Yeo Cheow Tong
Singapore
“Mdm Ho Geok Choo asked the Minister for Health in light of the recent report on fungal corneal infections (a) whether those who contracted the contact lens related fungal corneal infections will suffer permanent damage to their eyes; and (b) how long will his Ministry take to conclude its investigations into the causes of these contact le…”
“My Ministry performs a regulatory role and what we do is that we try to ensure that we have a conducive regulatory environment for the growth of this industry in Singapore. Let me tell him what we are doing in some areas.”
“Sir, on her two questions, whether we are satisfied that the school buses are collecting fares during the school holidays, as I mentioned just now, the school bus service is a contractual service between the parents and the service provider. It is therefore up to them to work out the terms and to abide by the terms.”
“Sir, on the first question, whether there is any abuse by owners of buses while using the 50% rebate, the answer is no, because LTA monitors very closely.”
“Sir, I have to repeat my answer. We are not responsible for regulating school buses and therefore will not be involved. SCHOOL BUSES (Installation of seat belts) 5. Assoc. Prof.”
“Ong Soh Khim asked the Minister for Community Development, Youth and Sports (a) if his Ministry will increase the cap of $10,000 per disabled person over their lifetime for the Assistive Technology Fund scheme; and (b) if not, whether there will be a flexibility to adjust the funding cap for this scheme based on the applicant's need, as j…”
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“Sir, I have already answered that just now. Perhaps, the Member was not listening properly. I have stated that the authorities in Indonesia had said that 80% of the haze was created initially by land clearing and forest clearing activities through burning by large plantation owners and the remaining 20% was due to the traditional slash-and-burn practices of the small farmers. However, because of the prolonged drought, these fires have now spread to other areas and have reached out of control.”
“Sir, we have searched for the information through various literature and we have not found any information on whether such haze particles over the period that we are being exposed to could be carcinogenic.”
“Such masks will only give a false sense of well-being to the users. On the other hand, there are special masks, referred to as `respirators', which are designed to protect workers exposed to occupational health hazards. These respirators are effective in filtering out fine particles. Sir, given our current air quality, there is no need for the general public to use respirators. However, respirators may be useful for those with chronic cardio-respiratory illness, but they should only be used on the recommendation of the attending doctors. For the general population, if the haze is intense with the 24-hour PSI exceeding 200, those who need to work outdoors for prolonged periods may find that respirators could provide some relief.”
“If the PSI is between 201 and 300, physical training would be held indoors and extra training would be cancelled. MINDEF has indicated that operational and field training will continue if the PSI is below 300. I will now address Members' questions on the health effects of the smoke haze. As I have mentioned earlier, the 24-hour PSI readings have remained mostly below 100 since the onset of this year's haze episode. Given this situation, the health effects of haze are mainly caused by the irritant effects of fine dust particles on the nose, throat, airways, skin and eyes. The effects would depend on the severity of the haze. There is also individual variation depending on one's ability to tolerate air pollution. Most people would experience sneezing, runny nose, eye irritation, dry throat and dry cough from the pollutant. These symptoms are mild and pose no danger to the health of the general population. However, persons with medical problems like asthma, chronic lung disease, chronic sinusitis and allergic skin conditions are likely to be more affected by the haze and they may experience more severe symptoms. Children and the elderly in general are more likely to be affected. For some, symptoms may worsen with physical activities. For persons under medical treatment, it is important that they take their medication regularly. Persons with chronic heart and lung problems are advised not to engage in outdoor sporting activities if the PSI is above 100. There is otherwise no need to take extraordinary precautions. My Ministry has also received many queries on the usefulness of face masks. We have informed the public that surgical or other similar masks are not effective in filtering out the fine particles present in the smoke haze.”
“The Haze Task Force, which now meets weekly, will meet more frequently to closely and critically appraise the situation and decide on the activation of certain response plans. For example, when the 24-hour PSI stays between 201 and 300, which is the "very unhealthy" range, we would decide on the need to require factories with fuel-burning equipment to further cut down on emissions, and vehicle fleet owners to implement additional measures to reduce emissions from their vehicles. When the 24-hour PSI is between 301 and 400, the air quality is in the "hazardous" range. The Haze Task Force would advise Government agencies on the need for closure of schools, childcare centres and sport facilities, and stoppage of military training and outdoor work. If the 24-hour PSI persists above 400, the Civil Defence Force's public warning system would be used to alert the public. The public will also be informed on the healthcare precautions to take through the radio and TV media. While it is possible that the 24-hour PSI may exceed the 200-mark on some days, the likelihood of the PSI entering the `hazardous' range of 301 to 400 or even persisting above 200 is low, based on air quality trends and other information that we have so far. Given the on-going efforts in Indonesia to control the raging fires, we would hope that the current situation will not take an unexpected turn for the worse between now and November, when the north-east monsoon is expected to set in and end the threat of smoke haze. Mr Charles Chong has asked about MINDEF's military training. MINDEF has indicated that military training will continue as normal when the PSI is between 101 and 200, but soldiers should not be made to run more than 5 km or go on road marches longer than 8 km.”
“Sir, on the home-front, my Ministry chairs an inter-ministry haze task force that formulates overall strategies and guidelines to help our citizens and residents cope with the smoke haze situation. This task force was formed in 1994, when Singapore was similarly affected by smoke haze. It drew up a Haze Action Plan in 1994, setting out the broad response plans for different ranges of the Pollutant Standards Index (PSI). This year, the task force expanded on the Haze Action Plan and is coordinating the efforts of key Government agencies in fine-tuning their individual action plans and the standard operating procedures. I can assure this House that the Government has in readiness the necessary plans to help Singaporeans cope during the haze period. Members of the House would have read about the salient features of the Haze Action Plan as well as the individual action plans of key agencies such as the Ministries of Education and Health. Nevertheless, I would like to take this opportunity to reiterate the key elements of the Haze Action Plan. When the 24-hour PSI remains largely below 100, which is the situation so far, the main task is to provide the public frequent air quality updates and health advisories. This is being done with hourly updates on the PSI through the media, on an Internet web page, and over the telephone through a haze info-line. The Meteorological Service Department also provides regular weather forecasts and updates on the haze situation. The provision of haze-related information to the public would be further intensified should the 24-hour PSI creep towards 200 or breach this level.”
