‘Life-And-Death’ Justifies Minister’s Interference Into Medical Profession: Senator

Senator Dr RA Lingeshwaran says the health minister should have overriding powers over decisions made by the Malaysian Medical Council in issues of “life and death”. Lingeshwaran believes Section 14 of the Medical Act will be revised in the amendment bill.

KUALA LUMPUR, May 3 — Senator Dr RA Lingeshwaran believes that the health minister should have ultimate authority over the Malaysian Medical Council (MMC) in matters of “life and death”.

Ahead of the government’s proposed amendments to the Medical Act 1971 to “regularise anomalies” between the parallel pathway and local Master’s programmes in medicine, the DAP lawmaker argued that the health minister should be allowed to intervene in decisions made by the medical profession or regulator.

“Millions of our taxpayers’ money have been used to send them overseas to study [under] the parallel pathway. All of this is money and we cannot just be wasting our taxpayers’ money,” Dr Lingeshwaran told CodeBlue in an interview here last Friday.

“If the minister needs to do so (meddle into decisions made by the medical fraternity), he has to because sometimes, the minister needs to put his foot down for the benefit of the rakyat; this is life and death of the rakyat,” added the 37-year-old first-term senator.

Both advocates and opponents of the Ministry of Health’s (MOH) parallel pathway programme with royal colleges from the United Kingdom for medical specialty training, particularly in cardiothoracic surgery, have cited people’s lives in their arguments.

Advocates claim that recognition of the parallel pathway will cut year-long wait lists for heart surgery in the public health service, amid a dire shortage of cardiothoracic surgeons.

Opponents, on the other hand, support the MMC’s decision not to recognise the Fellowship of the Royal College of Surgeons of Edinburgh (FRCS Ed) in Cardiothoracic Surgery, as they claim the parallel pathway training may produce unsafe specialists and the qualification isn’t recognised in its home country of the UK.

Health Minister Dzulkefly Ahmad has yet to announce the specific proposed amendments to the Medical Act. However, the amendment bill may grant the health minister greater overriding powers over decisions made by the regulatory body – particularly on recognition of the parallel pathway programme and the registration of specialist doctors on the National Specialist Register (NSR).

Currently, the health minister’s role within the MMC includes appointing or removing MMC council members, overseeing appeals by medical practitioners whose names have been removed from the NSR, as well as confirming, revoking, or adjusting disciplinary rulings made by the MMC’s disciplinary board or president.

Section 8 states that the minister may issue general directions, provided they are not inconsistent with the Act or any regulations made under it. The Council is obligated to comply with these directions.

Last December, the MMC rejected applications by four pioneer graduates of the cardiothoracic surgery parallel pathway with the Royal College of Surgeons of Edinburgh to register as specialists on the NSR.

The MMC, whose current president is Health director-general Dr Muhammad Radzi Abu Hassan, claims it never recognised the FRCS Ed in Cardiothoracic Surgery qualification.

If indeed the Medical Act amendment bill provides the health minister from the government of the day powers superseding the regulator of the medical profession, a similar cautionary tale involving ministerial powers occurred just over a year ago.

Dzulkefly’s predecessor, Dr Zaliha Mustafa, exercised her ministerial powers on March 31, 2023, to remove liquid nicotine from the list of scheduled poisons under the Poisons Act 1952, making an historical first veto of unanimous objection from the independent Poisons Board.

As a result of Dr Zaliha’s decision, nicotine vape has remained legally accessible to children and teens aged below 18 for more than a year now. The Control of Smoking Products for Public Health Act 2024 is not yet enforced despite gazettement, as Dzulkefly has yet to prescribe regulations under the law.

Brief MPs, Senators On Medical Act Amendment Bill One Month Ahead Of Tabling

Dr Lingeshwaran commended Dzulkefly for taking the “right step” to amend the Medical Act, as a direct way to resolve the imbroglio with MMC over parallel pathway training.

However, the senator said that members of the Dewan Rakyat and Dewan Negara should be briefed on the amendments “a month ahead” to allow for quality debate in Parliament.

Dzulkefly has announced plans to table the amendment bill in the upcoming parliamentary meeting that begins in the last week of June in the Dewan Rakyat.

