The Sunday Interview: New Act will ensure patients get better care

NST: Director-General of Health Tan Sri Dr Ismail Merican is prepared to go the distance to enforce legislation ensuring higher standards in private healthcare services. Some in the medical profession are not happy with the scope and practicality of the Private Healthcare Facilities and Services Act 1998. Dr Ismail tells ANNIE FREEDA CRUZ that the Act will benefit the public as it spells out conditions for the private healthcare sector, ranging from qualifications of personnel to renovations of premises. But this has struck a negative chord among doctors, who fear the threat of fines and imprisonment could prove a dampener on private practice.

Q: Is the private healthcare sector justified in its grouses over the enforcement of the Private Healthcare Facilities and Services Act 1998?

A: Whenever you introduce something new, you wake people up from their complacency, and they get rattled and air their grievances. Sometimes, they do so without making an attempt to understand why this is being done.
Many accusations have been levelled at us, ranging from being unfair to doctors to degrading the medical profession. Such outbursts are expected when we make changes.
But people must be prepared for change. It is not as if we are suddenly introducing these changes.
We have often mentioned the implications of the Act, which was passed in 1998. The regulations took eight years to take effect.
We would like to inform doctors and the public that there were consultations with interested parties during the formulation of the Act.

Q: Why the need for the Act when there are other pieces of legislation currently governing the sector?

A: We have the Private Hospitals Act 1971, Medical Act 1971 and Dental Act 1971, but these Acts only regulate professional practices not health- care facilities and services.
We found that these Acts were inadequate to regulate the present healthcare facilities and services.
The Malaysian Medical Council is not given an enforcement arm, and that makes it difficult to act or enter unlicensed premises such as clinics to act on public complaints.
The existing law is insufficient to address new developments in healthcare facilities and services.

Q: What does the Health Ministry hope to achieve through the Private Healthcare Facilities and Services Act?

A: We will be able to enhance social interests and ensure that the private healthcare sector provides the best service.
Among other things, it ensures that basic emergency care is not clustered around affluent areas and that the sector does not charge unreasonably.
Unhappy patients will have an avenue to air their grievances.
With the Act and its regulations, we will increase the scope of control and coverage of private facilities and services, maintain integrity, and enhance the professionalism of health- care professionals.
We will also ensure patients’ rights to quality, safety, accessibility and equitable healthcare.

Q: So the drafting of the Act and the regulations had input from the relevant parties?

A: During the consultations, our role was to prepare the substantive part of the law such as the procedures, standards, criteria for premises and services, registration, approval and licencing.
The Attorney-General’s Chambers advised us on the enforcement powers, offences and the penalties.
The ministry also held roadshows nationwide to explain the implications to people. Until June 20, 43 roadshows were conducted.

Q: What were the salient aspects of the roadshows?

A: We explained that the old laws were not comprehensive enough to cover new areas of healthcare in the light of medical progress.
We explained that the professional laws governing doctors, dental fraternity and the nurses were not sufficient to ensure qualified and competent professionals treated patients in specialised areas such as at haemodialysis centres, maternity homes, and hospices.

Q: Did Health Minister Datuk Dr Chua Soi Lek meet Dr Steven K. W. Chow (president of the Federation of Private Medical Practitioners’ Associations) over their grouses?

A: Yes. The federation raised concerns about the possibility of litigation. They were told not to worry about it, but to be more concerned about proper documentation of treatment.
We reminded them to ensure safe and quality practices. It is not easy for litigation to occur. I feel strongly that the law will help healthcare providers offer better services.
It’s time to realise that some of the older facilities may not have what it takes to control infection and sterile conditions.

Q: Some general practitioners are making a fuss over the RM1,500 fee for clinic registration.

A: This is a one-off payment. I do not understand the fuss. If the clinic had been operating for 30 years, it means it would cost the doctor only RM50 per year.
It does not mean they have to raise fees to treat patients. Their arguments are not convincing.
I am aware that some trivialise the recommendations relating to physical structures.
We are not asking them to do this for cosmetic reasons. It has to do with minimal standards at, among other places, haemodialysis centres, daycare centres and operation theatres.

Q: Why the need for these specifications?

A: The specifications are to ensure adherence to specific standards in establishing and operating healthcare facilities and clinics, taking into consideration aspects of infection control, stability in certain areas, clinical barriers to communicable diseases and comfort of patients.
Our recommendations will make the environment more conducive for patients.
The intention of the law is to improve the quality of healthcare and promote quality clinical practice for patients’ safety.
The majority of general practitioners have complied with the law. Only a few old clinics may face problems.
I am prepared to give them more time (a year) to comply.
If they still had difficulty and the reasons given were justified, we could always consider a longer period on a case-by-case basis.

Q: What about claims by doctors that the Act is too severe in terms of fines, besides the economic effects on them?

A: These two issues are being brought up each time our officers brief them. They say they have to pay RM1,500 for clinic registration besides underwriting the cost of renovations.
They are also unhappy over what they see as the punitive aspects of the Act.
But hardly any of them focused on the issues of safety, quality and public interest.
These issues also involve the importance of basic emergency care, capping of charges for procedures and the right of patients to understand why a procedure is necessary.
The focus each time is economic infringements and poor morale of doctors.

Q: Are their fears justified?

A: Is it easy to send doctors to jail? They must understand that I fully sympathise with them.
Those who practise medicine according to the code of professional conduct prepared by the Malaysian Medical Council should have no fear. One must be confident that he or she is doing the right thing.
I would advise doctors to keep proper documentation of their clinical findings, investigations and treatment plans, including advice given to patients.
The severe penalty is a reflection of the seriousness attributed to the medical profession. We are dealing with lives.
The fines of up to RM300,000 or six months’ jail are not meant to criminalise doctors.
We would like to assure doctors that we will enforce the law carefully and judiciously.
I must emphasise that it is the profession that is looking into the issue of errant doctors or practice. We are not the "police", they are.

Q: The Federation of Private Medical Practitioners’ Associations of Malaysia is unhappy that the Act requires private doctors to provide basic emergency medical treatment.

A: Every doctor should know about basic life support. If they have forgotten, it is time to re-learn.
It would be embarrassing when, during a dinner for example, someone collapses and the person who is providing the resuscitation is a layman who has learnt the skills, while doctors in attendance become mere spectators. I am surprised to hear that some doctors have forgotten how to read ECGs.
All we are asking of them is not to deny anyone the basic emergency services.