“A three-member fact-finding team visited the Command Post last month, on 25th and 26th September, to discuss with the Indonesian officials, the specific areas in which Singapore could offer further assistance in tackling the smoke haze problem. Several areas have been identified. Starting from 30th September, teams of environmental and meteorological experts from Singapore are being attached to the Command Post on rotation to assist the Indonesians in locating and tracking fires. The attachment will continue for the duration of the haze period. In terms of equipment support, Singapore is providing Indonesia with hand-held global positioning system (GPS) sets for their field officers, INMARSAT Communications equipment for direct communication between field offices in remote areas and Jakarta via satellite, and computers for the Command Post. These equipment will help enhance Indonesia's monitoring and enforcement capabilities. We have also finalised plans to send air monitoring equipment to help Indonesia monitor the smoke haze situation in Sumatra. In addition, my Ministry and the Meteorological Service Department will jointly conduct further training courses for Indonesian officials in air quality monitoring and satellite imagery. MINDEF is also involved in our cooperation effort with Indonesia. The SAF yesterday despatched an RFAF C130 Aircraft to assist Abri in its efforts to fight the haze. The aircraft is based at Bandung's Hussein Sastranegara Airport to carry out haze dispersion operations. It may also be used for airlift operation as required by Abri. The aircraft is accompanied by a full crew and personnel to carry out the dispensing of chemicals.”
“During the meeting, the Indonesian State Minister of the Environment spelt out Indonesia's action plans and programmes to fight the fires. The Indonesian authorities have since taken enforcement actions against plantation owners in Kalimantan and Sumatra for clearing land by burning. They have earlier issued warnings and show-cause letters to some 176 companies which have violated the ban, and have to date taken action to revoke 154 permits issued to 29 private companies. Indonesia has mobilised 50,000 military personnel to beef up its fire-fighting operations in Sumatra and Kalimantan. It has also set up a 24-hour Command Post to track and monitor land and forest fires. The Command Post is located in Jakarta in the office of the Environmental Impact Management Agency (BAPEDAL) under the Indonesian State Ministry of Environment. In addition, Indonesia has commenced cloud-seeding operations in Sumatra in a bid to combat the drought and put out fires. If proven successful, these operations will be extended to Kalimantan. On our part, Singapore has extended full co-operation to Indonesia in its efforts to control the fires and smoke haze. To help the Indonesians locate fires and plan their fire-fighting, we have been sending them daily satellite pictures showing the location of hot spots. For the cloud-seeding operations, Singapore assists by providing daily information on cloud formations and wind data. We have also trained some of their officials in the areas of satellite imagery and air quality monitoring. Indonesia has invited Singapore to help man its Command Post in Jakarta.”
“Sir, the current smoke haze affecting the region is caused by land and forest fires in Indonesia. Indonesian officials have reported that as much as 80% of the fires are caused by large-scale clearing of forests for plantation land. The remaining 20% are due to the traditional slash-and-burn practice by farmers. Given the prolonged drought in Indonesia, reported to be its worst in 50 years, many of these fires have spread to surrounding areas and raged out of control. The resulting smoke haze is very widespread, affecting Singapore and the neighbouring countries. The smoke haze problem is a matter of very serious concern to the Government and to all Singaporeans. It puts the health of our population under threat, and it can have major repercussions on our economy. The Government has therefore acted swiftly and decisively on the issue. We have raised the transboundary haze issue with the Indonesian authorities, both on a bilateral basis and in regional meetings. We began doing so long before the start of the current haze episode. Aside from registering our concerns with the Indonesian authorities and urging them to take effective actions to curb the haze problem, we have also offered our cooperation and assistance in tackling the problem. In a major step to curb burning by plantation owners, President Suharto announced an indefinite ban on land clearing by burning on 9th September 1997, and plantation owners were threatened with suspension of their licences and other legal action if they defied the ban. Also, at the opening ceremony of the 7th ASEAN Ministerial Meeting on the Environment in Jakarta on 16th September 1997, President Suharto emphasised his country's commitment and determination to control the fires.”
“Mr Speaker, Sir, may I have your permission to take Questions 1 to 6 together since they concern the same topic?”
“If the Member has got any suggestion, I would be very happy to listen to her. 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 Yeo Cheow Tong]. Bill considered in Committee; reported without amendment, read a Third time and passed. PORT OF SINGAPORE AUTHORITY (DISSOLUTION) BILL Order for Second Reading read. 4.45 pm”
“Sir, it is not possible for the Ministry to conduct spot checks on all premises in Singapore. For those who are using equipment that requires licensing, they of course have to obtain a licence. The question is: what about those people who obtain those equipment illegally, bring them into Singapore quietly and therefore use them without a licence? The only way for us to know about that is if the members of the public lodge a complaint, or if they have to go and see a medical practitioner for corrective work to be carried out. We would appeal to such patients to let us know so that we can do the proper investigations and take the necessary enforcement actions on such people.”
“The point is that there is a body that is responsible and there is a process and the process is the Minister who shall thoroughly review that appeal. He also talked about compulsory voting that if it is only for half of the Council, therefore there should be no great interest. I have already answered that in great detail and I shall not prolong except to tell him that it is precisely because of the fact that although it is important for them to vote, only 15% are voting shows that we are not there yet. We have to make it compulsory so that people will value their vote and make sure that they choose people of standing, reputation and integrity and vote them into the Council. Sir, I think I have answered all the points raised.”
