abuse but the question is the precedent that we are going to set in this House. I hope the Minister will consider this because it is going to affect the career and livelihood of the man.

Sir, Dr Lily Neo has, more than a lawyer, argued the case so well that I cannot add anything further other than those two comments and I ask the Minister to consider the proposal.

Mr Lim Hng Kiang: Mr Speaker, Sir, I would like to thank the two Members for their support of the Bill and their comments. Let me take the detailed comments in turn.

Dr Lily Neo made the comment that in clause 4, applications may be made in such form or manner and that she hopes that in administering the practising certificates, the Dental Council would not be too restrictive. I assure the House that the purpose of the Dentists Bill is to register and make sure that all dentists have the qualifications, that they are physically and mentally fit to practise and that they are of sound character and reputation.

Both Members questioned the need for clause 15 that practising dentists must be of good reputation and character. As I said, all dentists, and indeed all professions, must not only have the qualifications to practise. I think society requires that all professions have certain set standards and one of the standards is that they be of good reputation and character. I think that is quite well defined. The Bill allows for any person who is not registered because of that clause to have an avenue of appeal. This requirement incidentally appears in many professional Acts. Dr Lee tells me it also applies to veterinarians.

An hon. Member: Lawyers.

Mr Lim Hng Kiang: I do not know about lawyers. Maybe lawyers do not need to be of good reputation and character to be registered.

Mr Shriniwas Rai: I object to that remark.

Mr Lim Hng Kiang: My apologies. So it is also in the Legal Profession Act. In that case, there should not be any objection to having this clause of good reputation and character.

Clause 17(6) and (7) talks about the premises for a dentist to practise. The requirement is for practising in the premises. It is not laid out in the Dentists Bill. In fact, it is laid out in the Private Hospitals and Medical Clinics Act. In that Act, the criteria for premises to be registered for such practices are quite clearly laid out and also if the premises are not registered, the licensing authority is required to give reasons why the criteria are not met. So the applicant can make good the shortfalls and allow their premises to be registered.

Clause 21(1) talks about bond breaking. We have gone through this debate the last time when we discussed the Medical Registration Act. Basically, the number of applicants to both the medical and dentistry faculties in Singapore is very large. We have to restrict the numbers. The courses are conducted at great expense to the public. The courses are very heavily subsidised and therefore we require students entering these two faculties to give an undertaking that they serve the community after their graduation. If they break the bond, we will require them to pay up the liquidated damages for breaking the bond. If they do not pay the liquidated damages, of course they run the risk of being de-registered as a dentist. I think that is fair because they are educated at great expense by the community and it is not unfair of the community to expect them to serve the community in return.

Dr Lily Neo also asked about the way the Complaints Committee is conducted. Let me explain that the Complaints Committee is intended as a screening process before a complaint is taken up by the Disciplinary Committee. We want a process by which a complaint by the public or by other professionals is assessed to see whether that complaint is bona fide and, in fact, should be taken up by the Disciplinary Committee. There is no need for the dentist who is complained against to appear before the Complaints Committee. If he is required to show cause, he will have plenty of chances in front of the Disciplinary Committee.

Both Mr Rai and Dr Lily Neo also referred to a recent case where a dentist who advertised his services was penalised by the Dental Board. He appealed to the High Court and the High Court felt that the penalty was too severe, and part of this Bill is in response to that case to give a different gradation of penalties. It also illustrates that the mechanism that we have set out in the current Bill is the right one and that there is a due process through the Complaints Committee and the Disciplinary Council, and if the dentist feels that he is aggrieved, he can still appeal to the High Court. And in the High Court, we get the chance to hear the appeal and the judgement can then be taken. I think the process works well and that is in fact proposed in the Bill.

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 Lim Hng Kiang].

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