“I agree that members of the Dewan Rakyat and Dewan Negara should be given more time. Maybe, probably, the minister should give us a briefing a month ahead on what amendments that are going to be done so at least we are able to prepare,” Dr Lingeshwaran said.

“Definitely, before it is brought to the Dewan, the minister would have already engaged with the stakeholders. But at the same time, as parliamentarians, we also would definitely have some research [that need] to be done so that quality debate can be delivered in Parliament.

“Of course, most of the bills have been rushed through Parliament. I really suggest if Dr Dzulkefly is able to give us a brief idea on what the amendment is going to be done so that we also, as a member of Parliament, can give ideas, because at the end of the day, we are dealing with the rakyat’s lives. So, of course, we also would like to participate actively in this particular draft of the bill”.

Medical Act Amendment Should Include MMC Reforms

Dr Lingeshwaran thinks a key section that will be amended in the Medical Act will be Section 14 that outlines eligibility criteria for specialist registration.

Section 14B of the Medical Act is part of the 2012 amendment enforced in 2017 that mandates holding a “recognised specialist qualification” as among the criteria to be entitled to be registered as a specialist under the Act. MMC is now the legal guardian of the NSR.

Dr Lingeshwaran also reiterated calls for reforms to increase transparency in MMC’s decision-making process on recognition of postgraduate medical qualifications from both local universities and parallel pathway programmes.

Currently, among 33 members of the MMC, only 17 are elected while the remaining 16 are appointed. Under the Medical Act, the MMC president is the Health director-general.

“So, I feel this is not the right way. I feel we need to open up more for elections. At least 30 per cent should be [appointed] to safeguard the universities, hospitals, and private sector’s interests, the balance 70 per cent should be open to election. The election, if can, should be transparent from the ballot paper up until vote counting – everything should be transparent.

“[As I experienced previously], just two to three days before the election, I get the ballot paper, and I tick, and I send, and I’m not sure whether my vote actually reached or not. If you look, we have a total of about 70,000 registered medical practitioners in MMC, but the number of votes which reach MMC is far less.

“So, we need to look at some other ways so that the number of votes, and the way they vote should totally be looked into,” Dr Lingeshwaran said.

The senator from Penang previously told CodeBlue that MMC elections still utilise a postal voting system, and that the results as to how many total votes cast and total votes garnered by each candidate are not published widely.

Regulations 2 to 21 of the Medical Regulations 2017 outline the election process of elected MMC members, covering nomination, objection, voting, vote counting, and result declaration.

On the declaration of results, subregulation 1 of regulation 17 merely states that when the counting of votes has been completed, the returning officer (MMC president) shall “declare” the candidate with the highest number of votes to be elected and shall cause a notice of declaration to be published on the official website of the council or in any other form of publication which the council deems fit.

Nowhere in the regulations is it stipulated that the number of votes received by each candidate must be declared or published.

Parallel Pathway An ‘Urgent’ Issue, ‘Daily We’re Losing Lives’

CodeBlue asked Dr Lingeshwaran if he believed the parallel pathway was an urgent issue, since it only affects a handful of medical professionals (there are 30 plus trainees and graduates of the cardiothoracic surgery parallel pathway programme), compared to other issues like the severe shortage of house and medical officers.

Numerous government doctors recently highlighted the significant deterioration of the public health service that directly affects patients, due to the absence of housemen from all MOH hospitals except for state hospitals, and the continued spate of resignations and burnout among medical officers.

“I think it has been [going on for] quite long, I think it has been a year or two already. It’s not something that we can take time [for]. It’s urgent. We need to settle this issue because when you see four cardiothoracic surgeons, already qualified, and they are just waiting to practise as a cardiothoracic surgeon, daily we are losing lives because of this. They (MMC) can’t do this,” Dr Lingeshwaran said in response.

“I was also informed that urology [specialty] also has qualified [graduates] and they are not getting placed as pakar (specialists), and the same for family medicine specialists – hundreds of family medicine specialists [who are] qualified. So, we need to deliver the service for the patients. We can’t delay anymore.

“We have invested millions of ringgit of our taxpayers’ money and we cannot delay further; I think there is no more time.

“It is time for us to make the right decision, and it is time for us to push this parallel pathway to ensure that this parallel pathway is accepted in Malaysia.”

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