“Sir, it is the Medical Council that is responsible for registering or not registering applicants who are medical practitioners. If the Medical Council refuses to register, there is an appeal process. The appeal process is the Minister. What Mr Jeyaretnam was talking very emotionally on just now was that there is no appeal process, that it is unfair, undemocratic and so on.”
“Perhaps CASE might want to look into it. Mr Jeyaretnam waxed eloquence about many things without even studying what the Bill is all about. He talked about the unfairness of not registering applicants without any recourse to appeal. Sir, if he had read the Bill, he would have found that that is provided for. As for compulsory voting --- Mr Jeyaretnam rose ---”
“Sir, the practice of medicine is so broad that it is very difficult to define precisely what is medicine and what is not medicine. But what can be taken for granted is that any invasive procedure and any prescription of controlled drugs is the practice of medicine. So if a person is practising traditional Chinese medicine, that is provided for in this Bill. He is not infringing on this clause. If a person is selling herbal medicine, that is allowed. But, of course, it would be very difficult for us to come out and say, "People who are advertising cannot wear white frocks and white masks." If we do that, I think there will be a lot of professions, not just the medical profession, who will be affected. People in the catering business, many of them do wear gowns and masks as well. I think there are lots of complications. The key thing is to understand the whole spirit behind this Bill and to ensure that the message is clearly given to those who are inclined to stretch their business into fraudulent areas, including the carrying out of medical procedures just for financial gain.”
“The key thing to bear in mind is that in reviewing a complaint, the Complaints Panel, just as the current preliminary proceedings committee, will make sure that they get to hear both sides of the story, because that is the only way to investigate the complaint. It cannot be a one-sided investigation. Inevitably, the doctor complained against would either be asked to submit in writing his response to the complaint or, if there are still some other issues or matters which are not clear, he would be asked to appear. What this means is that the doctor cannot demand to appear because sometimes the written submission may be adequate. In any case, if the Committee finds that the complaint is warranted, the complaint is then referred to the Disciplinary Committee where formal inquiries are conducted. In this case, the doctor automatically is heard. Mr Bernard Chen talked about the lay member and he asked what is his role in the Disciplinary Committee. His role there is that of an observer but he is free to participate in the hearing. It is just that he cannot vote. So his views will still be heard, but he cannot participate in the vote. Whereas in the Complaints Committee, the lay member participates as a full member and he can vote. He also talked about the registration of doctors. Sir, I think he has missed out the clause that states that doctors who are aggrieved by the decision of the SMC not to register them may appeal to the Minister within 30 days. So there is always an appeal process and the Minister is the appeal process. Dr Toh See Kiat talked about clause 17 and said that "medicine" is not defined in this Bill and that it would be left to the judges to decide.”
“He has asked about the composition of the Complaints Panel; firstly, whether a doctor can object to the membership of the committee because he may be afraid that someone on the committee is biased against him, which is why we have three doctors and one lay person. So even if one person is biased, the other three members will make sure that this bias is counteracted. In any case, I think the fundamental approach must be to make sure that only people of standing and integrity are members of the Medical Council and members of the Complaints Panel, which is why the full participation of the medical profession is important, in terms of choosing those eight members who are going to be on the Council. He asked how the Minister would review appeals to him. Just as the Minister reviews appeals on other matters, the Minister will take advice from a group of senior people who may comprise officials of the Ministry as well as members of the profession. It will change from case to case, but this is how the whole system works. We do not just sit down and do a very arbitrary job. It is a proper review and a considered decision is made in the process. The Member said that members should be allowed to represent himself and be heard. He is referring to clause 40(21). That subclause has to be read in conjunction with the rest of the clause, because there is another subclause (16) which says, "a Complaints Committee may [amongst other things] require the registered medical practitioner concerned to give all information in relation to such book, document, paper or other record .".”
“But what Dr Michael Lim can be assured about is that most Ministers will be familiar with the leaders of the profession, and with people who are outstanding, people with good reputation, people with the necessary expertise. And because of that, whether it is the Singapore Medical Council, statutory boards or other bodies where Ministers as responsible for making the nominations and appointments, we have always made sure that only people of standing are appointed, and this will continue. He has asked whether those people who are on the Register of the Academy of Medicine would automatically be recognised as specialists. I think the intention must be that there must be a "grandfather system" where people who are already recognised and practising as specialists and who have sat for the necessary examinations and have undergone the necessary training would be recognised for registration in that specialty. On the process of defining what is a "specialty", we will leave that to the profession. As the Bill provides, the Specialists Accreditation Board would be setting up different committees which are made up of people who are specialists and people from each specialty to help them carry out their work. So it will be done by the profession itself and the leaders of the profession will be the ones who will be chosen to make the decisions. He has talked about the need to accredit doctors for procedures. I agree with him. In fact, when I was in the United States in the late 80s looking at some of the hospitals, there was a system of accreditation that impressed me very much. And we have asked for that to be instituted here. But I think more can be done and we should strengthen that process and make sure that it is enforced.”
“Dr Tan has also made the point that because of the fact that doctoring is now being turned into a business there is a lot of pressure from hospitals and other employers on their doctors to do more tests, investigations and whatnot and, therefore, whether we have enough safeguards in place. I would like to inform him that in terms of tissue audit, yes, it is now compulsory. We made that compulsory when we passed the Private Hospitals and Medical Clinics Act. The same Act also requires hospitals, both restructured and private, to establish medical audit committees. Of course, in terms of medical audit, it is still in an evolutionary stage and we would definitely be looking to see how those audit committees can be enhanced. Dr Lily Neo has also strongly supported the Bill. She has asked whether the definition of "specialists" would be fairly broad so that we do not allow a whole range and proliferation of sub-specialties. That is indeed our intention. The Specialists Accreditation Board will define what are the broad specialties that will be accredited. She has asked that the practising certificates not be used as a tool to create additional loads on the doctors. That indeed is not the intention. It is not meant to be a pressure point. It is just to make sure that doctors are suitably qualified and they have also kept up to date when they are given their practising certificates. Dr Michael Lim asked whether the Minister is familiar with all members of the medical profession, since the Minister is responsible for appointing half of the members. I think no Minister can expect to be familiar with all members of the profession, just as no single member of the profession can be expected to be familiar with all members of his own profession.”
