Tuesday, December 22, 2009

Malaysiakini Letter: PHFS: No 'ambulance' to rescue harassed doctors

PHFS: No 'ambulance' to rescue harassed doctors
Malaysiakini Letter: RS, Dec 21, 09, 4:46pm

I refer to the Malaysiakini article 1Malaysia Clinics: An exercise in futility and the continuing nationwide harassment of general practitioners especially in the state of Penang by elements at the health ministry led by its controversial director-general, Ismail Merican.. The current fault where private practitioners are now being treated as quasi-criminals by the health authorities and continue to do so must decidedly lie with these doctors themselves.

Unlike the majority of post-2008 Malaysians, they have chosen to remain silent and must now, like all unregistered voters, pay that proverbial high price for remaining cloistered in their shells.

Their grouse, the Private Health Facilities and Services Act (PHFSA) is the demonic brainchild of consumer groups. Doctors at the health ministry put together a disparate chunk of ambiguous edicts from various different countries and called it the PHFSA.

These doctors who tried to do a hard sell on the then health minister, Chua Jui Meng, throughout his tenure failed when, Jui Meng, being a trained lawyer, refused to buy it. For starters, he knew both of them had obstructed discussion of the proposed legislation by blocking inputs from the very doctors it was going to be applied upon by lumping all discussions pertaining to the act under the Official Secrets Act.

Secondly, Jui Meng, now a stalwart with Pakatan Rakyat, discovered their motives for wanting to force doctors to purchase equipment peddled or attend courses driven by health ministry cronies as the main reason behind the application of the OSA on a medical law. However, these doctors realised their opportunity when an ignorant Chua Soi Lek walked into the picture. This time their sales pitch worked.

Appalled doctors who realised the gravity of their connivance and implications of the proposed law threatened to march to Parliament but were let down when their own representatives sold them out lock, stock and barrel to Chua. The PHFSA became a reality and soon enough despite all of Chua's pronouncements (who himself was proven to be untrustworthy by subsequent video revelations at a Batu Pahat hotel) engulfed a bona fide, unsuspecting doctor from USM, Dr Basmullah Khan who did not even have the financial means to engage counsel.

Despite ambiguity virtually popping out of every line of the Act, a judge decided to throw Basmullah into the slammer instead of reading the PHFSA together with that of the duties of a medical practitioner as outlined in the Medical Act 1971.

Malaysia Medical Association (MMA) doctors who were stung by his jailing, tried to sign-up for an EGM to discuss this issue but yet again were foiled by their own brethren at the MMA who instead of focusing on the gravity of such a law on the profession, instead chose to split hairs regarding the inadequate number of members who had asked for the EGM (apparently, some had not paid their subscriptions on time and therefore not eligible to call for an EGM, let alone vote).

The MMA, from whom much was expected for something to be done about this law, remains quiescent and ineffective to say the least. The MMA has failed in two very important tasks. One is its role in the Malaysian Medical Council (MMC). It has been part and parcel of MMC hearings involving the suspensions or reprimanding of six leading specialists and 10 senior GPs, one of whom was suspended for employing a 'Medical Assistant' (now glamorously called 'Assistant Medical Officer' – the types that don't do housemanship and take only three years to graduate after Form 5 and appear today as possible stand-ins for the urban run '1Malaysia' clinics proposed by the government).What irony.

A significant number of these doctors lost their clinical rights based on an archaic misdemeanor called infamous conduct. What's that? The MMA, by being an active member in prosecuting and doling out 'punishments' by taking away doctor's livelihoods in hearings led by a hopelessly biased government establishment unschooled or poorly advised on medical litigation matters has no business representing private doctors anymore.

Of great disappointment is that almost all the doctors suspended, reprimanded or struck off are from the private sector, the very doctors whom the MMA purportedly represent. Despite the health ministry being the ministry with one of the highest number of complaints this government has ever had to face, why isn't there even one single doctor from the government sector struck off, reprimanded or suspended?

Legal advisors to the Malaysian Medical Counsel (MMC) have complained about the blatant abuse of PIC heads and the health ministry DG himself in not following legal procedures but who choose to become judge, jury and executioner against all legal advice despite evidence to the contrary. Some of these advisors have even walked out in protest.

But the MMA remains silent. Shouldn't the MMA, like the British Medical Association, be wearing the other shoe and taking the MMC to task or even to court instead of being part of this shameful charade?

But more ominous is the complete lack of action regarding the PHFSA. Clearly the harassment continues unabated. Doctors in Penang are up in arms, some even considering leaving the profession as the ministry's 'enforcement officers' who clearly have nothing better to do continue to prey on their practice. Meanwhile, the road side pile jabbers and 'sin seh' peddling leaves and acupuncture continue to do roaring business, no thanks to the ministry's endorsement of traditional medicine. Further, the '1Malaysia' clinics run by 'Assistant Medical Doctors'- a lobby far more powerful then the impotent MMA, are now threatening to come on aboard.

By now, the MMA should have written to every private practitioner if they want an EGM to discuss the PHFSA. By now, they should have consulted a team of lawyers to seek leave to look into a judicial review and stay all further actions of this acrimonious act. By now, they should have gone to the ground and provided legal assistance to doctors severely harassed by enforcement authorities.

By now, they should have pooled funds from all GPs affected and sued any authority who acted or trespassed clinics illegally or have contravened in the legal restitution of medical care to the infirm by qualified doctors.

By now, they should have decided whether they are up to the mark in delivering and discharging their duties to the very doctors who (and to those who didn't) put them in-charge. All future MMA presidential hopefuls should perhaps note that if they want to be 'yes men' like many of our Court of Appeal judges, then they should just perhaps focus on their practice instead of assuming an office from which they very well know they cannot discharge their duties effectively.


Obviously, here is a doctor who has some ideas as to what has been happening but also confused as to the exact roles of MMA and MMC. Furthermore, his suggestion that private doctors are erroneously charged and victimised by the MMC, using archaic rules of professional misconduct, is probably ill-advised and quite inaccurate. 

His blanket acceptance that all those charged by the MMC are innocent victims is also disturbing and not based on facts. Most if not all these complaints arise from disgruntled patients, with some where the MMA simply act as a conduit for the complaint towards the MMC because of inability to resolve the issues to the satisfaction of both parties. And no, not all MMC members are yes-men. MMA leaders likewise are not to be tarred with the same brush. 

But this letter provides some food for thought.

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