MEDICAL REGISTRATION (AMENDMENT) BILL

Order for Second Reading read. 3.37 pm

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 make amendments to the Medical Registration Act (Chapter 174 of the 1998 Revised Edition). Background

The Medical Registration Act provides for the establishment of the Singapore Medical Council (SMC) to register and regulate medical practitioners.

The amendments to the Act are needed to set the requirements for continuing medical education when doctors renew their practising certificates, to address the limitations that the SMC faces in its disciplinary processes and to keep pace with international developments in professional regulation.

Mr Speaker, Sir, let me now highlight the major amendments that are being introduced in this Bill.

Compulsory Continuing Medical Education (CME)

The pace of change in the practice of medicine is rapid, driven mainly by the dramatic advances in biomedical research and technology. At the same time, there is greater acceptance of evidence-based medicine, ie, medical practices that are supported by rigorous and comprehensive analyses of the relevant body of clinical research or trial data. This helps doctors to ensure that the care given to patients is necessary, beneficial and of good quality. Our patients and the general public also have high, and rising, expectations of the quality of healthcare that they receive.

It is imperative, therefore, for all doctors to maintain the currency of their professional knowledge and to stay abreast of developments in medical science and practice. Continuing Medical Education (CME) is a well-accepted mechanism to achieve this. There is a long history and tradition of CME within our local medical community. Two years ago, the SMC launched an on-line CME system for all registered medical practitioners and worked with the College of Family Physicians, the Academy of Medicine and the Singapore Medical Association, to establish a voluntary national CME system so as to better meet the needs of the different groups of medical practitioners through the provision of a diverse variety of accredited CME activities.

However, not all doctors have demonstrated participation to a satisfactory level of CME. Notifications by medical practitioners to the SMC's voluntary CME system showed that only 39% fulfilled the minimum CME requirements of 25 points per year in 2000. The situation improved to 49.5% participation rate in the year 2001. It is likely that there were some doctors who participated in CME but failed to notify. Nonetheless, the voluntary participation rate is far from satisfactory. Many developed countries, in fact, have made CME compulsory in their jurisdictions, eg, most states in the USA, some states in Australia, New Zealand, the Netherlands and Hong Kong. Canada and the UK are actively looking into doing so as well. We have therefore decided to make CME compulsory for all medical practitioners from 2003.

This Bill proposes an amendment that allows the SMC to prescribe conditions for the grant and renewal of a doctor's practising certificate, including mandatory participation in CME. The SMC has decided that doctors should accumulate at least 50 CME points within a 2-year cycle before they can renew their practising certificates.

Strengthening of SMC's Disciplinary Procedures

Mr Speaker, Sir, the SMC plays a critical role in the regulation of medical professionals and medical practice in Singapore. SMC has established an Ethical Code and Ethical Guidelines that set the standards of professionalism expected of all doctors in Singapore. SMC also has a well-established disciplinary procedure to assess and to deal with doctors who have been referred to the SMC. In the main, these procedures are working well and have allowed the SMC to maintain high standards of medical professionalism in Singapore. However, there are a number of limitations that the SMC faces in its current disciplinary processes. These will be addressed in the amendments to this Act so that SMC will be able to carry out its regulatory duties more efficiently and effectively.

Interim Orders Committee (IOC)

Because of the complexities of medical practice issues and the time required to gather and review all the relevant evidence, inquiries into disciplinary matters may take up to two years to complete. During that time, the doctor under investigation is still able to practise. In some situations, there may be compelling reasons to suspend a doctor from practising, even before the outcome of his disciplinary enquiry is known, in the interests of public safety.

We therefore propose that a new provision be created to allow for the establishment of an Interim Orders Committee (IOC). The IOC will be vested with the power to summarily suspend or restrict a doctor's practice before the outcome of an inquiry is known. This inquiry could be held either by the Disciplinary Committee (DC) which looks into the professional conduct of the doctor or the Health Committee (HC) which considers the physical and mental fitness of the doctor to practise.

I would like to assure the House that cases will only be referred to the IOC when there is compelling evidence that the doctor's continued practice poses a threat to public safety. Such evidence could include psychiatric reports and court convictions. Based on the experience of the IOC in the UK, examples of cases that could be referred to the IOC would include cases like failures of care that indicate a serious lack of basic medical knowledge or skills; or doctors with serious health problems that would affect their ability to practise medicine, such as severe mental illness, alcoholism or drug addiction.

I would like to highlight that a number of provisions have been built into the Act to safeguard the rights of the doctor who has been referred to the IOC. For example:

(1) The members of the IOC will not participate as members of any other committee that is involved in looking into the complaint against that doctor.

(2) No interim order shall be made by the IOC unless the doctor in question has been given the opportunity to appear before the IOC and be heard as to whether such an order should be made in his case. The doctor also has the right to be represented by legal counsel.

(3) Any doctor whose registration has been suspended or made subject to conditions by the IOC will have a right of appeal to the High Court.

(4) The IOC is required to review its interim order after 6 months to determine if it should be revoked or amended. After this first review, the order is subject to further review every three months until the matter is settled, or the IOC decides that the order is no longer necessary, or 18 months after the initial issue of the order. Any extension of the order beyond 18 months will require approval by the High Court.

These amendments to establish the IOC and to provide safeguards for the rights of the doctors are closely modelled on the current legislation and system in the UK.

Let me now highlight some other amendments to the Act that are intended to strengthen the current disciplinary process. We will empower the Complaints Committee to inquire into matters of professional conduct that were discovered in the course of investigations, but did not form part of the original complaint. The Complaints Committee will also be allowed to continue an investigation even if a complaint had been withdrawn. This is consistent with the powers vested in the Inquiry Committees under the Legal Profession Act.

The SMC will be authorised to refer, by its own volition, any information regarding the criminal conviction of a registered medical practitioner to the SMC's Complaints Panel, without first having to receive a formal complaint against this practitioner.

Mr Speaker: Mr Lim, could you pause for a while to let the Whip move the exempted business motion?