“Sir, I am always very compassionate. On the Specialists Accreditation Board, Dr Tan was concerned that a specialist would still be allowed to see cases that do not fall within his specialty. I think there are two aspects here. One is cases which fall into other specialties. For example, if he is a heart surgeon and a cancer patient comes to see him, will he be allowed to treat? The answer is no. If he is also not at the same time registered as a cancer specialist, he will not be allowed to take on the job of a cancer specialist. But because he is already a registered medical practitioner, as Dr Lily Neo had pointed out, he will be allowed to take on cases for which his undergraduate training has given him the necessary expertise and skills on managing patients with abdominal pains, headaches, colds. If the patient has those conditions, he is, of course, free to treat the patient. He has also asked whether we should go to a referral system where specialists only see patients who are referred to them. Sir, this has happened in countries where the main payment is a third party payment. In the UK, US, Australia, it can be enforced. In Singapore, it also happens to some extent. Patients who are being treated and who are paid by an insurance system or who are paid by the companies or by the employers, normally, these bodies, whether they are employers or insurance companies, would require that that patient is first seen by a GP and referred to a specialist, if need be, rather than allowing the patient to go directly to a specialist. The same thing applies to the Government sector. For the subsidised patients, they go to the polyclinics first and if necessary they are referred to the specialist outpatient clinics.”
“Sit down please, Dr Tan. Usually, when medical officers apply to break their bonds, we do hear them out. And if they request for time to pay the liquidated damages, quite often, we do allow them the time. So there is no need for conditional registration or otherwise. But if after having given their commitment to pay liquidated damages per their undertaking, they just walk away and do not pay up, if when given adequate time then, of course, the final step must be taken. But in getting to the final step, there are a lot of intermediate steps which need not be spelt out in this Bill. And that is why this provision has never had to be applied. As regards referring it to my colleague, the Minister for Law, the Bill is drawn up by the Attorney-General's Chambers and, therefore, it has been fully vetted. I can also assure him that all Bills which are drawn up by the Government have the consent of the Minister for Law. But we will definitely draw this particular provision to his attention and ask him for his considered advice too.”
“Sir, Dr Michael Lim says the student has got no choice. He has a choice, as he pointed out. He can either decide to do medicine or not to do medicine. Just as he can decide whether to take on a scholarship or not to take on a scholarship. It is the choice he has to take. And once he has made the choice, he sticks to it. What Dr Tan is concerned about is whether we apply this provision immediately a medical officer resigns from Government. I would like Members to realise and understand that actually my Ministry is made up of many compassionate people. Doctors are compassionate. Dr Tan Cheng Bock rose ---”
“Sir, far from it. In reviewing the clauses in this new Bill, we went through every clause and made sure that for those clauses which were adopted from the existing Medical Registration Act, we justified why that clause should be retained. In this particular case, we have decided to retain it for a very good reason. Doctors are meant to be people who are responsible and they have to be, because they are responsible for the lives of the people. They should have a sense of dedication. Responsibility also refers to the undertaking that you have made in pursuing a medical course. That is why it is important for them to realise that they have an undertaking. They have to reflect that they are responsible because if they cannot even be responsible for the first five years of their working life, what guarantees do we have of the future? And that is why this clause is there. Also, we have students from abroad who study here and who could easily walk away from us the moment they graduate. The ability to deregister them is a great deterrent and that is why, as I said, so far, based on my enquiries, we have not had to use this provision. So let us keep it, because it is a very effective deterrent.”
“Sir, Dr Tan Cheng Bock has unduly limited the scope of the current Act and this Bill. He has limited the definition of the grounds for which to remove registered practitioners from the register only on professional grounds.”
“Because of this clause, we have not had to apply it. But it is a useful deterrent. So in answer to Dr Lim's point, if he pays up his liquidated damages, he is allowed to practise. That is why we have so many medical officers who have broken the bond, left to join the private sector and they are practising quite happily.”
“On the point about the Law Society having different bands, the key thing to appreciate is that what we are looking for is to have a Medical Council that comprises people of not just integrity, but people who have enough expertise, knowledge and skills who can then sit in judgment of their peers. Where should that dividing line be? Should it be 10 years? Should it be 15 years? Should it be 5 years? I think there will always be contention. The key thing to note is that for the medical profession, even for specialists, it takes at least seven years to train a specialist. So based on past experience, 10 years appear to be a workable and satisfactory dividing line. It has worked very well so far. Let us keep to it. It makes the system a lot simpler for everybody. Dr Tan has asked whether we could require doctors who have conducted tests like ultrasound tests, and so on, to give their reports in writing. Sir, it is a proposal which I would be happy to ask my officials and the SMC to look into. Several Members have spoken on clause 33(1)(g) about the removal from the register for having failed to serve the Government or any such body as may be specified in any undertaking given by him to the Government. Sir, the key operative word there is "undertaking". When a medical student enters into a contract which allows him to go through medical school, he also signs a bond that requires him to serve the Government or any other organisation, as stipulated by the Government, in lieu of which he has to pay liquidated damages. That is the total undertaking. He either serves or pays liquidated damages. This clause applies to those who break the undertaking, ie, they refuse to serve the bond and they do not pay up the liquidated damages.”
“Sir, let me move on. If he has any other points, he can bring them up later. Dr Michael Lim Chun Leng resumed his seat.”
