Patients attend a hospital to seek treatment of their medical condition(s) and not to get injured, or worse still, die from a cause unrelated to their medical condition(s).
Fires in public health care facilities, particularly hospitals, continue to raise concerns.
Everyone in hospital management has a duty to understand fire safety requirements in order to ensure optimum safety for everyone present in the premises.
It is only by having such knowledge that the hospital’s board and senior management can understand their legal and ethical duties to provide safe, efficient, effective and reliable systems that are critical in supporting patient care.
Any fire in a health care facility would pose a major threat to the lives of everyone within it, particularly to patients. Therefore, all health care facilities require a fire safety policy based on avoidance of fire.
In the event that a fire occurs, there must be means for rapid detection, containment and reliable procedures for removing patients and others to places of safety.
Such a policy requires a high level of management commitment, professional competence and must be supported by procedures for continuing appraisals of fire precautions and for continuing staff training.
Fire safety is everyone’s concern. Every staff member is responsible for knowing the fire hazards within their working environment, practising and promoting fire prevention and knowing the right action to take in the event a fire occurs.
The overall responsibility for fire safety is at the highest management level i.e. the Ministry of Health (MOH), hospital or clinic director and Board of Visitors.
As an employer, the management has to be serious about its responsibility to provide a safe working environment for all employees, patients, visitors and contractors with regard to fire safety in the workplace.
Among others, the management’s duties include:
- The provision of adequate means of escape.
- Arrangements for detection and warning in case of fire.
- The provision of a means of fighting a fire appropriate to the risk and its maintenance.
- Plans for serious and imminent danger insofar as it relates to the evacuation of premises.
- Training of all staff in procedures to be followed in the event of fire appropriate to the risk, fire drills and evacuation exercises as required by law with maintenance of full accurate records.
- Regular fire risk assessments.
- The conduct its activities in such a way as to ensure that people who may not be employees, but who may be affected by those activities, are not exposed to risk to their health and safety in relation to fire, e.g. patients, general public, contractors and their employees, and temporary workers.
Concomitantly, all health care facility employees have a personal responsibility to safeguard themselves and their actions, either by instruction, example or behaviour; should not put other people, plant or property in jeopardy or are to co-operate with the employer in regard to the fire safety.
Hospital Sultanah Aminah Fire
The fire at the intensive care unit of Hospital Sultanah Aminah (HSA) in Johor Bahru on October 25, 2016 resulted in six patient deaths, confirmed by the then health minister, who also confirmed that another patient was transferred to the burns unit at Hospital Sultan Ismail and “Ten of our staff were also injured, and two of them have been transferred to a nearby hospital for treatment.”
According to the Johor Fire and Rescue department director, 166 firefighters in 10 trucks were involved in bringing the fire under control. He also stated that there was no fire drill in the hospital in the previous year.
An independent committee chaired by a former Court of Appeal judge, appointed to investigate the fire, handed over its report to the MOH secretary-general in June 2018. Its chairman made a call for public disclosure of the report which made 23 recommendations.
Parliament was informed on August 13, 2020 that the committee’s report, which was originally classified under the Official Secrets Act, was declassified after the Cabinet decided on October 2, 2019 to publish the report.
The HSA fire has left an indelible imprint on my memory.
In 2010, I visited HSA for the accreditation assessment of a medical school which used HSA as its clinical training hospital. The visit confirmed the findings in HSA’s hospital accreditation report the previous year, e.g. blocked fire escape routes, and doors with unavailable keys to the exterior, three to four heavy duty medical devices getting its electrical supply from one wall plug, and unlocked oxygen tanks on the building’s exterior with unextinguished cigarette stubs nearby.
Upon my return, the MOH’s top management were informed about the fire hazards in the hospital. Incidentally, I refused to sign off on HSA’s hospital accreditation report. Whether the hospital and the MOH acted on its hospital accreditation report is yet to be disclosed.
Whither Fire Safety In Public Hospitals And Clinics
The Dewan Rakyat was informed, in March 2017, that the MOH carried out fire safety audits, with the Fire and Rescue and Public Works departments, in 46 public hospitals more than 50 years old.
“Among several fire risks identified were ageing fire prevention systems, dilapidated electrical wiring and installation systems, the installation of medical gas systems which were not according to required standards, and other discoveries which needed engineering systems to be upgraded…A large number of the hospitals were fire hazards and in need of an overhaul, upgrade and repair to be carried out to ensure the hospitals are safe and did not affect its daily operations.”
The Dewan Rakyat was informed on October 5, 2021 that a 2016 fire audit, ordered by the then health minister, found that 47 public hospitals and institutions were more than 50 years old and another 32 between 30 to 49 years old; and that hospital assets which were more than 10 years old exceeded 50%. These findings were indicative of high fire risks.
Of the 47 facilities more than 50 years old, 21 and 26 will be upgraded in phases 1 and 2 respectively. Funding amounting to RM128.9, RM25.4 and RM154 million have been allocated to upgrade Hospital Sultanah Aminah, Hospital Tengku Ampuan Rahimah and Hospital Tunku Jaafar respectively, with work having begun or will be beginning.
Of 76 public hospitals and clinics that require a fire certificate, 32 have obtained the certificate, and the balance of 44 are in the process of doing so. In 2021, RM13.9 million had been allocated to public health facilities for maintenance. However, the facilities that have yet to obtain a fire certificate were not disclosed. Whether HSA has a fire certificate is still unknown.
Another fire occurred in the female ward of HSA on June 28, 2020. A fire occurred in a public clinic in Kuching on October 3, 2021 with an estimated 40 per cent destruction of its pharmaceutical store room. It was fortunate that no one was injured in both incidents.
What is the status of fire safety in public hospitals and clinics today? Has there been any improvement since 2016? When will all the facilities be retrofitted to improve fire safety in five or 10 years’ time?
Public disclosure of the report of the independent committee and its recommendations will enable everyone in health care facilities management, at all levels, to learn from it and implement measures in the prevention, suppression and evacuation in the event a fire occurs in the healthcare facility.
Delayed, non or selected disclosure of the report inevitably leads to a perception of a cover-up, amidst questions of public safety and accountability. It will also aggravate the trust deficit generated by the management of Covid-19.
Compassion surely must be the basis of the management of the relatives of the victims of the HSA fire. There is still time, albeit late, for the health ministry’s top management to ask themselves whether their actions have been in compliance with the ministry’s Client’s Charter.
It is time that the public health care facilities without fire certificates be named. This will enable the public to make a choice whether to seek care in such facilities and if they do so, to be more aware and take the necessary precautions. Concomitantly, it will expedite the obtaining of its fire certificates.
It is pertinent to note that the Private Health Care Facilities and Services Act (PHCFSA) requires all private health care facilities to have a fire certificate. Had a fire similar to that in HSA occurred in a private hospital, the health ministry would, in all probability, have suspended the hospital’s license and operations.
Why are there double standards in the physical and staff requirements for public and private health care facilities? Are patients who seek care in a public health care facility different from those who seek care in a private healthcare facility?
Should not the same legal protection on safety and quality of care be available to patients who seek care in public healthcare facilities? It is time that Parliament delete the word “Private” from PHCFSA so that it is also applicable to public health care facilities, thereby ensuring that the same standards on safety and quality of care are available to all patients, irrespective of whether care is sought in the public or private sector.
Truth, which is the basis of the patient-doctor relationship, is also applicable to the relationship between the health ministry and the public. Truth-telling goes beyond providing facts – it also entails humanity.
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.