KUALA LUMPUR, Oct 3 — The Academy of Medicine of Malaysia (AMM) denounced today a third-party administrator’s (TPA) local anaesthesia (LA)-first policy for daycare surgeries that required prior approval of general anaesthesia (GA) use.
The umbrella body representing specialist doctors in the country said the choice of anaesthesia was a complex clinical decision made by qualified professionals after a thorough assessment of the patient’s medical history, the specific surgical procedure, and the patient’s own informed preferences.
“AMM views this directive as a significant overreach that directly impinges upon the clinical autonomy of surgeons and anaesthesiologists,” said AMM in a statement.
The decision-making process about anaesthesia choice, it said, was fundamental to both clinical ethics and patient safety.
“To outsource this critical judgement to a non-clinical third party, which has not assessed the patient, sets a dangerous precedent,” said AMM.
CodeBlue reported yesterday a directive by MediExpress (Malaysia) Sdn Bhd in a memo to panel hospitals to prioritise LA as the first-line anaesthesia modality over GA for daycare procedures and surgeries, requiring health care providers to provide a “detailed” justification of the need for general anaesthesia.
The TPA’s October 1 memo also directed “appropriate justification” for guarantee letter (GL) approval if the TPA deemed the procedure to be more suitable as a daycare service rather than inpatient treatment.
AMM, which comprises 13 colleges of various specialties, outlined three core concerns with MediExpress’ LA-first directive: prioritising profits over patient wellbeing, erosion of the doctor-patient relationship, and ethical and medicolegal risks.
“The choice of anaesthesia is a critical safety decision that must be tailored to the individual, considering factors like anxiety, procedural complexity, and co-morbidities – none of which a TPA can assess.
“Upholding the principle that patient safety is paramount, we reject any measure that allows financial motives to compromise clinical integrity and patients’ fundamental right to receive the care best suited to them.”
AMM also said introducing a mandatory approval from an external, non-clinical entity undermined the trust between doctor and patient and “inappropriately” delegated medical responsibility.
“Directing treatment plans based on cost-containment rather than clinical necessity creates substantial ethical and legal pitfalls,” it added.
“Medical professionals could be held liable for adverse outcomes resulting from a suboptimal anaesthesia method chosen under administrative duress.”
While AMM acknowledged the need for sustainable health care financing and cost containment, it stressed that such measures must not come at the expense of clinical standards and patient welfare.
“Policies that prioritise cost savings over sound medical judgement are ultimately detrimental to the quality of care.”
AMM’s statement was issued by AMM master Prof Dr Hanafiah Harunarashid, along with the respective presidents of 13 colleges of anaesthesiologists, dental specialists, emergency physicians, otorhinolaryngologists – head & neck surgeons, obstetricians and gynaecologists, ophthalmologists, oncologists, paediatrics, pathologists, physicians, public health medicine, radiology, and surgeons.