“It is very easy for someone to use an analogy which has got no comparison at all. This is a Parliament that is responsible for the entire affairs of the country. As I said, for professional bodies, there is a whole variety of options. Of course, if Dr Michael Lim feels that it is not worthwhile to have half the members, people whom he has chosen, I would be quite happy in future amendments to convert the SMC into something more akin to the engineers, accountants and architects and I think it would be to the great disadvantage of the profession. The key thing now is the profession has the advantage of being able to elect half of the members of the Council, make sure that those half are people of high standing and integrity who would be prepared to listen to the complaints and conduct the inquiry in a fair and unbiased manner. It is not the people whom he is afraid of, people with biases, people with axes to grind, who would inevitably get in if only a few members of the profession vote because they will then get their best friends to vote for them. If that is what Dr Michael Lim is worried about, then he should welcome this. Because under this system, it is less likely that those people whom he fears very much, and apparently, he has got many people whom he fears, these are the ones who will not be able to get in. Dr Michael Lim Chun Leng rose ---”
“Sir, this has always been the case and if any of the Members have information to the contrary, I will be very happy to hear about that. In terms of the election, Dr Tan Cheng Bock has said that actually it is because many doctors found the election process very cumbersome, that they have to get two names to countersign. Sir, I think he has got it mixed up. The need to have two names only applies to the nomination process. If you are nominating somebody, you need a proposer and a seconder. But if you are voting, the vote is supposed to be secret, so therefore you submit your vote without the need to have another peer checking whom you have voted for, and this will still apply under the compulsory voting. If Dr Michael Lim is worried about the standing of doctors who are members of the Council, then I think it is even more important that for the half who are elected, they are people who have withstood the scrutiny of the entire membership of the medical profession. I think to have only 15% vote in half the membership of the Council is definitely unsatisfactory. If you want to have people of good standing, then they must be people who have withstood the scrutiny of all the members.”
“Mr Speaker, Sir, first, let me thank the five elected MPs who have spoken in strong support of the Bill and, of course, the NCMP for his remarks which I will respond to in an appropriate manner afterwards. Sir, Dr Tan Cheng Bock spoke very strongly in support of the Bill. He has raised quite a few questions which I shall endeavour to answer one by one. Sir, he has talked quite a fair bit about compulsory voting which Dr Michael Lim and Mr Jeyaretnam have also spoken about. I will take them altogether. He has asked why should the majority of the members of the Council be nominated members rather than the reverse. Let me explain that the compositions of the governing bodies of the different professions vary. For example, for the Professional Engineers Board, the Board of Architects and the Public Accountants Board, in fact, all members are nominated members. For the Law Society, 15 out of 19 are elected. For the Singapore Medical Council, it has always been that half of the Council are elected members, half are nominated, and one is ex-officio, which is the Director of Medical Services. The system has worked well mainly because whilst the Government is responsible for nominating half the Council, we have always made sure that those nominated members are professionals of the highest standing and of the highest reputation as well.”
“We will continue to see the development of new medical procedures and treatments, and the introduction of new diagnostic equipment and tests, and so on and so forth. To safeguard our patients, the profession must ensure that its members are properly trained before they are allowed to use the new medical developments and technology. At the same time, we must deter doctors from being tempted into advising their patients to undergo unnecessary tests, procedures or operations for financial or other reasons. This Bill will help to achieve these objectives. It will enhance the role and structure of the Medical Council, and empower it to safeguard our high standards of medical practice, and promote the further development of the medical profession. My Ministry has actively sought the views and inputs of the Singapore Medical Council, Singapore Medical Association, Academy of Medicine and College of Family Physicians during the preparation of the Bill. These professional bodies have given their general agreement and support to the Bill. They have made some suggestions on the voting procedures and other operational details. My Ministry will take these inputs into consideration when preparing the Regulations. Sir, I beg to move. Question proposed.”
“Proposed increase in penalty for unauthorised person acting as medical practitioner I had mentioned in my opening remarks about unauthorised people carrying out medical procedures and treatments illegally. Clause 17 increases the maximum penalty for a first offender from the present $500 to $100,000 or imprisonment of up to one year, or both. For subsequent offences, the penalties will be increased to $200,000 or imprisonment of up to two years or both. This provision will enable the Government to act effectively against unauthorised persons who are illegally providing medical treatment and procedures, even though they had not claimed to be registered medical practitioners. These enhanced penalties very clearly signal that the Government is determined to stamp out such abuses. Consequential and other minor amendments The Bill also proposes consequential changes as a result of the proposed amendments that I have just described, other minor amendments to delete obsolete terminology and to update the existing provisions. Conclusion Mr Speaker, Sir, we have come a long way in the provision of medical care. We have a high standard of care today because we have well trained and highly competent doctors, backed by equally competent supporting personnel and well-equipped hospitals and clinics. Our doctors are not only professionally competent but the vast majority also practise medicine as a calling. Collectively, they help to uphold the professional and ethical standards and integrity of the system. However, the challenges facing the medical profession and the entire health care sector will be even greater in the years ahead.”
“The proposed amendments will allow the SMC to discipline doctors who have been guilty of any improper act or conduct which brings disrepute to his profession, or who have been guilty of professional misconduct. Enhancement of Disciplinary Powers Under the existing MRA, if a doctor is guilty of infamous conduct in any professional respect, the SMC can either censure him, suspend his registration for a period of not more than 12 months, or strike his name off the register. The wide difference in severity of the penalties provided in the existing MRA has often resulted in a lower penalty being imposed on the doctor. For example, if a doctor has been found guilty of an offence which warrants more than a censure, but which was not serious enough to merit a suspension, he is likely to end up with only a censure. In such cases, a fine would have been more appropriate. The Bill addresses these shortcomings by enhancing the penalty options available to the Medical Council. It empowers the Council to: (a) remove the name of the doctor from the medical registers; (b) suspend the doctor from practice for a maximum period of three years, instead of the current maximum of one year; (c) impose restrictions on the practice of the doctor for up to three years; or (d) impose a penalty of not more than $10,000. The Council may also 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 medical practitioner concerned. Restoration of Name Clause 46 provides for a doctor whose name has been removed from the Register by order of the Disciplinary Committee to apply for his name to be restored after a minimum period of three years.”
