1Malaysia clinic: is the Health Ministry above the law?

Letter
By RS

It is distressing to learn from Dr. T. Jayabalan, the health adviser to the Consumers Association of Penang that medical assistants are giving out prescriptions for the wrong medicines or prescribing medicines which they are not allowed to prescribe and they have also been found to have wrongfully diagnosed patients at a study conducted at Kampar, Perak. And feedback thus far, from the MOH regarding the validity of MCs (Medical Certificates) issued by 1Malaysia Clinics have been unsatisfactory. The explanation issued by the Health Ministry’s Medical Practice Division officer, Dr Noraini Baba, stating that according to an internal MOH circular, MAs are allowed to issue MCs seems to suggest that she either doesn’t know the law or thinks she can actually circumvent a law through a department circular.

But perhaps CAP too should share of the blame for this vague situation. The last time they made so much noise, it resulted in ignorant officers at the Health Ministry rushing to pass an reckless legislation called the Private Healthcare, Facilities and Services Act (PHFSA) which was conjured up in the dark corners of the Health Ministry and stamped with the Official Secrets Act (OSA) effectively excluding the stake holders from taking part in the discussions. The Act is surely unconstitutional.

A doctor today with an Annual Practicing Certificate (APC) is legal under the Medical Act 1971 but becomes illegal if his premise is unregistered under the PHFSA 2006. But a Hospital Assistant (HA) working in a presumably legal PHFSA premise, 1Malaysia Clinic, becomes immediately illegal as he has committed a felony under the Medical Act 1971 since under this Act only registered medical practitioners are allowed to work in medical clinics. This is the end result of people like SM Idris who give half-baked ideas to our poorly trained civil servants who then create silly laws in a knee-jerk unthinking fashion, which ultimately not only endanger people’s lives but place the government eventually in a legal quandary. Worrying statistics of wrong prescriptions and misdiagnoses seeping out of 1Malaysia Clinics maybe just the tip of a disaster waiting to happen.

If we keep making up unending rules and regulations for the delivery of healthcare in this country, the whole of Sabah and Sarawak will soon be paralyzed as HAs there run many of our rural clinics and even provide anesthesia for many of the rural hospitals there. And anesthesia is no child’s play as even propofol; supposedly a very safe anesthetic can kill as it did the late Michael Jackson. In a country with limited trained medical human resources we have to initially stratify the levels of care that we can offer and much depends on both the quantity and today, the quality of medical professionals we have at hand.

Our rural health clinics are still run by midwives termed “Jururawat Desa“ while our health clinics are run by a combination of staff nurses, medical assistants and doctors. Our hospitals are run by all of these people and specialists. But specialists alone are not good enough if we want to deliver quality care as we need the help of physiotherapists, lab technologists, radiographers, biomedical personnel, critical care nurses, operating room technicians, anesthetic technicians and a whole gamut of other health personnel. Some of the monster hospitals that this government has built like Sungai Buloh, Ampang and Serdang are today nothing more then glorified nursing homes. Patients rush in thinking they are in for high-tech care, but a quick glimpse of the ICU will show 20 beds with 5 junior nurses trying desperately to man the 20 beds with no respiratory therapists, technicians, doctors or even the critical care specialists or anesthetists around.

A great many of the Malaysian population, especially in urban areas are very dependant on the General Practitioner who are the lynchpins in healthcare both in the UK and Australia . In the UK , GPs are today credited in reducing smoking in the general population, monitoring and preventing strokes and heart attacks from modern day epidemics such as diabetes mellitus and hypertension. In Mexico , Singapore , the US and in Europe , GPs were in the forefront in stopping the spread of the deadly influenza virus H1N1. GPs there were provided training, test kits and eventually Tamiflu to check the disease. Amazingly, in direct contrast, the MOH in Malaysia decided to bypass the resourceful neighborhood GP and instruct likely infected patients to rush to the Sungai Buloh Hospital with disastrous results where hundreds of patients mulled around at its lobby with staff stretched to their limits. Only after a huge public outcry in the face of mounting unacceptable mortalities did the MOH rescind and supply the generic version of Tamiflu to GPs.

For chaps like Idris, GPs in Malaysia are there only to make money and must therefore be shackled with draconian laws and treated as common criminals if they cross the line. They should be jailed or fined if their premises are unlicensed. In fact one doctor, Basmullah Khan, was needlessly jailed for three months just because his premise license was technically “not approved”. Only a malicious government would close down any health facility where hundreds of patients have been depending upon the expertise of the doctor for treatment and follow-up simply based on a bureaucratic edict. No country in this world treats its doctors this way except for Malaysia , another Malaysian first I guess.

But what are the repercussions of this sought of enactments on medical practitioners? A GP in Sungai Pelek, who once used to put up a drip for a dehydrated patient suffering from diarrhea due to food poisoning, refers the patient because he doesn’t want to take a risk under the PHFSA. He has even been told to remove the two beds he always keeps for such emergencies at this remote town. A GP in Triang seeing a dengue patient, lethargic, nauseated with a platelet count of 80,000 decides to refer when previously he would have asked the patient to come for a daily course of IV fluids and monitored his clinical features and platelet counts. And a GP out in Gemas refuses to deliver a full-term patient in labour with an almost full cervical opening for fear the baby may be born ‘flat’ and he would have to face the draconian PHFSA. So he decides to be safe and call for the ambulance to Segamat, 20 miles away. The baby is of course born in the ambulance.

And right here in Penang, a GP sees a diabetic patient suffering a coronary, lies him flat and places a couple of GTN tablets under his tongue when previously he himself would have administered crushed aspirin to the patient and given him a bolus of heparin which he always keeps for emergencies of this nature and perhaps some morphine. Of course he could have administered all of this and nothing would have happened if everything went well. But if the patient developed a complication, lo and behold he would be criminally charged and the MOH would tell him to speak to the judge if he wanted a lesser sentence. The GP doesn’t need this. It’s better to play safe. Is there any wonder why our government hospitals and their outpatient departments are overflowing. This is the type of defensive medicine that placed America into trouble.

The Prime Minister may have meant well in wanting to provide free outpatient care for poor urbanites. And the MOH could have advised him of a multitude of options including opening their own current urban health care clinics, even for 24 hours using their own doctors or outsource the service to GPs for an appropriate price. Why did the MOH choose to break the law by allowing unregistered medical practitioners to treat patients when surely they know that this is wrong? Were they politically pressured or were they plain ignorant. How would the Ministry defend itself in the event a patient sues for malpractice? It is an irony in itself that the MOH goes around closing clinics run by registered medical practitioners while they themselves use unregistered medical practitioners to run clinics in urban areas where there are an abundance of doctors. Is the Ministry of Health above the law?