Former Health Minister Subra Denies Parallel Pathway ‘Illegal’

Ex-Health Minister Dr S. Subramaniam maintains that the parallel pathway isn’t illegal, explaining the historical context and how the NSR only came in 2017. “All these years, MMC members were recognising it. Suddenly, MMC members now don’t recognise it.”

PETALING JAYA, May 9 — Former Health Minister Dr S. Subramaniam has denied allegations that the parallel pathway programme violates the law, claiming that the Malaysian Medical Council (MMC) has always recognised it. 

Dr Subramaniam – who served as health minister from 2013 to 2018 – oversaw the signing of three memoranda of understanding (MOUs) with the Royal College of Surgeons of Edinburgh (RCSEd) in 2014 and 2018 on the establishment of the cardiothoracic surgery parallel pathway programme in Malaysia.

In court documents, the MMC claimed that it had never made nor authorised any endorsements of these MOUs executed by “third parties”. The signing of two of the MOUs with the RCSEd were witnessed by Dr Noor Hisham Abdullah, who was then the Health director-general and also MMC president.

At an interview here last April 24, CodeBlue, citing MMC’s claim, asked Dr Subramaniam if he, the government, or Dr Noor Hisham had acted unilaterally or broken the law in that respect.

“No such thing,” Dr Subramaniam said in response.

“You must understand the National Specialist Register (NSR) came into being in 2017. Before that, all these people have been trained, right? The DG is also the [president] of the MMC.

“The MMC accredits courses, right? For the undergraduate [programme], we have settled. Undergraduate is settled. For specialised, postgraduate, we are not settled, because we are just going into it.

“Undergraduate, you go and enter the [Medical] Act itself, I think under the second schedule of MMC, they recognise degrees from nearly half of the world – degrees from Uganda, Saudi Arabia, Egypt, India, Pakistan, Indonesia – all that, a few hundred universities are there.”

The amended Medical Act 1971, under its second schedule, recognises degree qualifications from nine local universities and over 200 universities abroad.

“So, why did that happen? There’s a historical reason for that. Over the years, this was done, and this was recognised. 

“Whereas when you come to… we have not really stated in undergraduate saying that only the 30-odd Malaysian universities will be recognised and all the few hundreds, which are there, will be derecognised, no, because it’s historical, it’s in the schedule, we accept it.

“Likewise, these degrees, these accredits, you go into the MMC postgraduate qualifications, a lot of these postgraduate royal colleges actually recognised as pathways, until today it’s still there,” Dr Subramaniam said.

Parallel pathway opponents have accused those who started the parallel pathway for medical training of doing so “without due regard for laws”

An ex-MMC member said there is no such thing as a “parallel pathway” in academics and that the RCSEd Cardiothoracic Surgery and the Malaysia-Ireland Training Programme for Family Medicine (MinTFM) programmes were started “without due process”.

“[At] that time and the ministry, we were signing a programme for training and for assessment so our doctors can train themselves to be accredited by these entities (royal colleges),” Dr Subramaniam said.

“So the next stage is for the Medical Council (MMC), using historical perspectives, to put them into the recognition list. As the DG and as a ministry, we don’t… Actually this argument that any person has to go and ask MMC before they do training is – that has not been something which we have done before. 

“MMC is recognising. Even the Master’s programme, they set up the programme, then MMC evaluates it, and recognises it. Likewise, these [parallel pathway] training programmes are for MMC to evaluate and recognise. 

“All these years, MMC members were recognising it. Suddenly, MMC members now don’t recognise it. Why? Is it because of the perception of individuals within MMC? That should not be the case. The MMC, per se, has to look at national needs.”

MMC president Dr Muhammad Radzi Abu Hassan, who is also the Health DG, said in a statement last March that the MMC had never, at any time, recognised the Fellowship of the Royal College of Surgeons of Edinburgh in Cardiothoracic Surgery.

Last December, the regulator rejected NSR specialist registration applications of four pioneer graduates from the cardiothoracic surgery parallel pathway with that qualification from the royal college.

Dr Subramaniam previously told CodeBlue of plans to expand and strengthen the parallel pathway programme during his tenure.

“MMC’s main thing should be how we can have enough specialists and how we can ensure there are enough specialists.”

“The crux of the issue is how to have enough specialists. There are two pathways which are contributing and you want to close one pathway, then the question comes, can the other pathway actually answer this gap? It’s very evident, at this point in time, it will not be possible. If that’s so, why do you want to stop it?

“If your issue is about standards then address those issues, right? If your issue is training, then address those issues. If the issue is standardisation, then address those issues, but not stop something which is functioning,” Dr Subramaniam said.

Provide Evidence That Parallel Pathway Specialists Are ‘Unsafe’

When CodeBlue asked if he agreed with those claiming that parallel pathway specialists are unsafe, Dr Subramaniam said such parallel pathway opponents need to give proper evidence to back their allegations.

“If anybody says that, you need to provide the evidence. Have you got evidence to suggest that they are unsafe?

“Is there a number of cases in which they are unsafe? Is that amount of information available within the MMC’s disciplinary committee or those who deal with medical negligence or within the MOH itself, those people responsible for this, using their data, can you actually come to a conclusion that this is actually the truth or is it a perception of some people.

“So, I think, you put that kind of argument, you have to actually back it with your data. If you don’t have the data, then you shouldn’t give these kinds of perceptions. We cannot be driven by individual perceptions. We have to be driven by evidence.

“Unless you’ve got the evidence, it’s not [the case],” Dr Subramaniam said.

Prof Dr Noor Hassim Ismail, in a letter to CodeBlue published yesterday, alleged that the parallel pathway programmes were run illegally, citing the Medical Act 2012 (Act 50), Medical Regulations 2017, the Malaysian Qualifications Agency Act 2007 (Act 679), the Private Higher Educational Institutions Act 1996 (Act 555), and the Universities and University Colleges Act 1971 (Act 30). 

The head of the Group of Professors of Health and Medicine claimed that the quality of the parallel pathway was “unknown” because of the lack of third-party auditors conducting regular audits. 

“We are concerned about the competency of graduates, and the safety of patients and the public,” said Dr Noor Hassim.

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