“Each Committee will comprise two members of the Complaints Panel who are members of the Medical Council, a member of the Panel who is a doctor but not a member of the Medical Council, and a member of the Panel who is a lay person. The large membership of the Complaints Panel will enable several Complaints Committees to be formed should the need arise, and help expedite the processing of complaints. The concept of lay persons being involved in disciplinary procedures is also present in the Legal Profession Act and Accountants Act, and will make the disciplinary process more transparent and open. The Complaints Committee will inquire into the complaint, and upon completion of its inquiry, shall:- (a) dismiss the complaint; (b) warn the doctor complained against; (c) issue him with a letter of advice; or (d) refer the complaint to either the Disciplinary Committee or the Health Committee for action. To ensure that complaints are dealt with expeditiously, each Complaints Committee will be given three months to complete its preliminary investigations. Disciplinary Committees Clause 42 provides for the Medical Council to appoint Disciplinary Committees, each comprising not less than three doctors of at least 10 year's standing, of whom at least two shall be members of the Medical Council, and one lay observer. The Disciplinary Committee shall formally inquire into any matter referred to it by the Complaints Committee, and is expected to make its finding and order within six months of its appointment. Today, doctors are disciplined only if they are convicted of any heinous offence, or are guilty of infamous conduct in a professional respect. This is too restrictive a definition of the offences for which disciplinary action can be taken by the Medical Council.”
“Health Committee At present, a doctor who is unfit to practise because of psychiatric condition, drug/alcohol dependency or any other physical or mental condition, cannot be removed from the Register. Clauses 47 to 49 provide for the setting up of a Health Committee to review any doctor whose fitness to practise is impaired by reason of his physical or mental condition. It will be empowered to restrict or suspend the doctor's practice, or recommend that his name be removed from the Register. The Medical Act of the United Kingdom also provides for the establishment of a Health Committee with similar functions. Disciplinary Procedures Sir, let me move on now to disciplinary procedures. Presently, complaints are dealt with by the Preliminary Proceedings Committee (PPC) of the SMC, before being referred to the Council for an inquiry if so determined by the Committee. As the PPC is made up only of Medical Council members, their limited numbers inevitably slow down the processing of complaints. The PPC's authority is limited to either dismissing the complaint or referring it for formal inquiry by the SMC. To overcome the present limitations and to allow for wider representation, clause 39 provides for the establishment of a Complaints Panel, consisting of: (a) not less than 3 members of the Medical Council; (b) not less than 10 and not more than 40 doctors of at least 10 years' standing who are not members of the Medical Council; and (c) not less than six and not more than 40 lay persons. Clause 40 provides for the appointment of Complaints Committees, with the members appointed from the Complaints Panel.”
“The usual conditions are that they have to work for a minimum of two years under the supervision of a registered medical practitioner, and be assessed by the SMC before being granted full registration. This is to ensure that they have adequate knowledge, skill and competence before full registration is granted. Conditional registration is also practised in countries like the United Kingdom, Australia and New Zealand. Clause 21 formalises this practice. Full registration can, however, be granted immediately to a foreign-trained doctor if the SMC decides that he holds recognised qualifications, or has the knowledge and skills which we need. Specialists Accreditation Board Another new provision in the Bill is the creation of a Specialists Accreditation Board, consisting of not less than eight doctors. The Specialists Accreditation Board will: (a) determine the qualifications, experience and standards required for specialists registration; (b) define the specialties in medicine for the Register of Specialists; (c) determine and accredit the training programmes for speciality training; (d) grant certificates to persons who fulfil the qualifications for specialists registration; and (e) recommend to the Medical Council programmes for the continuing medical education of registered specialists. These provisions are in line with current practices in the United Kingdom and the United States. The provisions are not intended to restrict the doctors' practice to specialist practice only, as they are already qualified as registered medical practitioners for general practice. The Specialists Register will, however, ensure that only qualified specialists are allowed to practise in the field of specialisation in which they have been registered.”
“Additional functions for the Singapore Medical Council (SMC) The Bill will broaden the functions of the Singapore Medical Council. Clause 5 empowers the SMC, in addition to its current functions, to also make recommendations to the appropriate authorities on: (a) the content and nature of courses of instruction and examinations leading to the Singapore Medical degree; and (b) the training and continuing education of registered medical practitioners. This is to ensure that our medical students and practising doctors are continuing to receive appropriate medical training, and are keeping abreast of medical advances and developments in order to maintain high professional standards. Compulsory Voting by Medical Practitioners Currently only about 15% of registered medical practitioners participate in the election of representatives to the Council. This is clearly not satisfactory. To ensure that those elected are truly representative of the medical profession, the Bill will make voting compulsory. Those failing to vote shall not be entitled to apply for practising certificates unless they have good reasons or unless they pay a fine. This is similar to the Legal Profession Act, which provides for compulsory voting of members to the Law Council. Vacating Office To ensure that Council members take their appointments seriously, clause 9 provides for the removal from office any member of the Council who is absent without leave for 3 consecutive ordinary meetings of the Council or its Committees. Conditional Registration of Foreign Medical Graduates The SMC currently grants conditional registration to foreign-trained graduates from Universities listed in the Schedule to the Act.”
“We therefore need to strengthen the Medical Council's structure to enable it to better handle the increasing number of complaints. We will need to increase the membership of the Council and improve the inquiry process so that complaints can be processed expeditiously. Another problem that we face from time to time is the illegal conduct of procedures and treatments which are to be performed only by qualified and registered medical practitioners. Often, these illegal procedures are done improperly, and patients need to go to qualified specialist doctors for corrective treatment. Some less fortunate patients may have to suffer for life because the damage to their tissues or organs was permanent and could not be corrected completely. Many of these illegal procedures are conducted by beauticians or other lay persons who unscrupulously mislead their clients into believing that they are qualified to undertake such procedures. One example is the recent case where a lay person provided colonic washout treatment to a member of the public resulting in permanent damage to her rectum and anus. The present MRA provides for a penalty of only a maximum fine of $500 for unauthorised persons providing treatments which only registered doctors are allowed to do. The current penalty is a grossly inadequate deterrent in view of the potentially large financial gains possible. I shall now highlight the major new provisions that are being introduced in this Bill. Larger Medical Council To widen the representation in the Singapore Medical Council and to expedite the processing of complaints, clause 4 increases the number of members in the Council from the current 13 to 17.”
“As a result, doctors now have a variety of effective treatment options for many medical conditions. For example, numerous operations can now be performed either as conventional open surgery or as minimally invasive surgery. Doctors are also able to offer drug therapy instead of subjecting the patient to surgical procedures for an increasing number of medical conditions. These changes have benefited Singaporeans. We now enjoy a standard of medical care that is comparable to the best in the developed countries. Singaporeans now have a much wider choice of doctors and treatment modalities. But because medical science has made so much progress, and the number of specialties expanded so rapidly, there is an urgent need to provide for an accreditation system for specialists that will ensure that they have undergone the necessary training and are continuing to upgrade their knowledge and skills. Another change is that, as Singaporeans become more affluent and better educated, their expectations of the quality and outcome of medical care also increase. Patients are now more ready to seek redress when they are dissatisfied with the performance of their doctors. Although the level of medical litigation in Singapore is much lower than that of the developed countries, there is, nonetheless, an up-trend in the number of complaints filed with the Singapore Medical Council (SMC) against doctors for alleged professional negligence, misconduct, unethical practice and so on and so forth. In 1996, the SMC received 66 formal complaints against doctors compared to only 18 in 1986. In terms of number of complaints per 1,000 doctors, these figures represent an increase from 6 complaints per 1,000 doctors in 1986, to 14 in 1996. In the sixties, formal complaints against doctors were rare.”
“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 medical practitioners and for matters connected therewith, and to repeal the Medical Registration Act (Chapter 174 of the 1985 Revised Edition). The current Medical Registration Act (MRA) derived its origin from the Medical Registration Ordinance 1953. The title of the legislation was changed to Medical Registration Act in 1971. Other than some minor amendments in 1979, the MRA has remained essentially unchanged. We need to update the MRA as the medical profession and the practice of medicine in Singapore have undergone tremendous changes over the past 30 years. We need to enhance the role and structure of the Singapore Medical Council to enable it to perform its functions more effectively and raise standards of professional conduct and practice. Let me briefly explain some of the major changes in our medical sector over the past 30 years. Firstly, the number of doctors in Singapore has increased almost five-fold, from less than 1,000 in the mid-sixties to 4,800 today. Today, nearly 50% of the doctors are in private practice, unlike in the past where most of the doctors worked in the public health care sector. Secondly, about 40% of the doctors now have post-graduate qualifications today, compared to only a small number 30 years ago. The range of specialisation and sub-specialisation has also increased tremendously. For example, we only had general surgeons previously, we now have surgeons specialising in heart surgery, with further sub-specialisation in surgery for children with congenital heart diseases. Medical science and technology have also changed tremendously over the past 30 years.”
“Should the discharge exceed what we have allowed them, there is an automated shut-off device that will shut the access into the sewers and the company will have to call the Ministry of the Environment to get our officers to go into the premises to open up that access into the sewer. When that happens, not only will we open up the access for them, but we will also impose penalties on them. We do have very stringent requirements on both the usage as well as the storage of hazardous materials.”
“Sir, I agree with Dr Wan that we need to ensure that stringent conditions are imposed on those who are handling toxic materials and hazardous wastes because if any accident happens, there is a tremendous threat to both life, property and the environment. Sir, it is for this reason that the Environment Ministry has stringent requirements to ensure that all hazardous substances are properly stored and used and that the wastes generated can be safely managed and disposed of. And it is perhaps because we have all these stringent requirements in place that when the Chem-Solv fire broke out, no lives were lost. Sir, let me give some examples of some of the requirements that we have imposed to ensure that hazardous materials are handled properly in Singapore and do not pose a threat to Singaporeans. Firstly, when companies apply for permission to establish operations in Singapore, whether as manufacturing operations or as recycling plants or as storage facilities, they require a licence from my Ministry to store, handle and use such hazardous materials. In processing the applications, my Ministry will then require the companies to incorporate preventive measures in the design and operation of their facilities. This is to ensure that, firstly, should any accident happen, such hazardous materials are not released into the atmosphere or pose a threat to people. 4.00 pm Sir, they are also required to have stringent safeguards to ensure that they do not discharge these hazardous materials into either our sewers or the public drainage system. In fact, we require factories to install automated monitoring equipment that monitor the quality of the discharge into the sewers.”
“Sir, the Chief Valuer values the stalls before setting the selling price. The selling price will vary from centre to centre because it depends on the location of the centre as well as the location of the stalls within that particular centre. And I am sure the Chief Valuer will continue to compare the new selling prices with the old prices, as well as to ensure that the new selling prices represent what is a reasonable market value for that particular stall.”
“Those enjoying subsidised rentals at the present moment are not allowed to sublet. They must personally be present at the stalls when the stalls are being operated. As Mr Ang has pointed out, it limits the number of hours that they can operate the stall. Sir, since 1992, my Ministry has been tendering out hawker stalls and those successful tenderers are now paying market rates. Their stalls are next to the subsidised stalls and therefore it is not fair to allow those subsidised stalls to operate in the same way as those who have tendered and who are paying market rates. Sir, we do recognise that consumers will ultimately benefit if all hawker stalls are operated optimally. For this reason, we are now reviewing how we can achieve this. Mr Ang Mong Seng( In Mandarin): Sir, what I am concerned with is the selling price of the stalls. According to the record, in 1994, the lowest price, after discount, was $73,000. In 1995, it was increased to $90,000, and in 1996, it was further increased to $112,000. So I am concerned that the prices are increasing year by year. Those who have yet to buy their stalls face the problem of having to pay higher prices in future. I would like to ask the Minister whether some careful consideration has been given to ensure that the selling prices will not increase year by year, resulting in those who have to buy later, having to pay more for their stalls.”
“Sir, Mr Ang Mong Seng has made two proposals. Firstly, to extend the lease period of stalls that are being sold to 30 years and, if not possible, then to 25 years. Secondly, to allow those who are currently enjoying the subsidised rentals to sublet their stalls. Sir, extension of the lease period, as I have explained just now to Mr Peh, must inevitably result in an increase in the selling price. The property market reflects that very well, and that is why freehold properties are more expensive than leasehold properties. So if you are going to increase the lease period for the stalls that are sold to 25 or 30 years, it must inevitably impact on the selling price. In the end, it gets back to the same problem. Sir, as I have explained to Mr Peh, the stalls that are being sold are actually very affordable. And that is why there is such a good response to the sale of stalls programme. The other thing is that although the instalments every month are higher than what they are paying now as subsidised rentals, those instalments are still lower than what their counterparts, who have tendered for the stalls or who are renting stalls in coffeeshops or foodcourts, have to pay. The advantage here is that being a stallholder and a stall owner now, he can sublet and employ people to help him, and there are no restrictions. Therefore he is able to operate the stall optimally and reduce his overhead costs. And that is why our surveys have shown that the food prices in the hawker centres that have been sold are comparable to the food prices in the hawker centres that are being rented out at subsidised rentals. Sir, he has asked whether those who are currently renting at subsidised rates can be allowed to sublet their stalls.”
“Sir, whilst the roads are all swept only by the DREs, there are equivalent jobs, such as gardening. Even for the Town Council cleansing operations, not all of them are sweeping stairs. There are big common areas to be swept by the cleansing workers under the sun. By the way, the Ministry of Labour would be very interested to know which Town Council is employing foreign workers illegally. Sir, the crux of the matter is exactly what has been pointed out by Mr Sinnakaruppan, ie, that the bulk of the DREs are people with very minimal skills and the challenge really is how to upgrade their skills to enable them to earn a higher income. This is what we are doing. Amendment, by leave, withdrawn.”
“On malaria, Mr Kenneth Chen also asked how can we minimise the import of malaria cases into Singapore and, secondly, what is the local malaria situation. Sir, all foreign workers who are seeking employment in Singapore are required to undergo health screening and the health screening package includes screening for malaria. That is how we are able to spot the malaria cases before they actually come to work in Singapore. He has asked about the number of cases in Singapore. Singapore has been declared malaria free by the WHO since 1982. But that does not mean there is no malaria. It means that there are very, very few cases of malaria in Singapore. In 1995, we had one case and 1996 we had three cases, which means that we are malaria free.”
“We are assisting in some of these projects by providing land in the Sarimbun recycling park and part of our Lorong Halus dumping ground. We will continue to promote entrepreneurs who wish to set up recycling plants down the road. On vector control, Mr Kenneth Chen asked what steps we are taking to suppress the outbreak of dengue fever by the Aedes mosquito and whether frequent checks are adequate and whether we need to increase the fines to discourage breeding of mosquitoes. More importantly, why are there more Aedes mosquitoes in the East Coast where he lives? Sir, there are more cases of dengue fever in the eastern part of Singapore simply because the Aedes population there is higher. There are more people breeding Aedes in the east than elsewhere in Singapore. The reason is very simple. The eastern part of Singapore has more landed properties and we are more likely to find Aedes mosquito breeding in landed properties than in the highrise flats. Sir, we have intensified our surveillance programme on the breeding of Aedes mosquitoes in not just the eastern part of Singapore but throughout the whole of Singapore. The surveillance efforts are important. But as I have stated about three weeks ago, when there was a Question on dengue fever, that public cooperation is very, very important. We will continue to educate the public but we will need to be able to motivate them to translate their awareness of what causes dengue fever into personal actions. This is where Members can also help by conveying this message in their constituency activities. Sir, on whether increased fines are necessary, we will look into his suggestion.”
“Mr Kenneth Chen also talked about recycling and whether we are doing enough recycling, how successful have the programmes been, and what else can we do in the future. Like any other business, recycling of waste must be economically viable. Otherwise, it would not be sustainable in the long run. Also, this effort must be market driven, as there must be demand for the recovered waste. Otherwise, you end up dumping the waste. This is exactly what has happened in some of the projects that we launched. For example, there was an active bottle collection scheme some years back, except the people who were collecting the bottles found that there was no market for the bottles. So the scheme stopped. BP also started a programme of placing recycled green bins in various places. What they found was that instead of throwing the required materials into the specific bins, for example, waste paper in the waste paper bins, they found all kinds of other things in the waste paper bins. Therefore, the karang-guni men could not even use the waste papers. Again the scheme stopped. But we will continue to look for other ways. We are promoting the setting up of recycling plants by the private sector. Some of those in the pipeline include, for example, plants that can convert marine clay into bricks because there is a lot of marine clay, and not only that, when we go into the deep tunnel sewerage projects, we are going to generate a lot of marine clay. So there is a ready supply of raw materials looking for someone to make better use of, otherwise we have to dump it. There is also a plant that will be using wood waste for power generation. There is also another plant coming up that will recycle scrap tyres.”